Eligibility code lists
You may need to reference the following code lists when submitting eligibility checks through the Stedi clearinghouse. 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
Returned in the benefitsInformation.benefitsServiceDelivery.deliveryOrCalendarPatternCode
property. This code specifies the routine shipments, deliveries, or calendar pattern.
1
- 1st Week of the Month2
- 2nd Week of the Month3
- 3rd Week of the Month4
- 4th Week of the Month5
- 5th Week of the Month6
- 1st & 3rd Weeks of the Month7
- 2nd & 4th Weeks of the Month8
- 1st Working Day of Period9
- Last Working Day of PeriodA
- Monday through FridayB
- Monday through SaturdayC
- Monday through SundayD
- MondayE
- TuesdayF
- WednesdayG
- ThursdayH
- FridayJ
- SaturdayK
- SundayL
- Monday through ThursdayM
- ImmediatelyN
- As DirectedO
- 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 FridaySL
- Monday, Tuesday and ThursdaySP
- Monday, Tuesday and FridaySX
- Wednesday and ThursdaySY
- Monday, Wednesday and ThursdaySZ
- Tuesday, Thursday and FridayT
- 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 NecessaryX
- 1/2 By Wed., Bal. By Fri.Y
- None (Also Used to Cancel or Override a Previous Pattern)
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 ShiftC
- 3rd ShiftD
- A.M.E
- P.M.F
- As DirectedG
- Any ShiftY
- None (Also Used to Cancel or Override a Previous Pattern)
Eligibility and benefit type codes
Returned in the benefitsInformation.code
property. Visit Interpret benefit response for a complete list.
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 ReserveAO
- Active Military - OverseasAS
- Academy StudentAT
- Presidential AppointeeAU
- Active Military - USACC
- ContractorDD
- Dishonorably DischargedHD
- Honorably DischargedIR
- Inactive ReservesLX
- Leave of Absence: MilitaryPE
- Plan to EnlistRE
- RecommissionedRM
- Retired Military - OverseasRR
- Retired Without RecallRU
- Retired Military - USA
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 ForceB
- Air Force ReservesC
- ArmyD
- Army ReservesE
- Coast GuardF
- Marine CorpsG
- Marine Corps ReservesH
- National GuardI
- NavyJ
- Navy ReservesK
- OtherL
- Peace CorpM
- Regular Armed ForcesN
- ReservesO
- U.S. Public Health ServiceQ
- Foreign MilitaryR
- American Red CrossS
- Department of DefenseU
- United Services OrganizationW
- Military Sealift Command
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 Number34
- Social Security Number46
- Electronic Transmitter Identification Number (ETIN)FA
- Facility IdentificationFI
- Federal Taxpayer’s Identification NumberII
- Standard Unique Health Identifier for each Individual in the United StatesMI
- Member Identification NumberNI
- National Association of Insurance Commissioners (NAIC) IdentificationPI
- Payor IdentificationPP
- Pharmacy Processor NumberSV
- Service Provider NumberXV
- Centers for Medicare and Medicaid Services PlanIDXX
- Centers for Medicare and Medicaid Services National Provider Identifier
Industry Codes
Used 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.
Information Status Codes
Returned in the subscriber.informationStatusCode
and dependents.informationStatusCode
properties. These codes are used to report military service data.
