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Medical Eligibility File Submission

Rhode Island

Versions: February 2014 - v1.1• June 2014 - v1.3Compare Versions


Name:Medical Eligibility File Submission
State:Rhode Island
Definition:Not provided
VersionJune 2014 - v1.3

File Specification for Medical Eligibility File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type This field must be coded HD to indicate the start of the header record. Text 2
Multiple versionsHD002 Submitter Code This field must contain the submitter code assigned to you by Onpoint Health Data. Text 8
Multiple versionsHD003 Placeholder This field must be coded as null; it is reserved for header consistency across all clients using Onpoint Health Data's APCD services. Text 30
Multiple versionsHD004 Type of File This field must be coded ME to indicate submission of eligibility data. Text 2
Multiple versionsHD005 Period Beginning Date Use this field to report the earliest eligibility year/month included in the submission in CCYYMM format. Submissions with records containing an eligibility period (ME004, ME005) before this date will fail. Integer 6
Multiple versionsHD006 Period Ending Date Use this field to report the latest eligibility year/month included in the submission in CCYYMM format. Submissions with records containing an eligibility period (ME004, ME005) after this date will fail. Integer CCYYMM 6
Multiple versionsHD007 Record Count Use this field to report the total number of records in the submission, excluding the header and trailer records. If the number of records within the submission does not equal the number reported in this field, the submission will fail. Integer 10
Multiple versionsHD008 Comments This field may be used by the submitter to document a file name, system source, or other administrative device to assist with their internal tracking of the submission. Text 80
Multiple versionsME001 Submitter Code Use this field to report your Onpoint-assigned submitter code for the data submitter. Note that the first two characters of the submitter code are used to indicate the reporting state and the third character designates the type of submitter. Notes: A single data submitter may have multiple submitter codes if they are 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 six 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
Multiple versionsME002 NAIC Use this field to report, at a record level, the code as assigned by the NAIC that uniquely identifies the applicable insurance plan. If no NAIC number has been assigned, report as "0". Text 5
Multiple versionsME003 Insurance Type / Product Code Use this field to report the member's type of insurance or insurance product. Notes: The value reported for this field should be reported consistently in the "Insurance Type / Product Code" field in both the medical claims (MC003) and pharmacy claims (PC003) data. To ensure reporting consistency between submitters, all Medicare Advantage plans should use the code "HN" to denote a Health Maintenance Organization (HMO) - Medicare Risk. Valid codes are maintained by the Accredited Standards Committee (ASC) and are available in the ASC X12 transaction set. Text 2
Multiple versionsME004 Year Use this field to report the year of eligibility using a 4-digit format of CCYY (e.g., January 1972, would be coded as "1972"). Integer CCYY 4
Multiple versionsME005 Month Use this field to report the month of eligibility using a 2-digit format of MM (e.g., January would be coded as "01"). Text MM 2
Multiple versionsME005A Days Eligible Use this field to report the number of days for which the member was eligible during this reporting period. Integer 3
Multiple versionsME006 Insured Group or Policy Number Use this field to report the group or policy number. Notes: The value reported for this field should be reported consistently in the "Insured Group or Policy Number" field in both the medical claims (MC006) and pharmacy claims (PC006) data. This is not the number that uniquely identifies the subscriber. If a policy is sold to an individual as a non-group policy, then both the Insured Group or Policy Number (ME006) and Group Name (ME037) should be reported with a value of "IND". This principle pertains to all claim types: commercial, Medicaid, and Medicare. Text 50
Multiple versionsME007 Coverage Level Code Use this field to report the benefit level of coverage. Notes: Valid codes are maintained by the Accredited Standards Committee (ASC) and are available in the ASC X12 transaction set. Text 3
Multiple versionsME008 Subscriber Social Security Number Use this field to report the subscriber's 9-digit Social Security number. Notes: The value reported for this field should be reported consistently in the "Subscriber Social Security Number" field in both the medical claims (MC007) and pharmacy claims (PC007) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 9
Multiple versionsME009 Plan-Specific Contract Number Use this field to report the submitter-assigned contract number for the subscriber. Notes: The value reported for this field should be reported consistently in the "Plan-Specific Contract Number" field in both the medical claims (MC008) and pharmacy claims (PC008) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 80
