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 ME035 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 Provider ID. Report the Federal Tax Identification Health Number of the medical home here. If Care Home Required Health Care is not medical home to report, do ME 37 (PCMH) 2/2017 ID Tax char[9] when ME035 90% C Home EIN not report any value. Do not use Tax ID = 1 hyphen or alpha prefix. Reminder: Must Number not be an SSN. 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 . Do not populate with any data. ME 39 Filler 2/2017 Text Filler char[0] Filler All 100% C Required to be NULL Report the carrier / submitter-assigned identifier as it appears in 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 Start Date Integer CCYYMMDD Date Format. Product Full Century Year Report the date the member was Enrollment ME 42 Enrollment 6/24/10 Date - Month Day - int[8] disenrolled from the product in All 98% B Date End Date Integer CCYYMMDD CCYYMMDD Format. If the member
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 Provider ID. Required when ME035 = 1 90% C ME 37 Health Care Home (PCMH) Tax ID Number 2/2017 ID Tax char[9] Health Care Home EIN Report the Federal Tax Identification Number of the medical home here. If is not medical home to report, do not report any value. Do not use hyphen or alpha prefix. Reminder: Must not be an SSN. 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 Filler 2/2017 Text Filler char[0] Filler . Do not populate with any data. Required to be NULL All 100% 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 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 Start 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 All 98% B
v6-apcd-member-eligibility-file-submission-guide-FINAL.docx