Eligibility code lists

You may need to reference the following code lists when submitting eligibility checks through Stedi. Note that this page doesn't contain every code list in the eligibility request and response. It only contains code lists that are too long to represent clearly within the API reference documentation.

Delivery Frequency Codes

This code specifies the routine shipments, deliveries, or calendar pattern.

Stedi returns this code in the following properties:

• plans[].benefits.<benefit type>[].serviceLimits[].delivery.delivery.schedule. Contains the name instead of the code. For example, 1 (1st Week of the Month) is FIRST_WEEK_OF_THE_MONTH.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].benefitsServiceDelivery[].deliveryOrCalendarPatternQualifierCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Payers can send any of the following codes:

• 1 - 1st Week of the Month
• 2 - 2nd Week of the Month
• 3 - 3rd Week of the Month
• 4 - 4th Week of the Month
• 5 - 5th Week of the Month
• 6 - 1st & 3rd Weeks of the Month
• 7 - 2nd & 4th Weeks of the Month
• 8 - 1st Working Day of Period
• 9 - Last Working Day of Period
• A - Monday through Friday
• B - Monday through Saturday
• C - Monday through Sunday
• D - Monday
• E - Tuesday
• F - Wednesday
• G - Thursday
• H - Friday
• J - Saturday
• K - Sunday
• L - Monday through Thursday
• M - Immediately
• N - As Directed
• O - Daily Mon. through Fri.
• P - 1/2 Mon. & 1/2 Thurs.
• Q - 1/2 Tues. & 1/2 Thurs.
• R - 1/2 Wed. & 1/2 Fri.
• S - Once Anytime Mon. through Fri.
• SG- Tuesday through Friday
• SL - Monday, Tuesday and Thursday
• SP - Monday, Tuesday and Friday
• SX - Wednesday and Thursday
• SY - Monday, Wednesday and Thursday
• SZ - Tuesday, Thursday and Friday
• T - 1/2 Tue. & 1/2 Fri.
• U - 1/2 Mon. & 1/2 Wed.
• V - 1/3 Mon., 1/3 Wed., 1/3 Fri.
• W - Whenever Necessary
• X - 1/2 By Wed., Bal. By Fri.
• Y - None (Also Used to Cancel or Override a Previous Pattern)

Delivery Pattern Time Codes

This code specifies the time for routine shipments or deliveries.

Stedi returns this code in the following properties:

• plans[].benefits.<benefit type>[].serviceLimits[].delivery.delivery.pattern. Contains the name instead of the code. For example, A (1st Shift (Normal Working Hours)) is FIRST_SHIFT.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].benefitsServiceDelivery[].deliveryPatternTimeQualifierCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Payers can send any of the following codes:

• A - 1st Shift (Normal Working Hours)
• B - 2nd Shift
• C - 3rd Shift
• D - A.M.
• E - P.M.
• F - As Directed
• G - Any Shift
• Y - None (Also Used to Cancel or Override a Previous Pattern)

Eligibility and benefit type codes

These codes identify the type of benefit, such as active coverage, a co-payment, or a deductible. They're different from service type codes, which identify the service a benefit covers.

Stedi returns these codes in the following properties:

• plans[].benefits. No equivalent property. The benefit type determines which array the entry appears in. For example, a B (Co-Payment) benefit appears in the coPayment array.

  Docs: JSON

• benefitsInformation[].code

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Visit Active coverage and benefits for a complete list.

Employment Status Codes

These codes indicate the employment status of the subscriber or dependent as it relates to military service.

Stedi returns these codes in the following properties:

• subscriber.employmentStatusCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

• dependents[].employmentStatusCode

  Docs: Raw X12 | Poll Batch Checks | JSON (Legacy)

• dependent.employmentStatusCode

  Docs: Insurance Discovery

Payers can send any of the following codes:

• AE - Active Reserve
• AO - Active Military - Overseas
• AS - Academy Student
• AT - Presidential Appointee
• AU - Active Military - USA
• CC - Contractor
• DD - Dishonorably Discharged
• HD - Honorably Discharged
• IR - Inactive Reserves
• LX - Leave of Absence: Military
• PE - Plan to Enlist
• RE - Recommissioned
• RM - Retired Military - Overseas
• RR - Retired Without Recall
• RU - Retired Military - USA

Government Service Affiliation Codes

These codes indicate the government service affiliation of the subscriber or dependent as it relates to military service.

Stedi returns these codes in the following properties:

• subscriber.governmentServiceAffiliationCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

• dependents[].governmentServiceAffiliationCode

  Docs: Raw X12 | Poll Batch Checks | JSON (Legacy)

• dependent.governmentServiceAffiliationCode

  Docs: Insurance Discovery

Payers can send any of the following codes:

• A - Air Force
• B - Air Force Reserves
• C - Army
• D - Army Reserves
• E - Coast Guard
• F - Marine Corps
• G - Marine Corps Reserves
• H - National Guard
• I - Navy
• J - Navy Reserves
• K - Other
• L - Peace Corp
• M - Regular Armed Forces
• N - Reserves
• O - U.S. Public Health Service
• Q - Foreign Military
• R - American Red Cross
• S - Department of Defense
• U - United Services Organization
• W - Military Sealift Command

Identification Code Qualifiers

These codes designate the type of identifier the payer sent for a related entity.

