USHIK: APCD File Submission Comparison

Item Name	Version	State	Type	Organization
Medical Eligibility File Submission	February 2014 - v1.1	Rhode Island	File Specification	Rhode Island Department of Health (RIDoH)
Medical Eligibility File Submission	June 2014 - v1.3	Rhode Island	File Specification	Rhode Island Department of Health (RIDoH)

File Specification:	Medical Eligibility File Submission - February 2014 - v1.1 (Rhode Island)	Medical Eligibility File Submission - June 2014 - v1.3 (Rhode Island)
Responsible Organization:	Rhode Island Department of Health	Rhode Island Department of Health
Definition:	Not provided	Not provided

HD001

Name:	Record Type
Type:	Text
Length:	2
Codes:
HD	header record

Name:	Record Type
Type:	Text
Length:	2
Codes:
HD	header record

HD002

Name:	Submitter Code
Type:	Text
Length:	8

Name:	Submitter Code
Type:	Text
Length:	8

HD003

Name:	Placeholder
Type:	Text
Length:	30
Codes:
Null

Name:	Placeholder
Type:	Text
Length:	30
Codes:
Null

HD004

Name:	Type of File
Type:	Text
Length:	2
Codes:
ME	eligibility data

Name:	Type of File
Type:	Text
Length:	2
Codes:
ME	eligibility data

HD005

Name:	Period Beginning Date
Type:	Integer
Length:	6

Name:	Period Beginning Date
Type:	Integer
Length:	6

HD006

Name:	Period Ending Date
Type:	Integer
Length:	6

Name:	Period Ending Date
Type:	Integer
Length:	6

HD007

Name:	Record Count
Type:	Integer
Length:	10

Name:	Record Count
Type:	Integer
Length:	10

HD008

Name:	Comments
Type:	Text
Length:	80

Name:	Comments
Type:	Text
Length:	80

ME001

Name:	Submitter Code
Type:	Text
Length:	8
Codes:
RIC	Commercial carrier
RIG	Governmental agency
RIT	Third-party administrator

Name:	Submitter Code
Type:	Text
Length:	8
Codes:
RIC	Commercial carrier
RIG	Governmental agency
RIT	Third-party administrator

ME002

Name:	NAIC
Type:	Text
Length:	5

Name:	NAIC
Type:	Text
Length:	5

ME003

Name:	Insurance Type / Product Code
Type:	Text
Length:	2

Name:	Insurance Type / Product Code
Type:	Text
Length:	2

ME004

Name:	Year
Type:	Integer
Length:	4

Name:	Year
Type:	Integer
Length:	4

ME005

Name:	Month
Type:	Text
Length:	2

Name:	Month
Type:	Text
Length:	2

ME005A

Name:	Days Eligible
Type:	Integer
Length:	3

Name:	Days Eligible
Type:	Integer
Length:	3

ME006

Name:	Insured Group or Policy Number
Type:	Text
Length:	50

Name:	Insured Group or Policy Number
Type:	Text
Length:	50

ME007

Name:	Coverage Level Code
Type:	Text
Length:	3

Name:	Coverage Level Code
Type:	Text
Length:	3

ME008

Name:	Subscriber Social Security Number
Type:	Text
Length:	9

Name:	Subscriber Social Security Number
Type:	Text
Length:	9

ME009

Name:	Plan-Specific Contract Number
Type:	Text
Length:	80

Name:	Plan-Specific Contract Number
Type:	Text
Length:	80

ME010

Name:	Member Suffix or Sequence Number
Type:	Text
Length:	20

Name:	Member Suffix or Sequence Number
Type:	Text
Length:	20

ME010A

Name:	Unique Member Identifier
Type:	String
Length:	32

Name:	Unique Member Identifier
Type:	String
Length:	32

ME010B

Name:	Unique Member Identifier (Legacy)
Type:	String
Length:	32

Name:	Unique Member Identifier (Legacy)
Type:	String
Length:	32

ME010C

Name:	Unique Member Identifier Merge/Split Indicator
Type:	Text
Length:	1
Codes:
M	Merged
S	Split

Name:	Unique Member Identifier Merge/Split Indicator
Type:	Text
Length:	1
Codes:
M	Merged
S	Split

ME010D

Name:	Member Opt-Out Status
Type:	Text
Length:	1
Codes:
I	Included
O	Omitted
U	Unknown

Name:	Member Opt-Out Status
Type:	Text
Length:	1
Codes:
I	Included
O	Omitted
U	Unknown

