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 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 Count 11/8/12 Integer Counter varchar[10] Header Record Count 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 Field 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 2/2017 - 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 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as of October 2013: No longer as of May 2015 4.0 Version 4.0: required for reporting periods October 2013 onward; No longer valid as of August 2016. 5.0 Version 5.0; required for reporting periods October 2013 onward as of August 2016; ; No longer valid as of August 2017. ME
ME 4 Year 6/24/10 Date Period - Integer Century Year - CCYY int[4] Eligibility year reported in this submission. Report the year for which 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 - - 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 varchar[30] Group / 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 Table - 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 2/2017 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 here. (Will be hashed prior to submission via CHIA’s FileSecure application.) All 85% A0
23 Sponsored Dependent 24 Dependent of a Minor Dependent 29 Significant 32 Mother 33 Father 34 Other Adult 36 Emancipated Minor 39 Organ Donor 40 Cadaver 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 alpha 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 2/2017 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Member's date of Report the date the member was born in CCYYMMDD Format. Used to create Unique Member ID. (Will be hashed to submission via CHIA’s FileSecure application.) All 99% A0 ME 15 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% A0 ME 16 Member State Code Source Address External Code Source 2 - States char[2] State / Province of the Member Report the of the member’s residence as defined by the US Postal Service. Report Province when Country Code does not = USA. All 99% A0
2 - Text ME 17 Member ZIP Code Code Source 2 - Text Address Zip External Code Source 2 - Zip varchar[5] Zip Code of the Member Report the 5 Zip Code of the member’s residence as defined by the United States Postal Service. Must not submit the 9-digit 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 2 No 3 Unknown 4 5 Not Applicable ME 19 Prescription Drug Coverage 11/8/12 Lookup Table - 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 Table - Integer int[1] Indicator - Dental Option Report the value 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 “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 Asian R3 Black/African American R4 Native Hawaiian or other Pacific Islander R5 White R9 Other Race UNKNOW Unknown/not specified
UNKNOW Unknown / not specified ME 26 Ethnicity 2 11/8/12 Lookup Table - OR - Code Source 17 - Text External Code Source 17 - Ethnicity char[6] Member's Secondary Ethnicity Report the Member-identified secondary ethnicity from either the External Code Source or here, whichever provides the best detail as obtained from the Member / Subscriber. The value “UNKNOW” should be used ONLY when the Member answers unknown, or refuses to answer. Do not report any value here if data has not been collected. Report only collected data. All 2% C Code Description AMERCN American BRAZIL Brazilian CVERDN Cape Verdean CARIBI Caribbean Island (see CDC Code PORTUG Portuguese RUSSIA Russian EASTEU Eastern European Other Ethnicity UNKNOW Unknown / not specified ME 27 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% C ME 28 Primary Insurance Indicator 11/8/12 Lookup Table - Integer int[1] Indicator - Primary Insurance Coverage Report the value that defines the element. EXAMPLE: 1 = Yes, Insurance is Primary (Products, Plans or Benefits that only cover Copays, Coinsurance and Deductibles [Gap Coverage] will answer 2 = No here). All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other
5 Not Applicable ME 29 Coverage Type 11/8/12 Lookup Table - Text char[3] Type of Coverage Code Report the code that defines the type of insurance policy by the enrollee is covered. EXAMPLE: UND = Plan underwritten by the insurer All 98% A0 Code Description ASW Self-funded plans that are administered by a third-party administrator, where the employer has purchased stop-loss, or group excess, insurance coverage ASO Self-funded plans that are administered by a third-party administrator, where the employer has not purchased stop-loss, or group excess, insurance coverage STN non-renewable health insurance UND underwritten by the insurer OTH Any other plan. Insurers using this code shall obtain prior approval. ME 30 Market Category Code 11/8/12 Lookup Table - Text varchar[4] Market Category Code Report the code that defines the market, by size and or association, to which the policy is directly sold and issued All 99% A0 Code Description IND Individuals (non-group) ISCO Individuals as a Senior Care Option FCH Individuals on a franchise basis GCV Individuals as group conversion Policies GS1 Employers having exactly 1 employee GS2 Employers having 2 thru 9 employees GS3 Employers having 10 thru 25 employees GS4 Employers having 26 thru 50 employees GLG1 Employers having 51 thru 100 employees GLG2 Employers having 101 thru 250 employees GLG3 Employers having 251 thru 500 employees
GLG4 Employers having more than 500 employees GSA Small employers through a qualified association trust OTH Other types of entities. Insurers using this market code shall obtain prior approval. ME 31 Special Coverage 2/2016 Lookup Table - Text varchar[3] Special Coverage Code Report the code that defines the product coverage as related to a health exchange or Reports N/A if neither apply. EXAMPLE: N/A = Not Applicable All 98% A2 Code Description CC Commonwealth Care 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 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% C ME 35 Health Care Home (PCMH) Assigned Flag 11/8/12 Lookup - 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 Provider ID. Required when ME035 = 1 90% C ME 37 Health Care Home (PCMH) Tax ID Number 2/2017 ID Tax char[9] Health Care Home EIN Report the Federal Tax Identification Number of the medical home here. If is not medical home to report, do not report any value. Do not use hyphen or alpha prefix. Reminder: Must not be an SSN. 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 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% 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 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 Start 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 All 98% B