Multiple versionsME010 Member Suffix or Sequence Number Use this field to report the unique number of the member within the contract. Text 20
Multiple versionsME010A Unique Member Identifier Use this field to report the Unique Member Identifier assigned by the Lockbox Vendor. Notes: The value for this field will be supplied in the Response File from the Lockbox Vendor using the field RF017. The value reported for this field should be reported consistently in the Unique Member Identifier field in both the medical claims (MC010A) and pharmacy claims (PC010A) data. String 32
Multiple versionsME010B Unique Member Identifier (Legacy) Use this field to report the Unique Member Identifier (Legacy) previously assigned by the Lockbox Vendor. Notes: The value for this field will be supplied in the Response File from the Lockbox Vendor using the field RF020. This legacy ID has been replaced by the Unique Member Identifier reported above in ME010A. This change is due to the merging or splitting of the member's previously assigned Unique Member Identifier as identified by the code reported in the Response File from the Lockbox Vendor using the field RF019 (and below in ME010C). String 32
Multiple versionsME010C Unique Member Identifier Merge/Split Indicator Use this field to report a code that indicates whether a legacy ID was created because a member's ID was merged with another ID (for a member identified by the Lockbox Vendor as being reported duplicatively) or split into a different ID (for a member identified by the Lockbox Vendor as incorrectly previously grouped under a single Unique Member ID) Notes: The value for this field will be supplied in the Response File from the Lockbox Vendor using the field RF019. Text 1
Multiple versionsME010D Member Opt-Out Status Use this field to indicate that a member has elected to opt out of having their data submitted to the APCD as provided to you in the Lockbox Vendor's Response File using field RF018. Notes: The value for this field will be supplied in the Response File from the Lockbox Vendor using the field RF018. Even though you may have submitted a value of I for this field to the Lockbox Vendor, indicating inclusion in the APCD, the member may have requested to opt out via another insurer or the Opt- Out Portal, therefore, therefore requiring a value of O to be returned to all insurers providing coverage for the same individual. If the value reported in the Member Opt-Out Status field is O, the only reportable data fields for this record are Submitter Code (ME001), Year (ME004), Month (ME005), Unique Member Identifier (ME010A), and Member Opt-Out Status (ME010D) and Record Type (ME899); all other fields must be reported as null. Text 1
Multiple versionsME011 Member Social Security Number Use this field to report the member's 9-digit Social Security number. Notes: The value reported for this field should be consistently reported in the "Member Social Security Number" field in both the medical claims (MC010) and pharmacy claims (PC010) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 9
Multiple versionsME012 Member Relationship Use this field to report the member's relationship to the subscriber or the insured. Notes: The value reported for this field should be consistently reported in the "Member Relationship" field in both the medical claims (MC011) and pharmacy claims (PC011) data. Valid codes are maintained by the Accredited Standards Committee (ASC) and are available in the ASC X12 transaction set. Text 2
Multiple versionsME013 Member Gender Use this field to report the member's gender. Notes: The value reported for this field should be consistently reported in the "Member Gender" field in both the medical claims (MC012) and pharmacy claims (PC012) data. Text 1
Multiple versionsME014 Member Date of Birth Use this field to report the member's date of birth using an 8-digit format of CCYYMMDD (e.g., January 18, 1972, would be coded as "19720118"). Notes: The value reported for this field should be consistently reported in the "Member Date of Birth" field in both the medical claims (MC013) and pharmacy claims (PC013) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Immediately prior to hashing this field, Onpoint's hashing application calculates a member's age in months based on the Member Date of Birth field (ME014, MC013, PC013). The Member Date of Birth field is then hashed and both the hashed value and the value- added Age in Months element are submitted to the APCD - the hashed value to allow for quality assurance review, the de-identified Age in Months to enable analytic use of the APCD. Date CCYYMMDD 8
Multiple versionsME015 Member City Use this field to report the name of the member's city of residence. Text 30
Multiple versionsME016 Member State or Province Use this field to report the member's state or province using the two-character abbreviation code defined by the U.S. Postal Service (for U.S. states) and Canada Post (for Canadian provinces). Text 2
