United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Medical Eligibility File Submission August 2011 - v3 Colorado File Specification Center for Improving Value in Health Care (CIVHC)
Medical Eligibility File Submission March 2013 - v5 Colorado File Specification Center for Improving Value in Health Care (CIVHC)
Medical Eligibility File Submission March 2014 - v6 Colorado File Specification Center for Improving Value in Health Care (CIVHC)

Identifying Attributes

File Specification: Medical Eligibility File Submission - August 2011 - v3 (Colorado) Medical Eligibility File Submission - March 2013 - v5 (Colorado) Medical Eligibility File Submission - March 2014 - v6 (Colorado)
[Shared] Responsible Organization:
Center for Improving Value in Health Care Center for Improving Value in Health Care Center for Improving Value in Health Care
[Shared] Definition:
Not Provided Not Provided Not Provided

Data Elements & Codes

File Specification: Medical Eligibility File Submission - August 2011 - v3 (Colorado) Medical Eligibility File Submission - March 2013 - v5 (Colorado) Medical Eligibility File Submission - March 2014 - v6 (Colorado)
HD001
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
HD002
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
HD003
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
HD004
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
HD005
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
HD006
[Shared] Name: Record count
[Shared] Type: int
[Shared] Length: 10
[Shared] Name: Record count
[Shared] Type: int
[Shared] Length: 10
[Shared] Name: Record count
[Shared] Type: int
[Shared] Length: 10
ME001
[Unshared] Name: Payer Name/Code
[Shared] Type: varchar
[Shared] Length: 8
[Unshared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Unshared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
ME002
[Unshared] Name: National Plan ID
[Shared] Type: varchar
[Shared] Length: 30
[Unshared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 30
[Unshared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 30
ME003
[Shared] Name: Insurance Type Code/Product
[Shared] Type: char
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
 
 
99
Other
CI
Commercial Insurance Company
 
 
HM
Health Maintenance Organization
HN
HMO Medicare Risk/ Medicare Part C
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MP
Medicare Primary
QM
Qualified Medicare Beneficiary
SP
Supplemental Policy
TV
Title V
[Shared] Name: Insurance Type Code/Product
[Shared] Type: char
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
17
Dental Maintenance Organization (DMO)
99
Other
CI
Commercial Insurance Company
DN
Dental
HM
Health Maintenance Organization
HN
HMO Medicare Risk/ Medicare Part C
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MP
Medicare Primary
QM
Qualified Medicare Beneficiary
SP
Medicare Supplemental (Medi-gap) plan
TV
Title V
[Shared] Name: Insurance Type Code/Product
[Shared] Type: char
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
17
Dental Maintenance Organization (DMO)
99
Other
CI
Commercial Insurance Company
DN
Dental
HM
Health Maintenance Organization
HN
HMO Medicare Risk/ Medicare Part C
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MP
Medicare Primary
QM
Qualified Medicare Beneficiary
SP
Medicare Supplemental (Medi-gap) plan
TV
Title V
ME004
[Shared] Name: Year
[Shared] Type: int
[Shared] Length: 4
[Shared] Name: Year
[Shared] Type: int
[Shared] Length: 4
[Shared] Name: Year
[Shared] Type: int
[Shared] Length: 4
ME005
[Shared] Name: Month
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Month
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Month
[Shared] Type: char
[Shared] Length: 2
ME006
[Shared] Name: Insured Group or Policy Number
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: varchar
[Shared] Length: 30
ME007
[Shared] Name: Coverage Level Code
[Shared] Type: char
[Shared] Length: 3
Codes:
CHD
Children Only
DEP
Dependents Only
ECH
Employee and Children
ELF
Employee and Life Partner
EMP
Employee Only
EPN
Employee plus N where N equals the number of other covered dependents
ESP
Employee and Spouse
FAM
Family
IND
Individual
SPC
Spouse and Children
SPO
Spouse Only
[Shared] Name: Coverage Level Code
[Shared] Type: char
[Shared] Length: 3
Codes:
CHD
Children Only
DEP
Dependents Only
ECH
Employee and Children
ELF
Employee and Life Partner
EMP
Employee Only
EPN
Employee plus N where N equals the number of other covered dependents
ESP
Employee and Spouse
FAM
Family
IND
Individual
SPC
Spouse and Children
SPO
Spouse Only
[Shared] Name: Coverage Level Code
[Shared] Type: char
[Shared] Length: 3
Codes:
CHD
Children Only
DEP
Dependents Only
ECH
Employee and Children
ELF
Employee and Life Partner
EMP
Employee Only
EPN
Employee plus N where N equals the number of other covered dependents
ESP
Employee and Spouse
FAM
Family
IND
Individual
SPC
Spouse and Children
SPO
Spouse Only
ME008
[Shared] Name: Subscriber Social Security Number
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Subscriber Social Security Number
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Subscriber Social Security Number
[Shared] Type: varchar
[Shared] Length: 9
ME009
[Shared] Name: Plan Specific Contract Number
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Plan Specific Contract Number
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Plan Specific Contract Number
[Shared] Type: varchar
[Shared] Length: 128
ME010
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: varchar
[Shared] Length: 128
ME011
[Shared] Name: Member Identification Code
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Member Identification Code
[Shared] Type: varchar
[Shared] Length: 9
[Shared] Name: Member Identification Code
[Shared] Type: varchar
[Shared] Length: 9
ME012
[Shared] Name: Individual Relationship Code
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Employee/Self
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
[Shared] Name: Individual Relationship Code
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Employee/Self
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
[Shared] Name: Individual Relationship Code
[Shared] Type: char
[Shared] Length: 2
Codes:
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Employee/Self
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
ME013
[Shared] Name: Member Gender
[Shared] Type: char
[Shared] Length: 1
Codes:
F
Female
M
Male
U
UNKNOWN
[Shared] Name: Member Gender
[Shared] Type: char
[Shared] Length: 1
Codes:
F
Female
M
Male
U
UNKNOWN
[Shared] Name: Member Gender
[Shared] Type: char
[Shared] Length: 1
Codes:
F
Female
M
Male
U
UNKNOWN
ME014
[Shared] Name: Member Date of Birth
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Shared] Type: char
[Shared] Length: 8
ME015
[Shared] Name: Member City Name
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Member City Name
[Shared] Type: varchar
[Shared] Length: 30
[Shared] Name: Member City Name
[Shared] Type: varchar
[Shared] Length: 30
ME016
[Shared] Name: Member State or Province
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Member State or Province
[Shared] Type: char
[Shared] Length: 2
[Shared] Name: Member State or Province
[Shared] Type: char
[Shared] Length: 2
ME017
[Shared] Name: Member ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
[Shared] Name: Member ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
[Shared] Name: Member ZIP Code
[Shared] Type: varchar
[Shared] Length: 11
ME018
[Shared] Name: Medical Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
 
