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File Submission Comparison

Selected Items
Item Name Version State Type Organization
Pharmacy Eligibility File Submission 2010-03-16 Maine File Specification Maine Health Data Organization (MHDO)
Pharmacy Eligibility File Submission v1.1 Maine File Specification Maine Health Data Organization (MHDO)
File Specification: Pharmacy Eligibility File Submission - 2010-03-16 (Maine) Pharmacy Eligibility File Submission - v1.1 (Maine)
[Shared] Responsible Organization:
Maine Health Data Organization Maine Health Data Organization
[Shared] Definition:
Not Provided Not Provided
File Specification: Pharmacy Eligibility File Submission - 2010-03-16 (Maine) Pharmacy Eligibility File Submission - v1.1 (Maine)
PE001
[Shared] Name: Payer
[Unshared] Type: varchar
[Unshared] Length: 8
Codes:
 
 
 
 
 
 
[Shared] Name: Payer
[Unshared] Type: CHAR
[Unshared] Length: 6
Codes:
C
Commercial carrier
T
Third Party Administrator
U
Unlicensed entity
PE002
[Shared] Name: National Plan ID
[Unshared] Type: varchar
[Shared] Length: 30
[Shared] Name: National Plan ID
[Unshared] Type: CHAR
[Shared] Length: 30
PE003
[Shared] Name: Insurance Type/Product Code
[Unshared] Type: varchar
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Insurance Type/Product Code
[Unshared] Type: CHAR
[Shared] Length: 2
Codes:
12
Medicare Secondary Working Aged Beneficiary or Spouse with Employer Group Health Plan
13
Medicare Secondary End-Stage Renal Disease Beneficiary in the 12 month coordination period with an employer's group health plan
14
Medicare Secondary, No-fault insurance including Auto is primary
15
Medicare Secondary Worker's Compensation
16
Medicare Secondary Public Health Service or Other Federal Agency
41
Medicare Secondary Black Lung
42
Medicare Secondary Veteran's Administration
43
Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health Plan (LGHP)
47
Medicare Secondary, Other Liability Insurance is Primary
AP
Auto Insurance Policy
CP
Medicare Conditionally Primary
D
Disability
DB
Disability Benefits
EP
Exclusive Provider Organization
HM
Health Maintenance Organization (HMO)
HN
Health Maintenance Organization (HMO) Medicare Risk
HS
Special Low Income Medicare Beneficiary
IN
Indemnity
LC
Long Term Care
LD
Long Term Policy
LI
Life Insurance
LT
Litigation
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MH
Medigap Part A
MI
Medigap Part B
MP
Medicare Primary
PE004
[Shared] Name: Year
[Unshared] Type: integer
[Shared] Length: 4
[Shared] Name: Year
[Unshared] Type: NUMBER
[Shared] Length: 4
PE005
[Shared] Name: Month
[Unshared] Type: integer
[Shared] Length: 2
[Shared] Name: Month
[Unshared] Type: NUMBER
[Shared] Length: 2
PE006
[Shared] Name: Insured Group or Policy Number
[Unshared] Type: varchar
[Unshared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Unshared] Type: CHAR
[Unshared] Length: 31
PE007
[Shared] Name: Coverage Level Code
[Unshared] Type: varchar
[Shared] Length: 3
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Coverage Level Code
[Unshared] Type: CHAR
[Shared] Length: 3
Codes:
CHD
Children Only
DEP
Dependents Only
ECH
Employee and Children
EMP
Employee Only
ESP
Employee and Spouse
FAM
Family
IND
Individual
SPC
Spouse and Children
SPO
Spouse Only
PE008
[Shared] Name: Encrypted Subscriber Social Security Number
[Unshared] Type: varchar
[Unshared] Length: 128
[Shared] Name: Encrypted Subscriber Social Security Number
[Unshared] Type: CHAR
[Unshared] Length: 32
PE009
[Shared] Name: Plan Specific Contract Number
[Unshared] Type: varchar
[Unshared] Length: 128
[Shared] Name: Plan Specific Contract Number
[Unshared] Type: CHAR
[Unshared] Length: 64
PE010
[Shared] Name: Member Suffix or Sequence Number
[Unshared] Type: integer
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Unshared] Type: CHAR
[Shared] Length: 20
PE011
[Shared] Name: Member Identification Code
[Unshared] Type: varchar
[Unshared] Length: 128
[Shared] Name: Member Identification Code
[Unshared] Type: CHAR
[Unshared] Length: 64
PE012
[Shared] Name: Individual Relationship Code
[Unshared] Type: integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Individual Relationship Code
[Unshared] Type: CHAR
[Shared] Length: 2
Codes:
01
Spouse
18
Self/Employee
19
Child
21
Unknown
34
Other Adult
PE013
[Shared] Name: Member Gender
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
 