Multiple versionsME017 Member ZIP/Postal Code Use this field to report the ZIP/postal code of the member's residence. Notes: For U.S. ZIP codes, include the ZIP+4 (also referred to as the "plus-four" or "add-on" code). Do not code dashes or spaces within ZIP/postal codes. Text 9
Multiple versionsME018 Medical Coverage Use this field to report whether or not the member had medical coverage during the reported period. Text 1
Multiple versionsME019 Prescription Drug Coverage Use this field to report whether or not the member had prescription drug coverage during the reported period. Y ...................... Yes N...................... No Text 1
Multiple versionsME021 Race - 1 Use this field to report the member's primary race. If data has not been collected, leave as null. Text 6
Multiple versionsME022 Race - 2 Use this field to report the member's secondary race. If data has not been collected, leave as null. Text 6
Multiple versionsME023 Race - Other Use this field to report a member's self-disclosed race when ME021 or ME022 is reported as R9 (Other Race). Notes: Leave null if not applicable. Text 15
Multiple versionsME024 Hispanic Indicator Use this field to report whether or not a member has identified as Hispanic. Notes: If the data has not been collected, leave as null. Text 1
Multiple versionsME025 Ethnicity - 1 Use this field to report the member's primary ethnicity. Notes: The code "UNKNOW" (Unknown / Not specified) should be used only when a member answers unknown or refuses to answer. If data has not been collected, leave as null. Text 6
Multiple versionsME026 Ethnicity - 2 Use this field to report the member's secondary ethnicity. Notes: The code "UNKNOW" (Unknown / Not specified) should be used only when a member answers unknown or refuses to answer. If data has not been collected, leave as null. Text 6
Multiple versionsME027 Ethnicity - Other Use this field to report a member's self-disclosed ethnicity when either ME025 or ME026 is reported as OTHER (Other ethnicity). Notes: Leave null if not applicable. Text 20
Multiple versionsME028 Primary Insurance Indicator Use this field to report whether or not this coverage is primary. Text 1
Multiple versionsME029 Coverage Type Use this field to report the type of coverage, distinguishing self-funded plans from commercially insured plans. Text 3
Multiple versionsME030 Market Category Code Use this field to report the type of policy sold by the insurer. Text 4
Multiple versionsME031 Placeholder N/A N/A N/A
Multiple versionsME032 PCMH Assigned Flag Use this field to report whether or not the member has an approved medical home for this coverage period. Text 1
Multiple versionsME033 PCMH Number Use this field to report the submitter-assigned number for the medical home when ME032 is reported as Y. Notes: Leave null if not applicable. Text 30
Multiple versionsME034 PCMH Tax ID Use this field to report the federal taxpayer's identification number for the medical home when ME032 is reported as Y. Notes: Leave null if not applicable. Text 9
Multiple versionsME035 PCMH NPI Use this field to report the National Provider Identifier (NPI) for the medical home when ME032 is reported as Y. Notes: Leave null if not applicable. Text 10
Multiple versionsME036 PCMH Name Use this field to report the full name of the medical home when ME032 is reported as Y. Notes: If an individual, report in the format of last name, first name, and middle initial with no punctuation (e.g., John J. Doe would be reported as "DOEJOHNJ"). Leave null if not applicable. Text 60
Multiple versionsME037 Group Name Use this field to report the name of the group that covers the member. Notes: If a policy is sold to an individual as a non-group policy, then both the Insured Group or Policy Number (ME006) and Group Name (ME037) should be reported with a value of "IND". This principle pertains to all claim types: commercial, Medicaid, and Medicare. Text 60
Multiple versionsME050 Assigned Primary Care Provider Flag Use this field to report whether or not the member identified a primary care provider at the time of enrollment. Text 1
Multiple versionsME051 Assigned Primary Care Provider Plan ID Use this field to report the submitter-assigned or legacy provider plan ID for the member's primary care provider. Note: The provider data reported in the eligibility, claims, and provider files are used to create a Provider Master Index that is used to match the data across all file types. It is expected that a provider's identifiers (e.g., plan-assigned ID, NPI, etc.) will be reported consistently by a submitter across file types as this is the payer-assigned provider ID (ME051, MC024, PC048A, PV006). Text 50
Multiple versionsME052 Assigned Primary Care Provider NPI Use this field to report the National Provider Identifier (NPI) for the member's assigned primary care provider. Text 10
Multiple versionsME053 Assigned Primary Care Provider Last Name Use this field to report the last name of the member's assigned primary care provider. Text 60
