[EMEVS ACCEPTED]
002=MA Eligible
003=Eligible Only Outpatient Care
004=Eligible Only Inpatient Care
005=Eligible Capitation Guarantee Only
006=Eligible PCP
007=Emergency Services Only
008=Presumptive Eligible Long Term Care
009=Medicare Coinsurance Deductible Only
010=Eligible Except Long-Term Care
012=MA Eligible Spenddown
013=Presumptive Eligiblity Prenatal A
014=Presumptive Eligiblity Prenatal B
015=Perinatal Family
016=MA Eligible - HR - Utilization Threshold
017=Family Health Plus
018=Eligible Family Planning Only
021=Record Canceled
106=Elig Only Home Health and Personal Care Serv
113=HR Limited
114=Eligible PCP HR
115=Guarantee HR
116=HR Full Limited Inpatient

[EMEVS DENIAL]
001=Not MA Eligible
023=Download Required
024=Software Upgrade Required
030=Expired Temporary Card
031=Invalid Plastic Card Status
033=Non-Current Card
040=Invalid County Code
041=Case Number not on File
043=Services Not Ordered
044=Call 800-343-9000
045=No Authorization Found
046=Authorization Cannot be Canceled
047=Invalid Transaction/Terminal
050=Alternate Access Not Allowed
051=Invalid Provider Number
052=Provider Not on File
053=No Access for this Provider
054=No Access for this Device Type
055=Provider Not Eligible
056=Reenter Ordering Provider Number
057=Excluded Ordering Provider
058=No Service Units Entered
059=Invalid License Type
060=SSN Not on File
061=Invalid Access Number
062=Invalid Medicaid Number
063=Invalid Sequence Number
064=Invalid Person Number
065=Recipient Not on File
066=Disqualified Ordering Provider
067=Deceased Ordering Provider
068=Invalid Ordering Provider
071=Invalid Date
075=Invalid Tran Code
090=Invalid System Number
091=Invalid Transaction Type
092=Invalid Specialty Code
093=Invalid Service Category
100=Invalid Referring Provider Number
101=Restricted Recipient No Auth
103=No Coverage: Pending Family Health Plus
104=No Coverage: Excess Income
105=QMB-Requires Medicare Approval
118=MCCP Recipient No Auth
120=Service Approved Inpatient
121=At Service Limit Inpatient
122=Partial Approval Inpatient
123=Service Approved Inpatient
124=Inpatient Disallowed
125=Invalid Service Units
126=Invalid Co-Pay - Re-Enter
700=Year of Birth Not Equal to File
701=Sex Not Equal to File
702=ECC Not Allowed
703=Invalid PIN
704=Invalid TSN
900=Host Unavailable
999=Header Field Error

[UT]
094=UT Override Not Required
095=Services Approved for UT
096=Services Approved for UT, Near Service Limit
097=At UT Service Limit
098=Partial Approval for UT
099=UT process was not invoked
117=UT Exempt

[PC]
110=Services Approved for Post & Clear
111=Partial Approval for Post & Clear
112=Post & Clear process was not invoked

[CO-PAYMENT]
127=Co-Payment Requirements Have Been Met
128=No Co-Payment Required

[RX DENIAL]
705=NDC/APC Not Covered
706=Refill Code Exceeds Number of Refills Authorized
707=Previously Filled Refill
708=Exceeds NY Allowed Refill Maximum
709=Maximum Days Supply Exceeded
710=Maximum Quantity Exceeded
711=Date Filled prior to Date RX Written
712=Override Denied - UT not at limit
713=Refill over 180 days old from Date RX Written
714=Date Filled More than 14 days from Date RX Written
715=Other Payor Amount must be Greater than Zero
716=Other Payor Amount must be Equal to Zero
717=Recipient has Other Insurance
718=HR Recipient - No Rebate Agreement

[RX UTPC]
AA="UT Approved, P&C Approved"
AD="UT Approved, Services Not Ordered"
AN="UT Approved, P&C Not Invoked"
DA="UT At Service Limits, P&C Approved"
DD="UT At Service Limits, Services Not Ordered"
DN="UT At Service Limits, P&C Not Invoked"
LA="UT Approved Near Limits, P&C Approved"
LD="UT Approved Near Limits, Services Not Ordered"
LN="UT Approved Near Limits, P&C Not Invoked"
NA="UT Not Invoked, P&C Approved"
ND="UT Not Invoked, Services Not Ordered"
NN="UT Not Invoked, P&C Not Invoked"
PA="UT Override Denied, P&C Approved"
PD="UT Override Denied, Services Not Ordered"
PN="UT Override Denied, P&C Not Invoked"
XX=DUR Denial


[DME]
129=Duplicate/Redundant DVS Request
130=DVS Process Was Not Invoked
131=Item Approved/DVS Number Issued
132=Missing/Invalid Item/NDC Code
133=Item Not Covered For Patient Gender
134=Patient Age Exceeds Maximum Age
135=Patient Age Precedes Minimum Age
136=Requested Item Exceeds Frequency Limitation
137=Missing/Invalid Quantity Dispensed
138=DVS Number Not Required
139=DVS Requires Current Date Entry
140=Category of Service Not Valid For Item/NDC Code
142=Missing/Invalid Category of Service
143=Missing/Invalid Tooth/Quadrant
144=Procedure Not Covered
705=Item/NDC Not Covered or Discontinued
710=Maximum Quantity Exceeded
722=Family Health Plus Denial

