Insurance Descriptor Codes

Maintenance Request Form

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

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.

The information submitted on this form may be edited for clarity or accuracy during the X12 triage and consideration processes.

All the fields on the form are required, except Existing Code which is only required on requests for revision or deactivation of a code, but should not be entered on a request for a new code.

*Request Type
Existing Code

*Brief 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.