 
N
NO
Y
YES
[Shared] Name: Medical Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
[Shared] Name: Medical Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
ME019
[Shared] Name: Prescription Drug Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
 
 
N
NO
Y
YES
[Shared] Name: Prescription Drug Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
[Shared] Name: Prescription Drug Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
ME020
[Shared] Name: Dental Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
[Shared] Name: Dental Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
[Shared] Name: Dental Coverage
[Shared] Type: char
[Shared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
ME021
[Shared] Name: Race 1
[Shared] Type: varchar
[Shared] Length: 6
Codes:
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
[Shared] Name: Race 1
[Shared] Type: varchar
[Shared] Length: 6
Codes:
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
[Shared] Name: Race 1
[Shared] Type: varchar
[Shared] Length: 6
Codes:
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
ME022
[Shared] Name: Race 2
[Shared] Type: varchar
[Shared] Length: 6
Codes:
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
[Shared] Name: Race 2
[Shared] Type: varchar
[Shared] Length: 6
Codes:
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
[Shared] Name: Race 2
[Shared] Type: varchar
[Shared] Length: 6
Codes:
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
ME023
[Shared] Name: Other Race
[Shared] Type: varchar
[Shared] Length: 15
[Shared] Name: Other Race
[Shared] Type: varchar
[Shared] Length: 15
[Shared] Name: Other Race
[Shared] Type: varchar
[Shared] Length: 15
ME024
[Shared] Name: Hispanic Indicator
[Shared] Type: char
[Shared] Length: 1
Codes:
N
Patient is not Hispanic/Latino/Spanish
U
Unknown
Y
Patient is Hispanic/Latino/Spanish
[Shared] Name: Hispanic Indicator
[Shared] Type: char
[Shared] Length: 1
Codes:
N
Patient is not Hispanic/Latino/Spanish
U
Unknown
Y
Patient is Hispanic/Latino/Spanish
[Shared] Name: Hispanic Indicator
[Shared] Type: char
[Shared] Length: 1
Codes:
N
Patient is not Hispanic/Latino/Spanish
U
Unknown
Y
Patient is Hispanic/Latino/Spanish
ME025
[Shared] Name: Ethnicity 1
[Shared] Type: varchar
[Shared] Length: 6
Codes:
2028-9
Asian
2029-7
Asian Indian
2033-9
Cambodian
2034-7
Chinese
2036-2
Filipino
2039-6
Japanese
2040-4
Korean
2041-2
Laotian
2047-9
Vietnamese
2058-6
African American
2060-2
African
2071-9
Haitian
2108-9
European
2118-8
Middle Eastern
2148-5
Mexican, Mexican American, Chicano
2155-0
Central American (not otherwise specified)
2157-6
Guatemalan
2158-4
Honduran
2161-8
Salvadoran
2165-9
South American (not otherwise specified)
2169-1
Columbian
2180-8
Puerto Rican
2182-4
Cuban
2184-0
Dominican
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown/Not Specified
[Shared] Name: Ethnicity 1
[Shared] Type: varchar
[Shared] Length: 6
Codes:
2028-9
Asian
2029-7
Asian Indian
2033-9
Cambodian
2034-7
Chinese
2036-2
Filipino
2039-6
Japanese
2040-4
Korean
2041-2
Laotian
2047-9
Vietnamese
2058-6
African American
2060-2
African
2071-9
Haitian
2108-9
European
2118-8
Middle Eastern
2148-5
Mexican, Mexican American, Chicano
2155-0
Central American (not otherwise specified)
2157-6
Guatemalan
2158-4
Honduran
2161-8
Salvadoran
2165-9
South American (not otherwise specified)
2169-1
Columbian
2180-8
Puerto Rican
2182-4
Cuban
2184-0
Dominican
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown/Not Specified
[Shared] Name: Ethnicity 1
[Shared] Type: varchar
[Shared] Length: 6
Codes:
2028-9
Asian
2029-7
Asian Indian
2033-9
Cambodian
2034-7
Chinese
2036-2
Filipino
2039-6
Japanese
2040-4
Korean
2041-2
Laotian
2047-9
Vietnamese
2058-6
African American
2060-2
African
2071-9
Haitian
2108-9
European
2118-8
Middle Eastern
2148-5
Mexican, Mexican American, Chicano
2155-0
Central American (not otherwise specified)
