979 - Insurance Descriptor Codes

X12 External Code Source 979 7/19/2018 LAST UPDATED

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

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DDisability Insurance
Provides periodic payments to replace income when an insured person is unable to work as a result of illness, injury or disease.
Start: 05/17/2018
MMedicare Advantage Point of Service (POS) Plan that excludes Part D coverage
Start: 05/17/2018
12Medicare 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.
13Medicare 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.
14Medicare 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.
15Medicare 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.
16Medicare 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
18Vision Insurance
Start: 05/17/2018
19Prescription Drug Insurance
Start: 05/17/2018
41Medicare 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.
42Medicare 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.
43Medicare 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.
47Medicare 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
COBeneficiary 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
Gives subscriber a choice of providers from an approved/contracted payer list; there are fixed dollar co-payments for most covered services in return for using plan providers.
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
LTImpacted 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