Plan Types
When Solum runs an eligibility check (270/271 transaction), the payer returns an insurance type code — a short X12 code like PR or HM that identifies the patient’s plan type. Solum stores this code and displays a human-readable label on the patient’s payor record.
Plan type is automatically extracted from eligibility responses. You can also set it manually on a patient’s payor record using the plan type dropdown.
Common Plan Types
These are the plan types you’ll see most often:
| Code | Label | Full Name |
|---|
HM | HMO | Health Maintenance Organization |
PR | PPO | Preferred Provider Organization |
EP | EPO | Exclusive Provider Organization |
PS | POS | Point of Service |
C1 | Commercial | Commercial |
MC | Medicaid | Medicaid |
MA | Medicare Part A | Medicare Part A |
MB | Medicare Part B | Medicare Part B |
MP | Medicare Primary | Medicare Primary |
IP | Individual Policy | Individual Policy |
GP | Group Policy | Group Policy |
WC | Workers Comp | Workers Compensation |
CO | COBRA | COBRA |
All Plan Types
Commercial & Managed Care
| Code | Label | Full Name |
|---|
HM | HMO | Health Maintenance Organization |
PR | PPO | Preferred Provider Organization |
EP | EPO | Exclusive Provider Organization |
PS | POS | Point of Service |
OA | Open Access POS | Open Access POS |
C1 | Commercial | Commercial |
HD | HDHP | High Deductible Health Plan |
IN | Indemnity | Indemnity |
IP | Individual Policy | Individual Policy |
GP | Group Policy | Group Policy |
CO | COBRA | COBRA |
PP | Self Pay | Self Pay (Cash - No Insurance) |
Medicare
| Code | Label | Full Name |
|---|
MA | Medicare Part A | Medicare Part A |
MB | Medicare Part B | Medicare Part B |
MD | Medicare Part D | Medicare Part D |
MP | Medicare Primary | Medicare Primary |
CP | Medicare Cond. Primary | Medicare Conditionally Primary |
MH | Medigap Part A | Medigap Part A |
MI | Medigap Part B | Medigap Part B |
HN | HMO Medicare Risk | HMO Medicare Risk |
Medicare Advantage (without Part D)
| Code | Label | Full Name |
|---|
M | MA POS | Medicare Advantage POS (excludes Part D) |
ME | MA PPO | Medicare Advantage PPO (excludes Part D) |
MT | MA HMO | Medicare Advantage HMO (excludes Part D) |
MR | MA HMO Risk | Medicare Advantage HMO Risk (excludes Part D) |
MN | MA Indemnity | Medicare Advantage Indemnity (excludes Part D) |
Medicare Advantage (with Part D)
| Code | Label | Full Name |
|---|
MO | MA POS + Part D | Medicare Advantage POS (includes Part D) |
MM | MA PPO + Part D | Medicare Advantage PPO (includes Part D) |
MJ | MA HMO + Part D | Medicare Advantage HMO (includes Part D) |
MK | MA HMO Risk + Part D | Medicare Advantage HMO Risk (includes Part D) |
ML | MA Indemnity + Part D | Medicare Advantage Indemnity (includes Part D) |
Medicare Secondary
These codes indicate Medicare is the secondary payer due to another coverage:
| Code | Label | Reason |
|---|
12 | MSP Working Aged | Working aged beneficiary |
13 | MSP ESRD | End-stage renal disease |
14 | MSP No-Fault | No-fault insurance |
15 | MSP Workers Comp | Workers compensation |
16 | MSP PHS | Public Health Service |
41 | MSP Black Lung | Black lung benefits |
42 | MSP VA | Veterans Affairs |
43 | MSP Disabled LGHP | Disabled, large group health plan |
47 | MSP Other Liability | Other liability insurance |
Medicaid & Dual Eligible
| Code | Label | Full Name |
|---|
MC | Medicaid | Medicaid |
48 | Medicaid | Medicaid (alternate code) |
03 | Dual Eligible | Medicare & Medicaid Dual Eligible |
49 | Dual Eligible | Medicare & Medicaid Dual Eligible (alternate) |
QM | QMB | Qualified Medicare Beneficiary |
HS | Special Low Income Medicare | Special Low Income Medicare Beneficiary |
Health Insurance Exchange (HIX)
| Code | Label | Full Name |
|---|
HB | HIX Bronze | Health Insurance Exchange Bronze |
HG | HIX Gold | Health Insurance Exchange Gold |
HP | HIX Platinum | Health Insurance Exchange Platinum |
The X12 standard uses the code HS for both HIX Silver and Special Low Income Medicare Beneficiary. Solum maps HS to Special Low Income Medicare. If you see HS on a patient’s record, it could actually be a HIX Silver plan — verify with the patient or payer if needed.
Specialty
| Code | Label | Full Name |
|---|
02 | TRICARE | TRICARE |
17 | Dental | Dental Insurance |
18 | Vision | Vision Insurance |
19 | Rx | Prescription Drug Insurance |
WC | Workers Comp | Workers Compensation |
D | Disability | Disability |
DB | Disability Benefits | Disability Benefits |
LI | Life Insurance | Life Insurance |
LC | Long Term Care | Long Term Care |
LD | Long Term Policy | Long Term Policy |
Other
| Code | Label | Full Name |
|---|
01 | Short Term | Short Term Insurance |
AP | Auto Insurance | Auto Insurance |
FF | Family/Friends | Family or Friends |
LT | Litigation | Litigation |
OT | Other | Other |
PE | Personal Property | Property Insurance - Personal |
PL | Personal | Personal |
RP | Real Property | Property Insurance - Real |
SA | Set Aside | Set Aside Arrangement |
SP | Supplemental | Supplemental Policy |
TF | TEFRA | TEFRA |
WU | Wrap Up | Wrap Up Policy |
Notes
- Plan type can be empty. Not all payers return a plan type code in their eligibility response. When missing, the field shows as blank on the patient’s payor record.
- Automatically populated. When you run an eligibility check, the plan type is extracted from the response and saved to the patient’s payor record.
- Manually editable. You can set or change the plan type from the patient’s payor details using the plan type dropdown. Common types appear at the top of the list.
- Stored as X12 codes. The raw code (e.g.,
PR) is what’s stored. The UI displays the human-readable label (e.g., “PPO”).