2157-6
Guatemalan
2158-4
Honduran
2161-8
Salvadoran
2165-9
South American (not otherwise specified)
2169-1
Columbian
2180-8
Puerto Rican
2182-4
Cuban
2184-0
Dominican
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown/Not Specified
ME026
[Shared] Name: Ethnicity 2
[Shared] Type: varchar
[Shared] Length: 6
Codes:
2028-9
Asian
2029-7
Asian Indian
2033-9
Cambodian
2034-7
Chinese
2036-2
Filipino
2039-6
Japanese
2040-4
Korean
2041-2
Laotian
2047-9
Vietnamese
2058-6
African American
2060-2
African
2071-9
Haitian
2108-9
European
2118-8
Middle Eastern
2148-5
Mexican, Mexican American, Chicano
2155-0
Central American (not otherwise specified)
2157-6
Guatemalan
2158-4
Honduran
2161-8
Salvadoran
2165-9
South American (not otherwise specified)
2169-1
Columbian
2180-8
Puerto Rican
2182-4
Cuban
2184-0
Dominican
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown/Not Specified
[Shared] Name: Ethnicity 2
[Shared] Type: varchar
[Shared] Length: 6
Codes:
2028-9
Asian
2029-7
Asian Indian
2033-9
Cambodian
2034-7
Chinese
2036-2
Filipino
2039-6
Japanese
2040-4
Korean
2041-2
Laotian
2047-9
Vietnamese
2058-6
African American
2060-2
African
2071-9
Haitian
2108-9
European
2118-8
Middle Eastern
2148-5
Mexican, Mexican American, Chicano
2155-0
Central American (not otherwise specified)
2157-6
Guatemalan
2158-4
Honduran
2161-8
Salvadoran
2165-9
South American (not otherwise specified)
2169-1
Columbian
2180-8
Puerto Rican
2182-4
Cuban
2184-0
Dominican
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown/Not Specified
[Shared] Name: Ethnicity 2
[Shared] Type: varchar
[Shared] Length: 6
Codes:
2028-9
Asian
2029-7
Asian Indian
2033-9
Cambodian
2034-7
Chinese
2036-2
Filipino
2039-6
Japanese
2040-4
Korean
2041-2
Laotian
2047-9
Vietnamese
2058-6
African American
2060-2
African
2071-9
Haitian
2108-9
European
2118-8
Middle Eastern
2148-5
Mexican, Mexican American, Chicano
2155-0
Central American (not otherwise specified)
2157-6
Guatemalan
2158-4
Honduran
2161-8
Salvadoran
2165-9
South American (not otherwise specified)
2169-1
Columbian
2180-8
Puerto Rican
2182-4
Cuban
2184-0
Dominican
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown/Not Specified
ME027
[Shared] Name: Other Ethnicity
[Shared] Type: varchar
[Shared] Length: 20
[Shared] Name: Other Ethnicity
[Shared] Type: varchar
[Shared] Length: 20
[Shared] Name: Other Ethnicity
[Shared] Type: varchar
[Shared] Length: 20
ME028
[Shared] Name: Primary Insurance Indicator
[Shared] Type: char
[Shared] Length: 1
Codes:
N
No, secondary or tertiary insurance
Y
Yes, primary insurance
[Shared] Name: Primary Insurance Indicator
[Shared] Type: char
[Shared] Length: 1
Codes:
N
No, secondary or tertiary insurance
Y
Yes, primary insurance
[Shared] Name: Primary Insurance Indicator
[Shared] Type: char
[Shared] Length: 1
Codes:
N
No, secondary or tertiary insurance
Y
Yes, primary insurance
ME029
[Shared] Name: Coverage Type
[Shared] Type: char
[Shared] Length: 3
Codes:
OTH
any other plan
STN
short-term, non-renewable health insurance (ie COBRA)
UND
plans underwritten by the insurer
[Shared] Name: Coverage Type
[Shared] Type: char
[Shared] Length: 3
Codes:
OTH
any other plan
STN
short-term, non-renewable health insurance (ie COBRA)
UND
plans underwritten by the insurer
[Shared] Name: Coverage Type
[Shared] Type: char
[Shared] Length: 3
Codes:
OTH
any other plan. Insurers using this code shall obtain prior approval.
STN
short-term, non-renewable health insurance (ie COBRA)
UND
plans underwritten by the insurer
ME030
[Shared] Name: Market Category Code
[Shared] Type: varchar
[Shared] Length: 4
Codes:
FCH
policies sold and issued directly to individuals on a franchise basis
GS3
policies sold and issued directly to employers having 50 or more employees
GSA
policies sold and issued directly to small employers through a qualified association trust
IND
policies sold and issued directly to individuals (non-group)
 
