United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Member Eligibility File Submission December 1, 2010 - v2.1 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
Member Eligibility File Submission June 7, 2013 - v3.1 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
Member Eligibility File Submission October 1, 2014 - v4.0 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
File Specification: Member Eligibility File Submission - December 1, 2010 - v2.1 (Massachusetts) Member Eligibility File Submission - June 7, 2013 - v3.1 (Massachusetts) Member Eligibility File Submission - October 1, 2014 - v4.0 (Massachusetts)
[Shared] Responsible Organization:
Massachusetts Center for Health Information and Analysis Massachusetts Center for Health Information and Analysis Massachusetts Center for Health Information and Analysis
[Shared] Definition:
A file that includes data about a person who receives health care coverage from a payer, including but not limited to subscriber and member identifiers; member demographics; race, ethnicity and language information; plan type; benefit codes; enrollment start and end dates; and behavioral and mental health, substance abuse and chemical dependency and prescription drug benefit indicators. A file that includes data about a person who receives health care coverage from a payer, including but not limited to subscriber and member identifiers; member demographics; race, ethnicity and language information; plan type; benefit codes; enrollment start and end dates; and behavioral and mental health, substance abuse and chemical dependency and prescription drug benefit indicators. A file that includes data about a person who receives health care coverage from a payer, including but not limited to subscriber and member identifiers; member demographics; race, ethnicity and language information; plan type; benefit codes; enrollment start and end dates; and behavioral and mental health, substance abuse and chemical dependency and prescription drug benefit indicators.
File Specification: Member Eligibility File Submission - December 1, 2010 - v2.1 (Massachusetts) Member Eligibility File Submission - June 7, 2013 - v3.1 (Massachusetts) Member Eligibility File Submission - October 1, 2014 - v4.0 (Massachusetts)
HD001
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
 
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
Header Elements
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
Header Elements
HD002
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
HD003
[Shared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
HD004
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
ME
 
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
ME
ELIGIBILITY
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
ME
ELIGIBILITY
HD005
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
HD006
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
HD007
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
HD008
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
HD009
Data Element: HD009
not present in this file submission.
[Unshared] Name: APCD Version Number
[Unshared] Type: Decimal - Numeric
[Unshared] Length: 3
Codes:
2.1
Prior Version; valid only for reporting periods prior to October 2013
3.0
Current Version; required for reporting periods as of October 2013
 
 
[Unshared] Name: APCD Version Number
[Unshared] Type: Decimal - Numeric
[Unshared] Length: 3
Codes:
2.1
Prior 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 VALID as of May 2015
4.0
Version 4.0: required for reporting periods October 2013 onward as of May 2015
ME001
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
ME002
[Shared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
ME003
[Shared] Name: Insurance Type Code/Product
[Unshared] Type: Text
[Shared] Length: 2
Codes:
 
 
 
 
 
 
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
17
Dental Maintenance Organization (DMO)
 
 
 
 
AM
Automobile Medical
 
 
 
 
 
 
 
 
 
 
DS
Disability
HM
Health Maintenance Organization
HN
HMO Medicare Risk/Medicare Part C
 
 
LI
Liability
LM
Liability Medical
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MO
Medicaid Managed Care Organization
MP
Medicare Primary
 
 
OF
Other Federal Program (e.g. Black Lung)
QM
Qualified Medicare Beneficiary
SC
Senior Care Option
SP
Supplemental Policy
 
 
TV
Title V
VA
Veterans Administration Plan
WC
Workers' Compensation
 
 
[Shared] Name: Insurance Type Code/Product
[Unshared] Type: Text
[Shared] Length: 2
Codes:
09
Self-pay
10
Central Certification
11
Other Non-Federal Programs
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
17
Dental Maintenance Organization (DMO)
20
Medicare Advantage PPO
21
Medicare Advantage Private Fee for Service
AM
Automobile Medical
BL
Blue Cross / Blue Shield
CC
Commonwealth Care
CE
Commonwealth Choice
CH
CHAMPUS
CI
Commercial Insurance
DS
Disability
HM
Health Maintenance Organization
HN
HMO Medicare Risk/Medicare Part C
 
