Specification Question Clarification Rationale What is the frequency of submission? Monthly, but representing persons over a rolling 24 month period with open andor closed segments of eligibility. CHIA requires monthly Eligibility files to capture the attributes necessary for matching to the various Claims Files coming in on the same schedule. What is the format of the file? Each submission must start with a Header Record and end with a Trailer Record to define the contents of the data within the submission. Each Detail Record must contain elements in an asterisk delimited format. The Header and Trailer Records help to determine period-specific editing and create an intake control for quality. The asterisk is an inherited symbol from previous filings that submitters had already coded their systems to compile for previous version of the MA APCD. What does each row in a file represent? Each row, or Detail Record, contains the information of a unique Eligibility + Product that a carrier or maintains to process Member claims. CHIA recognizes that information at this detailed level is necessary for aggregation and reporting utilization and aids with maintaining Master Member IDs to nsure privacy of data. There appear to be similar fields on eligibility that are also collected on the claims file. Can you clarify? Many of the elements in the files use similar semantics and a few are exact duplicates. CHIA is concerned with the details presented in the ME File regardless of the information presented on the Claims Files. CHIA is required to standardize and analyze information on Members and the variations of Eligibility. The like elements on the Records mirror what is typically billed by providers and aids with QA work when analyzing covered services, in- vs. and/or Third Party Administrator attributes.
5 Period Beginning Date 11/8/12 Date Period - Integer Century Year Month - CCYYMM int[6] Header Period Start Date Report the Year and Month of the reported submission period in CCYYMM format. This date period must be repeated in HD006, TR005 and TR006. This same date must be selected in the upload application for successful transfer. Mandatory 100% HM 6 Period Ending Date 11/8/12 Date Period - Integer Century Year Month - CCYYMM int[6] Header Period Ending Date Report the Year and Month of the reporting submission period in CCYYMM format. This date period must match the date period reported in HD005 and be repeated in TR005 and TR006 Mandatory 100% HM 7 Record 11/8/12 Integer Counter varchar[10] Header Record Report the total number of records submitted within this file. Do not report leading zeros, space fill, decimals, or any special characters. Mandatory 100% HM 8 Comments 11/8/12 Text Free Text varchar[80] Header Carrier Comments May be used to document the submission by assigning a filename, system source, compile identifier, etc. Optional 0% HO 9 APCD Version Number 2/201 - ID Version char[3] Submission Guide Version Report the version number as presented on the APCD Member Eligibility File Submission Guide in 0.0 Format. Sets the intake control for editing elements. Version must be accurate else file will drop. EXAMPLE: 3.0 = Version 3.0 Mandatory 100% HM Code Description 2.1 Prior Version; valid only for reporting periods prior to October 2013 3.0 Version 3.0; required for reporting periods as of October 2013: No longer VALID as of May 2015 4.0 Version 4.0: required for reporting periods October 2013 onward; No longer valid as of August 2016. 5.0 Version 5.0; required for reporting periods October 2013 onward as of August 2016 ME
CH CHAMPUS CI Commercial Insurance DS Disability HM Health Maintenance Organization HN HMO Medicare Risk/Medicare Part C IC Integrated Care Organization LI Liability LM Liability Medical MA Medicare Part A MB Medicare Part B MC Medicaid MD Medicare Part D MO Medicaid Managed Care Organization MP Medicare Primary MS Medicare Secondary Plan OF Other Federal Program (e.g. Black Lung) QM Qualified Medicare Beneficiary SC Senior Care Option SP Supplemental Policy TF HSN Trust Fund TV Title V VA Veterans Administration Plan WC Workers' Compensation ZZ Other ME 4 Year 6/24/10 Date Period - Integer Century Year - CCYY int[4] Eligibility year reported in this submission. Report the year for eligibility is reported in this submission in CCYY format. If reporting previous year's data, the year reported here will not match current year. Do not report a future year here. All 100% A0
