Schema name: X12_00501_270 Eligibility, Coverage or Benefit Inquiry Transaction Set Header Transaction Set Identifier Code_143 Transaction Set Control Number_329 Implementation Convention Reference_1705 Transaction Set Trailer Number of Included Segments_96 Transaction Set Control Number_329 Loop for Information Source Name Loop for Information Receiver Name Loop for Subscriber Eligibility or Benefit Inquiry Loop for Subscriber Name Loop for Dependent Eligibility or Benefit Inquiry Loop for Dependent Name Loop for Dependent Level Loop for Subscriber Level Loop for Information Receiver Level Loop for Information Source Level Beginning of Hierarchical Transaction Hierarchical Structure Code_1005 Transaction Set Purpose Code_353 Reference Identification_127 Date_373 Time_337 Transaction Type Code_640 Information Source Level Hierarchical ID Number_628 Hierarchical Parent ID Number_734 Hierarchical Level Code_735 Hierarchical Child Code_736 Information Source Name Entity Identifier Code_98 Entity Type Qualifier_1065 Name Last or Organization Name_1035 Name First_1036 Name Middle_1037 Name Prefix_1038 Name Suffix_1039 Identification Code Qualifier_66 Identification Code_67 Entity Relationship Code_706 Entity Identifier Code_98 Name Last or Organization Name_1035 Information Receiver Level Hierarchical ID Number_628 Hierarchical Parent ID Number_734 Hierarchical Level Code_735 Hierarchical Child Code_736 Information Receiver Name Entity Identifier Code_98 Entity Type Qualifier_1065 Name Last or Organization Name_1035 Name First_1036 Name Middle_1037 Name Prefix_1038 Name Suffix_1039 Identification Code Qualifier_66 Identification Code_67 Entity Relationship Code_706 Entity Identifier Code_98 Name Last or Organization Name_1035 Information Receiver Additional Identification Reference Identification Qualifier_128 Reference Identification_127 Description_352 Information Receiver Address Address Information_166 Address Information_166 Information Receiver City, State, ZIP Code City Name_19 State or Province Code_156 Postal Code_116 Country Code_26 Location Qualifier_309 Location Identifier_310 Country Subdivision Code_1715 Information Receiver Provider Information Provider Code_1221 Reference Identification Qualifier_128 Reference Identification_127 State or Province Code_156 Provider Organization Code_1223 Subscriber Level Hierarchical ID Number_628 Hierarchical Parent ID Number_734 Hierarchical Level Code_735 Hierarchical Child Code_736 Subscriber Trace Number Trace Type Code_481 Reference Identification_127 Originating Company Identifier_509 Reference Identification_127 Subscriber Name Entity Identifier Code_98 Entity Type Qualifier_1065 Name Last or Organization Name_1035 Name First_1036 Name Middle_1037 Name Prefix_1038 Name Suffix_1039 Identification Code Qualifier_66 Identification Code_67 Entity Relationship Code_706 Entity Identifier Code_98 Name Last or Organization Name_1035 Subscriber Additional Identification Reference Identification Qualifier_128 Reference Identification_127 Description_352 Subscriber Address Address Information_166 Address Information_166 Subscriber City, State, ZIP Code City Name_19 State or Province Code_156 Postal Code_116 Country Code_26 Location Qualifier_309 Location Identifier_310 Country Subdivision Code_1715 Provider Information Provider Code_1221 Reference Identification Qualifier_128 Reference Identification_127 State or Province Code_156 Provider Organization Code_1223 Subscriber Demographic Information Date Time Period Format Qualifier_1250 Date Time Period_1251 Gender Code_1068 Marital Status Code_1067 Citizenship Status Code_1066 Country Code_26 Basis of Verification Code_659 Quantity_380 Code List Qualifier Code_1270 Industry Code_1271 Multiple Birth Sequence Number Yes/No Condition or Response Code_1073 Individual Relationship Code_1069 Maintenance Type Code_875 Maintenance Reason Code_1203 Benefit Status Code_1216 Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying 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Address