ME011

Name:	Member Social Security Number
Type:	Text
Length:	9

Name:	Member Social Security Number
Type:	Text
Length:	9

ME012

Name:	Member Relationship
Type:	Text
Length:	2

Name:	Member Relationship
Type:	Text
Length:	2

ME013

Name:	Member Gender
Type:	Text
Length:	1
Codes:
F	Female
M	Male
U	Unknown

Name:	Member Gender
Type:	Text
Length:	1
Codes:
F	Female
M	Male
U	Unknown

ME014

Name:	Member Date of Birth
Type:	Date
Length:	8

Name:	Member Date of Birth
Type:	Date
Length:	8

ME015

Name:	Member City
Type:	Text
Length:	30

Name:	Member City
Type:	Text
Length:	30

ME016

Name:	Member State or Province
Type:	Text
Length:	2

Name:	Member State or Province
Type:	Text
Length:	2

ME017

Name:	Member ZIP/Postal Code
Type:	Text
Length:	9

Name:	Member ZIP/Postal Code
Type:	Text
Length:	9

ME018

Name:	Medical Coverage
Type:	Text
Length:	1
Codes:
N	No
Y	Yes

Name:	Medical Coverage
Type:	Text
Length:	1
Codes:
N	No
Y	Yes

ME019

Name:	Prescription Drug Coverage
Type:	Text
Length:	1
Codes:
N	No
Y	Yes

Name:	Prescription Drug Coverage
Type:	Text
Length:	1
Codes:
N	No
Y	Yes

ME021

Name:	Race - 1
Type:	Text
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

Name:	Race - 1
Type:	Text
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

Name:	Race - 2
Type:	Text
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

Name:	Race - 2
Type:	Text
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

Name:	Race - Other
Type:	Text
Length:	15

Name:	Race - Other
Type:	Text
Length:	15

ME024

Name:	Hispanic Indicator
Type:	Text
Length:	1
Codes:
N	No
U	Unknown
Y	Yes

Name:	Hispanic Indicator
Type:	Text
Length:	1
Codes:
N	No
U	Unknown
Y	Yes

ME025

Name:	Ethnicity - 1
Type:	Text
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

UNKNOW	Unknown / Not specified

Name:	Ethnicity - 1
Type:	Text
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

Name:	Ethnicity - 2
Type:	Text
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

UNKNOW	Unknown / Not specified

Name:	Ethnicity - 2
Type:	Text
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

Name:	Ethnicity - Other
Type:	Text
Length:	20

Name:	Ethnicity - Other
Type:	Text
Length:	20

ME028

Name:	Primary Insurance Indicator
Type:	Text
Length:	1
Codes:
N	No
P	Partial (Includes CNOM, EFT, etc) (for Medicaid use only)
Y	Yes

Name:	Primary Insurance Indicator
Type:	Text
Length:	1
Codes:
N	No
P	Partial (Includes CNOM, EFT, etc) (for Medicaid use only)
Y	Yes

ME029

Name:	Coverage Type
Type:	Text
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
STN	Short-term, non-renewable health insurance
UND	Plans underwritten by the insurer

Name:	Coverage Type
Type:	Text
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
STN	Short-term, non-renewable health insurance
UND	Plans underwritten by the insurer

ME030

Name:	Market Category Code
Type:	Text
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 51-99 employees
GLG2	Policies sold and issued directly to employers having 100 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 10-25 employees
GS4	Policies sold and issued directly to employers having 26-50 employees
GSA	Policies sold and issued directly to small employers through a qualified association trust
IND	Policies sold and issued directly to individuals (ie, a non-group policy)
OTH	Policies sold to other types of entities

Name:	Market Category Code
Type:	Text
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 51-99 employees
GLG2	Policies sold and issued directly to employers having 100 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 10-25 employees
GS4	Policies sold and issued directly to employers having 26-50 employees
GSA	Policies sold and issued directly to small employers through a qualified association trust
IND	Policies sold and issued directly to individuals (ie, a non-group policy)
OTH	Policies sold to other types of entities

