> ## Documentation Index > Fetch the complete documentation index at: https://docs.getsolum.com/llms.txt > Use this file to discover all available pages before exploring further. # Plan Types > X12 insurance plan type codes returned in eligibility responses and how they map to common plan names # 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").