Decode every X12 271 EB segment qualifier combination to determine the exact benefit coverage tier, network status, and cost-sharing amounts for a given service type code
Parse the 2100C subscriber loop and 2100D dependent loop to identify the correct benefit-holder context before reading EB segments
For each EB segment, read element EB01 (Eligibility or Benefit Information Code) to classify the record as active coverage, deductible, out-of-pocket maximum, copay, or coinsurance
Read EB02 (Coverage Level Code) and EB03 (Service Type Code) together — the combination scopes the benefit to individual vs family and to a specific service category such as professional visits or surgical procedures
Check EB04 (Insurance Type Code) to distinguish primary, secondary, or Medicare supplemental coverage before trusting EB06 and EB07 monetary amounts
Traverse the 2110C or 2110D MSG segment and the REF segments for additional qualifiers such as plan identifiers, authorization requirements, or network tier indicators that supplement the EB record
Correlate multiple EB records for the same service type code to reconstruct the full cost-sharing stack: active coverage indicator first, then deductible, then out-of-pocket max, then copay or coinsurance
Known gotchas
Payers often return multiple EB records with the same EB01 code but different EB02 coverage levels; reading only the first EB record will miss family-level deductibles that differ from individual amounts
EB06 (Time Period Qualifier) and EB07 (Monetary Amount) must be interpreted together — an amount with no time period qualifier may be a lifetime benefit maximum rather than an annual deductible
Some payers omit the EB segment for covered services and only return a top-level active coverage EB01=1 record; absence of an EB record for a specific service type code does not mean the service is not covered
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp