1390 Eligibility or Benefit Information

Code identifying eligibility or benefit information

Type
Identifier (ID)
Length
Min 1 / Max 2
Codes
CodeDescription
1Active Coverage
2Active - Full Risk Capitation
3Active - Services Capitated
4Active - Services Capitated to Primary Care Physician
5Active - Pending Investigation
6Inactive
7Inactive - Pending Eligibility Update
8Inactive - Pending Investigation
ACo-Insurance
AAPatient Reimbursement
ABCo-payment Maximum
ACCo-insurance Maximum
BCo-Payment
CDeductible
CBCoverage Basis
DBenefit Description
EExclusions
FLimitations
GOut of Pocket (Stop Loss)
HUnlimited
INon-Covered
JCost Containment
KReserve
LPrimary Care Provider
MPre-existing Condition
MCManaged Care Coordinator
NServices Restricted to Following Provider
ONot Deemed a Medical Necessity
PBenefit Disclaimer
QSecond Surgical Opinion Required
ROther or Additional Payor
SPrior Year(s) History
TCard(s) Reported Lost/Stolen
UContact Following Entity for Eligibility or Benefit Information
VCannot Process
WOther Source of Data
XHealth Care Facility
YSpend Down

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