United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Medical Eligibility File Submission February 20, 2013 Maryland File Specification Maryland Health Care Commission (MHCC)
Medical Eligibility File Submission September 13, 2013 Maryland File Specification Maryland Health Care Commission (MHCC)
Medical Eligibility File Submission January 9, 2014 Maryland File Specification Maryland Health Care Commission (MHCC)

Identifying Attributes

File Specification: Medical Eligibility File Submission - February 20, 2013 (Maryland) Medical Eligibility File Submission - September 13, 2013 (Maryland) Medical Eligibility File Submission - January 9, 2014 (Maryland)
[Shared] Responsible Organization:
Maryland Health Care Commission Maryland Health Care Commission Maryland Health Care Commission
[Shared] Definition:
Not provided Not provided Not provided

Data Elements & Codes

File Specification: Medical Eligibility File Submission - February 20, 2013 (Maryland) Medical Eligibility File Submission - September 13, 2013 (Maryland) Medical Eligibility File Submission - January 9, 2014 (Maryland)
1
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
5
Medical Eligibility
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
5
Eligibility
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
5
Eligibility
2
[Unshared] Name: Encrypted Enrollee IdentifierP (payer encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Unshared] Name: Encrypted Enrollee IdentifierP (payor encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Unshared] Name: Encrypted Enrollee IdentifierP (payor encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
3
[Shared] Name: Encrypted Enrollee IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Shared] Name: Encrypted Enrollee IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Shared] Name: Encrypted Enrollee IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
4
[Shared] Name: Enrollee Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Enrollee Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Enrollee Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
5
[Shared] Name: Enrollee Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
[Shared] Name: Enrollee Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
[Shared] Name: Enrollee Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
6
[Unshared] Name: Enrollee Zip Code of Residence
[Shared] Type: numeric
[Unshared] Length: 5
[Unshared] Name: Enrollee Zip Code of Residence +4-digit add-on
[Shared] Type: numeric
[Unshared] Length: 10
[Unshared] Name: Enrollee Zip Code of Residence +4-digit add-on
[Shared] Type: numeric
[Unshared] Length: 10
7
[Shared] Name: Enrollee County of Residence
[Shared] Type: numeric
[Shared] Length: 3
Codes:
001
Allegany
003
Anne Arundel
005
Baltimore County
009
Calvert
011
Caroline
013
Carroll
015
Cecil
017
Charles
019
Dorchester
021
Frederick
023
Garrett
025
Harford
027
Howard
029
Kent
031
Montgomery
033
Prince George's
035
Queen Anne's
037
St. Mary's
039
Somerset
041
Talbot
043
Washington
045
Wicomico
047
Worcester
510
Baltimore City
999
Unknown
[Shared] Name: Enrollee County of Residence
[Shared] Type: numeric
[Shared] Length: 3
Codes:
001
Allegany
003
Anne Arundel
005
Baltimore County
009
Calvert
011
Caroline
013
Carroll
015
Cecil
017
Charles
019
Dorchester
021
Frederick
023
Garrett
025
Harford
027
Howard
029
Kent
031
Montgomery
033
Prince George's
035
Queen Anne's
037
St. Mary's
039
Somerset
041
Talbot
043
Washington
045
Wicomico
047
Worcester
510
Baltimore City
999
Unknown
[Shared] Name: Enrollee County of Residence
[Shared] Type: numeric
[Shared] Length: 3
Codes:
001
Allegany
003
Anne Arundel
005
Baltimore County
009
Calvert
011
Caroline
013
Carroll
015
Cecil
017
Charles
019
Dorchester
021
Frederick
023
Garrett
025
Harford
027
Howard
029
Kent
031
Montgomery
033
Prince George's
035
Queen Anne's
037
St. Mary's
039
Somerset
041
Talbot
043
Washington
045
Wicomico
047
Worcester
510
Baltimore City
999
Unknown
8
[Unshared] Name: Source of Enrollee Race/Ethnicity Information
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Enrollee not asked
1
Enrollee asked and reported
2
Enrollee asked but refused
3
Obtained from other source
 
 
[Unshared] Name: Source of Enrollee Race/Ethnicity Information
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
Enrollee not asked
1
Enrollee asked and reported
2
Enrollee asked but refused
3
Obtained from other source
 
 
[Unshared] Name: Source of Direct Reporting of Enrollee Race
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
Enrollee reported to payor
2
Enrollee reported to another source
 
