Data Element Date Maximum # Data Element Name Effective Type Length Description/Codes/Sources ME001 Submitter 1/1/2003 Text 8 MHDO-assigned identifier of payer submitting claims data. Do not leave blank. ME002 Payer 7/1/2012 Text 8 MHDO-assigned code of the insurer/underwriter in the case of coverage, or of the administrator in the case of self-funded coverage. Do not leave blank. ME003 Insurance Type/Product Code 1/1/2003 Text 2 Code identifying the type of insurance policy within a specific insurance program. to Appendix A HN Medicare Part C MD Medicare Part D 1/1/2003 Number 4 Year for which eligibility is reported in this submission ME004 Year ME005 Month 1/1/2003 Text 2 Month for which eligibility is reported in this submission ME006 Insured Group or Policy 1/1/2003 Text 30 Group or policy number not the number that uniquely identifies the – subscriber Number ME007 Coverage Level Code 1/1/2003 Text 3 Benefit coverage level Refer to Appendix A ME008 Subscriber Social Security 1/1/2003 Text 9 Subscriber’s social security number Number Leave blank if unavailable ME009 Plan Specific Contract Number 1/1/2003 Text 80 Plan assigned subscriber’s contract number Leave blank if contract number = subscriber’s social security number ME010 Member Suffix or Sequence 1/1/2003 Text 20 Unique number of the member within the contract Number 1/1/2003 Text 50 Member’s social security number ME011 Member Identification Code Leave blank if unavailable
Data Element Date Maximum # Data Element Name Effective Type Length Description/Codes/Sources ME001 Submitter 1/1/2003 Text 8 MHDO-assigned identifier of payer submitting claims data. Do not leave blank. ME002 Payer 7/1/2012 Text 8 MHDO-assigned code of the insurer/underwriter in the case of coverage, or of the administrator in the case of self-funded coverage. Do not leave blank. ME003 Insurance Type/Product Code 1/1/2003 Text 2 Code identifying the type of insurance policy within a specific insurance program. to Appendix A HN Medicare Part C MD Medicare Part D ME004 Year 1/1/2003 Number 4 Year for which eligibility is reported in this submission ME005 Month 1/1/2003 Text 2 Month for which eligibility is reported in this submission ME006 Insured Group or Policy Number 1/1/2003 Text 30 Group or policy number – not the number that uniquely identifies the subscriber ME007 Coverage Level Code 1/1/2003 Text 3 Benefit coverage level Refer to Appendix A ME008 Subscriber Social Security Number 1/1/2003 Text 9 Subscriber’s social security number Leave blank if unavailable ME009 Plan Specific Contract Number 1/1/2003 Text 80 Plan assigned subscriber’s contract number Leave blank if contract number = subscriber’s social security number ME010 Member Suffix or Sequence Number 1/1/2003 Text 20 Unique number of the member within the contract ME011 Member Identification Code 1/1/2003 Text 50 Member’s social security number Leave blank if unavailable
Chapter%20243_Proposed%20Rule_V4_12_15_16%20AAG%20edits.docx