[NCPDP REJECT]
01=M/I BIN
02=M/I Version Number
03=M/I Transaction Code
04=M/I Processor Control Number
05=M/I Pharmacy Number
07=M/I Cardholder ID Number
08=M/I Person Code
09=M/I Birthdate
10=M/I Sex Code
13=M/I Other Coverage Code
14=M/I Eligibility Override Code
15=M/I Date Filled
16=M/I Prescription Number
17=M/I New-Refill Code
18=M/I Metric Quantity
19=M/I Days Supply
20=M/I Compound Code
21=M/I NDC Number
22=M/I Dispense as Written Code
23=M/I Ingredient Cost
25=M/I Prescriber ID
28=M/I Date Prescription Written
29=M/I Refills Authorized
30=M/I P.A./M.C. Code
34=M/I Prescription Denial Override
35=M/I Primary Prescriber
50=Non-Matched Pharmacy Number
52=Non-Matched Cardholder ID
56=Non-Matched Prescriber ID
58=Non-Matched Primary Prescriber
61=Drug Not Covered for Patient Gender
65=Patient is Not Covered
66=Patient Age Exceeds Maximum Age
70=NDC Not Covered
75=Prior Authorization Required
76=Plan Limitations Exceeded
77=Discontinued NDC Number
79=Refill Too Soon
81=Claim Too Old
83=Duplicate Paid/Captured Claim
84=Claim Not Paid/Captured
85=Claim Not Processed
87=Reversal Not Processed
88=DUR Reject Error
DQ=M/I Usual and Customary
DV=M/I Other Payor Amount
DX=M/I Patient Paid Amount
E1=Alternate Product Type
E2=Alternate Product Code
E4=DUR Conflict Code
E5=DUR Intervention Code
E6=DUR Outcome Code
E9=Pharmacist's ID
M7=Host Drug File Error
M8=Host Provider File Error
MZ=Error Overflow

[COUNTY]
01=Albany
02=Allegany
03=Broome
04=Cattaraugus
05=Cayuga
06=Chautauqua
07=Chemung
08=Chenango
09=Clinton
10=Columbia
11=Cortland
12=Delaware
13=Dutchess
14=Erie
15=Essex
16=Franklin
17=Fulton
18=Genesee
19=Greene
20=Hamilton
21=Herkimer
22=Jefferson
23=Lewis
24=Livingston
25=Madison
26=Monroe
27=Montgomery
28=Nassau
29=Niagara
30=Oneida
31=Onondaga
32=Ontario
33=Orange
34=Orleans
35=Oswego
36=Otsego
37=Putnam
38=Rensselaer
39=Rockland
40=St. Lawrence
41=Saratoga
42=Schenectady
43=Schoharie
44=Schuyler
45=Seneca
46=Steuben
47=Suffolk
48=Sullivan
49=Tioga
50=Tompkins
51=Ulster
52=Warren
53=Washington
54=Wayne
55=Westchester
56=Wyoming
57=Yates
58=Bronx
59=Brooklyn/Kings
60=Queens
62=Richmond/Staten Island
66=NYC/Manhattan
97=OMH Administered
98=OMR/DD Administered
99=Oxford Home

[OFFICE]
013=Waverly
019=Yorkville
023=East End
024=Amsterdam
026=St. Nicolas
028=Hamilton
032=East Harlem
035=Dyckman
037=Roosevelt
038=Rider
039=Boulevard
040=Melrose
041=Tremont
043=Kingsbridge
044=Fordham
045=Concourse
046=Crotona
047=Soundview
048=Bergen
049=Willis
051=Queensboro
052=Office of Treatment Monitoring
053=Queens
054=Jamaica
061=Fulton
062=Clinton
063=Wyckoff
064=Dekalb
066=Bushwick
067=Linden
068=Prospect
070=Bay Ridge
071=Nevins
072=Livingston
073=Brownsville
074=Queens
075=Staten Island
078=Euclid
079=Rockaway
080=Fort Greene
084=Williamsburg
099=Richmond
500=34th Street Manhattan
801=Brooklyn
802=Jamaica
806=Manhattan
810=Division of Group Homes
823=Division of Group Residence
826=Diagnostic Reception Centers
DOP=Division of Placement
OPA=Office of Placement and Accountability

[MEDICARE COVERAGE]
A=Inpatient Coverage Only
B=Outpatient Coverage Only
C=Inpatient/Outpatient Coverage
Q=Inpatient/Outpatient Coverage plus Qualified Medicare Beneficiary

[MEDICAID CATEGORY]
A=Dependent Children
H=Home Relief
M=Medicaid Only
S=Social Security

[MC COVERAGE]
01=Full Coverage
10=Full Except Long Term Care
11=Legal Alien
15=Perinatal Family
16=Home Relief/Full Coverage
30=Enrolled in Prepaid Capitation Plan(PCP)
31=Capitation(CAP) Guarantee
32=Home Relief Enrolled in PCP
33=Home Relief Guarantee
34=Family Health Plus
36=Family Health Plus Guarantee
02=Outpatient Only
03=Inpatient Only
04=Not Eligible
05=Sanctioned
06=Provisional
07=Emergency Only
08=Presumptive Home Care
09=Medicare Co-ins/Deductible
14=Presumptive-Prenatal B
17=COBRA-Aids

