United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Item Name Version State Type Organization
Medical Eligibility File Submission August 12, 2009 - v1.3 Utah File Specification Utah Department of Health, Office of Health Care Statistics (UDH - OHCS)
Medical Eligibility File Submission December 5, 2013 - v2.0 Utah File Specification Utah Department of Health, Office of Health Care Statistics (UDH - OHCS)
File Specification: Medical Eligibility File Submission - August 12, 2009 - v1.3 (Utah) Medical Eligibility File Submission - December 5, 2013 - v2.0 (Utah)
[Shared] Responsible Organization:
Utah Department of Health, Office of Health Care Statistics Utah Department of Health, Office of Health Care Statistics
[Shared] Definition:
Not Provided Not Provided
File Specification: Medical Eligibility File Submission - August 12, 2009 - v1.3 (Utah) Medical Eligibility File Submission - December 5, 2013 - v2.0 (Utah)
1
[Unshared] Name: Record Type
[Unshared] Type: Not Provided
[Unshared] Length: 1
Codes:
1
 
Data Element: 1
not present in this file submission.
2
[Unshared] Name: Transaction Code
[Unshared] Type: Not Provided
[Unshared] Length: 1
Codes:
A
add
C
Change
Data Element: 2
not present in this file submission.
3
[Unshared] Name: File Create Date
[Unshared] Type: Not Provided
[Unshared] Length: 8
Data Element: 3
not present in this file submission.
4
[Unshared] Name: Member ID
[Unshared] Type: Not Provided
[Unshared] Length: 20
Data Element: 4
not present in this file submission.
5
[Unshared] Name: SSN
[Unshared] Type: Not Provided
[Unshared] Length: 9
Data Element: 5
not present in this file submission.
6
[Unshared] Name: Member's Relationship to Subscriber
[Unshared] Type: Not Provided
[Unshared] Length: 2
Codes:
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
09
Adopted Child
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
18
Self
19
Child
20
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
G8
Other Relationship
Data Element: 6
not present in this file submission.
7
[Unshared] Name: Last Name
[Unshared] Type: Not Provided
[Unshared] Length: 35
Data Element: 7
not present in this file submission.
8
[Unshared] Name: First Name
[Unshared] Type: Not Provided
[Unshared] Length: 25
Data Element: 8
not present in this file submission.
9
[Unshared] Name: Middle Name
[Unshared] Type: Not Provided
[Unshared] Length: 25
Data Element: 9
not present in this file submission.
10
[Unshared] Name: Sex
[Unshared] Type: Not Provided
[Unshared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
Data Element: 10
not present in this file submission.
11
[Unshared] Name: Street
[Unshared] Type: Not Provided
[Unshared] Length: 55
Data Element: 11
not present in this file submission.
12
[Unshared] Name: City
[Unshared] Type: Not Provided
[Unshared] Length: 30
Data Element: 12
not present in this file submission.
13
[Unshared] Name: State
[Unshared] Type: Not Provided
[Unshared] Length: 2
Data Element: 13
not present in this file submission.
14
[Unshared] Name: Zip Code
[Unshared] Type: Not Provided
[Unshared] Length: 15
Data Element: 14
not present in this file submission.
15
[Unshared] Name: Primary Phone
[Unshared] Type: Not Provided
[Unshared] Length: 10
Data Element: 15
not present in this file submission.
16
[Unshared] Name: Birth date
[Unshared] Type: Not Provided
[Unshared] Length: 8
Data Element: 16
not present in this file submission.
17
[Unshared] Name: Race
[Unshared] Type: Not Provided
[Unshared] Length: 6
Codes:
1
White - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
2
Black or African American - A person having origins in any of the black racial groups of Africa.
3
Native Hawaiian or Other Pacific Islander - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
4
Asian - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.
5
American Indian or Alaska Native - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.
6
Unknown
Data Element: 17
not present in this file submission.
18
[Unshared] Name: Ethnicity
[Unshared] Type: Not Provided
[Unshared] Length: 1
Codes:
1
Not Hispanic or Latino
2
Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
3
Unknown
Data Element: 18
not present in this file submission.
19
[Unshared] Name: Primary/Secondary
[Unshared] Type: Not Provided
[Unshared] Length: 1
Codes:
P
Primary
Q
Quaternary
S
Secondary
T
Terciary
Data Element: 19
not present in this file submission.
20
[Unshared] Name: Designated Primary Care Physician
[Unshared] Type: Not Provided
[Unshared] Length: 55
Data Element: 20
not present in this file submission.