Stedi returns these codes in the following properties:

• plans[].benefits.<benefit type>[].relatedEntities[]. No equivalent property. The qualifier becomes the property name, such as npi.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].benefitsRelatedEntities[].entityIdentification

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Payers can send any of the following codes:

• 24 - Employer's Identification Number
• 34 - Social Security Number
• 46 - Electronic Transmitter Identification Number (ETIN)
• FA - Facility Identification
• FI - Federal Taxpayer's Identification Number
• II - Standard Unique Health Identifier for each Individual in the United States
• MI - Member Identification Number
• NI - National Association of Insurance Commissioners (NAIC) Identification
• PI - Payor Identification
• PP - Pharmacy Processor Number
• SV - Service Provider Number
• XV - Centers for Medicare and Medicaid Services PlanID
• XX - Centers for Medicare and Medicaid Services National Provider Identifier

Industry Codes

These codes identify the place of service for a benefit.

Stedi returns these codes in the following properties:

• plans[].benefits.<benefit type>[].placesOfService[].code. Contains the code itself, not the name. The placesOfService[].name property contains the name.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].eligibilityAdditionalInformationList[].industryCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Visit the Centers for Medicare and Medicaid Services Place of Service Code Set for a complete list of codes and descriptions.

Information Status Codes

These codes report military service data.

Stedi returns these codes in the following properties:

• subscriber.informationStatusCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

• dependents[].informationStatusCode

  Docs: Raw X12 | Poll Batch Checks | JSON (Legacy)

• dependent.informationStatusCode

  Docs: Insurance Discovery

Payers can send any of the following codes:

• A - Partial
• C - Current
• L - Latest
• O - Oldest
• P - Prior
• S - Second Most Current
• T - Third Most Current

Insurance Type Codes

These codes indicate the type of insurance policy within a specific insurance program.

Stedi returns these codes in the following properties:

• plans[].benefits.<benefit type>[].insuranceType. Contains the name instead of the code. For example, MB (Medicare Part B) is MEDICARE_PART_B.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].insuranceTypeCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Payers can send any of the following codes:

• 12 - Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
• 13 - Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer's Group Health Plan
• 14 - Medicare Secondary, No-fault Insurance including Auto is Primary
• 15 - Medicare Secondary Worker's Compensation
• 16 - Medicare Secondary Public Health Service (PHS) or Other Federal Agency
• 41 - Medicare Secondary Black Lung
• 42 - Medicare Secondary Veteran's Administration
• 43 - Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
• 47 - Medicare Secondary, Other Liability Insurance is Primary
• AP - Auto Insurance Policy
• C1 - Commercial
• CO - Consolidated Omnibus Budget Reconciliation Act (COBRA)
• CP - Medicare Conditionally Primary
• D - Disability
• DB - Disability Benefits
• EP - Exclusive Provider Organization
• FF - Family or Friends
• GP - Group Policy
• HM - Health Maintenance Organization (HMO)
• HN - Health Maintenance Organization (HMO) - Medicare Risk
• HS - Special Low Income Medicare Beneficiary
• IN - Indemnity
• IP - Individual Policy
• LC - Long Term Care
• LD - Long Term Policy
• LI - Life Insurance
• LT - Litigation
• MA - Medicare Part A
• MB - Medicare Part B
• MC - Medicaid
• MH - Medigap Part A
• MI - Medigap Part B
• MP - Medicare Primary
• OT - Other | When this code is returned by Medicare or a Medicare Part D administrator, it indicates a type of insurance of Medicare Part D.
• PE - Property Insurance - Personal
• PL - Personal
• PP - Personal Payment (Cash - No Insurance)
• PR - Preferred Provider Organization (PPO)
• PS - Point of Service (POS)
• QM - Qualified Medicare Beneficiary
• RP - Property Insurance - Real
• SP - Supplemental Policy
• TF - Tax Equity Fiscal Responsibility Act (TEFRA)
• WC - Workers Compensation
• WU - Wrap Up Policy

Military Service Rank Codes

These codes indicate the military service rank of the subscriber or dependent.