[MC PLAN ID]
10=HIP/HMO
15=Private. HIP Outpatient
A5=Aetna: Medicare Cost
B7=Blue Choice
BS=Blue Care Plus
C2=Community Blue
C3=Capital District Physicians Health Plan
C5=Community Blue (Buffalo Area)
C6=Choicecare (Long Island)
CE=BC/BS of Michigan
CP=Chp of Bassett
CX=Capital Area Community Health Plan
CY=BC/BS of Greater NY
CZ=Community Health Plan of Suffolk, Inc.
DL=Oxford Health Plan: Medicare Risk
DM=Blue Choice: Medicare Cost
DN=Chp Albany: Medicare Cost
DO=Chp Albany: Medicare Risk
DQ=Chp Poughkeepsie: Medicare Cost
DR=HIP GNY: Medicare Cost
DS=HIP GNY: Medicare Risk
DT=Health Care Plan: Medicare Risk
DU=Health Care Plan: Medicare Cost
E7=Senior Care Connection (Eddy)
EG=Elderplan (Brooklyn)
FR=Foundation Health Plan
G3=Bhard - WAJ, Gaur M.D.
HA=Health Ins. Plan of Greater NY
HG=Health Source
HL=Health Care Plan
HM=HIP of Greater NJ, Inc
HN=Health Serv. Medical Corp of Central NY
HR=Health Shield Community Health Plan
HU=Healthnet
IF=Independent Health Assoc, Inc
IJ=Independent Prepaid Health Plan
KB=Kaiser Health Plan of the Northeast
MP=Manhattan Health Plan, Inc.
MQ=Mohawk Valley Physicians Health Plan
MT=Mid-Hudson Health Plan (Kingston Area)
NG=Northcare
P2=Physicians Health Services
P4=Preferred Care: Medicare Risk
PE=Patient's Choice
PR=Preferred Care
PS=Prepaid Health Plan of Central NY
PX=Prucare/Putnam
RE=Rochester Health Network
RG=Rutgers Community Health Plan (NJ)
SM=Sanus Health Plan: Medicare Risk
SU=Southern Connecticut Community Health Plan
SX=Sanus Health Plan
SZ=Suffolk County Employee Health Plan (Choicecare)
TU=Traveler Health Network
U2=U.S. Health Care: Medicare Risk
UQ=U.S. Health Care
WE=Westchester Community Health Plan
WI=Whole Health Ins Network
WT=Wellcare of NY