 
[Shared] Name: Member Gender
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
PE014
[Shared] Name: Member Date of Birth
[Unshared] Type: date
[Unshared] Length: Not Provided
[Shared] Name: Member Date of Birth
[Unshared] Type: DATE
[Unshared] Length: 8
PE015
[Shared] Name: Member City Name
[Unshared] Type: varchar
[Shared] Length: 30
[Shared] Name: Member City Name
[Unshared] Type: CHAR
[Shared] Length: 30
PE016
[Shared] Name: Member State or Province
[Unshared] Type: varchar
[Shared] Length: 2
[Shared] Name: Member State or Province
[Unshared] Type: CHAR
[Shared] Length: 2
PE017
[Shared] Name: Member ZIP Code
[Unshared] Type: varchar
[Shared] Length: 11
[Shared] Name: Member ZIP Code
[Unshared] Type: CHAR
[Shared] Length: 11
PE018
[Shared] Name: Medical Coverage
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
[Shared] Name: Medical Coverage
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
N
No
Y
Yes
PE019
[Shared] Name: Prescription Drug Coverage
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
[Shared] Name: Prescription Drug Coverage
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
N
No
Y
Yes
PE020
[Shared] Name: Dental Coverage
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
[Shared] Name: Dental Coverage
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
N
No
Y
Yes
PE021
[Unshared] Name: Race 1
[Unshared] Type: varchar
[Unshared] Length: 6
Codes:
 
 
[Unshared] Name: Record Type
[Unshared] Type: CHAR
[Unshared] Length: 2
Codes:
PE
Pharmacy Eligibility
PE022
[Unshared] Name: Race 2
[Unshared] Type: varchar
[Unshared] Length: 6
Data Element: PE022
not present in this file submission.
PE023
[Unshared] Name: Other Race
[Unshared] Type: varchar
[Unshared] Length: 15
Data Element: PE023
not present in this file submission.
PE024
[Unshared] Name: Hispanic Indicator
[Unshared] Type: varchar
[Unshared] Length: 1
Data Element: PE024
not present in this file submission.
PE025
[Unshared] Name: Ethnicity 1
[Unshared] Type: varchar
[Unshared] Length: 6
Data Element: PE025
not present in this file submission.
PE026
[Unshared] Name: Ethnicity 2
[Unshared] Type: varchar
[Unshared] Length: 6
Data Element: PE026
not present in this file submission.
PE027
[Unshared] Name: Other Ethnicity
[Unshared] Type: varchar
[Unshared] Length: 20
Data Element: PE027
not present in this file submission.
PE028
[Unshared] Name: Primary Insurance Indicator
[Unshared] Type: varchar
[Unshared] Length: 1
Codes:
1
Yes
2
No
Data Element: PE028
not present in this file submission.
PE029
[Unshared] Name: Coverage Type
[Unshared] Type: varchar
[Unshared] Length: 3
Data Element: PE029
not present in this file submission.
PE030
[Unshared] Name: Market Category Code
[Unshared] Type: varchar
[Unshared] Length: 4
Data Element: PE030
not present in this file submission.
PE031
[Unshared] Name: Special Coverage
[Unshared] Type: varchar
[Unshared] Length: 3
Data Element: PE031
not present in this file submission.
PE032
[Unshared] Name: Group Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: PE032
not present in this file submission.
PE101
[Unshared] Name: Encryped Subscriber Last Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: PE101
not present in this file submission.
PE102
[Unshared] Name: Encryped Subscriber First Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: PE102
not present in this file submission.
PE103
[Unshared] Name: Encryped Subscriber Middle Initial
[Unshared] Type: varchar
[Unshared] Length: 1
Data Element: PE103
not present in this file submission.
PE104
[Unshared] Name: Encryped Member Last Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: PE104
not present in this file submission.
PE105
[Unshared] Name: Encryped Member First Name
[Unshared] Type: varchar
[Unshared] Length: 128
Data Element: PE105
not present in this file submission.
PE106
[Unshared] Name: Encryped Member Middle Initial
[Unshared] Type: varchar
[Unshared] Length: 1
Data Element: PE106
not present in this file submission.
PE899
[Unshared] Name: Record Type
[Unshared] Type: varchar
[Unshared] Length: 2
Codes:
PE
 