Multiple versionsME054 Assigned Primary Care Provider First Name Use this field to report the first name of the member's assigned primary care provider. Text 35
Multiple versionsME055 Assigned Primary Care Provider Middle Initial Use this field to report the middle initial of the member's assigned primary care provider. Text 1
Multiple versionsME056 Assigned Primary Care Provider Street Address 1 Use this field to report the first line of the street address for the member's assigned primary care provider. Text 55
Multiple versionsME057 Assigned Primary Care Provider Street Address 2 Use this field to report the second line of the street address for the member's assigned primary care provider (if needed). Text 55
Multiple versionsME058 Assigned Primary Care Provider City Use this field to report the city of the member's assigned primary care provider. Text 30
Multiple versionsME059 Assigned Primary Care Provider State or Province Use this field to report the state or province of the member's assigned primary care provider using the two-character abbreviation defined by the U.S. Postal Service (for U.S. states) and Canada Post (for Canadian provinces). Text 2
Multiple versionsME060 Assigned Primary Care Provider ZIP/Postal Code Use this field to report the ZIP/postal code of the member's assigned primary care provider. Notes: For U.S. ZIP codes, include the ZIP+4 (also referred to as the "plus-four" or "add-on" code). Do not code dashes or spaces within ZIP/postal codes. Text 9
Multiple versionsME070 Purchased Through Exchange Indicator Use this field to indicate whether or not the product was purchased through the Rhode Island Health Benefits Exchange. Text 1
Multiple versionsME071 Exchange Market Type Use this field to report the type of policy sold by the insurer through the Exchange. Text 2
Multiple versionsME072 HIOS ID Use this field to report the member's type of insurance or insurance product provided through the Exchange. Text 17
Multiple versionsME073 Exchange Metallic Tier Use this field to report the metallic tier that designates the level of the member's Exchange product. Text 1
Multiple versionsME080 Placeholder N/A N/A N/A
Multiple versionsME081 Placeholder N/A N/A N/A
Multiple versionsME082 Placeholder N/A N/A N/A
Multiple versionsME083 Placeholder N/A N/A N/A
Multiple versionsME084 Placeholder N/A N/A N/A
Multiple versionsME101 Subscriber Last Name Use this field to report the subscriber's last name. Notes: The value reported for this field should be consistently reported in the "Subscriber Last Name" field in both the medical claims (MC101) and pharmacy claims (PC101) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 60
Multiple versionsME102 Subscriber First Name Use this field to report the subscriber's first name. Notes: The value reported for this field should be consistently reported in the "Subscriber First Name" field in both the medical claims (MC102) and pharmacy claims (PC102) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 35
Multiple versionsME103 Subscriber Middle Initial Use this field to report the subscriber's middle initial. Notes: The value reported for this field should be consistently reported in the "Subscriber Middle Initial" field in both the medical claims (MC103) and pharmacy claims (PC103) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 1
Multiple versionsME104 Member Last Name Use this field to report the member's last name. Notes: The value reported for this field should be consistently reported in the "Member Last Name" field in both the medical claims (MC104) and pharmacy claims (PC104) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 60
Multiple versionsME105 Member First Name Use this field to report the member's first name. Notes: The value reported for this field should be consistently reported in the "Member First Name" field in both the medical claims (MC105) and pharmacy claims (PC105) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 35
Multiple versionsME106 Member Middle Initial Use this field to report the member's middle initial. Notes: The value reported for this field should be consistently reported in the "Member Middle Initial" field in both the medical claims (MC106) and pharmacy claims (PC106) data. This field will be rendered non-recoverable through the use of a one-way hashing algorithm prior to transmission to Onpoint. Upon receipt by Onpoint, this field will be a text field with a length of 128. Text 1
Multiple versionsME201 Aid Category For Medicaid claims only, use this field to report the member's Medicaid aid category based on service date. Text 2
Multiple versionsME202 Dual Eligibility Flag For Medicaid and Medicare claims only, use this field to report whether or not a member had both Medicaid and Medicare coverage (i.e., dual coverage) for the reported membership month. Text 2
Multiple versionsME203 Placeholder N/A N/A N/A
Multiple versionsME205 Long-Term Care (LTC) Coverage Flag For Medicaid claims only, use this field to report the level of care provided to a member who had long-term care coverage for the reported membership month. Text 1