21
[Unshared] Name: PCP ID
[Unshared] Type: Not Provided
[Unshared] Length: 20
Data Element: 21
not present in this file submission.
22
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 8
Data Element: 22
not present in this file submission.
23
[Unshared] Name: Healthplan Code
[Unshared] Type: Not Provided
[Unshared] Length: 4
Data Element: 23
not present in this file submission.
24
[Unshared] Name: Benefit Option Code
[Unshared] Type: Not Provided
[Unshared] Length: 20
Data Element: 24
not present in this file submission.
25
[Unshared] Name: Option Effective Date
[Unshared] Type: Not Provided
[Unshared] Length: 8
Data Element: 25
not present in this file submission.
26
[Unshared] Name: HP Termination Date
[Unshared] Type: Not Provided
[Unshared] Length: 8
Data Element: 26
not present in this file submission.
27
[Unshared] Name: Employer Group Code
[Unshared] Type: Not Provided
[Unshared] Length: 20
Data Element: 27
not present in this file submission.
28
[Unshared] Name: Patient ID
[Unshared] Type: Not Provided
[Unshared] Length: 15
Data Element: 28
not present in this file submission.
29
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 9
Data Element: 29
not present in this file submission.
30
[Unshared] Name: Health Plan Description
[Unshared] Type: Not Provided
[Unshared] Length: 30
Data Element: 30
not present in this file submission.
31
[Unshared] Name: Orig. HP Effective Date
[Unshared] Type: Not Provided
[Unshared] Length: 8
Data Element: 31
not present in this file submission.
32
[Unshared] Name: Member Status
[Unshared] Type: Not Provided
[Unshared] Length: 1
Codes:
1
Verified
2
Provisional
Data Element: 32
not present in this file submission.
33
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 1
Data Element: 33
not present in this file submission.
34
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 1
Data Element: 34
not present in this file submission.
35
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 1
Data Element: 35
not present in this file submission.
36
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 1
Data Element: 36
not present in this file submission.
37
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 10
Data Element: 37
not present in this file submission.
38
[Unshared] Name: Reserved for future use
[Unshared] Type: Not Provided
[Unshared] Length: 10
Data Element: 38
not present in this file submission.
ME001
Data Element: ME001
not present in this file submission.
[Unshared] Name: Payer Code
[Unshared] Type: varchar
[Unshared] Length: 8
ME002
Data Element: ME002
not present in this file submission.
[Unshared] Name: Payer Name
[Unshared] Type: varchar
[Unshared] Length: 30
ME003
Data Element: ME003
not present in this file submission.
[Unshared] Name: Insurance Type Code/Product
[Unshared] Type: char
[Unshared] 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
Data Element: ME004
not present in this file submission.
[Unshared] Name: Year
[Unshared] Type: int
[Unshared] Length: 4
ME005
Data Element: ME005
not present in this file submission.
[Unshared] Name: Month
[Unshared] Type: char
[Unshared] Length: 2
ME006
Data Element: ME006
not present in this file submission.
[Unshared] Name: Insured Group or Policy Number
[Unshared] Type: varchar
[Unshared] Length: 30
ME007
Data Element: ME007
not present in this file submission.
[Unshared] Name: Coverage Level Code
[Unshared] Type: char
[Unshared] 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
Data Element: ME008
not present in this file submission.
[Unshared] Name: Subscriber Social Security Number
[Unshared] Type: varchar
[Unshared] Length: 9
ME009
Data Element: ME009
not present in this file submission.
[Unshared] Name: Plan Specific Contract Number
[Unshared] Type: varchar
[Unshared] Length: 128
ME010
Data Element: ME010
not present in this file submission.
[Unshared] Name: Member Suffix or Sequence Number
[Unshared] Type: varchar
[Unshared] Length: 128
ME011
Data Element: ME011
not present in this file submission.
[Unshared] Name: Member Identification Code
[Unshared] Type: varchar
[Unshared] Length: 9
ME012
Data Element: ME012
not present in this file submission.
[Unshared] Name: Individual Relationship Code
[Unshared] Type: char
[Unshared] 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
Data Element: ME013
not present in this file submission.
[Unshared] Name: Member Gender
[Unshared] Type: char
[Unshared] Length: 1
Codes:
F
Female
M
Male
U
UNKNOWN
ME014
Data Element: ME014
not present in this file submission.
[Unshared] Name: Member Date of Birth
[Unshared] Type: char
[Unshared] Length: 8
ME015
Data Element: ME015
not present in this file submission.