 
LI
Liability
LM
Liability Medical
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MO
Medicaid Managed Care Organization
MP
Medicare Primary
MS
Medicare Secondary Plan
OF
Other Federal Program (e.g. Black Lung)
QM
Qualified Medicare Beneficiary
SC
Senior Care Option
SP
Supplemental Policy
TF
HSN Trust Fund
TV
Title V
VA
Veterans Administration Plan
WC
Workers' Compensation
ZZ
Other
[Shared] Name: Insurance Type Code/Product
[Unshared] Type: Lookup Table - Text
[Shared] Length: 2
Codes:
09
Self-pay
10
Central Certification
11
Other Non-Federal Programs
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
17
Dental Maintenance Organization (DMO)
20
Medicare Advantage PPO
21
Medicare Advantage Private Fee for Service
AM
Automobile Medical
BL
Blue Cross / Blue Shield
CC
Commonwealth Care
CE
Commonwealth Choice
CH
CHAMPUS
CI
Commercial Insurance
DS
Disability
HM
Health Maintenance Organization
HN
HMO Medicare Risk/Medicare Part C
IC
Integrated Care Organization
LI
Liability
LM
Liability Medical
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
MD
Medicare Part D
MO
Medicaid Managed Care Organization
MP
Medicare Primary
MS
Medicare Secondary Plan
OF
Other Federal Program (e.g. Black Lung)
QM
Qualified Medicare Beneficiary
SC
Senior Care Option
SP
Supplemental Policy
TF
HSN Trust Fund
TV
Title V
VA
Veterans Administration Plan
WC
Workers' Compensation
ZZ
Other
ME004
[Shared] Name: Year
[Unshared] Type: Date Period
[Shared] Length: 4
[Shared] Name: Year
[Unshared] Type: Date Period - Integer
[Shared] Length: 4
[Shared] Name: Year
[Unshared] Type: Date Period - Integer
[Shared] Length: 4
ME005
[Shared] Name: Month
[Unshared] Type: Date Period Month
[Shared] Length: 2
[Shared] Name: Month
[Unshared] Type: Date Period - Numeric
[Shared] Length: 2
[Shared] Name: Month
[Unshared] Type: Date Period - Numeric
[Shared] Length: 2
ME006
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 30
ME007
[Shared] Name: Coverage Level Code
[Unshared] Type: Text
[Shared] Length: 3
Codes:
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
 
 
[Shared] Name: Coverage Level Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
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
[Shared] Name: Coverage Level Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
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
ME008
[Unshared] Name: Subscriber Unique Identification Number
[Unshared] Type: Text
[Shared] Length: 9
[Unshared] Name: Subscriber SSN
[Unshared] Type: Numeric
[Shared] Length: 9
[Unshared] Name: Subscriber SSN
[Unshared] Type: Numeric
[Shared] Length: 9
ME009
[Shared] Name: Plan Specific Contract Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Plan Specific Contract Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Plan Specific Contract Number
[Shared] Type: Text
[Shared] Length: 30
ME010
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
ME011
[Unshared] Name: Member Identification Code
[Unshared] Type: Text
[Shared] Length: 9
[Unshared] Name: Member SSN
[Unshared] Type: Numeric
[Shared] Length: 9
[Unshared] Name: Member SSN
[Unshared] Type: Numeric
[Shared] Length: 9
ME012
[Shared] Name: Individual 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
 
