eligibilities accepted input values:
| Value | Description |
|---|---|
'1' |
Active Coverage |
'2' |
Active - Full Risk Capitation |
'3' |
Active - Services Capitated |
'4' |
Active - Services Capitated to Primary Care Physician |
'5' |
Active - Pending Investigation |
'6' |
Inactive |
'7' |
Inactive - Pending Eligibility Update |
'8' |
Inactive - Pending Investigation |
'A' |
Co-Insurance |
'B' |
Co-Payment |
'C' |
Deductible |
'CB' |
Coverage Basis |
'D' |
Benefit Description |
'E' |
Exclusions |
'F' |
Limitations |
'G' |
Out of Pocket (Stop Loss) |
'H' |
Unlimited |
'I' |
Non-Covered |
'J' |
Cost Containment |
'K' |
Reserve |
'L' |
Primary Care Provider |
'M' |
Pre-existing Condition |
'MC' |
Managed Care Coordinator |
'N' |
Services Restricted to Following Provider |
'O' |
Not Deemed a Medical Necessity |
'P' |
Benefit Disclaimer |
'Q' |
Second Surgical Opinion Required |
'R' |
Other or Additional Payor |
'S' |
Prior Year(s) History |
'T' |
Card(s) Reported Lost/Stolen |
'U' |
Contact Following Entity for Eligibility or Benefit Information |
'V' |
Cannot Process |
'W' |
Other Source of Data |
'X' |
Health Care Facility |
'Y' |
Spend Down |