C.M.R. 90, 590, ch. 243, app 590-243-C-2
Data Element # | Data Element Name | HIPAA Reference ASC X12N/005010 Transaction Set/Loop/ Segment ID/Code Value/ Reference Designator |
ME001 | Submitter | N/A |
ME002 | Payor | N/A |
ME003 | Insurance Type/Product Code | 271/2110C/EB/04, 271/2110D/EB/04 |
ME004 | Year | N/A |
ME005 | Month | N/A |
ME006 | Insured Group or Policy Number | 271/2100C/REF/1L/02, 271/2100C/REF/IG/02, 271/2100C/REF/6P/02, 271/2100D/REF/1L/02, 271/2100D/REF/IG/02, 271/2100D/REF/6P/02, |
ME007 | Coverage Level Code | 271/2110C/EB/02, 271/2110D/EB/02 |
ME008 | Subscriber Social Security Number | 271/2100C/REF/SY/02 |
ME009 | Plan Specific Contract Number | 271/2100C/NM1/MI/09 |
ME010 | Member Suffix or Sequence Number | 271/2100C/REF/49/02, 271/2100D/REF/49/02 |
ME011 | Member Identification Code | 271/2100C/REF/SY/02, 271/2100D/REF/SY/02 |
ME012 | Individual Relationship Code | 271/2100C/INS/Y/02, 271/2100D/INS/N/02 |
ME013 | Member Gender | 271/2100C/DMG/03, 271/2100D/DMG/03 |
ME014 | Member Date of Birth | 271/2100C/DMG/D8/02, 271/2100D/DMG/D8/02 |
ME015 | Member City Name | 271/2100C/N4/01, 271/2100D/N4/01 |
ME016 | Member State or Province | 271/2100C/N4/02, 271/2100D/N4/02 |
ME017 | Member ZIP Code | 271/2100C/N4/03, 271/2100D/N4/03 |
ME018 | Medical Coverage | N/A |
ME019 | Prescription Drug Coverage | N/A |
ME020 | Dental Coverage | N/A |
ME021 | Race 1 | N/A |
ME022 | Race 2 | N/A |
ME023 | Race 3 | N/A |
ME024 | Hispanic Indicator | N/A |
ME025 | Ethnicity 1 | N/A |
ME026 | Ethnicity 2 | N/A |
ME027 | Ethnicity 3 | N/A |
ME028 | Primary Insurance Indicator | N/A |
ME029 | Coverage Type | N/A |
ME030 | Market Category Code | N/A |
ME031 | Special Coverage | N/A |
ME032 | Group Name | 271/2100C/REF/18/03, 271/2100D/REF/28/03, 271/2100C/REF/6P/03, 271/2100D/REF/6P/03, 271/2100C/REF/N6/03, 271/2100D/REF/N6/03 |
ME101 | Subscriber Last Name | 271/2100C/NM1/ /03 |
ME102 | Subscriber First Name | 271/2100C/NM1/ /04 |
ME103 | Subscriber Middle Name | 271/2100C/NM1/ /05 |
ME104 | Member Last Name | 271/2100C/NM1/ /03, 271/2100D/NM1/ /03 |
ME105 | Member First Name | 271/2100C/NM1/ /04, 271/2100D/NM1/ /04 |
ME106 | Member Middle Name | 271/2100C/NM1/ /05, 271/2100D/NM1/ /05 |
ME107 | Member Address Line 1 | 271/2100C/N3/01, 271/2100D/N3/01 |
ME108 | Member Address Line 2 | 271/2100C/N3/02, 271/2100D/N3/02 |
ME109 | Member Country Code | 271/2100C/N4/04, 271/2100D/N4/04 |
ME110 | Placeholder | N/A |
ME111 | Subscriber MBI | 271/2100C/NM1/MI/09 |
ME112 | Placeholder | N/A |
ME113 | Member MBI | 271/2100D/NM1/MI/09, 271/2100D/REF/F6/02 |
ME114 | Plan Begin Date (Member Effective Date) | 271/2100C/DTP/346/D8, 271/2100D/DTP/346/D8 |
ME115 | Plan End Date (Member Cancellation Date) | 271/2100C/DTP/347/D8, 271/2100D/DTP/347/D8 |
ME116 | Grandfathered Plan Indicator | N/A |
ME117 | Metal Tier | N/A |
ME118 | Enrolled Through a Public Health Insurance Exchange | N/A |
ME119 | Cost-Sharing Reduction Indicator | N/A |
ME899 | Record Type | N/A |
C.M.R. 90, 590, ch. 243, app 590-243-C-2