12/14/2021
(ASC X12) 1390 Eligibility or Benefit Information
TYPE=ID MIN=1 MAX=2
Code identifying eligibility or benefit information
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 |
| CB | Coverage Basis |
| MC | Managed Care Coordinator |
Appears in
| EB | Eligibility or Benefit Information |
Categories: