Redefined field - ME001_CAT (PAYER_TYPE)
Number | 0133 |
|---|---|
Submitting Entity (SE) | All submitting entities |
Add Date | Jul 14, 2023 |
Update Date | Jan 17, 2024 |
Update | included in January 2024 Data Tips email |
Description | ME001_CAT values are assigned at the enrollment record level. These rules are applied to assign type of 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 |
COM | Arkansas APCD | Where Payer Type 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" |
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 Payer Type has not been populated. |
MCD_QHP | Arkansas APCD | Where the HIOS ID (ME992) ends in the following values: “32","36","21","41","61","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". |
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" 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. |