Laboratory Lookup Indicator - Report the value that defines the ME 52 Benefit 11/8/12 - int[1] Laboratory element. EXAMPLE: 1 = Yes, Lab is All 100% A2 Flag Integer Option covered benefit. Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Disease Chronic Report the value that defines the Lookup Illness element. EXAMPLE: 1 = Yes, ME 53 11/8/12 Table - int[1] All 100% A2 Enrollee Management Member's chronic illness is being Integer Flag indicator managed by plan or vendor of plan. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Eligibility Full Century Year Report the date the member eligibility ME 54 11/8/12 Date - Day - int[8] Eligibility date was determined in CCYYMMDD All 98% B Date Integer CCYYMMDD Format. Report the that defines the Lookup Business Business submitter's line of business for this line ME 55 11/8/12 Table - int[1] All 100% A2 Type Code Type of eligibility. EXAMPLE: 1 = Risk Integer Holder of this line of eligibility Value Description 1 Risk Holder 2 TPA - Third Party Administrator DBA - Delegated Business 3 Administrator 4 PBM - Pharmacy Benefit Manger 5 DBM - Dental Benefit Manager 6 CSO - Computer Service Organization
ME 52 Laboratory Benefit Flag 11/8/12 Lookup - Integer int[1] Indicator - Laboratory Option Report the value that defines the element. EXAMPLE: 1 = Yes, Lab is covered benefit. All 100% A2 Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 53 Disease Enrollee Flag 11/8/12 Lookup Table - Integer int[1] Chronic Illness Management indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Member's chronic illness is being managed by plan or vendor of plan. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable ME 54 Eligibility Date 11/8/12 Full Date - Integer Century Year Day - CCYYMMDD int[8] Eligibility date Report the date the member eligibility was determined in CCYYMMDD Format. All 98% B ME 55 Business Type Code 11/8/12 Lookup Table - Integer int[1] Business Type Report the that defines the submitter's line of business for this line of eligibility. EXAMPLE: 1 = Risk Holder of this line of eligibility All 100% A2 Value Description 1 Risk Holder 2 TPA - Third Party Administrator 3 DBA - Delegated Business Administrator 4 PBM - Pharmacy Benefit Manger 5 DBM - Dental Benefit Manager 6 CSO - Computer Service Organization
v6-apcd-member-eligibility-file-submission-guide-FINAL.docx