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”).

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Basic Configuration

Patients

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Insurance & Eligibility

Prior Authorizations

Plan Types

Plan Types

Common Plan Types

All Plan Types

Commercial & Managed Care

Medicare

Medicare Advantage (without Part D)

Medicare Advantage (with Part D)

Medicare Secondary

Medicaid & Dual Eligible

Health Insurance Exchange (HIX)

Specialty

Other

Notes

​Plan Types

​Common Plan Types

​All Plan Types

​Commercial & Managed Care

​Medicare

​Medicare Advantage (without Part D)

​Medicare Advantage (with Part D)

​Medicare Secondary

​Medicaid & Dual Eligible

​Health Insurance Exchange (HIX)

​Specialty

​Other

​Notes

Plan Types

Common Plan Types

All Plan Types

Commercial & Managed Care

Medicare

Medicare Advantage (without Part D)

Medicare Advantage (with Part D)

Medicare Secondary

Medicaid & Dual Eligible

Health Insurance Exchange (HIX)

Specialty

Other

Notes