 
9
Missing/Unknown/Not specified
9
[Unshared] Name: Enrollee OMB Race 1
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
American Indian or Alaska Native
2
Asian
3
Black or African American
4
Native Hawaiian or Other Pacific Islander
5
White/Caucasian
6
Some Other Race
9
Missing/Unknown/Not specified
[Unshared] Name: Enrollee OMB Race 1
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
American Indian or Alaska Native
2
Asian
3
Black or African American
4
Native Hawaiian or Other Pacific Islander
5
White/Caucasian
6
Some Other Race
9
Missing/Unknown/Not specified
[Unshared] Name: Race Category White - Direct
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
10
[Unshared] Name: Enrollee OMB Race 2
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
American Indian or Alaska Native
2
Asian
3
Black or African American
4
Native Hawaiian or Other Pacific Islander
5
White/Caucasian
6
Some Other Race
9
Missing/Unknown/Not specified
[Unshared] Name: Enrollee OMB Race 2
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
American Indian or Alaska Native
2
Asian
3
Black or African American
4
Native Hawaiian or Other Pacific Islander
5
White/Caucasian
6
Some Other Race
9
Missing/Unknown/Not specified
[Unshared] Name: Race Category Black or African American - Direct
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
11
[Unshared] Name: Enrollee OMB Race 3
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Enrollee OMB Race 3
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Race Category American Indian or Alaska Native - Direct
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
12
[Unshared] Name: Enrollee OMB Hispanic Ethnicity 1 (Hispanic Indicator)
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
Hispanic or Latino or Spanish origin
2
Not Hispanic or Latino or Not of Spanish origin
9
Missing/Unknown/Not specified
[Unshared] Name: Enrollee OMB Hispanic Ethnicity 1 (Hispanic Indicator)
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
Hispanic or Latino or Spanish origin
2
Not Hispanic or Latino or Not of Spanish origin
9
Missing/Unknown/Not specified
[Unshared] Name: Race Category Asian - Direct
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
13
[Unshared] Name: Enrollee Other Ethnicity 2
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Enrollee Other Ethnicity 2
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Race Category Native Hawaiian or Other Pacific Islander - Direct
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
14
[Unshared] Name: Enrollee Preferred Spoken Language
[Shared] Type: numeric
[Unshared] Length: 2
Codes:
 
 
 
 
[Unshared] Name: Enrollee Preferred Spoken Language
[Shared] Type: numeric
[Unshared] Length: 2
Codes:
 
 
 
 
[Unshared] Name: Race Category Other - Direct
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
15
[Unshared] Name: Coverage Type
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
 
 
1
Medicare Supplemental (i.e., Individual, Group, WRAP)
2
Medicare Advantage Plan
3
Individual Market (not MHIP)
4
Maryland Health Insurance Plan (MHIP)
5
Private Employer Sponsored or Other Group (i.e. union or association plans)
6
Public Employee - Federal (FEHBP)
7
Public Employee - Other (state, county, local/municipal government and public school systems)
8
Comprehensive Standard Health Benefit Plan [a self employed individual or small businesses (public or private employers) with 2-50 eligible employees]
9
Health Insurance Partnership (HIP)
A
Student Health Plan
Z
Unknown
[Unshared] Name: Coverage Type
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
 
 
1
Medicare Supplemental (i.e., Individual, Group, WRAP)
2
Medicare Advantage Plan
3
Individual Market (not MHIP)
4
Maryland Health Insurance Plan (MHIP)
5
Private Employer Sponsored or Other Group (i.e. union or association plans)
6
Public Employee - Federal (FEHBP)
7
Public Employee - Other (state, county, local/municipal government and public school systems)
8
Comprehensive Standard Health Benefit Plan [a self employed individual or small businesses (public or private employers) with 2-50 eligible employees]
9
Health Insurance Partnership (HIP)
A
Student Health Plan
Z
Unknown
[Unshared] Name: Race Category Declined to Answer - Direct
[Unshared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
16
[Unshared] Name: Source Company
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
 
 
1
Health Maintenance Organization
2
Life & Health Insurance Company or Not-for-Profit Health Benefit Plan
3
Third-Party Administrator (TPA) Unit
[Unshared] Name: Source Company
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
 
 
1
Health Maintenance Organization
2
Life & Health Insurance Company or Not-for-Profit Health Benefit Plan
3
Third-Party Administrator (TPA) Unit
[Unshared] Name: Race Category Unknown or Cannot Determined - Direct
[Unshared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
17
[Unshared] Name: Product Type
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Exclusive Provider Organization (in any form)
2
Health Maintenance Organization
3
Indemnity
4
Point of Service (POS)
5
Preferred Provider Organization (PPO)
6
Limited Benefit Plan (Mini-Meds)
7
Student Health Plan
8
Catastrophic
 
