HSN Health Safety Net CCP ConnectorCare N/A Not Applicable Report the group name that the policy is Group attached to. Report IND for individual ME 32 11/8/12 Text Name Group varchar[50] Group name All 80% A2 Name policies. Do not report any value here if the data is not available Report the code that defines the spoken language preference of the member. Member's The code value 999 (Unknown/ Not External Member self-disclosed Specified), should only be used when Code Code Source ME 33 language 11/8/12 int[3] verbal patient/client answers unknown or All 3% B Source 7 - preference language refuses to answer. Do not report any 7 - Languages preference value here if the submitter does not Integer have the data. Report only collected data. ME 34 C Health Report the value that defines the Health Care Care Home Lookup element. EXAMPLE: 1 = Yes, Member Home ME 35 (PCMH) 11/8/12 Table - int[1] has an assigned approved patient All 100% A2 Assigned Assigned Integer centered medical home for this indicator Flag coverage period. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the submitter assigned patient centered medical home number. It is anticipated that this will be the same Health data submitter number used in reporting Required Care Home ID Link to Health Care ME 36 11/8/12 Text varchar[30] servicing provider. Do not report any when = 90% C (PCMH) PV002 Home ID data here if not applicable. The number 1 Number of the member’s healthcare home must also be in the Provider File in PV002, Provider ID.
HSN Health Safety Net CCP ConnectorCare N/A Not Applicable ME 32 Group Name 11/8/12 Text Name Group varchar[50] Group name Report the group name that the policy is attached to. Report IND for individual policies. Do not report any value here if the data is not available All 80% A2 ME 33 Member language preference 11/8/12 Code Source 7 - Integer External Code Source 7 - Languages int[3] Member's self-disclosed verbal language preference Report the code that defines the spoken language preference of the member. The code value 999 (Unknown/ Not Specified), should only be used when patient/client answers unknown or refuses to answer. Do not report any value here if the submitter does not have the data. Report only collected data. All 3% B ME 34 C ME 35 Health Care Home (PCMH) Assigned Flag 11/8/12 Lookup Table - Integer int[1] Health Care Home Assigned indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Member has an assigned approved patient centered medical home for this coverage period. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 36 Health Care Home (PCMH) Number 11/8/12 Text ID Link to PV002 varchar[30] Health Care Home ID Report the submitter assigned patient centered medical home number. It is anticipated that this will be the same data submitter number used in reporting servicing provider. Do not report any data here if not applicable. The number of the member’s healthcare home must also be in the Provider File in PV002, Provider ID. Required when = 1 90% C
v6-apcd-member-eligibility-file-submission-guide-Redline-.docx