1390 Eligibility or Benefit Information Code

Code identifying eligibility or benefit information

Type
Identifier (ID)
Length
Min 1 / Max 2
Codes
CodeDescription
1Active Coverage
2Active - Full Risk Capitation
3Active - Services Capitated
4Active - Services Capitated to Primary Care Physician
5Active - Pending Investigation
6Inactive
7Inactive - Pending Eligibility Update
8Inactive - Pending Investigation
9Coverage Never Activated
10Inactive - Premium Payment Not Received
Indicates that the payer has deemed the member inactive, based on the inquiry date submitted on the request, the eligibility status is returned as inactive because the date is either (1) after the due date of the initial premium payment or (2) after end of the 3 month grace period and the member is not eligible for benefits but whose membership may be effectuated.
11Active - Pending Receipt of Premium Payment
Indicates that the payer has deemed the member active, but, based on the inquiry date submitted on the request, the eligibility status is returned as Active because the date is either (1) prior to the due date of the initial premium payment or (2) within the 3 month grace period and the member is in the first month of the grace period, and any delinquent payment has not yet been received.
12Inactive - Pending Receipt of Premium Payment
Indicates that the payer has deemed the member inactive, based on the inquiry date submitted on the request, the eligibility status is returned as inactive because the date is either (1) after the due date of the initial premium payment or (2) the member is in the 2nd or 3rd month of the grace period and any delinquent payment has not yet been received by the payer.
ACo-Insurance
AAPatient Reimbursement
ABCo-payment Maximum
ACCo-insurance Maximum
BCo-Payment
CDeductible
CBCoverage Basis
CFCombination Forward Rolling Limitation (CFRL)
DBenefit Description
EExclusions
FLimitations
FCFirst Dollar Coverage, Applies to the Entire Plan
FDFirst Dollar Coverage
FGFirst Dollar Coverage, Group of Services
FSFirst Dollar Coverage, Single Service
GOut of Pocket (Stop Loss)
HUnlimited
HRHealth Reimbursement Account
INon-Covered
JCost Containment
KReserve
LPrimary Care Provider
MPre-existing Condition
MCManaged Care Coordinator
NServices Restricted to Following Provider
ONot Deemed a Medical Necessity
PBenefit Disclaimer
QSecond Surgical Opinion Required
ROther or Additional Payor
SPrior Year(s) History
SBShared Benefit Limitation
SDShared Benefit Deductible
SFSimple Forward Rolling Limitation (SFRL)
TCard(s) Reported Lost/Stolen
TBTiered Benefit
UContact Following Entity for Eligibility or Benefit Information
VCannot Process
WOther Source of Data
WVWaiver
XHealth Care Facility
YSpend Down

Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference is provided for marketing purposes and is 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.