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Element
in
X12 Release 005030

1390 Eligibility or Benefit Information Code

Code identifying eligibility or benefit information
Type
Identifier (ID)
Length
Min 1 / Max 2
Codes
1
Active Coverage
2
Active - Full Risk Capitation
3
Active - Services Capitated
4
Active - Services Capitated to Primary Care Physician
5
Active - Pending Investigation
6
Inactive
7
Inactive - Pending Eligibility Update
8
Inactive - Pending Investigation
A
Co-Insurance
B
Co-Payment
C
Deductible
D
Benefit Description
E
Exclusions
F
Limitations
G
Out of Pocket (Stop Loss)
H
Unlimited
I
Non-Covered
J
Cost Containment
K
Reserve
L
Primary Care Provider
M
Pre-existing Condition
N
Services Restricted to Following Provider
O
Not Deemed a Medical Necessity
P
Benefit Disclaimer
Q
Second Surgical Opinion Required
R
Other or Additional Payor
S
Prior Year(s) History
T
Card(s) Reported Lost/Stolen
U
Contact Following Entity for Eligibility or Benefit Information
V
Cannot Process
W
Other Source of Data
X
Health Care Facility
Y
Spend Down
AA
Patient Reimbursement
AB
Co-payment Maximum
AC
Co-insurance Maximum
CB
Coverage Basis
MC
Managed Care Coordinator
SB
Shared Benefit Limitation
SD
Shared Benefit Deductible
WV
Waiver
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.