00=None
01=General
02=HIP Outpatient
03=Other Inpatient
04=Other Outpatient
05=Other Inpatient/Outpatient
06=Group Health Inc
07=Union Inpatient
08=Union Outpatient
09=Union Inpatient/Outpatient
11=Medicare (Part A) Inpatient
12=Empire Blue Cross/Blue Shield of Greater NY
13=Medicare (Part B) Outpatient
17=Med Sr Care Inpatient
21=Veterans (NYC Only)
23=Empire Blue Cross of GNY
24=Medicare (Part A/B) Inpatient/Outpatient
26=Chautauqua Regional Medical Svcs Inc
45=Empire Blue Shield (Blue Shield of GNY)
77=Sunset Park (Lutheran Prepaid Capitation)
82=Bronx Health Plan
85=Elderplan
91=Manhattan Phsp
92=Metroplus (Metropolitan Health Plan)
93=Manhattan Phsp
94=Metropolitan Health Plan
95=Brooklyn/Queens Health Plan
96=Brooklyn/Queens Health Plan
98=HIP Bi-Link
99=HIP/NYC Comprehensive
A1=American Postal Workers Union
A2=American Psych Mgmt
A3=American Medical Life Insurance Co.
A4=Anthem Life
A6=Albany Cnty Physicians Case Mgmt Plan
A7=Aetna Capitation Plan
A8=Alta health Strategies
A9=Acordia of Western PA
AA=Accident Liability Benefits
AB=Aetna Casualty & Surety Co.
AC=Aetna Life Insurance Co.
AD=Aetna Variable Annuity Life Ins. Co.
AE=Agway Life Insurance & Health Co.
AF=American Family Life Insurance
AG=Allstate Life Insurance Co.
AH=Amalgamated Life Insurance Co Inc
AI=Allstate Insurance Co
AJ=Absent Parent Responsibility
AK=Allied Benefit Administrators
AL=American Group Administrators
AN=Community Health Care Services
AP=American Assoc of Retired Persons
AR=Broome Managed Care (Patel)
AS=Assoc Plan Admin Inc
AT=Afton Family Health Center
AU=American Medical Insurance Co
AX=ABC HEALTH PLAN
AY=American Patriot Health Insurance Co
AZ=American Progressive Health Insurance Co of NY
B1=Blue Cross of Western Pennsylvania
B2=Blue Shield of Florida
B3=Blue Shield of Massachusetts
B4=Blue Cross/Blue Shield Tennessee
B5=Blue Cross/Blue Shield of Northeast Ohio
B6=Blue Cross/Blue Shield of NJ
B8=Blue Cross Utica
B9=Blue Shield Utica
BA=Banker's Life Company
BB=Banker's Multiple Line Insurance Co
BC=Blue Cross of Central NY
BD=Blue Cross of Northeastern NY
BE=BC/BS of WNY
BF=Benefit Trust Life Insurance Co
BG=Blue Shield of Central NY
BH=Blue Shield of Northeastern NY
BI=BC/BS of WNY
BJ=Rochester Blue Cross
BK=Rochester Blue Shield
BL=Blue Cross of New Jersey
BM=Blue Shield of New Jersey
BN=Blue Cross/Blue Shield of Central NY
BO=Blue Cross/Blue Shield of Northeastern NY
BP=Blue Cross/Blue Shield of Western NY
BQ=Blue Cross/Blue Shield of Connecticut
BR=Blue Cross/Blue Shield of Florida
BT=Blue Cross/Blue Shield of Massachusetts
BU=Blue Care Plus
BV=Blue Cross/Blue Shield of Vermont
BW=Blue Cross of Florida
BX=Blue Cross/Blue Sield of Delaware
BY=Blue Cross of Massachusetts
BZ=Blue Cross of Northeastern Pennsylvania
C1=Captial Blue Cross
C4=Conneticut General/INA (Cigna)
C7=Comprehensive Case Management Corp
C8=Confederation Life Insurance
C9=Claim Management Services
CA=Champus
CB=Colonial Penn Franklin Ins Co
CC=Continental Asurance Co
CD=Continental Casualty Co
CF=Comprecare
CG=Capital District Physicians Health Plan
CH=Chubb Life America
CI=Colonial Penn Insurance Co
CJ=Columbian Mutual Life Insurance Co
CK=Combined Life Insurance Co of NY
CL=Service Employees of Central NY Welfare Fund
CM=Commercial Travelers Mutual Insurance Co
CN=Catskill Area Schools Employee Benefit Plan
CO=Companion Life Insurance Co
CQ=Choicecare
CR=Consolidated Mutual Insurance Co
CS=Continental American Life Insurance Co
CT=Continental Insurance Co
CU=Civil Service Employees Assoc
CV=Capital District Physicians Health Plan
CW=Catholic Health Service Plan (Fidelis)
D1=BC/BS of the National Captial Area
D2=Erisco
D3=Professional Insurance Agents Group
D4=Oxford Insurance Co
D5=DC 37 Health & Security Plan
D6=Benefit Management of Maine
D7=Blue Shield of N.E. Pennsylvania
D8=BC of California
D9=B-J Local 32 Health & Pension
DA=Benefit Administrators Ins
DB=BC of California
DC=Broome Managed Care (SMA)
DD=Broome Managed Care (D. Driscoll)
DE=Broome Managed Care (Chenango Bridge)
DF=BC/BS of Illinois
DG=Diversified Group Brokerage Corp
DH=Comprehensive Benefit Co
DI=Celtic Life Ins Co
DJ=BC/BS of Missouri
DK=BC of Phildelphia
DP=Diversified Pharmaceutical Services
DY=Broome Managed Care (Lourdes PC Assoc)
E1=Equicor
E2=Employee Security Fund
E3=Elm-Co Agency Inc
E4=Erie County PCMP II A
EB=Equitable Life Assurance Co
EC=Employer's Mutual Liab Ins Co of Wisconsin
ED=Equitable Life Ins Co of Iowa
EE=Equitable Variable Life Ins Co
EF=Executive Life Ins Co of NY
EH=Empire Plan/Metropolitan
EI=Erie County PCMP-1
EJ=Employer
EK=Erie County PCMP-2
EL=NY Care Plus-BS of NY Senior Blue
EM=Erie County PCMP-3 (Univ Medical Service)
EN=AETNA Health Plan-Senior Choice
EO=HIP Health Plan of New Jersey
EP=Oxford Health Plan (Oxford Medicare Advantage)
EQ=HMO Blue (Medicare Blue)
ER=Sheehan Memorial Hospital PCMP 111
ES=Amerihealth
ET=Qual Med Health Plans
EU=Nylcare-NJ (65-Medicare)
EV=Erie County PCMP-3 (MF1)
EW=Erie County PCMP-3 (MF2)
EX=Erie County PCMP-3 (MF3)
EY=Erie County PCMP-3 (Sisters of Charity Hosp)
EZ=Empire Plan/Empire Blue Cross
F1=First Fortis
FA=Family Health Services
FB=Farmers & Traders Life Ins Co
FD=Federal Life & Casualty Co
FE=Fidelity & Casualty Co of NY
FF=Fidelity Mutual Life Ins co