Stedi returns these codes in the following properties:

• subscriber.militaryServiceRankCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

• dependents[].militaryServiceRankCode

  Docs: Raw X12 | Poll Batch Checks | JSON (Legacy)

• dependent.militaryServiceRankCode

  Docs: Insurance Discovery

Payers can send any of the following codes:

• A1 - Admiral
• A2 - Airman
• A3 - Airman First Class
• B1 - Basic Airman
• B2 - Brigadier General
• C1 - Captain
• C2 - Chief Master Sergeant
• C3 - Chief Petty Officer
• C4 - Chief Warrant
• C5 - Colonel
• C6 - Commander
• C7 - Commodore
• C8 - Corporal
• C9 - Corporal Specialist 4
• E1 - Ensign
• F1 - First Lieutenant
• F2 - First Sergeant
• F3 - First Sergeant-Master Sergeant
• F4 - Fleet Admiral
• G1 - General
• G4 - Gunnery Sergeant
• L1 - Lance Corporal
• L2 - Lieutenant
• L3 - Lieutenant Colonel
• L4 - Lieutenant Commander
• L5 - Lieutenant General
• L6 - Lieutenant Junior Grade
• M1 - Major
• M2 - Major General
• M3 - Master Chief Petty Officer
• M4 - Master Gunnery Sergeant Major
• M5 - Master Sergeant
• M6 - Master Sergeant Specialist 8
• P1 - Petty Officer First Class
• P2 - Petty Officer Second Class
• P3 - Petty Officer Third Class
• P4 - Private
• P5 - Private First Class
• R1 - Rear Admiral
• R2 - Recruit
• S1 - Seaman
• S2 - Seaman Apprentice
• S3 - Seaman Recruit
• S4 - Second Lieutenant
• S5 - Senior Chief Petty Officer
• S6 - Senior Master Sergeant
• S7 - Sergeant
• S8 - Sergeant First Class Specialist 7
• S9 - Sergeant Major Specialist 9
• SA - Sergeant Specialist 5
• SB - Staff Sergeant
• SC - Staff Sergeant Specialist 6
• T1 - Technical Sergeant
• V1 - Vice Admiral
• W1 - Warrant Officer

Provider Codes

These codes indicate the type of provider.

Stedi returns these codes in the following properties:

• plans[].benefits.<benefit type>[].relatedEntities[].provider.code. Contains the name instead of the code. For example, AD (Admitting) is ADMITTING.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].benefitsRelatedEntities[].providerInformation.providerCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Payers can send any of the following codes:

• AD - Admitting
• AT - Attending
• BI - Billing
• CO - Consulting
• CV - Covering
• H - Hospital
• HH - Home Health Care
• LA - Laboratory
• OT - Other Physician
• P1 - Pharmacist
• P2 - Pharmacy
• PC - Primary Care Physician
• PE - Performing
• R - Rural Health Clinic
• RF - Referring
• SB - Submitting
• SK - Skilled Nursing Facility
• SU - Supervising

Quantity Qualifier Codes

These codes provide more information about the type of quantity.

Stedi returns these codes in the following properties:

• plans[].benefits.<benefit type>[].quantity.qualifier. Contains the name instead of the code. For example, VS (Visits) is VISITS.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].quantityQualifierCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Payers can send any of the following codes:

• 8H - Minimum
• 99 - Quantity Used
• CA - Covered - Actual
• CE - Covered - Estimated
• D3 - Number of Co-insurance Days
• DB - Deductible Blood Units
• DY - Days
• HS - Hours
• LA - Life-time Reserve - Actual
• LE - Life-time Reserve - Estimated
• M2 - Maximum
• MN - Month
• P6 - Number of Services or Procedures
• QA - Quantity Approved
• S7 - Age, High Value | Use this code when a benefit is based on a maximum age for the patient.
• S8 - Age, Low Value | Use this code when a benefit is based on a minimum age for the patient.
• VS - Visits
• YY - Years

Service Type Codes

These codes identify the services a benefit covers.

Stedi returns these codes in the following properties:

• plans[].benefits.<benefit type>[].service.value. Contains the code itself, not the name. The service.definition property contains the name.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].serviceTypeCodes

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Visit Service Type Codes for a complete list. This list is specific to X12 version 005010, the mandated version for eligibility checks. It differs from the current X12 Service Type Codes list, which applies to X12 versions later than 005010. Payers shouldn't send service type codes not explicitly listed in version 005010.

Time Qualifier Codes

These codes provide more information about the time period to which the benefit applies.

Stedi returns these codes in the following properties:

• plans[].benefits.<benefit type>[].timePeriod and plans[].benefits.<benefit type>[].serviceLimits[].delivery.period.qualifier. Both contain the name instead of the code. For example, 23 (Calendar Year) is CALENDAR_YEAR.

  Docs: JSON. Appears across benefit types in plans[].benefits.

• benefitsInformation[].timeQualifierCode

  Docs: Raw X12 | Poll Batch Checks | Insurance Discovery | JSON (Legacy)

Payers can send any of the following codes:

• 6 - Hour
• 7 - Day
• 13 - 24 Hours
• 21 - Years
• 22 - Service Year
• 23 - Calendar Year
• 24 - Year to Date
• 25 - Contract
• 26 - Episode
• 27 - Visit
• 28 - Outlier
• 29 - Remaining
• 30 - Exceeded
• 31 - Not Exceeded
• 32 - Lifetime
• 33 - Lifetime Remaining
• 34 - Month
• 35 - Week
• 36 - Admission