ME126 TME – Health Status Adjustment Tool Date Filler – No Input ME127 TME – Member’s Health Status Adjustment Score Filler – No Input ME128 TME – Member’s Health Status Adjustment Score - Normalized Filler – No Input ME129 TME – Member’s Health Status Adjustment Score Start Date Filler – No Input ME130 TME – Member’s Health Status Adjustment Score End Date Filler – No Input ME131 Payment Arrangement Type TME Global Budget/Payment Indicator ME132 Employer Contribution Total Contribution The following fields have a category change: Element Element Name Category ME045 Purchased through Massachusetts Exchange Flag B ME120 Actuarial Value B ME121 Metal Level B Technical specifications for these fields are: Element Element Name Type Description APCD Usage and Guidelines Condition % Provider File PV032 Registered Provider Organization ID Char 30 Placeholder for Registered Provider Organization ID Total Medical Expenses & Relative Price reporting requirement. Registered Provider Organization Number assigned by the Health Policy Commission. Assigned submitters only. Z 0 PV065 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0
PV066 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 PV067 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 PV068 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 PV069 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 PV070 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 Member Eligibility File ME045 Purchased through Massachusetts Exchange Flag 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 B 100 ME119 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 ME120 Actuarial Value 6 Calculated Score for Risk Adjustment Report the Actuarial Value of this member for the time period indicated by Enrollment Start and End dates in 0.0000 Format. Required for Risk Assessment. Required when Submitter is identified as a Risk Holder Submitter B 100 ME121 Metal Level Int 1 Standardized plan level in metal reference Report the Metal Level benefits that the member is associated to in this line of eligibility. Required for Risk Assessment. Required when Submitter is identified as a Risk Holder Submitter B 100
ME124 Attributed PCP Provider ID Text 30 ID Link to PV002. PV002 for PCP attributed to patient for prior year. Required for Total Medical Expense Reporting. OrgID specific. The PCP attributed to a member by the payer. Assigned submitters only. Required in December file only. Required when ME131 = 1 and ME046 is or or missing. A2 100 ME125 TME OrgID - Physician Group of the Member’s PCP Integer 6 TME Provider OrgID Required for Total Medical Expense Reporting. OrgID specific. TME Provider OrgID for the Physician Group of the Member’s PCP and not the place of service for the claim Assigned submitters only. A2 100 ME126 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 ME127 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 ME128 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 ME129 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0 ME130 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0
ME131 TME Global Budget/Payment Indicator Integer 1 TME Global Budget/Payment 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. A2 100 Value Description 1 Yes 2 No ME132 Total Contribution Integer 10 Employer + Subscriber’s total contribution to monthly premium Required for Cost Trends Analysis. Risk Holders report a value when ME060 = A, I, O or P and Member = Subscriber B 100 The following table lists general changes and updates to be made to file types: ACTION NARRATIVE Reset Length on ICD-CM Procedure Codes Set length of all Medical Claim Procedure Codes to varchar(7) to accommodate ICD-10 Updates (MC058, MC083-MC088).