 
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
[Unshared] Type: Numeric
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
12
Other Adult
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
[Shared] Name: Individual Relationship Code
[Unshared] Type: Lookup Table - Numeric
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
12
Other Adult
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
ME013
[Shared] Name: Member Gender
[Unshared] Type: Text
[Shared] Length: 1
Codes:
F
Female
M
Male
O
Other
U
Unknown
[Shared] Name: Member Gender
[Unshared] Type: Text
[Shared] Length: 1
Codes:
F
Female
M
Male
O
Other
U
Unknown
[Shared] Name: Member Gender
[Unshared] Type: Lookup Table - Text
[Shared] Length: 1
Codes:
F
Female
M
Male
O
Other
U
Unknown
ME014
[Shared] Name: Member Date of Birth
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
ME015
[Shared] Name: Member City Name
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Member City Name
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Member City Name
[Shared] Type: Text
[Shared] Length: 30
ME016
[Unshared] Name: Member State or Province
[Unshared] Type: Text
[Shared] Length: 2
[Unshared] Name: Member State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
[Unshared] Name: Member State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
ME017
[Shared] Name: Member ZIP Code
[Unshared] Type: Text
[Unshared] Length: 11
[Shared] Name: Member ZIP Code
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
[Shared] Name: Member ZIP Code
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
ME018
[Shared] Name: Medical Coverage
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Medical Coverage
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Medical Coverage
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
ME019
[Shared] Name: Prescription Drug Coverage
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Prescription Drug Coverage
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Prescription Drug Coverage
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
ME020
[Shared] Name: Dental Coverage
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Dental Coverage
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Dental Coverage
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
ME021
[Shared] Name: Race 1
[Unshared] Type: Text
[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
[Unshared] Type: Lookup Table - Text
[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
[Unshared] Type: Lookup Table - Text
[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
[Unshared] Type: Text
[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
[Unshared] Type: Lookup Table - Text
[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
[Unshared] Type: Lookup Table - Text
[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
[Unshared] Name: Other Race
[Shared] Type: Text
[Shared] Length: 15
[Unshared] Name: Other Race
[Shared] Type: Text
[Shared] Length: 15
[Unshared] Name: Filler
[Shared] Type: Text
[Shared] Length: 15
ME024
[Shared] Name: Hispanic Indicator
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Hispanic Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Hispanic Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
ME025
[Shared] Name: Ethnicity 1
[Unshared] Type: Text
[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
[Unshared] Type: Lookup Table - OR - External Code Source 17 - Text
[Shared] Length: 6
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island (see CDC Code 2075-0)
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown / not specified
[Shared] Name: Ethnicity 1
[Unshared] Type: Lookup Table - OR - External Code Source 17 - Text
[Shared] Length: 6
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island (see CDC Code 2075-0)
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown / not specified
ME026
[Shared] Name: Ethnicity 2
[Unshared] Type: Text
[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
[Unshared] Type: Lookup Table - OR - External Code Source 17 - Text
[Shared] Length: 6
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island (see CDC Code 2075-0)
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown / not specified
[Shared] Name: Ethnicity 2
[Unshared] Type: Lookup Table - OR - External Code Source 17 - Text
[Shared] Length: 6
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
AMERCN
American
BRAZIL
Brazilian
CARIBI
Caribbean Island (see CDC Code 2075-0)
CVERDN
Cape Verdean
EASTEU
Eastern European
OTHER
Other Ethnicity
PORTUG
Portuguese
RUSSIA
Russian
UNKNOW
Unknown / not specified
ME027
[Shared] Name: Other Ethnicity
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Other Ethnicity
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Other Ethnicity
[Shared] Type: Text
[Shared] Length: 20
ME028
[Shared] Name: Primary Insurance Indicator
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Primary Insurance Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Primary Insurance Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
ME029
[Shared] Name: Coverage Type
[Unshared] Type: Text
[Shared] Length: 3
Codes:
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
ASW
self-funded plans that are administered by a third-party administrator, where the employer has purchased stop-loss, or group excess, insurance coverage
OTH
Any other plan. Insurers using this code shall obtain prior approval.
STN
short-term, non-renewable health insurance
UND
plans underwritten by the insurer
