Section title: External Code Lists

Insurance Descriptor Codes

979

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

Maintenance 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:

  1. Received
    The request has been submitted but is not yet under review.
  2. Pending
    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.
  3. In Process
    The CMG has initiated their decision process.
  4. On Hold
    The CMG has initiated their decision process but cannot complete it at this time.
  5. 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.
  6. 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.

Maintenance Request Form

Fields marked with an asterisk (*) are required





*The description you are suggesting for a new code or to replace the description for a current code.

*Explain the business scenario or use case when the requested new code would be used, the reason an existing code is no longer appropriate for the code list’s business purpose, or reason the current description needs to be revised.

7/19/2018
DDisability Insurance
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.
17Dental 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.
APAutomobile Insurance
Start: 05/17/2018
C1Commercial 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.
EPExclusive Provider Organization (EPO) Plan
Start: 05/17/2018
HBHealth Insurance Exchange (HIX) Bronze
Start: 05/17/2018
HDHigh Deductible Health Plan (HDHP)
Start: 05/17/2018
HGHealth Insurance Exchange (HIX) Gold
Start: 05/17/2018
HMHealth Maintenance Organization (HMO) Plan
Start: 05/17/2018
HPHealth Insurance Exchange (HIX) Platinum
Start: 05/17/2018
HSHealth Insurance Exchange (HIX) Silver
An individual eligible for Medicare for whom Medicaid pays only Medicare premiums.
Start: 05/17/2018
INIndemnity 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
LCLong 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
LILife 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.
MAMedicare Part A
Start: 05/17/2018
MBMedicare Part B
Start: 05/17/2018
MDMedicare Part D
Start: 05/17/2018
MEMedicare Advantage Preferred Provider Organization (PPO) Plan that excludes Part D Coverage
Start: 05/17/2018
MJMedicare Advantage Health Maintenance Organization (HMO) Plan that includes Part D Coverage
Start: 05/17/2018
MKMedicare Advantage Health Maintenance Organization (HMO) Risk Plan that includes Part D Coverage
Start: 05/17/2018
MLMedicare Advantage Indemnity Plan that includes Part D Coverage
Start: 05/17/2018
MMMedicare Advantage Preferred Provider Organization (PPO) Plan that includes Part D Coverage
Start: 05/17/2018
MNMedicare Advantage Indemnity Plan that excludes Part D coverage
Start: 05/17/2018
MOMedicare Advantage Point of Service (POS) Plan that includes Part D Coverage
Start: 05/17/2018
MRMedicare Advantage Health Maintenance Organization (HMO) Risk Plan that excludes Part D coverage
Start: 05/17/2018
MTMedicare Advantage Health Maintenance Organization (HMO) Plan that excludes Part D coverage
Start: 05/17/2018
OAOpen Access Point of Service Plan (POS) Plan
Start: 05/17/2018
PEProperty Insurance - Personal
Start: 05/17/2018
PRPreferred Provider Organization (PPO) Plan
Start: 05/17/2018
PSPoint of Service (POS) Plan
Start: 05/17/2018
RPProperty Insurance - Real
Start: 05/17/2018
SPSupplemental Insurance
An insurance policy intended to cover non-covered charges of another insurance policy.
Start: 05/17/2018
WCWorkers Compensation Insurance
Coverage provides medical treatment, rehabilitation, lost wages and related expenses arising from a job related injury or disease.
Start: 05/17/2018
WUWrap-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