XML Response

FieldFormatMinMaxComments
EligibilityBenefitInfoAN12
CoverageLevelAN33
TraceNumberAN130
RequestValidationIndicatorAN110
RequestValidationRejectReasonCodeAN110
RequestValidationRejectDescriptionAN180
InformationSourceNameAN180
InformationSourceIDAN180
InformationSourceIDQualifierAN110
SubscriberLastNameAN135
SubscriberFirstNameAN125
SubscriberMiddleNameAN125
SubscriberBirthDateDATE110
RelationshipCodeAN110
RelationshipDescriptionAN180
SubscriberID1AN180
SubscriberIDQualifier1AN110
SubscriberID2AN180
SubscriberIDQualifier2AN110
SubscriberID3AN180
SubscriberIDQualifier3AN110
SubscriberDatesDT
SubscriberEligibilityBenefitsAN
PatientLastNameAN135
PatientFirstNameAN125
PatientMiddleNameAN125
PatientBirthDateDATE110
PatientGenderAN11
PatientID1AN180
PatientIDQualifier1AN110
PatientID2AN180
PatientIDQualifier2AN110
PatientDatesDT
PatientEligibilityBenefitsAN
ResponseDetailTextAN1
PlanCoverageAN180
PlanCoverageNoteAN1255
PlanNumberAN1255
OtherPayerAN180
OtherPayerPlanNumberAN180
PrimaryCareProviderAN1255
EligibilityDateDT110
OfficeVisitCopayDEC115
PatientPrefixAN125
PatientSuffixAN125
SubscriberGroupNumberAN180
PatientDateOfBirthDATE110
PatientRelationshipAN110
SubscriberPrefixAN110
SubscriberSuffixAN110
PatientAddressAddress Data TableStreet1, Street2, Street3, City, State, Zip, Country, Company.
RejectCodeAN110
RejectReasonAN180
EligibilityExpirationDATE110