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 - Month Day - int[8] If the member is 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 across all benefit types (Medical, RX, vision, behavioral health, etc.) before Annual certain services are covered. Report maximum out only In-Network Deductibles here if plan of pocket Member has an In and Out-of-Network ME 49 12/1/10 Integer Currency varchar[10] Member All 90% A2 Deductible Deductible. Report 0 when there is no Deductible deductible applied to all benefits for this across all eligibility. Do not code decimal or round benefit up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Report the amount to-date the member / subscriber has incurred towards maximum deductible. Report 0 if no Member Member deductible has been incurred. Do not Required deductible ME 50 Deductible 11/8/12 Integer Currency varchar[10] code decimal or round up / down to when ME049 100% A2 amount Used whole dollars, code zero cents (00) > 0 incurred when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Behavioral Report the value that defines the Lookup Indicator - Health element. EXAMPLE: 1 = Yes, ME 51 11/8/12 - int[1] Behavioral All 100% A2 Benefit Behavioral/Mental Health is a covered Integer Health Option Flag benefit. Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable
ME 48 Member PCP Termination Date 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] PCP Termination Date with Member Report the Member termination date from the PCP in CCYYMMDD Format. If the member is 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 Report the maximum amount of member / subscriber's annual deductible across all benefit types (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 up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 All 90% A2 ME 50 Member Deductible Used 11/8/12 Integer Currency varchar[10] Member deductible amount incurred Report the amount to-date the member / subscriber has incurred towards maximum deductible. Report 0 if no deductible has been incurred. Do not code decimal or round up / down to whole dollars, code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when ME049 > 0 100% A2 ME 51 Behavioral Health Benefit Flag 11/8/12 Lookup - Integer int[1] Indicator - Behavioral Health Option Report the value that defines the element. EXAMPLE: 1 = Yes, Behavioral/Mental Health is a covered benefit. All 100% A2 Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable
v6-apcd-member-eligibility-file-submission-guide-FINAL.docx