Last Updated: 7/22/2025 8:42:49 PM
Intergy Version: 22.00.00.00
EligibilityBenefit
Table Definition Parent Tables Child Tables
Table Definition| Field | Datatype | Default | Null Option | Comment |
|---|---|---|---|---|
| EligibilitySID | INTEGER | ? | MANDATORY | FK - From Eligibility |
| EligibilityBenefitCount | INTEGER | 0 | MANDATORY | Loop Sequence Number related to a unique Eligibility. |
| BenefitStatus | CHARACTER(3) | OPTIONAL | Eligibility Status, Numerical or character from table 1390 of ANSI 271 spec. | |
| CoverageLevel | CHARACTER(3) | OPTIONAL | The benefit coverage level Code from Table 1207 of ANSI 271 spec. | |
| ServiceType | CHARACTER(2) | OPTIONAL | Code identifying the classification of service - Code from Table 1365 of ANSI 271 spec. | |
| InsTypeCode | CHARACTER(3) | OPTIONAL | Code identifying the type of insurance policy within a specific insurance program - Code from Table 1336 of ANSI 271 spec. | |
| TimePeriodQualifier | CHARACTER(2) | OPTIONAL | Code defining periods. Code from Table 615 of ANSI 271 spec. | |
| BenefitAmount | DECIMAL(10,2) | 0 | OPTIONAL | Eligibility or benefit amount. Must be qualified by a monetary amount; e.g., deductible, co-payment. |
| BenefitPercent | DECIMAL(10,4) | 0 | OPTIONAL | Eligibility or benefit percent. Must be qualified by a percentage; e.g., co-insurance. |
| QuantityQualifier | CHARACTER(2) | OPTIONAL | Identifies the type of units that are being conveyed in the Benefit Quantity Code from Table 673 of ANSI 271 spec. | |
| BenefitQuantity | DECIMAL(10,2) | 0 | OPTIONAL | Numeric value of quantity |
| AuthIndicator | CHARACTER(1) | OPTIONAL | To indicate if authorization or certification is required. (N)o (Y)es (U)nknown | |
| InPlanNetwork | CHARACTER(1) | OPTIONAL | To indicate if benefits are considered In or Out of Plan-Network or not. (N)o (Y)es (U)nknown | |
| ProductIDQualifier | CHARACTER(2) | OPTIONAL | Identifyies the type/source of the descriptive number used in Product/Service ID. Code from Table 235 of ANSI 271 spec. | |
| ProductID | CHARACTER(48) | OPTIONAL | Identifying number for a product or service | |
| ProductIDModifierList | CHARACTER(11) | OPTIONAL | Four Modifiers Concatenated | |
| ReferralNumber | CHARACTER(20) | OPTIONAL | Associated Referral Number | |
| PriorAuthNumber | CHARACTER(30) | OPTIONAL | Associated prior authorization number | |
| RelatedEntityType | CHARACTER(3) | OPTIONAL | Code identifying an organizational entity, a physical location, property or an individual. Code from Table 98 of ANSI 271 spec. | |
| RelatedEntityCode | CHARACTER(80) | OPTIONAL | The related entity's code or identifier | |
| RelEntIDType | CHARACTER(3) | OPTIONAL | Code designating the system/method of code structure - Code from Table 66 of ANSI 271 spec. | |
| RelEntLastName | CHARACTER(35) | OPTIONAL | Individual last name or organizational name | |
| RelEntFirstName | CHARACTER(25) | OPTIONAL | Individual first name | |
| RelEntMiddleName | CHARACTER(25) | OPTIONAL | Individual middle name | |
| RelEntAddressLine1 | CHARACTER(55) | OPTIONAL | Entity's Address Line 1 | |
| RelEntAddressLine2 | CHARACTER(55) | OPTIONAL | Entity's Address Line 2 | |
| RelEntCity | CHARACTER(30) | OPTIONAL | Entity's City | |
| RelEntState | CHARACTER(2) | OPTIONAL | Entity's State | |
| RelEntZipCode | CHARACTER(15) | OPTIONAL | Entity's Zip Code | |
| RelEntChampusLocation | CHARACTER(30) | OPTIONAL | CHAMPUS location or identifier | |
| RelEntPhoneNumber | CHARACTER(20) | OPTIONAL | Entity's Phone Number | |
| RelEntPhoneExt | CHARACTER(6) | OPTIONAL | Phone Extension | |
| RelEntFaxNumber | CHARACTER(20) | OPTIONAL | Entity's Fax Number | |
| RelEntProviderTypeCode | CHARACTER(3) | OPTIONAL | Code identifying the type of provider - Code from Table 1221 of ANSI 271 spec. | |
| RelEntProviderIDType | CHARACTER(3) | OPTIONAL | Code qualifying the Reference Identification Code from Table 128 of ANSI 271 spec. | |
| RelEntProviderIDTaxonomy | CHARACTER(30) | OPTIONAL | Provider Identification | |
| TimeStamp | CHARACTER(14) | OPTIONAL | System generated date/time stamp record was last written. | |
| LastUser | INTEGER | ? | OPTIONAL | User ID of user that last wrote the record. |
| CreateStamp | CHARACTER(14) | OPTIONAL | System generated date/time stamp record was created. | |
| CreateUser | INTEGER | ? | OPTIONAL | User ID of user that created the record. |
| PlanCoverageDescription | CHARACTER(50) | OPTIONAL | Description that Identifies the Plan or Coverage type. | |
| RelEntSuffix | CHAR(20) | Set_To_Empty_String | OPTIONAL | Entity Suffix (Jr, Sr) |
| Parent Table | Join Phrase | When deleting parent record... |
|---|---|---|
| Eligibility | EligibilityBenefit.EligibilitySID = Eligibility.EligibilitySID | CASCADE if EligibilityBenefit exists |
| Child Table | Join Phrase | When deleting EligibilityBenefit record... |
|---|---|---|
| EligibilityComment | EligibilityComment.EligibilitySID = EligibilityBenefit.EligibilitySID and EligibilityComment.EligibilityBenefitCount = EligibilityBenefit.EligibilityBenefitCount |
CASCADE if EligibilityComment exists |