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.

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Delivery Frequency Codes

Returned in the benefitsInformation.benefitsServiceDelivery.deliveryOrCalendarPatternCode property. This code specifies the routine shipments, deliveries, or calendar pattern.

• 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)

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Delivery Pattern Time Codes

Returned in the benefitsInformation.benefitsServiceDelivery.deliveryPatternTimeQualifierCode property. This code specifies the time for routine shipments or deliveries.

• 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)

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Eligibility and benefit type codes

Returned in the benefitsInformation.code property. Visit Determine patient benefits for a complete list.

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Employment Status Codes

Returned in the subscriber.employmentStatusCode and dependents.employmentStatusCode properties. These codes indicate the employment status of the subscriber or dependent as it relates to military service.

• 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

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Government Service Affiliation Codes

Returned in the subscriber.governmentServiceAffiliationCode and dependent.governmentServiceAffiliationCode properties. These codes indicate the government service affiliation of the subscriber or dependent as it relates to military service.

• 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

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Identification Code Qualifiers

Returned in the benefitsInformation.benefitsRelatedEntities.entityIdentification object. This property designates the type of identifier in the benefitsInformation.benefitsRelatedEntities.entityIdentificationValue property.

• 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

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Industry Codes

Returned in the benefitsInformation.eligibilityAdditionalInformation.industryCode property when benefitsInformation.eligibilityAdditionalInformationList.codeListQualifierCode is set to ZZ - Mutually defined. Visit the Centers for Medicare and Medicaid Services Place of Service Code Set for a complete list of codes and descriptions.

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Information Status Codes

Returned in the subscriber.informationStatusCode and dependents.informationStatusCode properties. These codes are used to report military service data.

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

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Insurance Type Codes

Returned in the benefitsInformation.insuranceTypeCode property. These codes indicate the type of insurance policy within a specific insurance program.

• 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

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Military Service Rank Codes

Returned in the subscriber.militaryServiceRankCode and dependents.militaryServiceRankCode properties. These codes indicate the military service rank of the subscriber or dependent.

• 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

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Provider Codes

This code list is used in the request provider.providerCode property. It’s also returned in the following response properties:

• provider.providerCode
• benefitsInformation.benefitsRelatedEntities.providerInformation.providerCode

These codes indicate the type of provider.

• 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

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Quantity Qualifier Codes

Returned in the benefitsInformation.quantityQualifierCode property. These codes provide more information about the type of quantity.

• 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

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Service Type Codes

Returned in the benefitsInformation.serviceTypeCodes array. 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.

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Time Qualifier Codes

Returned in the benefitsInformation.timeQualifierCode and benefitsInformation.benefitsServiceDelivery.timePeriodQualifierCode properties. These codes provide more information about the time period to which the benefit applies.

• 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