[Unshared] Name: Member City Name
[Unshared] Type: varchar
[Unshared] Length: 30
ME016
Data Element: ME016
not present in this file submission.
[Unshared] Name: Member State or Province
[Unshared] Type: char
[Unshared] Length: 2
ME017
Data Element: ME017
not present in this file submission.
[Unshared] Name: Member ZIP Code
[Unshared] Type: varchar
[Unshared] Length: 11
ME018
Data Element: ME018
not present in this file submission.
[Unshared] Name: Medical Coverage
[Unshared] Type: char
[Unshared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
ME019
Data Element: ME019
not present in this file submission.
[Unshared] Name: Prescription Drug Coverage
[Unshared] Type: char
[Unshared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
ME020
Data Element: ME020
not present in this file submission.
[Unshared] Name: Dental Coverage
[Unshared] Type: char
[Unshared] Length: 1
Codes:
3
UNKNOWN
N
NO
Y
YES
ME021
Data Element: ME021
not present in this file submission.
[Unshared] Name: Race 1
[Unshared] Type: varchar
[Unshared] 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
Data Element: ME022
not present in this file submission.
[Unshared] Name: Race 2
[Unshared] Type: varchar
[Unshared] 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
Data Element: ME023
not present in this file submission.
[Unshared] Name: Other Race
[Unshared] Type: varchar
[Unshared] Length: 15
ME024
Data Element: ME024
not present in this file submission.
[Unshared] Name: Hispanic Indicator
[Unshared] Type: char
[Unshared] Length: 1
Codes:
N
Patient is not Hispanic/Latino/Spanish
U
Unknown
Y
Patient is Hispanic/Latino/Spanish
ME025
Data Element: ME025
not present in this file submission.
[Unshared] Name: Ethnicity 1
[Unshared] Type: varchar
[Unshared] 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
Data Element: ME026
not present in this file submission.
[Unshared] Name: Ethnicity 2
[Unshared] Type: varchar
[Unshared] 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
Data Element: ME027
not present in this file submission.
[Unshared] Name: Other Ethnicity
[Unshared] Type: varchar
[Unshared] Length: 20
ME028
Data Element: ME028
not present in this file submission.
[Unshared] Name: Primary Insurance Indicator
[Unshared] Type: char
[Unshared] Length: 1
Codes:
N
No, secondary or tertiary insurance
Y
Yes, primary insurance
ME029
Data Element: ME029
not present in this file submission.
[Unshared] Name: Coverage Type
[Unshared] Type: char
[Unshared] Length: 3
Codes:
AWS
Self-funded
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
Data Element: ME030
not present in this file submission.
[Unshared] Name: Market Category Code
[Unshared] Type: varchar
[Unshared] 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.
ME032
Data Element: ME032
not present in this file submission.
[Unshared] Name: Group Name
[Unshared] Type: varchar
[Unshared] Length: 128
ME043
Data Element: ME043
not present in this file submission.
[Unshared] Name: Member Street Address
[Unshared] Type: varchar
[Unshared] Length: 50
ME044
Data Element: ME044
not present in this file submission.
[Unshared] Name: Employer Name
[Unshared] Type: varchar
[Unshared] Length: 50
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 nongroup market)
Y
Commercial small or non-group QHP purchased through the Exchange
ME101
Data Element: ME101
not present in this file submission.
[Unshared] Name: Subscriber Last Name
[Unshared] Type: varchar
[Unshared] Length: 128
ME102
Data Element: ME102
not present in this file submission.
[Unshared] Name: Subscriber First Name
[Unshared] Type: varchar
[Unshared] Length: 128
ME103
Data Element: ME103
not present in this file submission.
[Unshared] Name: Subscriber Middle Initial
[Unshared] Type: char
[Unshared] Length: 1
ME104
Data Element: ME104
not present in this file submission.
[Unshared] Name: Member Last Name
[Unshared] Type: varchar
[Unshared] Length: 128
ME105
Data Element: ME105
not present in this file submission.
[Unshared] Name: Member First Name
[Unshared] Type: varchar
[Unshared] 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+
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
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
ME120
Data Element: ME120
not present in this file submission.
[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
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
ME897
Data Element: ME897
not present in this file submission.
[Unshared] Name: Plan Effective Date
[Unshared] Type: char
[Unshared] Length: 8
ME899
Data Element: ME899
not present in this file submission.
[Unshared] Name: Record Type
[Unshared] Type: char
[Unshared] Length: 2
Codes:
ME
 
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