FH=Firemen's Insurance co of Newark, NJ
FI=Firemen's Fund American Life Insurance
FO=First Option HP of NY
FU=First United American Life Ins Co
G1=Group Administrators
GA=Guardian Ins & Annunity Co Inc
GB=Buffalo General PCP
GC=Gerber Life Insurance Co
GE=Genesis Health Plan
GG=Government Employee's Life Ins Co of NY
GH=Group Health, Inc
GI=General Insurance Exchange Agency
GJ=Guardian Life Insurnace Co of America
GK=Dr. William Coch
GO=Healthchoice (G. Ogden)
GS=Hum Health Systems, Inc.
GW=Great West Life
H1=Senior Health Partners
H2=Healthchoice (Graham)
H3=Healthchoice (Scott)
H4=Healthchoice (Cudahay)
H5=Healthchoice (Depner)
H6=Healthchoice (Fulatti)
H7=Healthchoice (Lawrence)
H8=Healthchoice (Schieer)
H9=Healthchoice (Koch)
HB=BCS Insurance Co
HC=Health & Welfare Life Ins Assoc
HD=Hosp Serv Corp
HE=Hartford Accident & Idemnity Co
HF=Hartford Life Ins Co
HH=Health Source-Rockland
HI=Home Life Ins Co
HJ=Health Plan Administrators
HK=Health Care Plan
HO=Health Svcs Medical Corp of Central NY
HP=Hospital Service Plan of Lehign Valley
HQ=Health Economics Group
HS=Healthways Inc
HT=HIP-Suffolk
HV=Health Claim Services
HW=HIP-Westchester
HX=HMO-CNY
HY=HIP-Nassau
HZ=Empire BC/BS (Healthnet)
IA=Int'l Life Investors Ins Co
ID=Indecs
IE=Independent Health Assoc (Erie)
IH=Income protection Policy
IK=Independence BLue Cross
IL=Independent Living Seniors (Rochester)
IM=Healthplus
IN=Independent Health Assoc (Niagara)
IS=Independent Living Services
IT=ITT Life Ins Corp
IV=Independent Health Assoc (Hudson Valley)
J1=J.J. Newman & Company
J2=Justo, Inc
JA=J.C. Penney Insurance Co
JB=John Deere Insurance Co
JC=John Hancock Mutual Life Ins Co
JD=Middletown Psychiatric Center
JE=Mohawk Valley Psychiatric Center
JF=NY Psychiatric Institute
JG=Pilgrim Psychiatric Center
JH=Rochester Psychiatric Center
JI=Rockland Psychiatric Center
JJ=St. Lawrence Psychiatric Center
JK=South Beach Psychiatric Center
JL=Binghamton Psychiatric Center
JM=Bronx Psychiatric Center
JN=Buffalo Psychiatric Center
JO=Capital Distric Psychiatric Center
JP=Central Islip Psychiatric Center
JQ=Creedmoor Psychiatric Center
JR=Elmira Psychiatric Center
JS=Hudson River Psychiatric Center
JT=Hutchings Psychiatric Center
JU=Kings Park Psychiatric Center
JV=Kingsboro Psychiatric Center
JW=Manhattan Psychiatric Center
JX=Cereal Palsy Health Plan
JY=Healthcare Plan
KA=Community Premier Plus, Inc.
KC=Community Choice
KD=Key Food Stores Corp Inc
KN=ASO Health Plans
KP=Careplus
KS=Healthchoice (Sale)
L1=Cusumano, Leo M.D. (Health Choice)
L2=Local 259 UAW
LA=Liberty Mutual Life Ins Co
LB=Liberty Life Assurance Co
LC=Lincoln National Life Ins Co of NY
LD=Lawrence Health Care Admin Svcs
LE=Broadlawn Health Partner
LG=Lumberman's Mutual Insurance Co
LH=Teamster's Local #182
LI=Life of America Ins Co
LO=Local 1199 Hosp & Health Care Emp
LW=Dr. Thomas Lawrence
M1=The Maxco Co
M3=Multi-Service Health Plan
M4=Magna Care Health Plan
MA=Metropolitan Life
MB=Mutual of Omaha Insurance Co
MC=Massachusetts Mutual Life Ins Co
MD=Med-Plan
ME=Mail Handlers Benefit Plan
MF=Medical Administrators
MG=Metropolitan Insurance & Annuity Co
MH=Upstate Administration Services
MI=United Food Workers Local One
MJ=Monarch Life Ins Co
MK=Managed Health Care Systems
ML=Montgomery Ware
MM=Mutual Benefit Life Insurance Co
MN=Mutual Life Ins Co of NY
MO=Metra Health (Met Life)
MR=Blue Choice Option
MS=Milk Plant Employees Welfare Trust Fund
MU=Mid Hudson Health Plan (Ulster)
MV=Mohawk Valley Health Plan
MW=Managed Health Inc
MX=MGA Plan Administrators
MZ=Mohawk Valley Network
N1=Nat'l Presc Admin
N2=National Benefit Life Ins Co
N3=National Prescription Services
N4=NYS Auto Dealers Assoc
N5=NY Farm Bureau/NYSAG
NA=NY Dental Svcs Corp
NB=North General Hosp Premier HP
NC=National Casualty Company
ND=NY Life Insurance Co
NE=Nationwide General Ins Co
NF=National Home & Health Assurance Co
NH=Niagra Falls PCP
NI=National Insurance Services, Inc
NK=Nationwide Life Insurance Co
NL=New England Mutual Life Ins Co
NM=North American Administrators
NO=Nova Heatlcare
NP=Neighborhood Health Plan
NR=Northwestern National Life Ins Co
NS=New Hampshire-Vermont Health Service
NW=New York Hospital MCP
NY=New York Health Plan
OC=Orange County MCP (Vossoughian)
OD=Orange County MCP (Grant)
OE=Orange County MCP (Prabhu)
OF=Orange County MCP (Klein)
OG=Orange County MCP (Ignaccio)
OH=Orange County MCP (Carey)
OI=Orange County MCP (Kaye)
OJ=Orange County MCP (Makabali)
OM=Our Lady of Mercy Medical Center
OX=Oxford Health Plan
OZ=Buffalo Comm Health Plan
P1=Principal Mutual Ins Co
P3=Pharm Serv Corp of NY
P5=Priority Care (Westfield Family Phys)
P6=Priority Care (Bartholomew)
P7=Priority Care (Bishop)
P8=Priority Care (Deshpande)
P9=Priority Care (Landis)
PA=Prudential
PB=Paul Revere Life Ins Co
PC=Phoenix Mutual Life Ins Co
PD=Peerless Insurance Co
PF=PC3
PG=Penn General Svcs of N.E., Inc
PH=Priority Health Care
PI=Healthsource (Patients' Choice)
PJ=Priority Care (Bumbald)
PK=Priority Care (Parish)
PL=Premier Health Care
PM=Provident Life & Accident Ins Co
PN=Primecare New York
PO=Provident Mutual Life Ins CO of Philadelphia
PP=Paid Prescriptions
PQ=Preferred Care
PT=Pennsylvania Blue Shield
PU=Pomco Insurance
PV=Health Services Medical Corp (HSMC)
PW=Prucare (Orange)
PY=Prudential Dental
