Tip: Identifying Subscribers

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Mar 1, 2019

Subscriber data and Member data are is carried in separate fields on enrollment and claims records.

In almost all cases the subscriber is also a member on a plan. In these cases, the values in member fields, e.g. carrier specific member ID (ME107), member gender (ME013), Member Birth Year (ME014_YEAR) or Member Birth Date (ME014) would also be found in carrier specific subscriber ID (ME117), Subscriber gender (ME151A) and Subscriber Birth Year (ME150A_YEAR) or Subscriber Birth Date (ME150A).

When no member data for a subscriber is available, the following approach can be used to identify the subscriber among the member records:

Group by carrier specific unique subscriber ID (ME117) and carrier specific unique member ID (ME107). Then when the subscriber and member ages (ME014_CURR_AGE, ME150A_CURR_AGE) match, review the relationship code (ME012) and/or the member suffix/person code (ME010). When these ages matches and relationship codes indicate“self”or “employee”, and/or the person code matches the last two or three digits in the carrier specific unique subscriber ID, you probably have the subscriber.

DSG

Member/Subscriber IDs

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