United States Health Information Knowledgebase

 

Insurance Type Code/Product

ME003, New Hampshire



Name:Insurance Type Code/Product
Data Element ID:ME003
Description:Not provided
State:New Hampshire
Data Type:Text
Length:2
HIPAA Reference Transaction Set/Loop/Segment/Qualifier/Data Element:271/2110C/EB/ /04, 271/2110D/EB/ /04
Permissible Values: Insurance Type Code/Product uses the following permissible values:
Code / Value Meaning
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 Group Health Plan
14 Medicare Secondary, No-fault insurance including insurance in which auto is primary
15 Medicare Secondary Workers' Compensation
16 Medicare Secondary Public Health Service or Other Federal Agency
41 Medicare Secondary Black Lung
42 Medicare Secondary Veterans 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 Advantage
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
MD Medicare Part D
MH Medigap Part A
MI Medigap Part B
MP Medicare Primary
PC Personal Care
PE Property Insurance - Personal
PR Preferred Provider Organization (PPO)
PS Point of Service (POS)
QM Qualified Medicare Beneficiary
SP Supplemental Policy
WC Workers' Compensation
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File Specification for Medical Eligibility File Submission - September 10, 2012

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not provided Text 2
HD002 Payer Payer submitting payments NHID Submitter Code Text 8
HD003 National Plan ID CMS National Plan ID Text 30
HD004 Type of File Not provided Text 2
HD005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
HD006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
HD007 Record Count Total number of records submitted in this file Integer 10
HD008 Comments Submitted may use to document this submission by assigning a filename, system source, etc. Text 80
ME001 Payer Payer submitting payments NHID Submitter Code Text 8
ME002 National Plan ID CMS National Plan ID Text 30
ME003 Insurance Type Code/Product Not provided Text 2
ME004 Year Year for which eligibility is reported in this submission Integer 4
ME005 Month Month for which eligibility is reported in this submission Integer 2
ME006 Insured Group or Policy Number Group or policy number (not the number that uniquely identifies the subscriber) Text 50
ME007 Coverage Level Code Benefit Coverage Level Text 3
ME008 Subscriber Social Security Number Subscriber's social security number (set as null if unavailable) (this data element will be de-identified by the NHpreprocessor application) Text 128
ME009 Plan Specific Contract Number Plan assigned contract number (set as null if contract number = subscriber's social security number) (this data element will be de-identified by the NHpreprocessor application) Text 128
ME010 Member Suffice or Sequence Number Uniquely numbers the member within the contract Integer 2
ME011 Member Identification Code Member's social security number (set as null if unavailable) (this data element will be de-identified by the NHpreprocessor application) Text 128
ME012 Individual Relationship Code Member's relationship to insured Integer 2
ME013 Member Gender Not provided Text 1
ME014 Member Date of Birth Not provided Date CCYYMMDD 8
ME015 Member City Name City name of member Text 30
ME016 Member State or Province As defined by the US Postal Service Text 2
ME017 Member ZIP Code ZIP Code of member - may include non-US codes. (Do not include dash) Text 11
ME018 Medical Coverage Not provided Text 1
ME019 Prescription Drug Coverage Not provided Text 1
ME020 Dental Coverage Not provided Text 1
ME021 Race 1 Not provided Text 6
ME022 Race 2 Not provided Text 6
ME023 Placeholder Not provided Not Supplied Not Supplied Not Supplied
ME024 Hispanic Indicator Not provided Text 1
ME025 Ethnicity 1 Not provided Text 6
ME026 Ethnicity 2 Not provided Text 6
ME027 Place holder Not provided 20
ME028 Primary Insurance Indicator Not provided Text 1
ME029 Coverage Type Not provided Text 3
ME030 Market Category Not provided Text 4
ME031 Special Coverage Not provided Text 3
ME032 Group Name Name of the group which the member is covered by. If the member is part of a group of one or non-group then this field shall be set as null Text 128
ME101 Subscriber Last Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME102 Subscriber First Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME103 Subscriber Middle Initial (this data element will be de- identified by the NHpreprocessor application) Not provided Text 1
ME104 Member Last Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME105 Member First Name (this data element will be de-identified by the NHpreprocessor application) Not provided Text 128
ME106 Member Middle Initial (this data element will be de-identified by the NHpreprocessor application) Not provided Text 1
ME899 Record Type Not provided Text 2
TR001 Record Type Not provided Text 2
TR002 Payer Payer submitting payments NHID Submitter Code Text 8
TR003 National Plan ID CMS National Plan ID Text 30
TR004 Type of File Not provided Text 2
TR005 Period Beginning Date Beginning of paid period for claims Beginning of month covered for eligibility Integer CCYYMM 6
TR006 Period Ending Date End of paid period for claims End of month covered for eligibility Integer CCYYMM 6
TR007 Date Processed Not provided Date CCYYMMDD 8

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