1390 Eligibility or Benefit Information
TYPE=ID MIN=1 MAX=2
Code identifying eligibility or benefit information
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