PZ=Priority Care (Wilkinson)
QA=Metropolitan Health Plan Actuarial Class 1
QB=Metropolitan Health Plan Actuarial Class 2
QC=Metropolitan Health Plan Actuarial Class 3
QD=Metropolitan Health Plan Actuarial Class 4
QE=Metropolitan Health Plan Actuarial Class 5
QF=Metropolitan Health Plan Actuarial Class 6
QG=Metropolitan Health Plan Actuarial Class 7
QH=Metropolitan Health Plan Actuarial Class 8
QI=Metropolitan Health Plan Actuarial Class 9
QJ=Metropolitan Health Plan Actuarial Class 10
QK=Metropolitan Health Plan Actuarial Class 11
QL=Metropolitan Health Plan Default
QM=Qualified Medicare Beneficiaries
QN=Bronx Health Plan Actuarial Class 2
QO=Bronx Health Plan Actuarial Class 3
QP=Bronx Health Plan Actuarial Class 4
QQ=Bronx Health Plan Actuarial Class 5
QR=Bronx Health Plan Actuarial Class 6
QS=Bronx Health Plan Actuarial Class 7
QT=Bronx Health Plan Actuarial Class 8
QU=Bronx Health Plan Actuarial Class 9
QV=Bronx Health Plan Actuarial Class 10
QW=Bronx Health Plan Actuarial Class 11
QX=Bronx Health Plan Default
RF=Rochester Hospital Service Corp
RH=Dr. Rajan Gulati
RM=AMSCO
SA=Syracuse Community Health Plan
SB=Sieba, Ltd
SC=St. Barnabus
SD=Susquehanna Admin Inc
SE=Sears, Roebuck & Company
SF=Health First
SG=Security Mutual Life Ins Co of NY
SH=Sentry Life Ins Co of NY
SI=Staten Island PCP
SK=Suffolk Health Plan
SL=Saeed, Azmat, M.D.
SN=Sanus
SP=Better Health Plan
SQ=State Farm Life & Accident Assurance Co
SR=Special Needs Mgmt Group
SS=State Mutual Life Assurance Co of America
ST=St. Vincent's PCP
SV=Security SS Plan
SW=Suffolk Co Physicians Case Mgmt Plan
SY=Southern Tier MCP
TA=Teacher's Insurance & Annuity Assoc of America
TB=Travelers
TC=Transamerica Insurance CO
TD=Transworld Life Ins Co of NY
TH=Cigna (Total Health)
TI=St. Luke's-Roosevelt Phsp Actuarial Class 1
TJ=St. Luke's-Roosevelt Phsp Actuarial Class 2
TK=St. Luke's-Roosevelt Phsp Actuarial Class 3
TL=St. Luke's-Roosevelt Phsp Actuarial Class 4
TM=St. Luke's-Roosevelt Phsp Actuarial Class 5
TN=St. Luke's-Roosevelt Phsp Actuarial Class 6
TO=St. Luke's-Roosevelt Phsp Actuarial Class 7
TP=St. Luke's-Roosevelt Phsp Actuarial Class 8
TQ=St. Luke's-Roosevelt Phsp Actuarial Class 9
TR=St. Luke's-Roosevelt Phsp Actuarial Class 10
TS=St. Luke's-Roosevelt Phsp Actuarial Class 11
TT=St. Luke's-Roosevelt Phsp Default
TV=Metra Health (Traveller's MCP)
U1=Bakery & Conf Union Health
U3=Uniteo Industry Workers Local 424
UA=Union Labor Life Ins Co
UB=Union Muttual Life Ins Co
UH=United Mutual Life Ins Co
UL=United States Life Ins Co
UO=Utica Mutual Ins Co
UP=Union Fidelity Life of Pennsylvania
UR=Union Security Trust
US=US Healthcare
UT=US Healthcare (Nassau/Suffolk)
VA=Veterans Aid & Attendant
VB=Value Rx Pharm Inc
VC=VNS Choice
VG=Vincent (Giordano)
VI=Manhattan Phsp Actuarial Class 1
VJ=Manhattan Phsp Actuarial Class 2
VK=Manhattan Phsp Actuarial Class 3
VL=Manhattan Phsp Actuarial Class 4
VM=Manhattan Phsp Actuarial Class 5
VN=Manhattan Phsp Actuarial Class 6
VO=Manhattan Phsp Actuarial Class 7
VP=Manhattan Phsp Actuarial Class 8
VQ=Manhattan Phsp Actuarial Class 9
VR=Manhattan Phsp Actuarial Class 10
VS=Manhattan Phsp Actuarial Class 11
VT=Manhattan Phsp Default
WA=Washinton National Life Ins Co of NY
WB=Workers Compensation
WC=Wellcare (Columbia)
WD=Wellcare (Dutchess)
WF=Employers of Wausau
WG=Wellcare (Greene)
WH=Westchester PHSP
WJ=WJ Jones Admin Services
WK=Westlink
WL=Westchester Gen Labor Welfare Fund
WM=Wal-Mart Self Insurance
WO=Wellcare (Orange)
WP=William Penn Ins Co of NY
WS=Westfield Family Physicians
X3=Community Health Plan
X4=Community Health Plan (Ulster)
X5=Community Health Plan (Dutchess)
X6=Community Health Plan (Delaware)
X7=Community Health Plan (Otsego)
X8=Rochester Health Network
XA=Metropolitan HMO-AFDC
XB=Metropolitan HMO-HR
XC=Metropolitan HMO-MA Only
XD=Metropolitan HMO-SSI
XE=Sunset Park Actuarial Class 1
XF=Sunset Park Actuarial Class 2
XG=Sunset Park Actuarial Class 3
XH=Sunset Park Actuarial Class 4
XI=Sunset Park Actuarial Class 5
XJ=Sunset Park Actuarial Class 6
XK=Sunset Park Actuarial Class 7
XL=Sunset Park Actuarial Class 8
XM=Sunset Park Actuarial Class 9
XN=Sunset Park Actuarial Class 10
XO=Sunset Park Actuarial Class 11
XP=Sunset Park Default
YE=Rand-Sunset Actuarial Class 1
YF=Rand-Sunset Actuarial Class 2
YG=Rand-Sunset Actuarial Class 3
YH=Rand-Sunset Actuarial Class 4
YI=Rand-Sunset Actuarial Class 5
YJ=Rand-Sunset Actuarial Class 6
YK=Rand-Sunset Actuarial Class 7
YL=Rand-Sunset Actuarial Class 8
YM=Rand-Sunset Actuarial Class 9
YN=Rand-Sunset Actuarial Class 10
YO=Rand-Sunset Actuarial Class 11
YP=Rand-Sunset Default
Z8=OKH/OMR Community Residence
Z9=Pregnancy Indicator
ZB=Zurich Insurance Company
ZI=Brooklyn/Queens Health Plan Actuarial Class 1
ZJ=Brooklyn/Queens Health Plan Actuarial Class 2
ZK=Brooklyn/Queens Health Plan Actuarial Class 3
ZL=Brooklyn/Queens Health Plan Actuarial Class 4
ZM=Brooklyn/Queens Health Plan Actuarial Class 5
ZN=Brooklyn/Queens Health Plan Actuarial Class 6
ZO=Brooklyn/Queens Health Plan Actuarial Class 7
ZP=Brooklyn/Queens Health Plan Actuarial Class 8
ZQ=Brooklyn/Queens Health Plan Actuarial Class 9
ZR=Brooklyn/Queens Health Plan Actuarial Class 10
ZS=Brooklyn/Queens Health Plan Actuarial Class 11
ZT=Brooklyn/Queens Health Plan Default
ZZ=Composite Coverage

