TME Health Status Adjustment Tool – ME126 Filler No Input – Date TME Health Status – Member’s ME127 Filler No Input – Adjustment Score TME Health Status – Member’s ME128 Filler No Input – Adjustment Score - Normalized TME Health Status – Member’s ME129 Filler No Input – Adjustment Score Start Date TME Health Status – Member’s ME130 Filler No Input – Adjustment Score End Date ME131 Payment Arrangement Type TME Global Budget/Payment Indicator ME132 Employer Contribution Total Contribution The following fields have a category change: Element Element Name Category Purchased through Massachusetts ME045 B Exchange Flag ME120 Actuarial Value B ME121 Metal Level B Technical specifications for these fields are: APCD Usage and Condition % Element Element Name Type Description Guidelines Provider File Total Medical Assigned Z 0 Expenses & Relative submitters Price reporting only. Registered Placeholder for requirement. PV032 Provider Char 30 Registered Provider Registered Provider Organization ID Organization ID Organization Number assigned by the Health Policy Commission. The APCD reserves All Z 0 this field for future PV065 Filler Char 0 Filler use. Do not populate with any data.
ME126 TME – Health Status Adjustment Tool Date Filler – No Input ME127 TME – Member’s Health Status Adjustment Score Filler – No Input ME128 TME – Member’s Health Status Adjustment Score - Normalized Filler – No Input ME129 TME – Member’s Health Status Adjustment Score Start Date Filler – No Input ME130 TME – Member’s Health Status Adjustment Score End Date Filler – No Input ME131 Payment Arrangement Type TME Global Budget/Payment Indicator ME132 Employer Contribution Total Contribution The following fields have a category change: Element Element Name Category ME045 Purchased through Massachusetts Exchange Flag B ME120 Actuarial Value B ME121 Metal Level B Technical specifications for these fields are: Element Element Name Type Description APCD Usage and Guidelines Condition % Provider File PV032 Registered Provider Organization ID Char 30 Placeholder for Registered Provider Organization ID Total Medical Expenses & Relative Price reporting requirement. Registered Provider Organization Number assigned by the Health Policy Commission. Assigned submitters only. Z 0 PV065 Filler Char 0 Filler The APCD reserves this field for future use. Do not populate with any data. All Z 0
ab-13-02-payers-claims-data-submissions-114-5-cmr-21-00.docx