Redefined field - ME001_CAT

0133

All submitting entities

14 Jul 2023

ME001_CAT values are assigned at the enrollment record level.

These rules are applied to assign type of coverage categories to each enrollment record. 

See the Categorization Rules below.

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Type of Coverage

Categorization Rule

QHP 

Where the HIOS ID (ME992) ends in the following values: "00", "01", "02", "03", "04", "05", "06" and is not all zeroes. 

HCIP 

Where Submitting Entity ID (ME001) is "99MCD1" and Health Plan Name (ME164A) is "HCIP"

MCD_QHP 

Where the HIOS ID (ME992) ends in the following values: "32","36"

EBD 

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 

Where Submitting Entity ID (ME001) is "95442" and Insurance Product Type Code (ME003) is "EBD" 

EBD_TPA 

Where Submitting Entity ID (ME001) is "95448B" and Group Name (ME032) includes the letters "ARBenefits" within the value. 

EBD_PBM 

Where Submitting Entity ID (ME001) is either "99MDI4" or "99MDI5" 

EBD_RET 

Where Submitting Entity ID (ME001) is "99EBD1" and Health Plan Name (ME164A) includes the letters "RET" within the value. 

EBD_NOHLTH 

Where Submitting Entity ID (ME001) is "99EBD1" and Health Plan Name (ME164A) includes the values "PSENOHLTH" or "ASENOHLTH" 

MCD 

Where Submitting Entity ID (ME001) is "99MCD1" and Insurance Product Type Code (ME003) is "MCD" and Type of Coverage has not been populated. 

MCRAdvPhrm 

Where Insurance Product Code (ME003) is "MD" and Submitting Entity ID (ME001) is not "10155". 

PASSE 

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 

Where Submitting Entity (ME001) is  "99CAR1","99MDI1","99SSC1","99MAG1","99MDI2" or "99MDI3" and Insurance Product Code (ME003) is not "MD" or "MCD" 

DNT 

Where Submitting Entity (ME001) is "70408" or Insurance Product Code (ME003) is "DNT".

MCR_ADV 

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 

Where Type of Coverage is not assigned (what remains without coverage)