 
[Unshared] Name: Product Type
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Exclusive Provider Organization (in any form)
2
Health Maintenance Organization
3
Indemnity
4
Point of Service (POS)
5
Preferred Provider Organization (PPO)
6
Limited Benefit Plan (Mini-Meds)
7
Student Health Plan
8
Catastrophic
 
 
[Unshared] Name: Imputed Race with Highest Probability
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
American Indian or Alaska Native
2
Asian
3
Black or African American
4
Native Hawaiian or Other Pacific Islander
5
White/Caucasian
6
Some Other Race
 
 
 
 
9
Missing/Unknown/Not specified
18
[Unshared] Name: Policy Type
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
1
Individual
2
Any combination of two or more persons
[Unshared] Name: Policy Type
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
1
Individual
2
Any combination of two or more persons
[Unshared] Name: Probability of Imputed Race Assignment
[Shared] Type: numeric
[Unshared] Length: 3
Codes:
 
 
 
 
19
[Unshared] Name: Encrypted Contract or Group Number
[Unshared] Type: alphanumeric
[Unshared] Length: 20
Codes:
 
 
 
 
 
 
[Unshared] Name: Encrypted Contract or Group Number
[Unshared] Type: alphanumeric
[Unshared] Length: 20
Codes:
 
 
 
 
 
 
[Unshared] Name: Source of Direct Reporting of Enrollee Ethnicity
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
Enrollee reported to payor
2
Enrollee reported to another source
9
Missing/Unknown/Not specified
20
[Unshared] Name: Employer Federal Tax ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 9
Codes:
 
 
 
 
 
 
[Unshared] Name: Employer Federal Tax ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 9
Codes:
 
 
 
 
 
 
[Unshared] Name: Enrollee OMB Hispanic Ethnicity (Hispanic Indicator)
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
Hispanic or Latino or Spanish origin
2
Not Hispanic or Latino or Not of Spanish origin
9
Missing/Unknown/Not specified
21
[Unshared] Name: Medical Services Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
[Unshared] Name: Medical Services Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
[Unshared] Name: Imputed Ethnicity with Highest Probability (Hispanic Indicator)
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
Hispanic or Latino or Spanish origin
2
Not Hispanic or Latino or Not of Spanish origin
7
Declined to Answer
9
Missing/Unknown/Not specified
22
[Unshared] Name: Pharmacy Services Indicator
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
[Unshared] Name: Pharmacy Services Indicator
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
[Unshared] Name: Probability of Imputed Ethnicity Assignment
[Shared] Type: numeric
[Unshared] Length: 3
Codes:
 
 
 
 
23
[Unshared] Name: Behavioral Health Services Indicator
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Behavioral Health Services Indicator
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Enrollee Preferred Spoken Language for a Healthcare Encounter
[Shared] Type: numeric
[Unshared] Length: 2
Codes:
 
 
 
 
01
English
02
Albanian
03
Amharic
04
Arabic
05
Burmese
06
Cantonese
07
Chinese (simplified & traditional)
08
Creole (Haitian)
09
Farsi
10
French (European)
11
Greek
12
Gujarati
13
Hindi
14
Italian
15
Korean
16
Mandarin
17
Portuguese (Brazilian)
18
Russian
19
Serbian
20
Somali
21
Spanish (Latin America)
22
Tagalog (Pilipino)
23
Urdu
24
Vietnamese
98
Other and unspecified languages
99
Unknown
24
[Unshared] Name: Dental Services Indicator
[Unshared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Dental Services Indicator
[Unshared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Coverage Type
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
 
