United States Health Information Knowledgebase

 

Medical Eligibility File Submission

Connecticut



Name:Medical Eligibility File Submission
State:Connecticut
Definition:Not provided
VersionDecember 5, 2013 - v1.2

File Specification for Medical Eligibility File Submission

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

Downloads
PDF
Download as a PDF file.
[Download PDF Reader Exit Disclaimer]
Download as an MS Excel™ spreadsheet.
[Download Excel Reader Exit Disclaimer]
Data Element ID Data Element Code Value
HD001 Record Type HD Header Elements
HD004 Type of File ME MEMBER ELIGIBILITY
HD009 APCD Version Number 1 Current Version; required for reporting periods as of October 2013
ME003 Insurance Type Code/Product 9 Self-pay
11 Other Non-Federal Programs(use of this value requires disclosure to Data Manager prior to submission)
12 Preferred Provider Organization (PPO)
13 Point of Service (POS)
14 Exclusive Provider Organization (EPO)
15 Indemnity Insurance
16 Health Maintenance Organization (HMO) Medicare Risk
17 Dental Maintenance Organization (DMO)
96 Husky Health A
97 Husky Health B
98 Husky Health C
99 Husky Health D
AM Automobile Medical
CH Champus (now TRICARE)
CI Commercial Insurance
DS Disability
HM Health Maintenance Organization
LM Liability Medical
MA Medicare Part A
MB Medicare Part B
MC Medicaid
OF Other Federal Program(use of this value requires disclosure to Data Manager prior to submission)
TV Title V
VA Veterans Affairs Plan
WC Workers' Compensation
ZZ Mutually Defined (use of this value requires disclosure to Data Manager prior to submission)
ME007 Coverage Level Code CHD Children Only
DEP Dependents Only
ECH Employee and Children
ELF Employee and Life Partner
EMP Employee Only
ESP Employee and Spouse
FAM Family
IND Individual
SPC Spouse and Children
SPO Spouse Only
UNK Unknown
ME012 Individual Relationship Code 1 Spouse
4 Grandfather or Grandmother
5 Grandson or Granddaughter
7 Nephew or Niece
10 Foster Child
12 Other Adult
15 Ward
17 Stepson or Stepdaughter
19 Child
20 Self / Employee
21 Unknown
22 Handicapped Dependent
23 Sponsored Dependent
24 Dependent of a Minor Dependent
29 Significant Other
32 Mother
33 Father
34 Other Adult
36 Emancipated Minor
39 Organ Donor
40 Cadaver Donor
41 Injured Plaintiff
43 Child Where Insured Has No Financial Responsibility
53 Life Partner
76 Dependent
ME013 Member Gender F Female
M Male
U Unknown
ME018 Medical Coverage 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME019 Prescription Drug Coverage 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME020 Dental Coverage 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
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
UN 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
UN Unknown/not specified
ME024 Hispanic Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME028 Primary Insurance Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
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. Insurers using this code shall obtain prior approval.
STN Short-term, non-renewable health insurance
UND Plans underwritten by the insurer
ME030 Group Size 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 between 51 and 99 employees
GLG2 Policies sold and issued directly to employers having between 100 and 249 employees
GLG3 Policies sold and issued directly to employers having between 250 and 499 employees
GLG4 Policies sold and issued directly to employers having 500 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 between 10 and 25 employees
GS4 Policies sold and issued directly to employers having between 26 and 50 employees
GSA Policies sold and issued directly to small employers through a qualified association trust
OTH Policies sold to other types of entities. Insurers using this market code shall obtain prior approval.
ME035 Medical Home Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME045 Purchased through Access Health CT Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME051 Behavioral Health Benefit Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME053 Disease Management Enrollee Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME055 Business Type Code 0 Unknown / Not Applicable
1 Risk Holder
2 TPA - Third Party Administrator
3 DBA - Delegated Business Administrator
4 PBM - Pharmacy Benefit Manger
5 DBM - Dental Benefit Manager
6 CSO - Computer Service Organization
7 Other
ME059 Disability Indicator 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME060 Employment Status A Active
I Involuntary Leave
O Orphan
P Pending
R Retiree
U Unknown
Z Unemployed
ME061 Student Status 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME062 Marital Status C Common Law Married
D Divorced
M Married
P Domestic Partnership
S Never Married
U Unknown
W Widowed
X Legally Separated
ME063 Benefit Status A Active
C COBRA
P Pending
S Surviving Insured
T TEFRA
U Unknown
ME064 Employee Type H Hourly
Q Seasonal
S Salaried
T Temporary
U Unknown
ME066 COBRA Status 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME071 Pool Indicator 1 State Employee - Active
2 State Employee - Retired
3 Federal Employee - Active
4 Federal Employee - Retired
5 Municipal Employee - Active
6 Municipal Employee - Retired
ME073 Fully Insured member 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME074 Interpreter 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME081 Medicare Code 0 No Medicare Coverage
1 Part A Only
2 Part B Only
3 Part A and B
4 Part C Only
5 Advantage
6 Part D Only
9 Not Applicable
ME118 Vision Benefit 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
ME121 Metal Level 0 Unknown / Not Applicable
1 Bronze
2 Silver
3 Gold
4 Platinum
5 Catastrophic
ME126 Risk Adjustment Covered Plan (RACP) 1 Yes
2 No
ME127 Billable Member 1 Yes
2 No
ME134 APCD ID Code 0 Unknown / Not Applicable
1 FIG - Fully-Insured Commercial Group Enrollee
2 SIG - Self-Insured Group Enrollee
3 State or Federal Employer Enrollee
4 Individual - Non-Group Enrollee
5 Supplemental Policy Enrollee
6 ICO - Integrated Care Organization
ME899 Record Type ME
TR001 Record Type TR Indicates the end of the data file.
TR004 Type of File ME
Scroll To Top