Appendix E - Enrollee Benefit Closure Reason Codes
The Enrollee Benefit Closure Reason Codes are organized in numerical order by Code.
| Code | Enrollee Benefit Closure Reason |
| 001 | Enrollee Deceased |
| 002 | Loss of Virginia Residence |
| 003 | Enrollee No Longer Eligible for Program |
| 004 | Provider No longer Eligible for Program |
| 008 | Benefit Added in Error |
| 009 | No Longer has Insurance Benefit |
| 014 | Enrollee Fraud |
| 018 | Data Entered Incorrectly |
| 055 | Corrected Information |
| 090 | Other |
| 097 | System Entered Due to Loss of Eligibility |
| 098 | System Entered Due to End Date in Past. |
| 099 | Unknown |
| 100 | No longer Medicare Eligible |
| 200 | Pre-existing relationship with non PCP |
| 201 | Too far to service area |
| 202 | Moved to a non managed care county |
| 203 | Recipient resides in a LTC facility |
| 204 | Managed care program closed top of page |
| 205 | Not a valid aid category for this type of managed care |
| 206 | No PCP currently available |
| 207 | Foster child |
| 208 | Enrolled in another managed care program |
| 209 | MC provider requests approved disenrollment |
| 210 | Other -do not re-enroll in same MC program |
| 211 | Quality of service is not what was expected |
| 212 | Needed service not available |
| 213 | Waiting time too long for appointment |
| 214 | Not happy with HMO policies and procedures |
| 215 | Prefer benefit offered by another HMO |
| 216 | Prefer managed care PCP |
| 217 | No reason given for recipient |
| 218 | Enrolled in Medallion top of page |
| 219 | Enrolled in an HMO or competetive plan |
| 220 | Engaged in disruptive, uncooperative behavior |
| 221 | Missed 3 consecutive appts within 6 months |
| 222 | Unreasonably refused treatment/excessive ER use |
| 223 | Enrollee has TPL |
| 224 | Provider withdrew |
| 225 | Hospital prior auth on file |
| 226 | Enrollee in NH or some other waiver/benefit pgm |
| 227 | Moved out of provider's area |
| 228 | Locality not in pre-assignment table |
| 229 | Benefit package exempt from managed care |
| 230 | Void Future Assignment |
| 231 | Assignment ended due to enrollee age/gender |
| 232 | Ended due to program expansion |
| 300 | Provider died |
| 301 | Provider moved/sold business |
| 302 | Provider requested change/do not reassign |
| 303 | Enrollee requested change/do not reassign |
| 304 | Provider locked out |
| 305 | Enrollee appealed top of page |
| 306 | Provider failed to re-enroll |
| 307 | No abuse, used services properly |
| 308 | Add continued lock-in period |
| 309 | Enrollee entered long term care |
| 310 | Enrollee entered waivered program |
| 311 | DMAS initiates Admin. Change |
| 312 | HMO assigned |
| 313 | Changed client med. Mgmt level |
| 314 | Lock-in diverted; eligibility cancelled |
| 315 | No abuse; track enrollee |
| 316 | Converted data |
| 317 | New DMAS provider number |
| 318 | New DMAS enrollee number |
| 403 | Changed Level of Care top of page |
| 410 | Denied Active Treatment |
| 411 | Enrollee Discharged to Adult Home |
| 412 | Enrollee Discharged to Community Based Care |
| 413 | Enrollee DisCharged Home |
| 414 | Enrollee No Longer Eligible for Medicaid |
| 415 | Enrollee Transferred to Another Nursing Home |
| 416 | Enrollee Discharged to Hospital, Stayed More Than 30 Days |
| 417 | Enrollee Discharged, Destination Unknown |
| 429 | Nursing Facility Cancellation to Receive Hospice |
| 430 | Enrollee to Nursing Home |
| 431 | Community Based Care Termination |
| 432 | Community Based Care Transfer |
| 433 | Nursing Home to Community Based Care |
| 434 | Change in Hours |
| 435 | New Admission |
| 436 | Utilization Review -Office |
| 437 | Utilization Review -Home |
| 438 | 6 Month Pre-authorization |
| 439 | Service Modification |
| 440 | Reopened Case |
| 488 | Auto Closure Due to Overlap |
| 501 | No Longer Employed |
| 502 | No Longer Cost Effective |
| 503 | No Longer Medicaid Eligible |
| 504 | Non-Compliant |
| 600 | Not Eligible for PACE |
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VCU-VISSTA. All rights reserved. Last Modified: June 3, 2003 Send comments to VISSTA Media Lab |
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