 
1
Medicare Supplemental (i.e., Individual, Group, WRAP)
2
Medicare Advantage Plan
3
Individual Market (not MHIP; not sold in MHBE)
4
Maryland Health Insurance Plan (MHIP)
5
Private Employer Sponsored or Other Group (i.e. union or association plans)
6
Public Employee - Federal (FEHBP)
7
Public Employee - Other (state, county, local/municipal government and public school systems)
8
Comprehensive Standard Health Benefit Plan (not sold in MHBE) [a self employed individual or small businesses (public or private employers) with 2-50 eligible employees]
9
Health Insurance Partnership (HIP)
A
Student Health Plan
B
Individual Market (sold in MHBE)
C
Small Business Options Program (SHOP) sold in MHBE
Z
Unknown
25
[Unshared] Name: Plan Liability
[Unshared] Type: numeric
[Shared] Length: 1
Codes:
1
Risk (under Maryland contract)
2
Risk (under non-Maryland contract)
3
ASO (employer self-insured)
[Unshared] Name: Plan Liability
[Unshared] Type: numeric
[Shared] Length: 1
Codes:
1
Risk (under Maryland contract)
2
Risk (under non-Maryland contract)
3
ASO (employer self-insured)
[Unshared] Name: Source Company
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
1
Health Maintenance Organization
2
Life & Health Insurance Company or Not-for-Profit Health Benefit Plan
3
Third-Party Administrator (TPA) Unit
26
[Unshared] Name: Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Product Type
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
Exclusive Provider Organization (in any form)
2
Health Maintenance Organization
3
Indemnity
4
Point of Service (POS)
5
Preferred Provider Organization (PPO)
6
Limited Benefit Plan (Mini-Meds)
7
Student Health Plan
8
Catastrophic
27
[Unshared] Name: Start Date of Coverage
[Shared] Type: numeric
[Unshared] Length: 8
Codes:
 
 
 
 
[Unshared] Name: Start Date of Coverage
[Shared] Type: numeric
[Unshared] Length: 8
Codes:
 
 
 
 
[Unshared] Name: Policy Type
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
1
Individual
2
Any combination of two or more persons
28
[Unshared] Name: End Date of Coverage
[Unshared] Type: numeric
[Unshared] Length: 8
[Unshared] Name: End Date of Coverage
[Unshared] Type: numeric
[Unshared] Length: 8
[Unshared] Name: Encrypted Contract or Group Number (payor encrypted)
[Unshared] Type: alphanumeric
[Unshared] Length: 20
29
[Unshared] Name: Date of FIRST Enrollment
[Unshared] Type: numeric
[Unshared] Length: 8
[Unshared] Name: Date of FIRST Enrollment
[Unshared] Type: numeric
[Unshared] Length: 8
[Unshared] Name: Employer Federal Tax ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 9
30
[Unshared] Name: Date of Disenrollment
[Shared] Type: numeric
[Unshared] Length: 8
Codes:
 
 
 
 
[Unshared] Name: Date of Disenrollment
[Shared] Type: numeric
[Unshared] Length: 8
Codes:
 
 
 
 
[Unshared] Name: Medical Services Indicator
[Shared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
31
[Unshared] Name: Relationship to Policyholder
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
Self/employee
2
Spouse
3
Child
4
Other Dependent
5
Other Adult
9
Unknown
[Unshared] Name: Relationship to Policyholder
[Shared] Type: numeric
[Shared] Length: 1
Codes:
 
 
1
Self/employee
2
Spouse
3
Child
4
Other Dependent
5
Other Adult
9
Unknown
[Unshared] Name: Pharmacy Services Indicator
[Shared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
32
[Unshared] Name: Payer ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 4
Codes:
 
 
 
 
P020
Aetna Life Insurance Co.
P030
Aetna Health, Inc.
P070
American Republic Insurance Co.
P130
CareFirst BlueChoice, Inc.
P131
CareFirst of Maryland, Inc.
P132
Group Hospitalization & Medical Services, Inc. (GHMSI)
P160
CIGNA Healthcare Mid-Atlantic, Inc.
P180
Connecticut General Life Ins. Co.
P220
Corporate Health Insurance Co.
P280
Assurant Health/Time Insurance Co.
P320
Golden Rule Insurance Co.
P480
Kaiser Permanente Mid-Atlantic States
P500
MAMSI Life and Health Ins. Co.
P520
MD-Individual Practice Association, Inc.
P530
MEGA Life & Health Insurance Co.
P620
Optimum Choice, Inc.
P680
Coventry Healthcare of Delaware, Inc.
P760
State Farm Mutual Automobile Ins. Co.
P820
United Healthcare Insurance Co.
P870
United Healthcare of the Mid-Atlantic, Inc.
[Unshared] Name: Payor ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 4
Codes:
 
 
 
 
P020
Aetna Life Insurance Co.
P030
Aetna Health, Inc.
 
