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.
Active/Resolved
Active
Action / Resolution
Category 1
Linking
Category 2
Data Quality
Tip / Issue
Tip
Categorization Rules
Type of Coverage
Data Source
Categorization Rule
COM
Arkansas APCD
Where Type of Coverage is not assigned (what remains without coverage)
DNT
Arkansas APCD
Where Submitting Entity (ME001) is "70408" or Insurance Product Code (ME003) is "DNT".
DUALS
Arkansas 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_NOHLTH
Arkansas APCD
Where Submitting Entity ID (ME001) is "99EBD1" and Health Plan Name (ME164A) 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_TPA
Arkansas APCD
Where Submitting Entity ID (ME001) is "95448B" and Group Name (ME032) includes the letters "ARBenefits" within the value.
HCIP
Arkansas APCD
Where Submitting Entity ID (ME001) is "99MCD1" and Health Plan Name (ME164A) is "HCIP"
MCD
Arkansas APCD
Where Submitting Entity ID (ME001) is "99MCD1" and Insurance Product Type Code (ME003) is "MCD" and Type of Coverage has not been populated.
MCD_QHP
Arkansas APCD
Where the HIOS ID (ME992) ends in the following values: "32","36"
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".
MCRAdvPhrm
Arkansas APCD
Where 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”. Applicable only to data requesters who can receive Arkansas Medicare data sourced from CMS ResDAC.
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”. 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.
No labels
0 Comments
You are not logged in. Any changes you make will be marked as anonymous. You may want to Log In if you already have an account.
0 Comments