Report the identifier the carrier / Carrier ID Link to submitter uses internally to uniquely Specific MC137, Member's identify the member. Used to create ME 90 11/8/12 Text varchar[50] All 100% A0 107 Unique PC107, Unique ID Unique Member ID and link across Member ID DC056 carrier's / submitter's for reporting and aggregation ME 91 A0 108 Address Subscriber Code External State of the Report the state of the subscriber here. ME 92 State or 11/8/12 char[2] All 99% A0 109 Source Code Source Subscriber Used to create Unique Member ID. Province 2 - 2 - States Text Address Zip Zip Code of Subscriber Code External Report the 5 Zip Code as defined by the ME 93 11/8/12 varchar[] the All 99% A0 110 ZIP Code Source Code Source United States Postal Service. . Subscriber 2 - 2 - Zip Codes Text Report the maximum amount of the member / subscriber's deductible that is applied to medical services before Maximum out certain services are covered. This is the of pocket Base Deductible for General Services. Required Medical amount of ME 94 11/8/12 Integer Currency varchar[10] Report 0 when there is no deductible for when ME018 90% A2 111 Deductible applied this benefit. Do not code decimal or = 1 member's round up / down to whole dollars, code deductible zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the maximum amount of the member / subscriber's deductible that is Maximum out applied to pharmacy services before of pocket certain prescriptions are covered. amount of Required Pharmacy Report 0 when there is no deductible for ME 95 11/8/12 Integer Currency varchar[10] member's when ME019 90% A2 112 Deductible this benefit. Do not code decimal or deductible = 1 round up / down to whole dollars, code applied to zero cents (00) when applicable. pharmacy EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070
ME 90 Carrier Specific Unique Member ID 11/8/12 Text ID Link to MC137, PC107, DC056 varchar[50] Member's Unique ID Report the identifier the carrier / submitter uses internally to uniquely identify the member. Used to create Unique Member ID and link across carrier's / submitter's for reporting and aggregation All 100% A0 ME 91 A0 ME 92 Subscriber State or Province 11/8/12 Code Source 2 - Text Address External Code Source 2 - States char[2] State of the Subscriber Report the state of the subscriber here. Used to create Unique Member ID. All 99% A0 ME 93 Subscriber ZIP Code 11/8/12 Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[] Zip Code of the Subscriber Report the 5 Zip Code as defined by the United States Postal Service. . All 99% A0 ME 94 Medical Deductible 11/8/12 Integer Currency varchar[10] Maximum out of pocket amount of applied member's deductible Report the maximum amount of the member / subscriber's deductible that is applied to medical services before certain services are covered. This is the Base Deductible for General Services. Report 0 when there is no deductible for this benefit. 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 ME018 = 1 90% A2 ME 95 Pharmacy Deductible 11/8/12 Integer Currency varchar[10] Maximum out of pocket amount of member's deductible applied to pharmacy Report the maximum amount of the member / subscriber's deductible that is applied to pharmacy services before certain prescriptions are covered. Report 0 when there is no deductible for this benefit. 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 ME019 = 1 90% A2 107 108 109 110 111 112
v6-apcd-member-eligibility-file-submission-guide-Redline-.docx