Insurance Descriptor Codes

X12 External Code Source 979

These codes describe, identify, or clarify the insurance being reported in an eligibility and benefits response.

Last updated: 7/19/2018

Code Lists

Maintence Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Triaged
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintence Request Form

Use the form below to request maintenance to the Code List. Maintenance includes a request for a new code, a revision to the description of code, or deactivation of a code.

Note The information submitted on this form may be edited for clarity or accuracy during the X12 triage and consideration processes. Fields marked with an asterisk are required. Existing Code is required on requests for revision or deactivation of a code.
* Name
* Phone
* Email
* Request Type	Select one of the above options.
Existing Code
	* Brief description, published with the Code
	Extended description, published with the Code
	* Include the business justification for this maintenance request here, including who would benefit and the circumstances that make the request appropriate or necessary.
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List

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.
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
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