[Shared] Name: Coverage Type
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
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
ASW
Self-funded plans that are administered by a third-party administrator, where the employer has purchased stop-loss, or group excess, insurance coverage
OTH
Any other plan. Insurers using this code shall obtain prior approval.
STN
Short-term, non-renewable health insurance
UND
Plans underwritten by the insurer
[Shared] Name: Coverage Type
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
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
ASW
Self-funded plans that are administered by a third-party administrator, where the employer has purchased stop-loss, or group excess, insurance coverage
OTH
Any other plan. Insurers using this code shall obtain prior approval.
STN
Short-term, non-renewable health insurance
UND
Plans underwritten by the insurer
ME030
[Shared] Name: Market Category Code
[Unshared] Type: Text
[Shared] Length: 4
Codes:
FCH
Policies sold and issued directly to individuals on a franchise basis
GCV
Policies sold and issued directly to individuals as group conversion Policies
GLG1
Policies sold and issued directly to employers having between 51 and 99 employees
GLG2
Policies sold and issued directly to employers having between 100 and 249 employees
GLG3
Policies sold and issued directly to employers having between 250 and 499 employees
GLG4
Policies sold and issued directly to employers having 500 or more employees
GS1
Policies sold and issued directly to employers having exactly one employee
GS2
Policies sold and issued directly to employers having between two and nine employees
GS3
Policies sold and issued directly to employers having between 10 and 25 employees
GS4
Policies sold and issued directly to employers having between 26 and 50 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
[Unshared] Type: Lookup Table - Text
[Shared] Length: 4
Codes:
FCH
Individuals on a franchise basis
GCV
Individuals as group conversion Policies
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
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
GSA
Small employers through a qualified association trust
IND
Individuals (non-group)
ISCO
Individuals as a Senior Care Option
OTH
Other types of entities. Insurers using this market code shall obtain prior approval.
[Shared] Name: Market Category Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 4
Codes:
FCH
Individuals on a franchise basis
GCV
Individuals as group conversion Policies
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
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
GSA
Small employers through a qualified association trust
IND
Individuals (non-group)
ISCO
Individuals as a Senior Care Option
OTH
Other types of entities. Insurers using this market code shall obtain prior approval.
ME031
[Shared] Name: Special Coverage
[Unshared] Type: Text
[Shared] Length: 3
Codes:
CC
Commonwealth Care
HSN
Health Safety Net
N/A
Not Applicable
[Shared] Name: Special Coverage
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
CC
Commonwealth Care
HSN
Health Safety Net
N/A
Not Applicable
[Shared] Name: Special Coverage
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
CC
Commonwealth Care
HSN
Health Safety Net
N/A
Not Applicable
ME032
[Shared] Name: Group Name
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Group Name
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Group Name
[Shared] Type: Text
[Shared] Length: 50
ME033
[Shared] Name: Member language preference
[Unshared] Type: Text
[Shared] Length: 3
Codes:
600
English
601
Cape Verdean Creole
607
German
619
Italian
620
French
623
Haitian Creole
625
Spanish
629
Portuguese
637
Greek
639
Russian
645
Polish
656
Persian
663
Hindi
671
Urdu
708
Chinese (Please specify in ME034)
723
Japanese
724
Korean
728
Vietnamese
742
Tagalog
777
Arabic
778
Hebrew
799
African (Please specify in ME034)
997
Other Language (Please specify in ME034)
999
Unknown / not specified
[Shared] Name: Member language preference
[Unshared] Type: External Code Source 7 - Integer
[Shared] Length: 3
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
[Shared] Name: Member language preference
[Unshared] Type: External Code Source 7 - Integer
[Shared] Length: 3
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ME034
[Shared] Name: Member language preference -Other
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Member language preference -Other
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Member language preference -Other
[Shared] Type: Text
[Shared] Length: 20
ME035
[Unshared] Name: Health Care Home Assigned Flag
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Unshared] Name: Health Care Home (PCMH) Assigned Flag
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Unshared] Name: Health Care Home (PCMH) Assigned Flag
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
ME036
[Unshared] Name: Health Care Home Number
[Shared] Type: Text
[Unshared] Length: 28
[Unshared] Name: Health Care Home (PCMH) Number
[Shared] Type: Text
[Unshared] Length: 30
[Unshared] Name: Health Care Home (PCMH) Number
[Shared] Type: Text
[Unshared] Length: 30
ME037
[Unshared] Name: Health Care Home Tax ID Number
[Unshared] Type: Text
[Unshared] Length: 20
[Unshared] Name: Health Care Home (PCMH) Tax ID Number
[Unshared] Type: Numeric
[Unshared] Length: 9
[Unshared] Name: Health Care Home (PCMH) Tax ID Number
[Unshared] Type: Numeric
[Unshared] Length: 9
ME038
[Unshared] Name: Health Care Home National Provider ID