ME 5 Month 6/24/10 Date Period - Month - MM char[2] Reporting Month of Eligibility Report the month for which eligibility is reported in this submission in MM Format. Leading zero is required for reporting January through September files. All 100% A0 ME 6 Insured or Policy Number 6/24/10 Text ID Group varchar[30] / Policy Number Report the number that defines the insured or policy. Do not report the number that uniquely identifies the subscriber or member All 99% A2 ME 7 Coverage Level Code 11/8/12 Lookup - Text char[3] Benefit Coverage Level Code Report the code that defines the dependent coverage All 99% A1 Code Description CHD Children Only DEP Dependents Only ECH Employee and Children ELF Employee and Life Partner EMP Employee Only ESP Employee and Spouse FAM Family IND Individual SPC Spouse and Children SPO Spouse Only UNK Unknown ME 8 Subscriber SSN ID Tax char[9] Subscriber's Social Security Number Report the Subscriber's SSN here; used to create Unique Member ID; will not be passed into analytic file. Do not use hyphen. If not available do not report any value here All 85% A0 ME 9 Plan Specific Contract Number Text ID Contract varchar[30] Contract Number Report the Plan assigned contract number. Do not include values in this element that will distinguish one member of the family from another. This should be the contract or certificate number for the subscriber and all of the dependents. All 9% A2 ME 10 Member Suffix or 6/24/10 Text ID Sequence varchar[20] Member's Contract Report the unique number / identifier of the member within the contract All 99%
40 Cadaver Donor 43 Child Where Insured Has No Financial Responsibility 53 Life Partner 76 Dependent ME 13 Member Gender 6/24/10 Lookup Table - Text tlkpGender char[1] Member's Gender Report member gender as reported on enrollment form in format. Used to create Unique Member ID. EXAMPLE: F = Female All 100% A0 Code Description F Female M Male O Other U Unknown ME 14 Member Date of Birth Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Member's date of birth Report the date the member was born in CCYYMMDD Format. Used to create Unique Member ID. All 99% A0 ME 15 Text char[0] All % A0 ME 16 Member State Code Source 2 - Text Address External Code Source 2 - States char[2] State / Province of the Member Report the state of the member’s residence as defined by the US Postal Service. Report Province when Country Code does not = USA. All 99% A0 ME 17 Member ZIP Code Code Source 2 - Text Address Zip External Code Source 2 - Zip varchar[] Zip Code of the Member Report the 5 Zip Code of the member’s residence as defined by the United States Postal Service. submit the Zip Code . All 99% A0 ME 18 Medical Coverage 11/8/12 Lookup Table - Integer int[1] Indicator - Medical Option Report the value that defines the element. EXAMPLE: 1 = Yes there is Medical Coverage. All 100% A0 Value Description 1 Yes digit
2 No 3 Unknown 4 Other 5 Not Applicable ME 19 Prescription Drug Coverage 11/8/12 Lookup - Integer int[1] Indicator - Pharmacy Option Report the value that defines the element. EXAMPLE: 1 = Yes there is Prescription Coverage. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 20 Dental Coverage 11/8/12 Lookup - Integer int[1] Indicator - Dental Option Report the that defines the element. EXAMPLE: 1 = Yes there is Dental Coverage. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 21 Race 1 11/8/12 Lookup Table - Text tlkpRace varchar[6] Member's self-disclosed Primary Race Report the Member-identified primary race here. The code value “UNKNOW” (Unknown/not specified), should be used ONLY when Member answers unknown, or refuses to answer. Do not report any value here if data has not been collected. Report only collected data. EXAMPLE: R9 = Other Race All 3% B Code Description R1 American Indian/Alaska Native R2 Asian R3 Black/African American
R4 Native Hawaiian or other Pacific Islander R5 White R9 Other Race UNKNOW Unknown/not specified ME 22 Race 2 11/8/12 Lookup Table - Text tlkpRace varchar[6] Member's self-disclosed Secondary Race Report the Member-identified secondary race here. The code value “UNKNOW” (Unknown/not specified), should be used ONLY when Member answers unknown, or refuses to answer. Do not report any value here if data has not been collected. Report only collected data. EXAMPLE: R9 = Other Race All 2% C Code Description R1 American Indian/Alaska Native R2 R3 Black/African American R4 Native Hawaiian or other Pacific Islander R5 White R9 Other Race UNKNOW Unknown/not specified ME 23 Filler Text Filler varchar[] Filler The MA APCD reserves this field for future use. Do not populate with any data. All 0% Z ME 24 Hispanic Indicator 11/8/12 Lookup - Integer int[1] Indicator - Hispanic Status Report the value that defines the element. The code value “3” for unknown, should be used ONLY when member answers unknown, or refuses to answer. Do not report any value here if the data has not been collected. Report only collected data. EXAMPLE: 1 = Yes, Member has indicated Hispanic status. All 3% B Value Description 1 Yes 2 No