A
- PartialC
- CurrentL
- LatestO
- OldestP
- PriorS
- Second Most CurrentT
- Third Most Current
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 Plan13
- Medicare Secondary End-Stage Renal Disease Beneficiary in the Mandated Coordination Period with an Employer’s Group Health Plan14
- Medicare Secondary, No-fault Insurance including Auto is Primary15
- Medicare Secondary Worker’s Compensation16
- Medicare Secondary Public Health Service (PHS) or Other Federal Agency41
- Medicare Secondary Black Lung42
- Medicare Secondary Veteran’s Administration43
- Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)47
- Medicare Secondary, Other Liability Insurance is PrimaryAP
- Auto Insurance PolicyC1
- CommercialCO
- Consolidated Omnibus Budget Reconciliation Act (COBRA)CP
- Medicare Conditionally PrimaryD
- DisabilityDB
- Disability BenefitsEP
- Exclusive Provider OrganizationFF
- Family or FriendsGP
- Group PolicyHM
- Health Maintenance Organization (HMO)HN
- Health Maintenance Organization (HMO) - Medicare RiskHS
- Special Low Income Medicare BeneficiaryIN
- IndemnityIP
- Individual PolicyLC
- Long Term CareLD
- Long Term PolicyLI
- Life InsuranceLT
- LitigationMA
- Medicare Part AMB
- Medicare Part BMC
- MedicaidMH
- Medigap Part AMI
- Medigap Part BMP
- Medicare PrimaryOT
- 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 - PersonalPL
- PersonalPP
- Personal Payment (Cash - No Insurance)PR
- Preferred Provider Organization (PPO)PS
- Point of Service (POS)QM
- Qualified Medicare BeneficiaryRP
- Property Insurance - RealSP
- Supplemental PolicyTF
- Tax Equity Fiscal Responsibility Act (TEFRA)WC
- Workers CompensationWU
- Wrap Up Policy
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
- AdmiralA2
- AirmanA3
- Airman First ClassB1
- Basic AirmanB2
- Brigadier GeneralC1
- CaptainC2
- Chief Master SergeantC3
- Chief Petty OfficerC4
- Chief WarrantC5
- ColonelC6
- CommanderC7
- CommodoreC8
- CorporalC9
- Corporal Specialist 4E1
- EnsignF1
- First LieutenantF2
- First SergeantF3
- First Sergeant-Master SergeantF4
- Fleet AdmiralG1
- GeneralG4
- Gunnery SergeantL1
- Lance CorporalL2
- LieutenantL3
- Lieutenant ColonelL4
- Lieutenant CommanderL5
- Lieutenant GeneralL6
- Lieutenant Junior GradeM1
- MajorM2
- Major GeneralM3
- Master Chief Petty OfficerM4
- Master Gunnery Sergeant MajorM5
- Master SergeantM6
- Master Sergeant Specialist 8P1
- Petty Officer First ClassP2
- Petty Officer Second ClassP3
- Petty Officer Third ClassP4
- PrivateP5
- Private First ClassR1
- Rear AdmiralR2
- RecruitS1
- SeamanS2
- Seaman ApprenticeS3
- Seaman RecruitS4
- Second LieutenantS5
- Senior Chief Petty OfficerS6
- Senior Master SergeantS7
- SergeantS8
- Sergeant First Class Specialist 7S9
- Sergeant Major Specialist 9SA
- Sergeant Specialist 5SB
- Staff SergeantSC
- Staff Sergeant Specialist 6T1
- Technical SergeantV1
- Vice AdmiralW1
- Warrant Officer
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
- AdmittingAT
- AttendingBI
- BillingCO
- ConsultingCV
- CoveringH
- HospitalHH
- Home Health CareLA
- LaboratoryOT
- Other PhysicianP1
- PharmacistP2
- PharmacyPC
- Primary Care PhysicianPE
- PerformingR
- Rural Health ClinicRF
- ReferringSB
- SubmittingSK
- Skilled Nursing FacilitySU
- Supervising
Quantity Qualifier Codes
Returned in the benefitsInformation.quantityQualifierCode
property. These codes provide more information about the type of quantity.
8H
- Minimum99
- Quantity UsedCA
- Covered - ActualCE
- Covered - EstimatedD3
- Number of Co-insurance DaysDB
- Deductible Blood UnitsDY
- DaysHS
- HoursLA
- Life-time Reserve - ActualLE
- Life-time Reserve - EstimatedM2
- MaximumMN
- MonthP6
- Number of Services or ProceduresQA
- Quantity ApprovedS7
- 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
- VisitsYY
- Years
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
- Hour7
- Day13
- 24 Hours21
- Years22
- Service Year23
- Calendar Year24
- Year to Date25
- Contract26
- Episode27
- Visit28
- Outlier29
- Remaining30
- Exceeded31
- Not Exceeded32
- Lifetime33
- Lifetime Remaining34
- Month35
- Week36
- Admission