Report the maximum amount of the member / subscriber’s deductible that is Maximum out applied to vision services before certain of pocket vision services are covered. If amount of deductible does not apply when vision Required Vision member's ME 99 11/8/12 Integer Currency varchar[10] benefits are available, submit as zero. when ME118 98% A2 116 Deductible deductible Do not code decimal or round up / down = 1 applied to to whole dollars, code zero cents (00) vision when applicable. EXAMPLE: 150.00 is services reported as 15000; 150.70 is reported as 15070 Report the identifier the carrier / Carrier ID Link to submitter uses internally to uniquely Specific MC141, Subscriber's identify the subscriber. Used to create ME Unique 11/8/12 Text varchar[50] All 100% A0 117 PC108, Unique ID Unique Member ID and link across Subscriber DC057 carrier's / submitter's files for reporting ID and aggregation Lookup Report the value that defines the Vision Indicator - ME 11/8/12 Table - int[1] element. EXAMPLE: 1 = Yes, Vision is All 100% A0 118 Benefit Vision Option Integer a covered benefit. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable The APCD reserves this field for future ME Filler 4/5/13 Filler Filler char[0] Filler All 0% Z use. Do not populate with any data. Calculate using the Federal AV The actuarial Calculator for the risk adjustment value of the covered plan the member is enrolled in. risk Required Actuarial - Percent as Report the Actuarial Value of this ME varchar[6] adjustment when ME126 100% A0 0.0000 member as of the 15th of the month. covered plan = 1 or 3 Format to be used is 0.0000. For the member example, an AV of 88.27689% should is enrolled in be reported as 0.8828. Report the Level benefits that the Standardized Lookup member is associated to in this line of Required plan level in ME Metal Level - int[1] eligibility. Required for Risk when ME126 100% A0 metal Integer Assessment. = 1 or 3 reference EXAMPLE: 1 = Bronze Level
ME 99 Vision Deductible 11/8/12 Integer Currency varchar[10] Maximum out of pocket amount of member's deductible applied to vision services Report the maximum amount of the member / subscriber’s deductible that is applied to vision services before certain vision services are covered. If deductible does not apply when vision benefits are available, submit as zero. 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 when ME118 = 1 98% A2 ME Carrier Specific Unique Subscriber ID 11/8/12 Text ID Link to MC141, PC108, DC057 varchar[50] Subscriber's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the subscriber. Used to create Unique Member ID and link across carrier's / submitter's files for reporting and aggregation All 100% A0 ME Vision Benefit 11/8/12 Lookup Table - Integer int[1] Indicator - Vision Option Report the value that defines the element. EXAMPLE: 1 = Yes, Vision is a covered benefit. All 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME Filler 4/5/13 Filler Filler char[0] Filler The APCD reserves this field for future use. Do not populate with any data. All 0% Z ME Actuarial - Percent as 0.0000 varchar[6] The actuarial value of the risk adjustment covered plan the member is enrolled in Calculate using the Federal AV Calculator for the risk adjustment covered plan the member is enrolled in. Report the Actuarial Value of this member as of the 15th of the month. Format to be used is 0.0000. For example, an AV of 88.27689% should be reported as 0.8828. Required when ME126 = 1 or 3 100% A0 ME Metal Level Lookup - Integer int[1] Standardized plan level in metal reference Report the Level benefits that the member is associated to in this line of eligibility. Required for Risk Assessment. EXAMPLE: 1 = Bronze Level Required when ME126 = 1 or 3 100% A0 116 117 118