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All Payer Claims: Data Element Comparison

Selected Items
Action Name Data Element ID Version State/Organization
Individual Relationship Code PC011 2010-03-16 Maine
Individual Relationship Code PC011 v1.2 Maine
Data Element: Individual Relationship Code PC011 - 2010-03-16
(Maine)
Individual Relationship Code PC011 - v1.2
(Maine)
[Shared]Data Element ID PC011 PC011
[Unshared]Definition Member's relationship to insured This field contains the member's relationship to the subscriber or the insured.
[Shared] State / Source Maine
Maine
[Unshared]Data Type integer CHAR
[Shared]Length 2 2
[Shared]Field Name REL REL
[Unshared]DATE AVAIL '1/1/2003 Not Supplied
[Unshared]Date Required Not Supplied '2003-01-31
[Unshared]Warnings Not Supplied Although there are several code values for distinguishing between the various relationships, some payers do not maintain this level of specificity in their systems. Some payers are only able to distinguish between the subscriber/employee and the dependent. Summarizing the data across payers by the individual relationship to the subscriber may cause an under reporting of spouse records. A valid relationship code is required for a minimum of 97% of records submitted. Payers must verify submissions with more than 80% of the records associated with a relationship of subscriber.
Data Element: Individual Relationship Code PC011 - 2010-03-16
(Maine)
Individual Relationship Code PC011 - v1.2
(Maine)
[Unshared]01 Not Utilized Spouse
[Unshared]04 Not Utilized Grandfather or Grandmother
[Unshared]05 Not Utilized Grandson or Granddaughter
[Unshared]07 Not Utilized Nephew or Niece
[Unshared]10 Not Utilized Foster Child
[Unshared]15 Not Utilized Ward
[Unshared]17 Not Utilized Stepson or Stepdaughter
[Unshared]19 Not Utilized Child
[Unshared]20 Not Utilized Employee/Self
[Unshared]21 Not Utilized Unknown
[Unshared]22 Not Utilized Handicapped Dependent
[Unshared]23 Not Utilized Sponsored Dependent
[Unshared]24 Not Utilized Dependent of a Minor Dependent
[Unshared]29 Not Utilized Significant Other
[Unshared]32 Not Utilized Mother
[Unshared]33 Not Utilized Father
[Unshared]36 Not Utilized Emancipated Minor
[Unshared]39 Not Utilized Organ Donor
[Unshared]40 Not Utilized Cadaver Donor
[Unshared]41 Not Utilized Injured Plaintiff
[Unshared]43 Not Utilized Child Where Insured Has No Financial Responsibility
[Unshared]53 Not Utilized Life Partner
[Unshared]76 Not Utilized Dependent
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