HSN Health Safety Net CCP ConnectorCare N/A Not Applicable ME 32 Group Name 11/8/12 Text Name Group varchar[50] Group name Report the group name that the policy is attached to. Report IND for individual policies. Do not report any value here if the data is not available All 80% A2 ME 33 Member language preference 11/8/12 Code Source 7 - Integer External Code Source 7 - Languages int[3] Member's self-disclosed verbal language preference Report the code that defines the spoken language preference of the member. The code value 999 (Unknown/ Not Specified), should only be used when patient/client answers unknown or refuses to answer. Do not report any value here if the submitter does not have the data. Report only collected data. All 3% B ME 34 C ME 35 Health Care Home (PCMH) Assigned Flag 11/8/12 Lookup Table - Integer int[1] Health Care Home Assigned indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Member has an assigned approved patient centered medical home for this coverage period. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 36 Health Care Home (PCMH) Number 11/8/12 Text ID Link to PV002 varchar[30] Health Care Home ID Report the submitter assigned patient centered medical home number. It is anticipated that this will be the same data submitter number used in reporting servicing provider. Do not report any data here if not applicable. The number of the member’s healthcare home must also be in the Provider File in PV002, Provider ID. Required when = 1 90% C
ME 37 Health Care Home (PCMH) Tax ID Number ID Tax char[9] Health Care Home EIN Report the Federal Tax Identification Number of the medical home here. If there is not medical home to report, do not report any value. Do not use hyphen or alpha prefix. Required when ME035 = 1 90% C ME 38 National Provider ID - Health Care Home (PCMH) 11/8/12 Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Health Care Home Provider Report the National Provider Identification (NPI) number for the entity or individual serving as the medical home. If there is no medical home to report, do not report any value. Required when ME035 = 1 10% C ME 39 C ME 40 Product ID Number 11/8/12 Text ID Link to PR001 varchar[30] Product Identification Report the carrier / submitter-assigned identifier as it appears in PR001 in the Product File. This element is used to understand Product and Eligibility attributes of the member / subscriber as applied to this record All 100% A0 ME 41 Product Enrollment Date 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Member Enrollment Date Report the date the member was enrolled in the product in CCYYMMDD Format. All 98% A1 ME 42 Product Enrollment End Date 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Enrollment Date Report the date the member was disenrolled from the product in CCYYMMDD Format. If the member was not disenrolled at the end of the current month, then do not fill with any value All 98% B ME 43 A0 ME 44 ME 45 Purchased through Exchange Flag Lookup Table - Integer int[1] Indicator - MA Exchange Purchase Report the value that defines the element. EXAMPLE: 1 = Yes, policy for this eligibility was purchased through MA Health Exchange. Required for Risk Assessment All 100% A2
Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 46 Member PCP ID 2/2016 Text ID Link to PV002 varchar[30] Member's PCP ID Report the identifier of the members PCP. The value in this element must have a corresponding Provider ID (PV002) in the Provider File. ME046 (Member PCP) is only used for members whose insurance products require the selection of a PCP (e.g., HMO or POS). Report a value of ‘999999999U’ when PCP is unknown or '999999999NA' if the eligibility does not require a PCP. All 100% A2 ME 47 Member PCP Effective Date 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] PCP Effective Date with Member Report the Member enrollment date with the PCP in CCYYMMDD Format. Required when PCP ID is not = 999999999U or 98% B ME 48 Member PCP Termination Date 6/24/10 Full Date - Integer Century Year Day - CCYYMMDD int[8] PCP Termination Date with Member Report the Member termination date from the PCP in CCYYMMDD Format. If the member is still active with their PCP at the end of the current month, then do not fill with any value Required when PCP ID is not = 999999999U or 98% B ME 49 Member Deductible 12/1/10 Integer Currency varchar[10] Annual maximum out of pocket Member Deductible across all benefit types Report the maximum amount of member / subscriber's annual deductible across all benefit (Medical, RX, vision, behavioral health, etc.) before certain services are covered. Report only In-Network Deductibles here if plan has an In and Out-of-Network Deductible. Report 0 when there is no deductible applied to all benefits for this eligibility. Do not code decimal or round All 90% A2