Multiple versionsME206 Attributed Income Level For Medicaid claims only, use this field to report the member's attributed income level for the reported membership month. These codes are based on aid categories and tie back to a member's specific eligibility, which may cause overlap in code values. Notes: Do not include the decimal point when coding this field. Text 1
Multiple versionsME212 Third-Party Liability Flag For Medicaid claims only, use this field to indicate that the member was covered by commercial insurance as well. Text 1
Multiple versionsME213 Medicaid Program Code Use this field to report the Medicaid program in which the member was enrolled for the reported month. Text 2
Multiple versionsME401 Date of Death Use this field to report the member's date of death using an 6-digit format of CCYYMM (e.g., January 1972 would be coded as "197201"). Date CCYYMM 8
Multiple versionsME402 Risk Score For Medicare claims only, use this field to report the member's most recent risk score. Notes: Always report with three decimal places. Do not code the decimal place when reporting this field to Onpoint. Decimal 22,3
Multiple versionsME404 Hospice Status Indicator For Medicare claims only, use this field to report whether or not a patient was enrolled in hospice. Text 2
Multiple versionsME405 Medicare Advantage Indicator For Medicare claims only, use this field to report whether or not the member is a participant in a group health organization (GHO). Text 2
Multiple versionsME406 Medicare Status Indicator For Medicare claims only, use this field to report the member's Medicare status with relationship to Aged, ESRD (End Stage Renal Disease), and Disability. Text 2
Multiple versionsME407 Monthly Reason For Entitlement For Medicare claims only, use this field to report whether the member qualified for Medicare for a specific reported eligibility month as Aged, Disabled, ESRD (End Stage Renal Disease), or Disabled and ESRD. Text 2
Multiple versionsME408 Original Reason For Entitlement For Medicare claims only, use this field to report the reason for the beneficiary's original entitlement to Medicare benefits. Text 2
Multiple versionsME899 Record Type Use this field to report the constant value of "ME" to denote a member eligibility record. Text 2
Multiple versionsTR001 Record Type This field must be coded TR to indicate the start of the trailer record. Text 2
Multiple versionsTR002 Submitter Code This field must contain the submitter code assigned to you by Onpoint Health Data. Text 8
Multiple versionsTR003 Placeholder This field must be coded as null; it is reserved for trailer consistency across all clients using Onpoint CDM. Text 30
Multiple versionsTR004 Type of File This field must be coded ME to indicate submission of eligibility data. Text 2
Multiple versionsTR005 Period Beginning Date Use this field to report the earliest eligibility year/month included in the submission in CCYYMM format. Submissions with records containing an eligibility period (ME004, ME005) before this date will fail. Integer CCYYMM 6
Multiple versionsTR006 Period Ending Date Use this field to report the latest eligibility year/month included in the submission in CCYYMM format. Submissions with records containing an eligibility period (ME004, ME005) after this date will fail. Integer CCYYMM 6
Multiple versionsTR007 Date Processed Use this field to report the date on which the file was created in CCYYMMDD format. Date CCYYMMDD 8

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Data Element ID Data Element Code Value
HD001 Record Type HD header record
HD003 Placeholder Null
HD004 Type of File ME eligibility data
ME001 Submitter Code RIC Commercial carrier
RIG Governmental agency
RIT Third-party administrator
ME010C Unique Member Identifier Merge/Split Indicator M Merged
S Split
ME010D Member Opt-Out Status I Included
O Omitted
U Unknown
ME013 Member Gender F Female
M Male
U Unknown
ME018 Medical Coverage N No
Y Yes
ME019 Prescription Drug Coverage N No
Y Yes
ME021 Race - 1 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 Race - 2 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
ME024 Hispanic Indicator N No
U Unknown
Y Yes
ME025 Ethnicity - 1 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 Ethnicity - 2 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
ME028 Primary Insurance Indicator N No
P Partial (Includes CNOM, EFT, etc) (for Medicaid use only)
Y Yes
ME029 Coverage Type 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 Market Category Code 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
ME032 PCMH Assigned Flag N No
U Unknown
Y Yes
ME050 Assigned Primary Care Provider Flag N No
U Unknown
Y Yes
ME070 Purchased Through Exchange Indicator N No
Y Yes
ME071 Exchange Market Type IN Individual
SG Small group
SH SHOP
ME073 Exchange Metallic Tier 0 Unknown / Not Applicable
1 Bronze
2 Silver
3 Gold
4 Platinum
5 Catastrophic
ME212 Third-Party Liability Flag N No
Y Yes
ME899 Record Type ME member eligibility record
TR001 Record Type TR trailer record
TR003 Placeholder Null
TR004 Type of File ME eligibility data
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