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. Non-grandfathered individual and small group plans underwritten and filed in the Commonwealth of Massachusetts are subject to risk adjustment. Large group Risk plans, self-insured plans, and plans Member Adjustment Lookup underwritten and filed in states other Enrolled in ME Covered 5/9/13 Flag Int(1) than Massachusetts are not subject to All 100% A0 – RACP Plan Integer risk adjustment. Indicator (RACP) Report RACP status as of the 15th of the month. EXAMPLE: 1 = Yes, the Member was enrolled in RACP as of the 15th of the month. Description 1 Yes 2 No Mock Provided for Simulation – 3 Purposes Only
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 ME Risk Adjustment Covered Plan (RACP) 5/9/13 Lookup – Integer Flag Int(1) Member Enrolled in RACP Indicator Non-grandfathered individual and small group plans underwritten and filed in the Commonwealth of Massachusetts are subject to risk adjustment. Large group plans, self-insured plans, and plans underwritten and filed in states other than Massachusetts are not subject to risk adjustment. Report RACP status as of the 15th of the month. EXAMPLE: 1 = Yes, the Member was enrolled in RACP as of the 15th of the month. All 100% A0 Description 1 Yes 2 No 3 Mock – Provided for Simulation Purposes Only
v6-apcd-member-eligibility-file-submission-guide-FINAL.docx