up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 ME 50 Member Deductible Used 11/8/12 Integer Currency varchar[10] Member deductible amount incurred Report the amount to-date the member / subscriber has incurred towards maximum deductible. Report 0 if no deductible has been incurred. Do not code decimal or up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when > 0 100% A2 ME 51 Behavioral Health Benefit Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Behavioral Health Option Report the value that defines the element. EXAMPLE: 1 = Yes, Behavioral/Mental Health is a covered benefit. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable ME 52 Laboratory Benefit Flag 11/8/12 Lookup - Integer int[1] Indicator - Laboratory Option Report the value that defines the element. EXAMPLE: 1 = Yes, Lab is covered benefit. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other
ME 57 Date of Death 6/24/10 Full Date - Integer Century Year Day - CCYYMMDD int[8] Member's Date of Report the date the member expired in CCYYMMDD Format. If still alive or date of death is unknown, do not report any value here. All 0% C ME 58 A0 ME 59 Disability Indicator Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Disability Status Report the value that defines the element. EXAMPLE: 1 = Yes, Member is on disability. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 60 Status 11/8/12 Lookup Table - Text char[1] Employment Status Code Report the code that defines the employment status of the member / subscriber All 100% A2 Code Description A Active I Involuntary Leave O Orphan P Pending R Retiree Z Unemployed U Unknown ME 61 Student Status 11/8/12 Lookup Table - Integer int[1] Indicator - Student Status Report the value that defines the element. EXAMPLE: 1 = Yes, Member is a student. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other
5 Not Applicable ME 62 Marital Status 11/8/12 Lookup Table - Text char[1] Marital Status Code Report the member's marital status here All 100% B Code Description C Common Law Married D Divorced M Married P Domestic Partnership S Married W Widowed X Legally Separated U Unknown ME 63 Benefit Status 11/8/12 Lookup Table - Text char[1] Benefit Status Code Report the code that defines status of benefits for the subscriber All 100% A2 Code Description A Active C COBRA P Pending S Surviving Insured T TEFRA U Unknown ME 64 Employee Type 11/8/12 Lookup - Text char[1] Employee Type Code Report the code that defines the subscribers employment Required when ME063 = A 100% C Code Description H Hourly Q Seasonal S Salaried T Temporary U Unknown
ME 65 Date of Retirement 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Member's date of Retirement Report the date of the subscriber's retirement in CCYYMMDD Format. Required when ME060 = R 98% B ME 66 COBRA Status 11/8/12 Lookup Table - Integer int[1] COBRA usage indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Member is covered using COBRA benefit. All 98% A2 Code Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable ME 67 Spouse Plan Type 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Plan Type char[2] Spouse Plan Type Code Report the code that defines the plan type of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when ME062 = M and ME134 = 3 1% C ME 68 Spouse Plan 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Plan char[2] Spouse Plan Medicare Code Report the code that defines the plan type of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when ME062 = M and ME134 = 3 1% C ME 69 Spouse Medical Coverage 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Medical char[2] Spouse Medical Medicare Coverage Code Report the code that defines the medical coverage of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when = M and ME134 = 3 1% C ME 70 Spouse Medicare Indicator 11/8/12 Carrier Table - Text Carrier Defined Table - GIC Medicare char[2] Spouse Medicare Selected Code Report the code that defines the Medicare Type of the spouse of the employee when Medicare coverage is selected and separate from GIC. Required when ME062 = M and ME134 = 3 1% C ME 71 Pool Indicator 11/8/12 Lookup - Integer int[1] Pool Indicator Code Report the value that defines one of the two GIC Risk Pools in which this member is enrolled. This element is required for GIC carriers only. Non GIC carriers should not report any value here. EXAMPLE: 1 = Regular State Employee and Retirees Required when ME134 = 3 98% B Value Description