ME031

Name:	Placeholder
Type:	N/A
Length:	N/A

Name:	Placeholder
Type:	N/A
Length:	N/A

ME032

Name:	PCMH Assigned Flag
Type:	Text
Length:	1
Codes:
N	No
U	Unknown
Y	Yes

Name:	PCMH Assigned Flag
Type:	Text
Length:	1
Codes:
N	No
U	Unknown
Y	Yes

ME033

Name:	PCMH Number
Type:	Text
Length:	30

Name:	PCMH Number
Type:	Text
Length:	30

ME034

Name:	PCMH Tax ID
Type:	Text
Length:	9

Name:	PCMH Tax ID
Type:	Text
Length:	9

ME035

Name:	PCMH NPI
Type:	Text
Length:	10

Name:	PCMH NPI
Type:	Text
Length:	10

ME036

Name:	PCMH Name
Type:	Text
Length:	60

Name:	PCMH Name
Type:	Text
Length:	60

ME037

Name:	Group Name
Type:	Text
Length:	60

Name:	Group Name
Type:	Text
Length:	60

ME050

Name:	Assigned Primary Care Provider Flag
Type:	Text
Length:	1
Codes:
N	No
U	Unknown
Y	Yes

Name:	Assigned Primary Care Provider Flag
Type:	Text
Length:	1
Codes:
N	No
U	Unknown
Y	Yes

ME051

Name:	Assigned Primary Care Provider Plan ID
Type:	Text
Length:	50

Name:	Assigned Primary Care Provider Plan ID
Type:	Text
Length:	50

ME052

Name:	Assigned Primary Care Provider NPI
Type:	Text
Length:	10

Name:	Assigned Primary Care Provider NPI
Type:	Text
Length:	10

ME053

Name:	Assigned Primary Care Provider Last Name
Type:	Text
Length:	60

Name:	Assigned Primary Care Provider Last Name
Type:	Text
Length:	60

ME054

Name:	Assigned Primary Care Provider First Name
Type:	Text
Length:	35

Name:	Assigned Primary Care Provider First Name
Type:	Text
Length:	35

ME055

Name:	Assigned Primary Care Provider Middle Initial
Type:	Text
Length:	1

Name:	Assigned Primary Care Provider Middle Initial
Type:	Text
Length:	1

ME056

Name:	Assigned Primary Care Provider Street Address 1
Type:	Text
Length:	55

Name:	Assigned Primary Care Provider Street Address 1
Type:	Text
Length:	55

ME057

Name:	Assigned Primary Care Provider Street Address 2
Type:	Text
Length:	55

Name:	Assigned Primary Care Provider Street Address 2
Type:	Text
Length:	55

ME058

Name:	Assigned Primary Care Provider City
Type:	Text
Length:	30

Name:	Assigned Primary Care Provider City
Type:	Text
Length:	30

ME059

Name:	Assigned Primary Care Provider State or Province
Type:	Text
Length:	2

Name:	Assigned Primary Care Provider State or Province
Type:	Text
Length:	2

ME060

Name:	Assigned Primary Care Provider ZIP/Postal Code
Type:	Text
Length:	9

Name:	Assigned Primary Care Provider ZIP/Postal Code
Type:	Text
Length:	9

ME070

Name:	Purchased Through Exchange Indicator
Type:	Text
Length:	1
Codes:
N	No, not purchased through the Exchange
Y	Yes, purchased through the Exchange

Name:	Purchased Through Exchange Indicator
Type:	Text
Length:	1
Codes:
N	No
Y	Yes

ME071

Name:	Exchange Market Type
Type:	Text
Length:	2
Codes:
IN	Individual
SG	Small group
SH	SHOP

Name:	Exchange Market Type
Type:	Text
Length:	2
Codes:
IN	Individual
SG	Small group
SH	SHOP

ME072

Name:	HIOS ID
Type:	Text
Length:	17

Name:	HIOS ID
Type:	Text
Length:	17

ME073

Name:	Exchange Metallic Tier
Type:	Text
Length:	1
Codes:
0	Unknown / Not Applicable
1	Bronze
2	Silver
3	Gold
4	Platinum
5	Catastrophic

Name:	Exchange Metallic Tier
Type:	Text
Length:	1
Codes:
0	Unknown / Not Applicable
1	Bronze
2	Silver
3	Gold
4	Platinum
5	Catastrophic