[MC PRINCIPAL PROVIDER]
01=Private Skilled Nursing Home Facility
02=Private Health Related Facility
03=Public Skilled Nursing Facility
04=Public Health Related Facility
05=OMR/DD Center
06=OMH Center
07=Acute Hospital - LTC(Chronic Care)
08=Hospital Excess - (Surplus or 6 month surplus)
09=Hospital Catastrophic
10=Child Care Facility
11=Hospital Full Coverage
14=Personal Care Services Provider
16=Long Term Home Health Care Provider

[MC RESTRICTION]
02=Restricted to one primary Podiatrist
03=Restricted to one primary Dentist
05=Restricted to one primary Pharmacy
06=Restricted to one primary Physician for Physician and Clinic services
08=Restricted to one primary Clinic for Clinic and Physician services
09=Restricted to one primary inpatient provider for inpatient services
17=Restricted to the period of pregnancy & delivery
30=Enrolled in Long-term Health Care Program (LTHHCP)
35=Enrolled in CMCM and exempt from Copay & UT processing
38=Resident in an ICF-DD Facility
39=Enrolled in Aid Continuing program
46=Enrolled in Home & Community Based Service Waiver (IRA, FC or at Home)
47=Enrolled in Home & Community Based Service Waiver (CR & Sub A)
48=Enrolled in Home & Community Based Service Waiver (CR only)
49=Enrolled in Home & Community Based Service Waiver (IRA Res Hab Consumer)
50=Has Connect services & eligible for service package with Perinatal Family
51=Has Connect services & eligible for services in Eligibility Response
53=HR recipient in area with no Managed Care Program
54=Limited Benefits:  Home Health/Personal Care Services
55=Enrolled in MCCP and restricted to one primary Pharmacy
56=Enrolled in MCCP and restricted to one primary Physician
58=Enrolled in MCCP and restricted to one primary Clinic
62=In the Care At Home I program
63=In the Care At Home II program
64=In the Care At Home III program
65=In the Care At Home IV program
66=In the Care At Home V program
67=In the Care At Home VI program
68=In the Care At Home VII program
69=In the Care At Home VIII program
70=In the Care At Home IX program
71=In the Care At Home X program
81=In Home and Community Based Service (HCBS) Waiver Program for TBI
83=Mandated by LDSS to receive alcohol & substance abuse services
90=Managed Care Exclusion
92=DOH/Managed Care Exemption
93=DOH/Managed Care Exemption
NH=Enrolled in Nursing Home program facility
CC=Enrolled in Child Care program facility
ZZ=Call (800)-343-9000 to obtain additional Exception codes