 
P130
CareFirst BlueChoice, Inc.
P131
CareFirst of Maryland, Inc.
P132
Group Hospitalization & Medical Services, Inc. (GHMSI)
P160
Cigna Health and Life Insurance Co., Inc.
P180
Connecticut General Life Insurance Co.
P220
Corporate Health Insurance Co.
P280
Assurant Health/Time Insurance Co.
P320
Golden Rule Insurance Co.
P480
Kaiser Permanente Mid-Atlantic States
P500
MAMSI Life and Health Insurance Co.
P520
MD-Individual Practice Association, Inc.
P530
MEGA Life and Health Insurance Co.
P620
Optimum Choice, Inc.
P680
Coventry Healthcare of Delaware, Inc.
P760
State Farm Mutual Automobile Insurance Co.
P820
United Healthcare Insurance Co.
P870
United Healthcare of the Mid-Atlantic, Inc.
[Unshared] Name: Behavioral Health Services Indicator
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
33
[Unshared] Name: Source System
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Source System
[Unshared] Type: alphanumeric
[Shared] Length: 1
Codes:
 
 
 
 
[Unshared] Name: Dental Services Indicator
[Unshared] Type: numeric
[Shared] Length: 1
Codes:
0
No
1
Yes
34
Data Element: 34
not present in this file submission.
Data Element: 34
not present in this file submission.
[Unshared] Name: Plan Liability
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
Risk (under Maryland contract)
2
Risk (under non-Maryland contract)
3
ASO (employer self-insured)
35
Data Element: 35
not present in this file submission.
Data Element: 35
not present in this file submission.
[Unshared] Name: Consumer Directed Health Plan (CDHP) with HSA or HRA Indicator
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
0
No
1
Yes
36
Data Element: 36
not present in this file submission.
Data Element: 36
not present in this file submission.
[Unshared] Name: Start Date of Coverage (in the month)
[Unshared] Type: numeric
[Unshared] Length: 8
37
Data Element: 37
not present in this file submission.
Data Element: 37
not present in this file submission.
[Unshared] Name: End Date of Coverage (in the month)
[Unshared] Type: numeric
[Unshared] Length: 8
38
Data Element: 38
not present in this file submission.
Data Element: 38
not present in this file submission.
[Unshared] Name: Date of FIRST Enrollment
[Unshared] Type: numeric
[Unshared] Length: 8
39
Data Element: 39
not present in this file submission.
Data Element: 39
not present in this file submission.
[Unshared] Name: Date of Disenrollment
[Unshared] Type: numeric
[Unshared] Length: 8
40
Data Element: 40
not present in this file submission.
Data Element: 40
not present in this file submission.
[Unshared] Name: Coverage Period End Date
[Unshared] Type: Not Provided
[Unshared] Length: 8
41
Data Element: 41
not present in this file submission.
Data Element: 41
not present in this file submission.
[Unshared] Name: Relationship to Policyholder
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
Self/employee
2
Spouse
3
Child
4
Other Dependent
5
Other Adult
9
Unknown
42
Data Element: 42
not present in this file submission.
Data Element: 42
not present in this file submission.
[Unshared] Name: Payor ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 4
43
Data Element: 43
not present in this file submission.
Data Element: 43
not present in this file submission.
[Unshared] Name: Source System
[Unshared] Type: alphanumeric
[Unshared] Length: 1
44
Data Element: 44
not present in this file submission.
Data Element: 44
not present in this file submission.
[Unshared] Name: Grandfathered Plan Indicator
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
Grandfathered
2
Non-Grandfathered
3
Transitional
4
Not Applicable
45
Data Element: 45
not present in this file submission.
Data Element: 45
not present in this file submission.
[Unshared] Name: Plan or Product ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 20
46
Data Element: 46
not present in this file submission.
Data Element: 46
not present in this file submission.
[Unshared] Name: Subscriber ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 20
47
Data Element: 47
not present in this file submission.
Data Element: 47
not present in this file submission.
[Unshared] Name: Health Insurance Oversight System (HIOS) ID Number
[Unshared] Type: alphanumeric
[Unshared] Length: 20
48
Data Element: 48
not present in this file submission.
Data Element: 48
not present in this file submission.
[Unshared] Name: Master Patient Index
[Unshared] Type: alphanumeric
[Unshared] Length: 40
49
Data Element: 49
not present in this file submission.
Data Element: 49
not present in this file submission.
[Unshared] Name: Reporting Quarter
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
First Quarter = January 1 thru March 31
2
Second Quarter = April 1 thru June 30
3
Third Quarter = July 1 thru September 30
4
Fourth Quarter = October 1 thru December 31
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