included in July 2023 January 2024 Data Tips email
Description
ME001_CAT values are assigned at the enrollment record level.
These rules are applied to assign type of coverage payer categories to each enrollment record.
See the Categorization Rules below.
Active/Resolved
Active
Action / Resolution
Category 1
Linking
Category 2
Data Quality
Tip / Issue
Tip
Categorization Rules
Type of Coverage
Data Source
Categorization Rule
QHP
COM
Arkansas APCD
Where
the HIOS ID (ME992) ends in the following values: "00", "01", "02", "03", "04", "05", "06" and is not all zeroes. HCIP
Payer Type is not assigned (what remains without coverage)
DNT
Arkansas APCD
Where Submitting Entity
ID
(ME001) is "
99MCD1" and Health Plan Name (ME164A
70408" or Insurance Product Code (ME003) is "
HCIP
DNT".
MCD_QHP
DUALS
Arkansas
APCDWhere the HIOS ID (ME992) ends in the following values: "32","36"
Medicare
DUAL Indicator fields exist for each month for each beneficiary year. This category is set in each monthly field when the value is “01”, “02”, “03”, “04”, “05”, “06”, “08”. Applicable only to data requesters who can receive Arkansas Medicare data sourced from CMS ResDAC.
EBD
Arkansas APCD
Where Submitting Entity ID (ME001) is "99EBD1
" and Enrollment Date (ME162A) less than or equal to "2022-05-31" and Disenrollment Date (ME163A) is greater than or equal to
"
2013-01-01"
EBD
Arkansas APCD
Where Submitting Entity ID (ME001) is "95442" and Insurance Product Type Code (ME003) is "EBD"
EBD_
TPA
NOHLTH
Arkansas APCD
Where Submitting Entity ID (ME001) is "
95448B
99EBD1" and
Group
Health Plan Name (
ME032
ME164A)
includes the letters "ARBenefits" within the value.
includes the values "PSENOHLTH" or "ASENOHLTH"
EBD_PBM
Arkansas APCD
Where Submitting Entity ID (ME001) is either "99MDI4" or "99MDI5"
EBD_RET
Arkansas APCD
Where Submitting Entity ID (ME001) is "99EBD1" and Health Plan Name (ME164A) includes the letters "RET" within the value.
EBD_
NOHLTH
TPA
Arkansas APCD
Where Submitting Entity ID (ME001) is "
99EBD1
95448B" and
Health Plan
Group Name (
ME164A
ME032)
includes
includes the
values
letters "
PSENOHLTH" or "ASENOHLTH"
ARBenefits" within the value.
MCD
HCIP
Arkansas APCD
Where Submitting Entity ID (ME001) is "99MCD1" and
Insurance Product Type Code (ME003
Health Plan Name (ME164A) is "
MCD" and Type of Coverage has not been populated. MCRAdvPhrm
HCIP"
MCD
Arkansas APCD
Where
Insurance Product Code (ME003) is "MD" and
Submitting Entity ID (ME001) is
not
"
10155".
PASSE
Arkansas APCD
Where Submitting Entity ID (ME001) is "16256" or "16244" -or-
Where Submitting Entity (ME001) is "60217"
99MCD1" and Insurance Product Type Code (ME003) is "MCD" and
Market Category (ME030) is "GPL"
Payer Type has not been populated.
PBM
MCD_QHP
Arkansas APCD
Where
Submitting Entity (ME001) is "99CAR1","99MDI1
the HIOS ID (ME992) ends in the following values: “32","36","
99SSC1
21","
99MAG1
41","
99MDI2
61"
or
,"
99MDI3" and Insurance Product Code (ME003) is not "MD" or "MCD"
DNT
Arkansas APCD
Where Submitting Entity (ME001) is "70408" or Insurance Product Code (ME003) is "DNT".
81","11"
MCR_ADV
Arkansas APCD
Where Insurance Product Code (ME003) is "MDV","HN","HS","MCR","MA","MB","MH", "MHO","MI", or "MPO" -or- Where Submitting Entity (ME001) is "10155".
COM
MCRAdvPhrm
Arkansas APCD
Where
Type of Coverage is not assigned (what remains without coverage)
Insurance Product Code (ME003) is "MD" and Submitting Entity ID (ME001) is not "10155".
MCRFFS
Arkansas Medicare
HMO Indicator fields exist for each month for each beneficiary year. This category is set in each monthly field when the value is “0”
DUALS
. Applicable only to data requesters who can receive Arkansas Medicare data sourced from CMS ResDAC.
MCRHMO
Arkansas Medicare
DUAL
HMO Indicator fields exist for each month for each beneficiary year. This category is set in each monthly field when the value
is “01”, “02”, “03”, “04”, “05”, “06”, “08”.
MCRHMO
Arkansas Medicare
HMO Indicator fields exist for each month for each beneficiary year. This category is set in each monthly field when the value = “C”
= “C”. Applicable only to data requesters who can receive Arkansas Medicare data sourced from CMS ResDAC.
PASSE
Arkansas APCD
Where Submitting Entity ID (ME001) is "16256" or "16244" -or-
Where Submitting Entity (ME001) is "60217" and Insurance Product Type Code (ME003) is "MCD" and Market Category (ME030) is "GPL".
PBM
Arkansas APCD
Where Submitting Entity (ME001) is "99CAR1","99MDI1","99SSC1","99MAG1","99MDI2" or "99MDI3" and Insurance Product Code (ME003) is not "MD" or "MCD"
QHP
Arkansas APCD
Where the HIOS ID (ME992) ends in the following values: "00", "01", "02", "03", "04", "05", "06" and is not all zeroes.