1 Regular State Employees and Retirees, plus local authorities 2 Elderly Governmental Retirees (EGR) and Retired Municipal Teachers (RMTs) ME 72 Family Size 11/8/12 Integer Counter varchar[2] Family Size Contracted Report the number of individuals covered under the policy/contract (ME009) of the subscriber. This is required for Risk Assessment and Division of Insurance reporting. No alpha or special characters All 100% A2 ME 73 Fully Insured member 11/8/12 Lookup Table - Integer int[1] Insured identifier Report the value that defines the element. EXAMPLE: 1 = Yes, Member is fully insured. All 100% A0 Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 74 Interpreter 11/8/12 Lookup Table - Integer int[1] Indicator - Interpreter Need Report the value that defines the element. EXAMPLE: 1 = Yes, Member requires an interpreter. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 75 NewMMIS ID 6/24/10 Text ID MassHealth char[12] Member ID Report the unique ID that NewMMIS uses to identify a member. This ID must be on all lines of eligibility for MassHealth and Medicaid MCOs Required when = 4 98% B ME 76 Member rating category 6/24/10 Carrier Table - Text Carrier Defined Table - MCO Rating Category char[5] Member Rating Category Code Report the rating category of the member here. Required when ME134 = 4 90% B
ME 77 Members NAICS Code 11/8/12 Code Source 6 - External Code Source 6 - Standard Industry Class varchar[6] Member Standard NAICS or SIC Code Report the standard code that describes the industry of the subscriber / member. This can be from either the NAICS list or the SIC 4-digit list All 2% C ME 78 Employer Zip Code (Situs) 11/8/12 Code Source 2 - Text External Code Source 2 - Zip Codes char[5] Zip code of the Employer Report the 5 Zip Code of the Employer of the Subscriber/Member as defined by the United States Postal Service. Required for GIC and Division of Insurance Reporting. (Situs) All 90% A2 ME 79 Recipient Number only) 11/8/12 Text ID MassHealth varchar[15] Member ID Report the previous MassHealth identification number here. This element is for MassHealth or Medicaid MCOs only and should only be populated when reporting older lines of eligibility Required when ME134 = 4 98% B ME 80 Recipient Historical Number only) 6/24/10 Text ID MassHealth varchar[15] Member ID Report the permanent MassHealth identification number here. This element is for MassHealth or Medicaid MCOs only and should only be populated when reporting older lines of eligibility. Required when ME134 = 4 98% B ME 81 Medicare Code 11/8/12 Lookup Table - Integer int[1] Medicare Plan Indicator Code Report the value that defines if and what type of Medicare coverage that applies to this line of eligibility. EXAMPLE: 1 = Part A Only All 100% B Value Description 1 Part A Only 2 Part B Only 3 Part A and B 4 Part C Only 5 Advantage 6 Part D Only 9 Not Applicable 0 No Medicare Coverage ME 82 Employer Name 11/8/12 Text Name Employer varchar[60] Member's Employer Name Report the name of the subscriber's / member's employer at time of enrollment. Required when = A or P 90% B
ME 90 Carrier Specific Unique Member ID 11/8/12 Text ID Link to MC137, PC107, DC056 varchar[50] Member's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the member. Used to create Unique Member ID and link across carrier's / submitter's for reporting and aggregation All 100% A0 ME 91 A0 ME 92 Subscriber State or Province 11/8/12 Code Source 2 - Text Address External Code Source 2 - States char[2] State of the Subscriber Report the state of the subscriber here. Used to create Unique Member ID. All 99% A0 ME 93 Subscriber ZIP Code 11/8/12 Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[] Zip Code of the Subscriber Report the 5 Zip Code as defined by the United States Postal Service. . All 99% A0 ME 94 Medical Deductible 11/8/12 Integer Currency varchar[10] Maximum out of pocket amount of applied member's deductible Report the maximum amount of the member / subscriber's deductible that is applied to medical services before certain services are covered. This is the Base Deductible for General Services. Report 0 when there is no deductible for this benefit. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when ME018 = 1 90% A2 ME 95 Pharmacy Deductible 11/8/12 Integer Currency varchar[10] Maximum out of pocket amount of member's deductible applied to pharmacy Report the maximum amount of the member / subscriber's deductible that is applied to pharmacy services before certain prescriptions are covered. Report 0 when there is no deductible for this benefit. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when ME019 = 1 90% A2 107 108 109 110 111 112
