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Actuarial Value

ME120, Connecticut



Name:Actuarial Value
Data Element ID:ME120
Description:Not Provided
State:Connecticut
Data Type:Decimal - Numeric
Format:varchar[6]
Length:6
Column:103
Threshold:100%
Required:Required when ME126 = 1
Element Submission Guideline:Report the Actuarial Value for the Member's coverage for the time period indicated by Enrollment Start and End dates in 0.0000 Format.
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File Specification for Medical Eligibility File Submission - December 5, 2013 - v1.2

Data Element ID Data Element Description Type Format Length
HD001 Record Type Header Record Identifier Text char[2] 2
HD002 Submitter Header Submitter / Carrier ID defined by AHCT Integer varchar[6] 6
HD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
HD004 Type of File Defines the file type and data expected. Text char[2] 2
HD005 Period Beginning Date Header Period Start Date Full Date - Integer int[8] YYYYMMDD 8
HD006 Period Ending Date Header Period Ending Date Full Date - Integer int[8] YYYYMMDD 8
HD007 Record Count Header Record Count Integer varchar[10] 10
HD008 Comments Header Carrier Comments Text varchar[80] 80
HD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
ME001 Submitter CT APCD defined and maintained unique identifier Integer varchar[6] 6
ME002 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
ME003 Insurance Type Code/Product Type / Product Identification Code Text char[2] 2
ME004 Year Eligibility year reported in this submission. Date Period - Integer int[4] YYYY 4
ME005 Month Reporting Month of Eligibility Date Period - Numeric char[2] MM 2
ME006 Insured Group or Policy Number Group / Policy Number Text varchar[30] 30
ME007 Coverage Level Code Benefit Coverage Level Code Text char[3] 3
ME008 Subscriber SSN Subscriber's Social Security Number Numeric char[9] 9
ME009 Plan Specific Contract Number Contract Number Text varchar[30] 30
ME010 Member Suffix or Sequence Number Member's Contract Sequence Number Text varchar[20] 20
ME011 Member SSN Member's Social Security Number Numeric char[9] 9
ME012 Individual Relationship Code Member to Subscriber Relationship Code Text varchar[2] 2
ME013 Member Gender Member's Gender Text char[1] 1
ME014 Member Date of Birth Member's date of birth Full Date - Integer int[8] YYYYMMDD 8
ME015 Member City Name City name of the Member Text varchar[30] 30
ME016 Member State State / Province of the Member External Code Source 2 - Text char[2] 2
ME017 Member ZIP Code Zip Code of the Member External Code Source 2 - Text varchar[9] 9
ME018 Medical Coverage Indicator - Medical Option Integer int[1] 1
ME019 Prescription Drug Coverage Indicator - Pharmacy Option Integer int[1] 1
ME020 Dental Coverage Indicator - Dental Option Integer int[1] 1
ME021 Race 1 Member's self-disclosed Primary Race Text char[2] 2
ME022 Race 2 Member's self-disclosed Secondary Race Text char[2] 2
ME023 Other Race Member's Other Race Text varchar[15] 15
ME024 Hispanic Indicator Indicator - Hispanic Status Integer int[1] 1
ME025 Ethnicity 1 Member's Primary Ethnicity External Code Source - CDC char[6] 6
ME026 Ethnicity 2 Member's Secondary Ethnicity External Code Source - CDC char[6] 6
ME027 Other Ethnicity Member's Other Ethnicity Text varchar[20] 20
ME028 Primary Insurance Indicator Indicator - Primary Insurance Coverage Integer int[1] 1
ME029 Coverage Type Type of Coverage Code Text char[3] 3
ME030 Group Size Group Size Code Integer varchar[4] 4
ME031 Filler Filler Filler char[0] 0
ME032 Filler Filler Filler char[0] 0
ME033 Member language preference Member's self-disclosed verbal language preference External Code Source - Census int[3] 3
ME034 Member language preference -Other Member's Other Language Preference Text varchar[20] 20
ME035 Medical Home Flag Medical Home indicator Integer int[1] 1
ME036 Medical Home Number Health Care Home ID Text varchar[30] 30
ME037 Medical Home Tax ID Number Health Care Home EIN Numeric char[9] 9
ME038 Medical Home National Provider ID - National Provider Identification (NPI) of the Health Care Home Provider External Code Source - NPPES int[10] 10
ME039 Health Care Home Name Name of Health Care Home Text varchar[60] 60
ME040 Product ID Number Product Identification Filler varchar[30] 30
ME041 Enrollment Start Date Start Date Integer int[8] YYYYMMDD 8
ME042 Enrollment End Date End Date Integer int[8] YYYYMMDD 8
ME043 Member Street Address Street address of the Member Text varchar[50] 50
ME044 Member Street Address 2 Secondary Street Address of the Member Text varchar[50] 50
ME045 Purchased through Access Health CT Flag Indicator - Access Health CT Integer int[1] 1
ME046 Member PCP ID Member's PCP ID Text varchar[30] 30
ME047 Filler Filler Filler char[0] 0
ME048 Filler Filler Filler char[0] 0
