3 Part A and B 4 Part C Only 5 Advantage 6 Part D Only 9 Not Applicable 0 No Medicare Coverage Member's Report the name of the subscriber's / Required Employer Name ME 82 11/8/12 Text varchar[60] Employer member's employer at time of when ME060 90% B Name Employer Name enrollment. = A or P Report the Federal Tax ID of the Required Employer Member's ME 83 11/8/12 ID Tax char[9] Employer here. Do not use hyphen or when ME082 90% B EIN Employer EIN alpha prefix. is populated Report the last name of the subscriber. Used to create Unique Member ID. Last name should exclude all punctuation, including hyphens and apostrophes. Name should be contracted where Subscriber Name Last Last name of ME 84 Text varchar[60] punctuation is removed, do not report All 100% A0 Last Name Subscriber Subscriber spaces. EXAMPLE: O'Brien becomes OBRIEN; Carlton-Smythe becomes CARLTONSMYTHE (Will be hashed prior to submission via CHIA’s FileSecure application.) Report the first name of the subscriber here. Used to create Unique Member ID. Exclude all punctuation, including hyphens and apostrophes. Name Subscriber Name First First name of should be contracted where punctuation ME 85 Text varchar[25] All 100% A0 102 First Name Subscriber Subscriber is removed, do not report spaces. EXAMPLE: Anne-Marie becomes ANNEMARIE (Will be hashed to submission via CHIA’s FileSecure application.) Report the Subscriber's middle initial Subscriber here. Used to create Unique Member Name Middle Middle initial ME 86 Middle Text char[1] ID. All 2% C 103 Subscriber of Subscriber Initial (Will be hashed to submission via CHIA’s FileSecure application.)
3 Part A and B 4 Part C Only 5 Advantage 6 Part D Only 9 Not Applicable 0 No Medicare Coverage ME 82 Employer Name 11/8/12 Text Name Employer varchar[60] Member's Employer Name Report the name of the subscriber's / member's employer at time of enrollment. Required when ME060 = A or P 90% B ME 83 Employer EIN 11/8/12 ID Tax char[9] Member's Employer EIN Report the Federal Tax ID of the Employer here. Do not use hyphen or alpha prefix. Required when ME082 is populated 90% B ME 84 Subscriber Last Name Text Name Last Subscriber varchar[60] Last name of Subscriber Report the last name of the subscriber. Used to create Unique Member ID. Last name should exclude all punctuation, including hyphens and apostrophes. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: O'Brien becomes OBRIEN; Carlton-Smythe becomes CARLTONSMYTHE (Will be hashed prior to submission via CHIA’s FileSecure application.) All 100% A0 ME 85 Subscriber First Name Text Name First Subscriber varchar[25] First name of Subscriber Report the first name of the subscriber here. Used to create Unique Member ID. Exclude all punctuation, including hyphens and apostrophes. Name should be contracted where punctuation is removed, do not report spaces. EXAMPLE: Anne-Marie becomes ANNEMARIE (Will be hashed to submission via CHIA’s FileSecure application.) All 100% A0 ME 86 Subscriber Middle Initial Text Name Middle Subscriber char[1] Middle initial of Subscriber Report the Subscriber's middle initial here. Used to create Unique Member ID. (Will be hashed to submission via CHIA’s FileSecure application.) All 2% C 102 103
v6-apcd-member-eligibility-file-submission-guide-FINAL.docx