reported as 15000; 150.70 is reported as 15070 ME Carrier Specific Unique Subscriber ID 11/8/12 Text ID Link to MC141, PC108, DC057 varchar[50] Subscriber's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the subscriber. Used to create Unique Member ID and link across carrier's / submitter's files for reporting and aggregation All 100% A0 ME Vision Benefit 11/8/12 Lookup Table - Integer int[1] Indicator - Vision Option Report the value that defines the element. EXAMPLE: 1 = Yes, Vision is a covered benefit. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME Filler 4/5/13 Filler Filler char[0] Filler The APCD reserves this field for future use. Do not populate with any data. All 0% Z ME Actuarial Value - Percent as 0.0000 varchar[6] The actuarial value of the risk adjustment covered plan the member is enrolled in Calculate the Federal AV Calculator for the risk adjustment covered plan the member is enrolled in. Report the Actuarial Value of this member as of the 15th of the month. Format to be used is 0.0000. For example, an AV of 88.27689% should be reported as 0.8828. Required when ME126 = 1 or 3 100% A0 ME Level Lookup Table - Integer int[1] Standardized plan in metal reference Report the Level benefits that the member is associated to in this line of eligibility. Required for Risk Assessment. EXAMPLE: 1 = Bronze Level Required when ME126 = 1 or 3 100% A0 Value Description 117
ME Benefit Plan Contract ID Text Benefit Plan ID varchar [30] Identifier for the benefit plan the member is enrolled in as of 15th of the month The Benefit Plan Contract ID is the issuer-generated unique ID number for each benefit plan for which the issuer sets a premium in the Massachusetts merged (non-group/small group) market. Report the carrier/submitter-assigned identifier as it appears in BP001 in the Benefit Plan File. This element is used to understand Benefit Plan and Eligibility attributes of the member / subscriber as applied to this record for the Massachusetts Alternative Risk Adjustment Methodology. Required when ME126 = 1 or 3 100% A0 ME Member Benefit Plan Contract Enrollment Start Date Date CCYYMMDD Int(8) Date the member is enrolled in the benefit plan Report the date the member was enrolled in the Benefit Plan in CCYYMMDD format. Required when ME126 = 1 or 3 100% A0 ME Member Benefit Plan Contract Enrollment End Date Date CCYYMMDD Int(8) Date the member’s enrollment ends with the benefit plan Report the date the member disenrolled in the Benefit Plan in CCYYMMDD format. When member is still active in the Benefit Plan, do not report any date in this element. Required when = 1 or 3 and member is disenrolled 100% B ME TME Global Indicator 4/5/13 Integer Int[1] TME Global Indicator Required when Submitter is identified as a TME / RP Submitter. Report whether the member’s contract was assigned under a global budget/payment contract. EXAMPLE: 1 = Yes, the member’s contract was assigned under a global/budget/payment contract. Assigned Submitters only. 100% A2 Description 1 Yes 2 No
1 Record Type 6/24/10 Text ID Record char[2] Trailer Record Identifier Report TR here. Indicates the end of the data file Mandatory 100% TM 2 Submitter 11/8/12 Integer ID Submitter varchar[6] Trailer Submitter / Carrier ID defined by CHIA Report the Unique Submitter ID as defined by CHIA here. This must match the Submitter ID reported in HD002 Mandatory 100% TM 3 National Plan ID 11/8/12 Integer ID Nat'l PlanID int[10] CMS National Plan Identification Number (PlanID) Do not report any here until National PlanID is fully implemented. This is a unique identifier as outlined by Centers for Medicare and Medicaid Services (CMS) for Plans or Sub plans Situational 0% TS 4 Type of File 6/24/10 Text ID File char[2] Validates the file type defined in HD004. Report ME here. This must the File Type reported in HD004 Mandatory 100% TM 5 Period Beginning Date 6/24/10 Date Period - Integer Century Year Month - CCYYMM int[6] Trailer Period Date Report the Year and Month of the reported submission period in CCYYMM format. This date period must match the date period reported in HD005, HD006 and TR006 Mandatory 100% TM 6 Period Ending Date 6/24/10 Date Period - Integer Century Year Month - CCYYMM int[6] Trailer Period Ending Date Report the Year and Month of the reporting submission period in CCYYMM format. This date period must match the date period reported in TR005 and HD005 and HD006 Mandatory 100% TM 7 Date Processed 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Trailer Processed Date Report the full date that the submission was compiled by the submitter in CCYYMMDD Format. Mandatory 100% TM Appendix – External Code Sources 2. States, Zip Codes and Other Areas of the US U.S. Postal Service
ME017 ME078 ME109 ME110 3. National Provider Identifiers National Plan & Provider Enumeration System ME038 6. North American Industry Classification System (NAICS) United States Census Bureau ME077 7. Language Preference United States Census Bureau ME033 17. Race and Ethnicity Codes Center for Disease Control ME025