ME049 Member Deductible Annual maximum out-of- pocket Member Deductible across all benefit types Integer varchar[10] 10
ME050 Filler Filler Filler char[0] 0
ME051 Behavioral Health Benefit Flag Indicator - Behavioral Health Option Integer int[1] 1
ME052 Filler Filler Filler char[0] 0
ME053 Disease Management Enrollee Flag Chronic Illness Management indicator Integer int[1] 1
ME054 Filler Filler Filler char[0] 0
ME055 Business Type Code Business Type Integer int[1] 1
ME056 Filler Filler Filler char[0] 0
ME057 Date of Death Member's Date of Death Full Date - Integer int[8] YYYYMMDD 8
ME058 Subscriber Street Address Street address of the Subscriber Text varchar[50] 50
ME059 Disability Indicator Indicator - Disability Integer int[1] 1
ME060 Employment Status Employment Status Code Text char[1] 1
ME061 Student Status Indicator - Student Status Integer int[1] 1
ME062 Marital Status Marital Status Code Text char[1] 1
ME063 Benefit Status Benefit Status Code Text char[1] 1
ME064 Employee Type Employee Type Code Text char[1] 1
ME065 Date of Retirement Employee's Date of Retirement Integer int[8] YYYYMMDD 8
ME066 COBRA Status Indicator - COBRA Usage Integer int[1] 1
ME067 Filler Filler Filler char[0] 0
ME068 Filler Filler Filler char[0] 0
ME069 Filler Filler Filler char[0] 0
ME070 Filler Filler Filler char[0] 0
ME071 Pool Indicator Indicator - Pool Grouping Integer int[1] 1
ME072 Family Size Family Size as Contracted Integer varchar[2] 2
ME073 Fully Insured member Fully Insured identifier Integer int[1] 1
ME074 Interpreter Indicator - Interpreter Need Integer int[1] 1
ME075 Filler Filler Filler char[0] 0
ME076 Filler Filler Filler char[0] 0
ME077 Member's North American Industry Code (NAICS) Member's Standard NAICS Code External Code Source - NAICS varchar[6] 6
ME078 Employer Zip Code Zip Code of the Employer Numeric char[5] 5
ME079 Filler Filler Filler char[0] 0
ME080 Filler Filler Filler char[0] 0
ME081 Medicare Code Indicator - Medicare Plan Integer int[1] 1
ME082 Employer Name Member's Employer Name Text varchar[60] 60
ME083 Employer EIN Member's Employer EIN Numeric char[9] 9
ME101 Subscriber Last Name Last name of Subscriber Text varchar[60] 60
ME102 Subscriber First Name First name of Subscriber Text varchar[25] 25
ME103 Subscriber Middle Initial Middle initial of Subscriber Text char[1] 1
ME104 Member Last Name Last name of Member Text varchar[60] 60
ME105 Member First Name First name of Member Text varchar[25] 25
ME106 Member Middle Initial Middle initial of Member Text char[1] 1
ME107 Carrier Specific Unique Member ID Member's Unique ID Text varchar[50] 50
ME108 Subscriber City Name City name of the Subscriber Text varchar[30] 30
ME109 Subscriber State or Province State of the Subscriber External Code Source 2 - Text char[2] 2
ME110 Subscriber ZIP Code Zip Code of the Subscriber External Code Source 2 - Text varchar[9] 9
ME111 Filler Filler Filler char[0] 0
ME112 Filler Filler Filler char[0] 0
ME113 Filler Filler Filler char[0] 0
ME114 Filler Filler Filler char[0] 0
ME115 Dental Deductible Maximum out-of-pocket amount of member's deductible applied to Dental Benefits Integer varchar[10] 10
ME116 Vision Deductible Maximum out-of-pocket amount of member's deductible applied to Vision Benefits Integer varchar[10] 10
ME117 Carrier Specific Unique Subscriber ID Subscriber's Unique ID Text varchar[50] 50
ME118 Vision Benefit Indicator - Vision Option Integer int[1] 1
ME119 Filler Filler Filler char[0] 0
ME120 Actuarial Value Not Provided Decimal - Numeric varchar[6] 6
ME121 Metal Level Standardized plan level in metal reference Integer int[1] 1
ME122 Filler Filler Filler char[0] 0
ME123 Filler Filler Filler char[0] 0
ME124 Filler Filler Filler char[0] 0
ME125 Filler Filler Filler char[0] 0
ME126 Risk Adjustment Covered Plan (RACP) Subscriber / Member enrolled in a Risk Adjustment Plan Integer int[1] 1
ME127 Billable Member Indicator - Billable Member Integer int[1] 1
ME128 Filler Filler Filler char[0] 0
ME129 Filler Filler Filler char[0] 0
ME130 Filler Filler Filler char[0] 0
ME131 Filler Filler Filler char[0] 0
ME132 Total Monthly Premium Combined contribution of Employer + Subscriber Integer varchar[10] 10
ME133 Filler Filler Filler char[0] 0
ME134 APCD ID Code Member Enrollment Type Integer int[1] 1
ME899 Record Type Tile Type Identifier Text char[2] 2
TR001 Record Type Trailer Record Identifier Text char[2] 2
TR002 Submitter Trailer Submitter / Carrier ID defined by AHCT Integer varchar[6] 6
TR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
TR004 Type of File Validates the file type defined in HD004. Text char[2] 2
TR005 Period Beginning Date Trailer Period Start Date Full Date - Integer int[8] YYYYMMDD 8
TR006 Period Ending Date Trailer Period Ending Date Full Date - Integer int[8] YYYYMMDD 8
TR007 Date Processed Trailer Processed Date Full Date - Integer int[8] YYYYMMDD 8

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