These codes describe, identify, or clarify the insurance being reported in an eligibility and benefits response.
The list below shows the status of change requests which are in process.
Each request will be in one of the following statuses:
| Num. | Date | Requested Description | Type | Code | Status |
|---|---|---|---|---|---|
| 88 | 12/4/2023 | This request is to add a new Insurance type code. The code would be to identify DoD (Department of Defense) and/or Tricare coverage. | New | CMG Approved | |
| 89 | 12/4/2023 | This request is to add a new Insurance type code. The code would be to identify Dual coverage, specific to coverage that is a combination of Medicare and Medicaid in a single plan. | New | CMG Approved |
| 01 | Short Term Insurance Start: 11/01/2022 |
| 02 | TRICARE Start: 11/01/2024 |
| 03 | Medicare and Medicaid Dual Eligible Start: 11/01/2024 |
| D | Disability Insurance Start: 05/17/2018 |
| M | Medicare Advantage Point of Service (POS) Plan that excludes Part D coverage Start: 05/17/2018 |
| 12 | Medicare is secondary, Working Aged Beneficiary or Spouse with employer group health plan is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 13 | Medicare is secondary, End-Stage Renal Disease Beneficiary in the mandated coordination period with an employer's group health plan is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 14 | Medicare is secondary, no-fault insurance, including auto, is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 15 | Medicare is secondary, Worker's Compensation is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 16 | Medicare is secondary, Public Health Service (PHS) or Other Federal Agency is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 17 | Dental Insurance Start: 05/17/2018 |
| 18 | Vision Insurance Start: 05/17/2018 |
| 19 | Prescription Drug Insurance Start: 05/17/2018 |
| 41 | Medicare is secondary, Black Lung is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 42 | Medicare is secondary, Veteran's Administration is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 43 | Medicare is secondary, Disabled Beneficiary Under Age 65 with a large group health plan (LGHP) is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 47 | Medicare is secondary, other liability insurance is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| 48 | Medicaid Start: 11/01/2023 |
| 49 | Medicare and Medicaid Dual Eligible. Start: 07/01/2024 |
| AP | Automobile Insurance Start: 05/17/2018 |
| C1 | Commercial Insurance Start: 05/17/2018 |
| CO | Beneficiary is under Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| EP | Exclusive Provider Organization (EPO) Plan Start: 05/17/2018 |
| HB | Health Insurance Exchange (HIX) Bronze Start: 05/17/2018 |
| HD | High Deductible Health Plan (HDHP) Start: 05/17/2018 |
| HG | Health Insurance Exchange (HIX) Gold Start: 05/17/2018 |
| HM | Health Maintenance Organization (HMO) Plan Start: 05/17/2018 |
| HP | Health Insurance Exchange (HIX) Platinum Start: 05/17/2018 |
| HS | Health Insurance Exchange (HIX) Silver An individual eligible for Medicare for whom Medicaid pays only Medicare premiums. Start: 05/17/2018 |
| IN | Indemnity Plan Gives a subscriber the choice to select any provider. Payment is fixed percentage of the cost for covered care after satisfying an annual deductible. Start: 05/17/2018 |
| LC | Long Term Care Insurance Coverage designed to help pay for some or all long term care costs, reducing the risk that a policy-holder would need to deplete all of his or her assets to pay for long term care. Start: 05/17/2018 |
| LI | Life Insurance Start: 05/17/2018 |
| LT | Impacted by litigation Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved. |
| MA | Medicare Part A Start: 05/17/2018 |
| MB | Medicare Part B Start: 05/17/2018 |
| MD | Medicare Part D Start: 05/17/2018 |
| ME | Medicare Advantage Preferred Provider Organization (PPO) Plan that excludes Part D Coverage Start: 05/17/2018 |
| MJ | Medicare Advantage Health Maintenance Organization (HMO) Plan that includes Part D Coverage Start: 05/17/2018 |
| MK | Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that includes Part D Coverage Start: 05/17/2018 |
| ML | Medicare Advantage Indemnity Plan that includes Part D Coverage Start: 05/17/2018 |
| MM | Medicare Advantage Preferred Provider Organization (PPO) Plan that includes Part D Coverage Start: 05/17/2018 |
| MN | Medicare Advantage Indemnity Plan that excludes Part D coverage Start: 05/17/2018 |
| MO | Medicare Advantage Point of Service (POS) Plan that includes Part D Coverage Start: 05/17/2018 |
| MR | Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that excludes Part D coverage Start: 05/17/2018 |
| MT | Medicare Advantage Health Maintenance Organization (HMO) Plan that excludes Part D coverage Start: 05/17/2018 |
| OA | Open Access Point of Service Plan (POS) Plan Start: 05/17/2018 |
| PE | Property Insurance - Personal Start: 05/17/2018 |
| PR | Preferred Provider Organization (PPO) Plan Start: 05/17/2018 |
| PS | Point of Service (POS) Plan Start: 05/17/2018 |
| RP | Property Insurance - Real Start: 05/17/2018 |
| SA | Set Aside Arrangement Set aside funds arrangement that exists for patients that are identified for Insurance Type Code 14, 15 or 47. Start: 11/01/2023 |
| SP | Supplemental Insurance An insurance policy intended to cover non-covered charges of another insurance policy. Start: 05/17/2018 |
| WC | Workers Compensation Insurance Coverage provides medical treatment, rehabilitation, lost wages and related expenses arising from a job related injury or disease. Start: 05/17/2018 |
| WU | Wrap-Up Insurance A Workers Compensation Policy written for a specific job site, which will include or cover more than one insured. Start: 05/17/2018 |