Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the identifier of the members PCP. The value in this element must have a corresponding Provider ID (PV002) in the Provider File. ME046 (Member PCP) is only used for Member ID Link to Member's ME 46 2/2016 Text varchar[30] members whose insurance products All A2 PCP ID PV002 PCP ID 100% require the selection of a PCP (e.g., HMO or POS). Report a value of when PCP is unknown or ‘999999999U’ '999999999NA' if the eligibility does not require a PCP. Required when PCP ID Member Full Century Year PCP Effective is not = PCP Report the Member enrollment date ME 47 6/24/10 Date - Month Day - int[8] Date with 999999999U 98% B Effective with the PCP in CCYYMMDD Format. Integer CCYYMMDD Member or Date Required Report the Member termination date when PCP ID Member PCP Full Century Year from the PCP in CCYYMMDD Format. is not = PCP Termination ME 48 6/24/10 Date - Day - int[8] If the member is still active with their 999999999U 98% B Termination Date with Integer CCYYMMDD PCP at the end of the current month, or Date Member then do not fill with any value Report the maximum amount of member / subscriber's annual deductible Annual across all benefit (Medical, RX, maximum out vision, behavioral health, etc.) before of pocket Member certain services are covered. Report ME 49 12/1/10 Integer Currency varchar[10] Member All 90% A2 Deductible only In-Network Deductibles here if plan Deductible has an In and Out-of-Network across all Deductible. Report 0 when there is no benefit types deductible applied to all benefits for this eligibility. Do not code decimal or round
Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 46 Member PCP ID 2/2016 Text ID Link to PV002 varchar[30] Member's PCP ID Report the identifier of the members PCP. The value in this element must have a corresponding Provider ID (PV002) in the Provider File. ME046 (Member PCP) is only used for members whose insurance products require the selection of a PCP (e.g., HMO or POS). Report a value of ‘999999999U’ when PCP is unknown or '999999999NA' if the eligibility does not require a PCP. All 100% A2 ME 47 Member PCP Effective Date 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] PCP Effective Date with Member Report the Member enrollment date with the PCP in CCYYMMDD Format. Required when PCP ID is not = 999999999U or 98% B ME 48 Member PCP Termination Date 6/24/10 Full Date - Integer Century Year Day - CCYYMMDD int[8] PCP Termination Date with Member Report the Member termination date from the PCP in CCYYMMDD Format. If the member is still active with their PCP at the end of the current month, then do not fill with any value Required when PCP ID is not = 999999999U or 98% B ME 49 Member Deductible 12/1/10 Integer Currency varchar[10] Annual maximum out of pocket Member Deductible across all benefit types Report the maximum amount of member / subscriber's annual deductible across all benefit (Medical, RX, vision, behavioral health, etc.) before certain services are covered. Report only In-Network Deductibles here if plan has an In and Out-of-Network Deductible. Report 0 when there is no deductible applied to all benefits for this eligibility. Do not code decimal or round All 90% A2
v6-apcd-member-eligibility-file-submission-guide-Redline-.docx