United States Health Information Knowledgebase

 

Medical Eligibility File Submission

Minnesota



Name:Medical Eligibility File Submission
State:Minnesota
Definition:"Health care claims data" means information included in an institutional, professional, or pharmacy drug claim or equivalent encounter information transaction for a covered individual that is required under Minnesota Statutes, section 62J.536.
VersionMay 2009

File Specification for Medical Eligibility File Submission

Data Element ID Data Element Description Type Format Length
HD001 Record Type Not Provided Text 2
HD002 Payer Payer Code Text 8
HD004 Type of File Not Provided Text 2
HD005 Period Beginning Date Not Provided Integer CCYYMM 6
HD006 Period Ending Date Not Provided Integer CCYYMM 6
HD007 Record Count Total number of records submitted in the file Integer 10
HD008 Comments Payer comments Text 80
ME001 Payer This field contains the NCDMS assigned submitter code for the data submitter. The first two characters of the submitter code indicate Minnesota and the third character designates the type of submitter. A single data submitter may have multiple submitter codes because the data submitter is submitting from more than one system or from more than one location. All submitter codes associated with a single data submitter will have the same first 6 characters. A suffix will be used to distinguish the location and/or system variations. This field contains a constant value and is primarily used for tracking compliance by data submitter. Text 8
ME003 Insurance Type / Product Code This field contains the insurance type or product code that indicates the type of insurance coverage the individual has. Code all but MC and XX as 2 characters; MC and XX must include a valid subcode. Text 6
ME004 Year The year during which the member is eligible for services. This field is generally used in conjunction with the month (ME005) to determine a specific period of eligibility. Integer 4
ME005 Month Month indicates the month during which the member is eligible for services. This field is generally used with the year field (ME004) to determine a specific period of eligibility. Integer 2
ME009 Plan Specific Contract Number This field contains the data submitter assigned contract number for the subscriber. This field is encrypted using the same algorithm across all data submitters and is not available in the analytical data warehouse. When this field is populated, it forms the core of the unique member identification code. Set as null if unavailable. Text 128
ME012 Individual Relationship Code This field contains the member's relationship to the subscriber or the insured. Integer 2
ME013 Member Gender Member's gender Text 1
ME014 Member Date of Birth This field contains the member's data of birth with a format of CCYYMMDD. During the encryption process, this field is used to calculate age as of the first day of the membership month. The field is then encrypted. This data element will not be transmitted in unencrypted form. Date CCYYMMDD 8
ME015 Member City Name This field contains the member's city of residence. Text 30
ME016 Member State or Province The member state or province contains the 2 character abbreviation code used by the US Postal Service. Text 2
ME017 Member ZIP Code This field contains ZIP code of the member. Text 5
ME018 Medical Coverage The medical coverage flag indicates whether this member is covered for medical expenses. This is an administrative field required by NCDMS and derived from the enrollment data maintained by the data submitter. Text 1
ME019 Prescription Drug Coverage The prescription drug coverage flag indicates whether this member is covered for prescription drug expenses. This is an administrative field required by NCDMS and derived from the enrollment data maintained by the data submitter. Text 1
ME032 Health Care Home Assigned Flag This flags whether the member reported has an approved medical home for this coverage period Text 1
ME033 Health Care Home Number Data submitter assigned medical home number. It is anticipated that this will be the same data submitter number used in reporting servicing provider. This field will be used to create a master provider index for Minnesota providers encompassing medical service providers, prescribing physicians and medical homes. Text 30
ME034 Health Care Home Tax ID Number Federal tax payer's identification number for medical home. This field will be used to create a master provider index for Minnesota providers encompassing medical service providers, prescribing physicians and medical homes Text 10
ME035 Health Care Home National Provider ID Report the National Provider Identification (NPI) number for the entity or individual serving as the medical home. This field will be used to create a master provider index for Minnesota providers encompassing medical service providers, prescribing physicians and medical homes. Text 20
ME036 Health Care Home Name Report the full name of the provider - facility, organization or individual. If the medical home is an individual, report in the format of Last name, first name and middle initial with no punctuation. Text 60
ME101 Subscriber Last Name Subscriber last name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME102 Subscriber First Name Subscriber first name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME103 Subscriber Middle Initial Subscriber middle initial, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
ME104 Member Last Name Member last name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME105 Member First Name Member first name, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 128
ME106 Member Middle Initial Member middle initial, used to create a unique de-identified member ID. It is encrypted at the data submitter's site. This data element will not be available in the data warehouse. Text 1
ME899 Record Type This field indicates the type of record. ME Eligibility This is an administrative field required by NCDMS and populated with a constant value. Text 2
TR001 Record Type Not Provided Text 2
TR002 Payer Payer Code Text 8
TR004 Type of File Not Provided Text 2
TR005 Period Beginning Date Not Provided Integer YYYYMM 6
TR006 Period Ending Date Not Provided Integer YYYYMM 6
TR007 Date Processed Date file was created Date CCYYMMDD 8

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Data Element ID Data Element Code Value
HD001 Record Type HD Header Record
HD004 Type of File ME Enrollment
ME001 Payer MNC Commercial carrier
MNG Governmental agency
MNT Third Party Administrator
MNU Unlicensed entity
ME003 Insurance Type / Product Code 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's Group Health Plan
14 Medicare Secondary, No-fault Insurance Including Auto is Primary
15 Medicare Secondary Worker's Compensation
16 Medicare Secondary Public Health Service or Other Federal Agency
41 Medicare Secondary Black Lung
42 Medicare Secondary Veteran's Administration
43 Medicare Secondary Disabled Beneficiary Under Age 65 with Large Group Health
47 Medicare Secondary, Other Liability Insurance is Primary
CP Medicare Conditionally Primary
D Disability
DB Disability Benefits
EP Exclusive Provider Organization
HM Health Maintenance Organization (HMO)
HN Health Maintenance Organization (HMO) Medicare Risk / Medicare Part C
HS Special Low Income Medicare Beneficiary
IN Indemnity
MA Medicare Part A
MB Medicare Part B
MCFFSM Medical Assistance - Fee-for-service Medical Assistance
MCMDHO Medical Assistance - MN Disability Health Options
MCMISC Medical Assistance - Other managed care program within Medical Assistance
MCMSHO Medical Assistance - MN Senior Health Options
MCPMAP Medical Assistance - Prepaid Medical Assistance Program
MCSNBC Medical Assistance - Special Needs Basic Care
MD Medicare Part D
MH Medigap Part A
MI Medigap Part B
MP Medicare Primary
PR Preferred Provider Organization (PPO)
PS Point of Service (POS)
QM Qualified Medicare Beneficiary
SP Supplemental Policy
XXCDEP Non-Medical-Assistance Public Program - Chemical Dependency
XXGAMC Non-Medical-Assistance Public Program - General Assistance Medical Care
XXHIVA Non-Medical-Assistance Public Program - HIV/AIDS
XXMCHA Non-Medical-Assistance Public Program - Minnesota Comprehensive Health Association
XXMISC Non-Medical-Assistance Public Program - Other non-Medical Assitance public program
XXMNCR Non-Medical-Assistance Public Program - MinnesotaCare
ME012 Individual Relationship Code 01 Spouse
18 Self
19 Child
21 Unknown
34 Other Adult
ME013 Member Gender F Female
M Male
U Unknown
ME018 Medical Coverage N No
Y Yes
ME019 Prescription Drug Coverage N No
Y Yes
ME032 Health Care Home Assigned Flag 1 Yes
2 No
3 Unknown
ME899 Record Type ME Eligibility
TR001 Record Type TR Trailer
TR004 Type of File ME Enrollment
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