Data Element: PE899
not present in this file submission.
PE901
[Shared] Name: Member Age
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Shared] Name: Member Age
[Unshared] Type: NUMBER
[Unshared] Length: 3
PE902
[Unshared] Name: Record ID#
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Record ID #
[Unshared] Type: NUMBER
[Unshared] Length: 12
PE903
[Unshared] Name: Date of Transfer to MHDO
[Unshared] Type: date
[Unshared] Length: Not Provided
[Unshared] Name: MHDO Extract Date
[Unshared] Type: DATE
[Unshared] Length: 8
PE904
[Unshared] Name: Encrypted Member ID# (longer of ESSN or Contract) + DOB
[Unshared] Type: varchar
[Shared] Length: 71
[Unshared] Name: Unique Member ID
[Unshared] Type: CHAR
[Shared] Length: 71
PE905
[Unshared] Name: Medicare coverage
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Medicare Coverage
[Unshared] Type: CHAR
[Shared] Length: 1
Codes:
N
No supplemental Medicare Coverage
Y
Yes supplemental Medicare Coverage
PE906
[Unshared] Name: Submission ID#
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Submission ID #
[Unshared] Type: NUMBER
[Unshared] Length: 12
PE907
[Unshared] Name: Double Encrypted Subscriber Social Security Number
[Unshared] Type: varchar
[Shared] Length: 64
[Unshared] Name: Double Encrypted Social Security Number
[Unshared] Type: CHAR
[Shared] Length: 64
PE908
[Unshared] Name: Double Encrypted Plan Specific Contract Number
[Unshared] Type: varchar
[Shared] Length: 128
[Unshared] Name: Double Encrypted Contract Number
[Unshared] Type: CHAR
[Shared] Length: 128
PE909
[Shared] Name: Double Encrypted Member Identification Code
[Unshared] Type: varchar
[Shared] Length: 128
[Shared] Name: Double Encrypted Member Identification Code
[Unshared] Type: CHAR
[Shared] Length: 128
PE910
[Unshared] Name: Double Encrypted Member ID# (longer of MHDO_ESSN or
[Unshared] Type: varchar
[Shared] Length: 135
[Unshared] Name: Double Encrypted Member ID
[Unshared] Type: CHAR
[Shared] Length: 135
PE911
[Unshared] Name: Standardized Insurance Individual Relationship Code
[Unshared] Type: integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Standardized Relationship Code
[Unshared] Type: INTEGER
[Shared] Length: 2
Codes:
1
Spouse
4
Grandfather or Grandmother
5
Grandson or Granddaughter
7
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Self/Employee
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
34
Other Adult
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
PE912
[Shared] Name: Standardized Insurance Type/Product Code
[Unshared] Type: varchar
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Standardized Insurance Type/Product Code
[Unshared] Type: CHAR
[Shared] Length: 2
Codes:
11
Other non Federal program
12
Medicare secondary working aged beneficiary or spouse with employer group health plan
13
Medicare secondary end-stage renal disease beneficiary in the 12 month coordination period with an employer's group health plan
14
Medicare secondary, no-fault insurance including auto is primary
15
Medicare secondary public health service (PHS) or other federal agency
41
Medicare secondary black lung
42
Medicare secondary veteran's administration
43
Medicare secondary disabled beneficiary under age 65 with large group health plan (LGHP)
47
Medicare secondary, other liability insurance is primary
AM
Auto insurance policy
CP
Medicare conditionally primary
DB
Disability benefits
DS
Disability
EP
Exclusive Provider Organization (EPO)
HM
Health Maintenance Organization (HMO)
HN
Health Maintenance Organization (HMO) Medicare risk
HS
Special low income Medicare beneficiary
IN
Indemnity Insurance
LC
Long term care
LD
Long term policy
LI
Life insurance
LM
Liability medical
LT
Litigation
MA
Medicare part A
MB
Medicare part B
MC
Medicaid
MH
Medigap part A
MI
Medigap part B
MP
Medicare primary
OF
Other federal program (e.g. black lung)
OT
Other
PE
Property Insurance - Personal
PR
Preferred Provider Organization (PPO)
PS
Point of Service (POS)
QM
Qualified Medicare beneficiary
SP
Supplemental policy
TV
Title V
VA
Veteran administration plan
WC
Workers' compensation
PE913
[Unshared] Name: Duplicate
[Unshared] Type: varchar
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Duplicate Member Flag
[Unshared] Type: INTEGER
[Shared] Length: 1
Codes:
1
Same member, same month, same payer
2
Same member, same month, administrative relationship between payers
PE914
[Unshared] Name: MTIME
[Unshared] Type: integer
[Unshared] Length: Not Provided
[Unshared] Name: Eligibility Yearand Month
[Unshared] Type: NUMBER
[Unshared] Length: 6
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