ASC X12 004010

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