Report the amount the subscriber is responsible for on a monthly to maintain this line of eligibility. Report 0 only when the subscriber is contractually free of this obligation. Expected Required for Risk Assessment and Monthly ME 2/2016 Integer Currency varchar[10] Monthly Division of Insurance reporting. Repeat Required 100% A2 Premium Premium the subscriber’s premium on the member’s record. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 For ME124, carriers should report PCPs attributed to the members based whose insurance products do not require the All selection of a primary care physician (e.g. PPO or Indemnity products). This Required in attribution is based on the carrier’s own December file PV002 for attribution methodology. only. Attributed PCP ID Link to Required ME PCP 2/2016 Text varchar[30] attributed to 100% A2 PV002 (ME046 (Member PCP) is only used for when ME046 Provider ID the patient for members whose insurance products is prior year. require the selection of a PCP (e.g., ‘999999999U’ HMO or POS).) Reported in December or only, for the year prior to the current year. For example: the December 2013 or missing. file reports the Attributed PCP for 2012 for members enrolled in 2012. Required for Total Medical Expense Reporting. OrgID specific. Report the TME Local Practice Group Provider Assigned TME OrgID OrgID for the Physician Group of the submitters - Physician Member’s PCP, and not the place of only. Group of TME Provider TME Provider ME Integer varchar[6] service for the claim. Required in 100% A2 the OrgID OrgID Reported in December only for the year the Member’s prior to the current year. For example December file PCP the Decemmber 2013 file reports the only. TME Local Practice Group for 2012 for members enrolled in 2012.
ME Monthly Premium 2/2016 Integer Currency varchar[10] Expected Monthly Premium Report the amount the subscriber is responsible for on a monthly to maintain this line of eligibility. Report 0 only when the subscriber is contractually free of this obligation. Required for Risk Assessment and Division of Insurance reporting. Repeat the subscriber’s premium on the member’s record. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required 100% A2 ME Attributed PCP Provider ID 2/2016 Text ID Link to PV002 varchar[30] PV002 for PCP attributed to the patient for prior year. For ME124, carriers should report PCPs attributed to the members based whose insurance products do not require the selection of a primary care physician (e.g. PPO or Indemnity products). This attribution is based on the carrier’s own attribution methodology. (ME046 (Member PCP) is only used for members whose insurance products require the selection of a PCP (e.g., HMO or POS).) Reported in December only, for the year prior to the current year. For example: the December 2013 file reports the Attributed PCP for 2012 for members enrolled in 2012. All Required in December file only. Required when ME046 is ‘999999999U’ or or missing. 100% A2 ME TME OrgID - Physician Group of the Member’s PCP Integer TME Provider OrgID varchar[6] TME Provider OrgID Required for Total Medical Expense Reporting. OrgID specific. Report the TME Local Practice Group Provider OrgID for the Physician Group of the Member’s PCP, and not the place of service for the claim. Reported in December only for the year prior to the current year. For example the Decemmber 2013 file reports the TME Local Practice Group for 2012 for members enrolled in 2012. Assigned submitters only. Required in the December file only. 100% A2