Eligibility Codes (EB01) - Registry Setting

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This registry setting allows the end-user to define the level of benefit information the system will use to determine eligibility for a patient.

The Eligibility Verified field on the Financial Eligibility form will be updated based on the value determined by the benefit information in this setting. This is accomplished by verifying that at least one of the code(s) entered in this registry setting are returned in the 271 request file (2110-EB-01).

Multiple selections are allowed if separated by an '&'. Example: 1&2&3&4.

'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 Entitiy for Eligibility or Benefit Information

'V' = Cannot Process

'W' = Other Source Data

'X' = Health Care Facility

'Y' = Spend Down