 
OTH
policies sold to other types of entities. Insurers using this market code shall obtain prior approval.
 
 
[Shared] Name: Market Category Code
[Shared] Type: varchar
[Shared] Length: 4
Codes:
FCH
policies sold and issued directly to individuals on a franchise basis
GS3
policies sold and issued directly to employers having 50 or more employees
GSA
policies sold and issued directly to small employers through a qualified association trust
IND
policies sold and issued directly to individuals (non-group)
 
 
OTH
policies sold to other types of entities. Insurers using this market code shall obtain prior approval.
 
 
[Shared] Name: Market Category Code
[Shared] Type: varchar
[Shared] Length: 4
Codes:
FCH
policies sold and issued directly to individuals on a franchise basis
GS3
policies sold and issued directly to employers having 50 or more employees
GSA
policies sold and issued directly to small employers through a qualified association trust
IND
policies sold and issued directly to individuals (non-group)
MED
Medicare and Retiree products.
OTH
policies sold to other types of entities. Insurers using this market code shall obtain prior approval.
SMG
Policies sold and issued to employers having less than 50 employees
ME032
[Unshared] Name: Group Name
[Shared] Type: varchar
[Unshared] Length: 128
[Unshared] Name: Group Name
[Shared] Type: varchar
[Unshared] Length: 128
[Unshared] Name: Employer Tax ID
[Shared] Type: varchar
[Unshared] Length: 50
ME043
[Shared] Name: Member Street Address
[Shared] Type: varchar
[Shared] Length: 50
[Shared] Name: Member Street Address
[Shared] Type: varchar
[Shared] Length: 50
[Shared] Name: Member Street Address
[Shared] Type: varchar
[Shared] Length: 50
ME044
[Unshared] Name: Employer Name
[Shared] Type: varchar
[Unshared] Length: 50
[Unshared] Name: Employer Name
[Shared] Type: varchar
[Unshared] Length: 50
[Unshared] Name: Employer Group Name
[Shared] Type: varchar
[Unshared] Length: 128
ME045
Data Element: ME045
not present in this file submission.
[Unshared] Name: Exchange Offering
[Unshared] Type: char
[Unshared] Length: 1
Codes:
N
Commercial small or non-group QHP purchased outside the Exchange
U
Not applicable (plan/product is not offered in the commercial small or non-group market)
Y
Commercial small or non-group QHP purchased through the Exchange
[Unshared] Name: Exchange Offering
[Unshared] Type: char
[Unshared] Length: 1
Codes:
N
Commercial small or non-group QHP purchased outside the Exchange
U
Not applicable (plan/product is not offered in the commercial small or non-group market or grandfathered )
Y
Commercial small or non-group QHP purchased through the Exchange
ME101
[Shared] Name: Subscriber Last Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Subscriber Last Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Subscriber Last Name
[Shared] Type: varchar
[Shared] Length: 128
ME102
[Shared] Name: Subscriber First Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Subscriber First Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Subscriber First Name
[Shared] Type: varchar
[Shared] Length: 128
ME103
[Shared] Name: Subscriber Middle Initial
[Shared] Type: char
[Shared] Length: 1
[Shared] Name: Subscriber Middle Initial
[Shared] Type: char
[Shared] Length: 1
[Shared] Name: Subscriber Middle Initial
[Shared] Type: char
[Shared] Length: 1
ME104
