Ryan,
For the 270/271 Health Care Eligibility and Benefit Inquiry and Response transaction
set, you would use the Service Type Code in 2110 EB03. For Dental you would use
either 35 - Dental Care or 41 - Routine (Preventive) Dental (there are a few more
specialized dental categories as well), for Vision you would use AL - Vision, and for
Pharmacy you would use 88 - Pharmacy. The insurance type code in EB04 identifies the
type of plan (e.g. indemnity, HMO) but not what type of benefits it covers.
Since there is a codified way to portray this information, you are prohibited by the
Implementation Guide itself from passing that information in EB05 or in a MSG segment.
Hope this helps,
Stuart Beaton
Vice President
Washington Publishing Company
Co-chair X12N/TG2/WG1 - Health Care Eligibility
[EMAIL PROTECTED]
-----Original Message-----
From: Bradford, Ryan D [mailto:[EMAIL PROTECTED]]
Sent: Wed 4/24/2002 2:26 PM
To: [EMAIL PROTECTED]
Cc: '[EMAIL PROTECTED]'
Subject: Insurance Type Codes
We are a little confused with the Insurance Type codes provided in the
Implementation guides. The codes do not cover such types as Dental, Vision, or
Pharmacy. We are using the code OT for Other to show these Insurance Types. Are there
more codes available than what are in the Guides?
At this point in time, we are almost ready to implement the 270/271
transaction. Would we be able to display a code OT for Other in the EB04 segment, and
populate the EB05 segment with text (Vision, Dental, Pharmacy). Is this compliant?
Thanks.
Ryan Bradford
EDS - REVS Provider Services
155 Federal Street, Floor 6
Boston, MA 02110
* phone: 617-350-8073
* fax: +01-617-350-8180
* mailto:[EMAIL PROTECTED]
