ME040 Value suffix definitions - Aetna

Number

0113

Submitting Entity (SE)

60054A

Add Date

Jun 7, 2022

Update Date

Jun 14, 2022 Jul 11, 2024

Update

Included in June 2022 Data Tips email. Included in the July 2024 Data Tips email

Description

The Aetna entity 60054A utilizes a trailing character in the value for Product identifier (ME040) to represent which type of plan benefit the Eligibility line is reporting:

B = Behavioral Health

D = Dental

M = Medical

P = Pharmacy

V = Vision (note, the Arkansas APCD does not include vision insurance claims)

X = Default for benefits we weren’t able to map initially (older files, no longer used)

For example:

ME040 = ‘0010000 DM’ represents a plan with medical coverage.

Active/Resolved

Active

Action / Resolution

 

Category 1

Product Identifier

Category 2

Member

Tip / Issue

Tip