was not disenrolled at the end of the current month, then do not fill with any value. ME 43 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% A0 ME 44 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% A0 ME 45 Purchased through Exchange Flag Lookup - 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 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 Month Day - CCYYMMDD int[8] PCP Termination Date with Member Report the Member termination date from the PCP in CCYYMMDD Format. If the member is 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 Report the maximum amount of member / subscriber's annual deductible across all benefit types (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 up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 90% A2 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 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 ME049 > 0 100% A2 ME 51 Behavioral Health Benefit Flag 11/8/12 Lookup - 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 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 Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 53 Disease Enrollee Flag 11/8/12 Lookup Table - Integer int[1] Chronic Illness Management indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Member's chronic illness is being managed by plan or vendor of plan. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 54 Eligibility Date 11/8/12 Full Date - Integer Century Year Day - CCYYMMDD int[8] Eligibility date Report the date the member eligibility was determined in CCYYMMDD Format. All 98% B ME 55 Business Type Code 11/8/12 Lookup Table - Integer int[1] Business Type Report the that defines the submitter's line of business for this line of eligibility. EXAMPLE: 1 = Risk Holder of this line of eligibility All 100% A2 Value Description 1 Risk Holder 2 TPA - Third Party Administrator 3 DBA - Delegated Business Administrator 4 PBM - Pharmacy Benefit Manger 5 DBM - Dental Benefit Manager 6 CSO - Computer Service Organization
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 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 Never Married W Widowed X Legally Separated U Unknown ME 63 Benefit Status 11/8/12 Lookup - 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 Table - 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 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 Other 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 ME062 = M and ME134 = 3 1% C
ME 70 Spouse Medicare Indicator 11/8/12 Carrier - 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 Table - 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 = 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 Insured member 11/8/12 Lookup Table - Integer int[1] Fully Insured identifier Report the value that defines the element. EXAMPLE: 1 = Yes, Member is fully insured. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 74 Interpreter 11/8/12 Lookup - 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
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 ME060 = A or P 90% B ME 83 Employer EIN 11/8/12 ID Tax char[9] Member's Employer EIN Report the Federal Tax ID of the Employer here. Do not use hyphen or alpha prefix. Required when ME082 is populated 90% B ME 84 Subscriber Last Name Text Name Last Subscriber varchar[60] Last name of Subscriber Report the last name of the subscriber. Used to create Unique Member ID. Last name should exclude all punctuation, including hyphens and apostrophes. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: O'Brien becomes OBRIEN; Carlton-Smythe becomes CARLTONSMYTHE (Will be hashed prior to submission via CHIA’s FileSecure application.) All 100% A0 ME 85 Subscriber First Name Text Name First Subscriber varchar[25] First name of Subscriber Report the first name of the subscriber here. Used to create Unique Member ID. Exclude all punctuation, including hyphens and apostrophes. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: Anne-Marie becomes ANNEMARIE (Will be hashed to submission via CHIA’s FileSecure application.) All 100% A0 ME 86 Subscriber Middle Initial Text Name Middle Subscriber char[1] Middle initial of Subscriber Report the Subscriber's middle initial here. Used to create Unique Member ID. (Will be hashed to submission via CHIA’s FileSecure application.) All 2% C 102 103
ME 87 Member Last Name Text Name Last Member varchar[60] Last name of Member Report the last name of the patient / member here. Used to create Unique Member ID. Last name should exclude all punctuation, including hyphens and apostrophes Name should be contracted punctuation is removed, do not report spaces. EXAMPLE: O'Brien becomes OBRIEN; becomes CARLTONSMYTHE (Will be hashed prior to submission via CHIA’s FileSecure application.) All 100% A0 ME 88 Member First Name 6/24/10 Text Name First Member varchar[25] First name of Member Report the first name of the member here. Used to create Unique Member ID. Exclude all punctuation, including hyphens and apostrophes. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: Anne-Marie becomes ANNEMARIE (Will be hashed prior to submission via CHIA’s FileSecure application.) All 100% A0 ME 89 Member Middle Initial 6/24/10 Text Name Middle Member char[1] Middle initial of Member Report the middle initial of the member when available. Used to create Unique Member ID. (Will be hashed prior to submission via CHIA’s FileSecure application.) All 2% C 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 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% 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 104 105 106 107 108 109
ME TME OrgID - Physician Group of the Member’s PCP Integer TME Provider OrgID varchar[6] TME Provider OrgID Required for Total Medical Expense Reporting. OrgID specific. Report the TME Local Practice Group Provider OrgID for the Physician Group of the Member’s PCP, and not the place of service for the claim. Reported in December only for the year prior to the current year. For example the Decemmber 2013 file reports the TME Local Practice Group for 2012 for members enrolled in 2012. Assigned submitters only. Required in the December file only. 100% A2 ME Risk Adjustment Covered Plan (RACP) 5/9/13 Lookup – Integer Flag Int(1) Member Enrolled in RACP Indicator Non-grandfathered individual and small group plans underwritten and filed in the Commonwealth of Massachusetts are subject to risk adjustment. Large group plans, self-insured plans, and plans underwritten and filed in states other than Massachusetts are not subject to risk adjustment. Report RACP status as of the 15th of the month. EXAMPLE: 1 = Yes, the Member was enrolled in RACP as of the 15th of the month. All 100% A0 Description 1 Yes 2 No 3 Mock – Provided for Simulation Purposes Only
3 GIC - Group Insurance Commission Enrollee 4 MCO - MassHealth Managed Care Organization Enrollee 5 Supplemental Policy Enrollee 6 ICO – Integrated Care Organization or SCO – Senior Care Option 0 Unknown / Not Applicable ME Aid Category Lookup Table – Aid Varchar[4] MassHealth Aid Category Report the code that identifies the richest MassHealth Aid Category. Required when submitter is MassHealth 100% A2 ME Record Type 6/24/10 Text ID File char[2] File Type Identifier Report ME here. This validates the type of file and the data contained within the file. This must HD004. All 100% A0 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 value 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 match 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 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