[MC SOB]
A=Inpatient Hospital
B=Physician In-Office
C=Emergency Room
D=Clinic
E=Psychiatric-Inpatient
F=Psychiatric-Outpatient
G=Physician In-Hospital
H=Drugs-No-Card
I=Lab/X-ray
J=Dental
K=Drugs-Co-pay
L=Nursing Home
M=Drugs-Major Med.
N=All Physician Services
O=Drugs
P=Home Health
Q=Psychiatric Services
R=ER and Clinic
S=Major Medical
T=Transportation
U=Coverage to compliment Medicare
V=Substance Abuse Services
W=Substance Abuse Outpatient
X=Substance Abuse Inpatient
Y=Durable Medical Equipment
Z=Optical
ALL=All Apply(A-Z)

[MC REASON]
01=Override enrollment via On-line EMEVS
03=Voluntary enrollment via On-line EMEVS
97=Moved out of plan area
96=Enrolled in error
95=Lost Medicaid Eligibility
94=Spend-down Eligible
93=Client or LDSS Initiated/Excluded
92=Client Initiated/Exempt
91=In receipt of cost beneficial insurance
90=Physically abusive (requested by Plan)
89=Habitually non-compliant (requested by Plan)
88=Good cause (State Fair Hearing)
87=30 Day enrollment grace period
86=Client request/Not Satisfied with Managed Care Procedures
85=Deceased
84=Foster Care Placement
83=Resident of Alcohol Substance Abuse Program
82=ICF/MR Resident
81=Enrolled in a Home & Community Based Care At Home Program
80=Resident of a State Operated Psychiatric Facility
79=Mental Health Family Care Patient
78=Enrolled in Capitated Long Term Care Demo Program
77=Homeless
76=Enrolled in Long Term Home Health Care Program
75=Hospice Resident
74=Chronically Disabled Recip enrolled with Certified Home Health Agency
73=Seriously & Persisently Mentally Ill or Seriously Emotionally Disturbed Recip
72=Dually Eligible for Medicare and Medicaid
71=Unable to Service Client's Needs
70=Incarcerated
69=Enrolled in the 1915 c Traumatic Brain Injury (TBI) Program
68=Child in Residental Treatment Center
67=Nursing Home Resident
66=Plan Withdrew from Program
65=Client Request/Problems Accessing Family Planning Services
64=Client Request/Difficulty in Obtaining Referrals
63=Client Request/Not Satisfied with Quality of Medical Care
62=Client Request/Problems with Appointment Availability
61=Current Provider Not in Network
60=Language and/or Physical Barrier
59=Disenrollment/LOST FHPlus Eligibility

[MC RESPONSE REASONS]
000=Request Accepted/Captured
001=Submitting Provider Not Authorized
002=Benefits Not Defined For Admin
003=MC Enrollment System is Closed
004=Unknown Recipient
005=Invalid Effective Date
006=Invalid Capitation Code
007=Sex Code Not Matching
008=Invalid Birth Date
009=Birth Date Not Matching
010=Eligibility Coverage Restriction
011=Principal Provider Code Restriction
012=Exception Code Restriction
013=Already Enrolled In Plan
014=Enrolled In Another MC Plan
015=Other Insurance Restriction
016=Not Currently Enrolled In Plan
017=Invalid Transaction Format
018=MC System Has Been Shut Down
019=No Contract With County
020=MC System Error: Failed Send
021=MC System Error: Recip Segment
022=MC System Error: Unknown Seg
023=Recipient Not In County
024=Invalid Reason Code
025=No Matching Request To Cancel
026=Can No Longer Be Cancelled
027=Access Type Not Authorized
028=Aid Category Not Provided
029=Enrollment Pending
030=Already has Activity on Date
031=Disenrollment Pending
032=MC System Error:  Failed Receive
033=Benefit Package Not Available for Recipient
099=Unknown Error