[Shared] Name: Member Last Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Member Last Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Member Last Name
[Shared] Type: varchar
[Shared] Length: 128
ME105
[Shared] Name: Member First Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Member First Name
[Shared] Type: varchar
[Shared] Length: 128
[Shared] Name: Member First Name
[Shared] Type: varchar
[Shared] Length: 128
ME106
Data Element: ME106
not present in this file submission.
[Unshared] Name: Group Size
[Unshared] Type: char
[Unshared] Length: 2
Codes:
A
1
B
2 to 50
C
51 - 100
D
100+
[Unshared] Name: Group Size
[Unshared] Type: char
[Unshared] Length: 2
Codes:
A
1
B
2 to 50
C
51 - 100
D
100+
ME107
Data Element: ME107
not present in this file submission.
[Unshared] Name: Risk Basis
[Unshared] Type: char
[Unshared] Length: 1
Codes:
F
Fully insured
S
Self-insured
[Unshared] Name: Risk Basis
[Unshared] Type: char
[Unshared] Length: 1
Codes:
F
Fully insured
S
Self-insured
ME108
Data Element: ME108
not present in this file submission.
[Unshared] Name: High Deductible/ Health Savings Account Plan
[Unshared] Type: char
[Unshared] Length: 1
Codes:
N
Plan is not High Deductible/HSA eligible
Y
Plan is High Deductible/HSA eligible
[Unshared] Name: High Deductible/ Health Savings Account Plan
[Unshared] Type: char
[Unshared] Length: 1
Codes:
N
Plan is not High Deductible/HSA eligible
Y
Plan is High Deductible/HSA eligible
ME120
Data Element: ME120
not present in this file submission.
[Unshared] Name: Actuarial Value
[Unshared] Type: decimal
[Unshared] Length: 6
[Unshared] Name: Actuarial Value
[Unshared] Type: decimal
[Unshared] Length: 6
ME121
Data Element: ME121
not present in this file submission.
[Unshared] Name: Metallic Value
[Unshared] Type: int
[Unshared] Length: 1
Codes:
0
Not Applicable
1
Platinum
2
Gold
3
Silver
4
Bronze
[Unshared] Name: Metallic Value
[Unshared] Type: int
[Unshared] Length: 1
Codes:
0
Not Applicable
1
Platinum
2
Gold
3
Silver
4
Bronze
ME122
Data Element: ME122
not present in this file submission.
[Unshared] Name: Grandfather Status
[Unshared] Type: Char
[Unshared] Length: 1
Codes:
N
No
Y
Yes
[Unshared] Name: Grandfather Status
[Unshared] Type: Char
[Unshared] Length: 1
Codes:
N
No
Y
Yes
ME897
[Shared] Name: Plan Effective Date
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Plan Effective Date
[Shared] Type: char
[Shared] Length: 8
[Shared] Name: Plan Effective Date
[Shared] Type: char
[Shared] Length: 8
ME899
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
TR001
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
[Shared] Name: Record Type
[Shared] Type: char
[Shared] Length: 2
Codes:
ME
 
TR002
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
[Shared] Name: Payer Code
[Shared] Type: varchar
[Shared] Length: 8
TR003
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
[Shared] Name: Payer Name
[Shared] Type: varchar
[Shared] Length: 75
TR004
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Beginning Month
[Shared] Type: date
[Shared] Length: 6
TR005
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
[Shared] Name: Ending Month
[Shared] Type: date
[Shared] Length: 6
TR006
[Shared] Name: Extraction Date
[Shared] Type: date
[Shared] Length: 8
[Shared] Name: Extraction Date
[Shared] Type: date
[Shared] Length: 8
[Shared] Name: Extraction Date
[Shared] Type: date
[Shared] Length: 8
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