Health Report the Federal Tax Identification Care Home Number of the medical home here. If Required Health Care ME 37 (PCMH) ID Tax char[9] there is not medical home to report, do when ME035 90% C Home EIN Tax ID not report any value. Do not use = 1 Number hyphen or alpha prefix. National National Provider Report the National Provider External Provider ID Identification Identification (NPI) number for the entity Required Code Code Source ME 38 - Health 11/8/12 int[10] (NPI) of the or individual serving as the medical when ME035 10% C Source 3 - National Care Home Health Care home. If there is no medical home to = 1 3 - Provider ID (PCMH) Home report, do not report any value. Integer Provider ME 39 C Report the carrier / submitter-assigned identifier as it appears in PR001 in the Product ID ID Link to Product Product File. This element is used to ME 40 11/8/12 Text varchar[30] All 100% A0 Number PR001 Identification understand Product and Eligibility attributes of the member / subscriber as applied to this record Product Full Century Year Member Report the date the member was ME 41 Enrollment 6/24/10 Date - Month Day - int[8] Enrollment enrolled in the product in CCYYMMDD All 98% A1 Date Integer CCYYMMDD Date Format. Report the date the member was disenrolled from the product in Product Full Century Year Enrollment CCYYMMDD Format. If the member ME 42 Enrollment 6/24/10 Date - Month Day - int[8] All 98% B Date was not disenrolled at the end of the End Date Integer CCYYMMDD current month, then do not fill with any value ME 43 A0 ME 44 Purchased Report the value that defines the through Lookup Indicator - MA element. EXAMPLE: 1 = Yes, policy for ME 45 Table - int[1] Exchange this eligibility was purchased through All 100% A2 Integer Purchase MA Health Exchange. Required for Exchange Risk Assessment Flag
ME 37 Health Care Home (PCMH) Tax ID Number ID Tax char[9] Health Care Home EIN Report the Federal Tax Identification Number of the medical home here. If there is not medical home to report, do not report any value. Do not use hyphen or alpha prefix. Required when ME035 = 1 90% C ME 38 National Provider ID - Health Care Home (PCMH) 11/8/12 Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Health Care Home Provider Report the National Provider Identification (NPI) number for the entity or individual serving as the medical home. If there is no medical home to report, do not report any value. Required when ME035 = 1 10% C ME 39 C ME 40 Product ID Number 11/8/12 Text ID Link to PR001 varchar[30] Product Identification Report the carrier / submitter-assigned identifier as it appears in PR001 in the Product File. This element is used to understand Product and Eligibility attributes of the member / subscriber as applied to this record All 100% A0 ME 41 Product Enrollment Date 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Member Enrollment Date Report the date the member was enrolled in the product in CCYYMMDD Format. All 98% A1 ME 42 Product Enrollment End Date 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Enrollment Date Report the date the member was disenrolled from the product in CCYYMMDD Format. If the member was not disenrolled at the end of the current month, then do not fill with any value All 98% B ME 43 A0 ME 44 ME 45 Purchased through Exchange Flag Lookup Table - Integer int[1] Indicator - MA Exchange Purchase Report the value that defines the element. EXAMPLE: 1 = Yes, policy for this eligibility was purchased through MA Health Exchange. Required for Risk Assessment All 100% A2
v6-apcd-member-eligibility-file-submission-guide-Redline-.docx