ME080

Name:	Placeholder
Type:	N/A
Length:	N/A

Name:	Placeholder
Type:	N/A
Length:	N/A

ME081

Name:	Placeholder
Type:	N/A
Length:	N/A

Name:	Placeholder
Type:	N/A
Length:	N/A

ME082

Name:	Placeholder
Type:	N/A
Length:	N/A

Name:	Placeholder
Type:	N/A
Length:	N/A

ME083

Name:	Placeholder
Type:	N/A
Length:	N/A

Name:	Placeholder
Type:	N/A
Length:	N/A

ME084

Name:	Placeholder
Type:	N/A
Length:	N/A

Name:	Placeholder
Type:	N/A
Length:	N/A

ME101

Name:	Subscriber Last Name
Type:	Text
Length:	60

Name:	Subscriber Last Name
Type:	Text
Length:	60

ME102

Name:	Subscriber First Name
Type:	Text
Length:	35

Name:	Subscriber First Name
Type:	Text
Length:	35

ME103

Name:	Subscriber Middle Initial
Type:	Text
Length:	1

Name:	Subscriber Middle Initial
Type:	Text
Length:	1

ME104

Name:	Member Last Name
Type:	Text
Length:	60

Name:	Member Last Name
Type:	Text
Length:	60

ME105

Name:	Member First Name
Type:	Text
Length:	35

Name:	Member First Name
Type:	Text
Length:	35

ME106

Name:	Member Middle Initial
Type:	Text
Length:	1

Name:	Member Middle Initial
Type:	Text
Length:	1

ME201

Name:	Aid Category
Type:	Text
Length:	2

Name:	Aid Category
Type:	Text
Length:	2

ME202

Name:	Dual Eligibility Flag
Type:	Text
Length:	2

Name:	Dual Eligibility Flag
Type:	Text
Length:	2

ME203

Name:	Placeholder
Type:	N/A
Length:	N/A

Name:	Placeholder
Type:	N/A
Length:	N/A

ME205

Name:	Long-Term Care (LTC) Coverage Flag
Type:	Text
Length:	1

Name:	Long-Term Care (LTC) Coverage Flag
Type:	Text
Length:	1

ME206

Name:	Attributed Income Level
Type:	Text
Length:	1

Name:	Attributed Income Level
Type:	Text
Length:	1

ME212

Name:	Third-Party Liability Flag
Type:	Text
Length:	1
Codes:
N	No
Y	Yes

Name:	Third-Party Liability Flag
Type:	Text
Length:	1
Codes:
N	No
Y	Yes

ME213

Name:	Medicaid Program Code
Type:	Text
Length:	2

Name:	Medicaid Program Code
Type:	Text
Length:	2

ME401

Name:	Date of Death
Type:	Date
Length:	8

Name:	Date of Death
Type:	Date
Length:	8

ME402

Name:	Risk Score
Type:	Text
Length:	2

Name:	Risk Score
Type:	Decimal
Length:	22,3

ME404

Name:	Hospice Status Indicator
Type:	Text
Length:	2

Name:	Hospice Status Indicator
Type:	Text
Length:	2

ME405

Name:	Medicare Advantage Indicator
Type:	Text
Length:	2

Name:	Medicare Advantage Indicator
Type:	Text
Length:	2

ME406

Name:	Medicare Status Indicator
Type:	Text
Length:	2

Name:	Medicare Status Indicator
Type:	Text
Length:	2

ME407

Name:	Monthly Reason For Entitlement
Type:	Text
Length:	2

Name:	Monthly Reason For Entitlement
Type:	Text
Length:	2

ME408

Name:	Original Reason For Entitlement
Type:	Text
Length:	2

Name:	Original Reason For Entitlement
Type:	Text
Length:	2

ME899

Name:	Record Type
Type:	Text
Length:	2
Codes:
ME	member eligibility record

Name:	Record Type
Type:	Text
Length:	2
Codes:
ME	member eligibility record

TR001

Name:	Record Type
Type:	Text
Length:	2
Codes:
TR	trailer record

Name:	Record Type
Type:	Text
Length:	2
Codes:
TR	trailer record

TR002

Name:	Submitter Code
Type:	Text
Length:	8

Name:	Submitter Code
Type:	Text
Length:	8

TR003

Name:	Placeholder
Type:	Text
Length:	30
Codes:
Null

Name:	Placeholder
Type:	Text
Length:	30
Codes:
Null

TR004

Name:	Type of File
Type:	Text
Length:	2
Codes:
ME	eligibility data

Name:	Type of File
Type:	Text
Length:	2
Codes:
ME	eligibility data

TR005

Name:	Period Beginning Date
Type:	Integer
Length:	6

Name:	Period Beginning Date
Type:	Integer
Length:	6

TR006

Name:	Period Ending Date
Type:	Integer
Length:	6

Name:	Period Ending Date
Type:	Integer
Length:	6

TR007

Name:	Date Processed
Type:	Date
Length:	8

Name:	Date Processed
Type:	Date
Length:	8

United States Health Information Knowledgebase

File Submission Comparison

Identifying Attributes

Data Elements & Codes