Information_166 Dependent City, State, ZIP Code City Name_19 State or Province Code_156 Postal Code_116 Country Code_26 Location Qualifier_309 Location Identifier_310 Country Subdivision Code_1715 Provider Information Provider Code_1221 Reference Identification Qualifier_128 Reference Identification_127 State or Province Code_156 Provider Organization Code_1223 Dependent Demographic Information Date Time Period Format Qualifier_1250 Date Time Period_1251 Gender Code_1068 Marital Status Code_1067 Citizenship Status Code_1066 Country Code_26 Basis of Verification Code_659 Quantity_380 Code List Qualifier Code_1270 Industry Code_1271 Dependent Relationship Yes/No Condition or Response Code_1073 Individual Relationship Code_1069 Maintenance Type Code_875 Maintenance Reason Code_1203 Benefit Status Code_1216 Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code_1219 Employment Status Code_584 Student Status Code_1220 Yes/No Condition or Response Code_1073 Date 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Reference Identification Qualifier_128 Reference Identification_127 Reference Identification Qualifier_128 Reference Identification_127 Provider Specialty Information Provider Specialty Code_1222 Agency Qualifier Code_559 Yes/No Condition or Response Code_1073 Reference Identifier Reference Identification Qualifier_128 Reference Identification_127 Reference Identification Qualifier_128 Reference Identification_127 Reference Identification Qualifier_128 Reference Identification_127 Provider Specialty Information Provider Specialty Code_1222 Agency Qualifier Code_559 Yes/No Condition or Response Code_1073 Composite Race or Ethnicity Information Race or Ethnicity Code_1109 Code List Qualifier Code_1270 Industry Code_1271 Medicare Status Code Medicare Plan Code_1218 Eligibility Reason Code_1701 Eligibility Reason Code_1701 Eligibility Reason Code_1701 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 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Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Composite Medical Procedure Identifier Product/Service ID Qualifier_235 Product/Service 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Qualifier_128 Reference Identification_127 Reference Identification Qualifier_128 Reference Identification_127 Provider Specialty Information Provider Specialty Code_1222 Agency Qualifier Code_559 Yes/No Condition or Response Code_1073 Composite Race or Ethnicity Information Race or Ethnicity Code_1109 Code List Qualifier Code_1270 Industry Code_1271 Medicare Status Code Medicare Plan Code_1218 Eligibility Reason Code_1701 Eligibility Reason Code_1701 Eligibility Reason Code_1701 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health 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Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Health Care Code Information Code List Qualifier Code_1270 Industry Code_1271 Date Time Period Format Qualifier_1250 Date Time Period_1251 Monetary Amount_782 Quantity_380 Version Identifier_799 Industry Code_1271 Yes/No Condition or Response Code_1073 Composite Medical Procedure Identifier Product/Service ID Qualifier_235 Product/Service ID_234 Procedure Modifier_1339 Procedure Modifier_1339 Procedure Modifier_1339 Procedure Modifier_1339 Description_352 Product/Service ID_234 Composite Diagnosis Code Pointer Diagnosis Code Pointer_1328 Diagnosis Code Pointer_1328 Diagnosis Code Pointer_1328 Diagnosis Code Pointer_1328 Composite Unit of Measure Unit or Basis for Measurement Code_355 Exponent_1018 Multiplier_649 Unit or Basis for Measurement Code_355 Exponent_1018 Multiplier_649 Unit or Basis for Measurement Code_355 Exponent_1018 Multiplier_649 Unit or Basis for Measurement Code_355 Exponent_1018 Multiplier_649 Unit or Basis for Measurement Code_355 Exponent_1018 Multiplier_649 Reference Identifier Reference Identification Qualifier_128 Reference Identification_127 Reference Identification Qualifier_128 Reference Identification_127 Reference Identification Qualifier_128 Reference Identification_127