United States Health Information Knowledgebase

 

Member ID Number

MEMBERIDN, Tennessee



Name:Member ID Number
Data Element ID:MEMBERIDN
Description:This field generally represents a unique combination of member fields unique to the payer. This field should not be used to aggregate all records associated with a member.
State:Tennessee
Data Type:Numeric
Length:15
Threshold:100%
Encrypt:No
Downloads
 
Download as an MS Excel™ spreadsheet.
[Download Excel Reader Exit Disclaimer]
 

File Specification for Member File Submission - January 31, 2014 - v1.0

Data Element ID Data Element Description Type Format Length
AGE Age This field contains the member's age. Note that: Children under the age of 1 are reported using a value of 0. If no date of birth is available, this value will be -1. Numeric 3
COVERAGE_LEVEL Coverage Level This field indicates the level of coverage. Its source is the Coverage Level Code element reported by the payer in the member eligibility data. Text 3
COVERAGE_TYPE Coverage Type This field indicates the type of coverage and is used to distinguish self-funded plans from commercially insured plans. Its source is the Coverage Type element reported by the payer in the member eligibility data. Text 3
COVG_EFF_DATE Coverage Effective Date Not Available Date 8
COVG_TERM_DATE Coverage Termination Date Not Available Date 8
GENDER Standardized Member Gender This field indicates the member's gender. Its source is the Member Gender element reported by the payer in the pharmacy claims data and medical claims data. Text 1
GROUP_NAME Insured Group Name This field contains the name of the group that covers the member as reported by the payer. If the member is part of a group of one or part of a non-group policy (i.e., when the Market Category Code (MARKET_CATEGORY) is coded as IND, FCH, GCV, or GS1), this field will be null (or display the value BLANK). Its source is the Group Name element in the member eligibility data. Text 128
INS_GROUP Insured Group or Policy Number This payer-supplied field contains the Insured Group or Policy Number associated with the entity that has purchased the insurance. If submitting an individual policy, use IND. For self-insured individuals, this relates to the purchaser. For the majority of eligibility and claims data, the group relates to the employer. The group number does not uniquely identify the subscriber. Text 30
MARKET_CATEGORY Market Category Code This field indicates the type of policy sold by the insurer. Its source is the Market Category Code element reported by the payer in the member eligibility data. Text 4
MEDICAL_COV_FLAG Medical Coverage Flag The medical coverage flag indicates whether this member is covered for medical expenses. Text 1
MEMBER_CITY Member City Name The city of residence for the person, for the most recent month of eligibility. Text 30
MEMBER_COUNTY Member County The county description for the residence of the person. Text 30
MEMBER_STATE Member State The state abbreviation for the residence of the person, for the most recent month of eligibility. Text 2
MEMBERIDN Member ID Number This field generally represents a unique combination of member fields unique to the payer. This field should not be used to aggregate all records associated with a member. Numeric 15
PAT_ZIPCODE Member Zip Code This payer-supplied field contains the member's ZIP code. Text 9
PAYER_NAME Payer Name Not Available Text 12
PAYER PAYER This field contains the Payer ID Number. This code is used to identify the data reporter. Its source is the Payer element reported by the payer in the pharmacy claims data and Payer element reported by the payer in the medical claims data. Text 8
PHARMACY_COV_FLAG Prescription Drug Coverage Flag This field indicates whether or not the member has prescription drug coverage. Text 1
PLAN_CODE Plan Code Not Available Text 8
PLAN_NPI National Plan ID This payer-supplied field contains the National Plan ID for the data reporter. This field is not populated. Char 30
PRIMARY_INS Primary Insurance Indicator This field indicates if the member has primary coverage or secondary/tertiary coverage. Text 1
PRODUCT Standardized Product Code or Insurance Type This field contains the code identifying the member's type of insurance or insurance product. Char 6
REL Individual Relationship to Subscriber This field contains the code indicating the member's relationship to the subscriber or the insured. Text 2
SPECIAL_COVERAGE Special Coverage This field indicates special coverage. Text 3
FILLER FILLER This field is reserved for additional fields that may be added in the future. Char 500

Scroll To Top