N.H. Code Admin. R. Ins 4010.01
(b) Member File Header Record Layout
Table 4010.01(b) Member File Header Record Layout
Data Element #
Element
Type
Length (decimal places)
Description/Codes/Sources
HD001
Record Type
Text
2
HD
HD002
Payer
Text
8
Payer submitting payments. NHID Submitter Code
HD003
National Plan ID
Text
30
CMS National Plan ID
HD004
Type of File
Text
2
ME Member Eligibility
HD005
Period Beginning Date
Date
8
Beginning of paid period for claims or beginning of month covered for eligibility
HD006
Period Ending Date
Date
8
End of paid period for claims or end of month covered for eligibility
HD007
Comments
Text
80
Submitter may use to document this submission by assigning a filename, system source, etc.
(c) Member File Trailer Record Layout
Table 4010.01(c) Member File Trailer Record Layout
Data Element #
Element
Type
Length (decimal places)
Description/Codes/Sources
TR001
Record Type
Text
2
TR
TR002
Payer
Text
8
Payer submitting payments. NHID Submitter Code
TR003
National Plan ID
Text
30
CMS National Plan ID
TR004
Type of File
Text
2
ME Member Eligibility
TR005
Period Beginning Date
Date
8
Beginning of paid period for claims or beginning of month covered for eligibility
TR006
Period Ending Date
Date
8
End of paid period for claims or beginning of month covered for eligibility
TR007
Extraction Date
Date
8
Date file was created
TR008
Record Count
Number
10 (0)
Total number of records submitted in this file
(d) Member File Detailed Specification
Table 4010.01(d) Member File Detailed Specification
Column Position
Data Element #
Element
Type
Length (decimal places)
Description/Codes/Sources
1
ME001
Payer
Text
8
Payer submitting payments NHID Submitter Code
2
ME002
National Plan ID
Text
30
CMS National Plan ID
3
ME003
Insurance Type Code/Product
Text
2
See Table 4010.6 (a) Insurance Type/Product Code-Eligibility File
4
ME004
Start Year
Number
4 (0)
Year for which eligibility is reported in this submission. CCYY format
5
ME005
Start Month
Number
2 (0)
Month for which eligibility is reported in this submission. MM format. Leading zero is required for reporting January through September files
6
ME006
Insured Group or Policy Number
Text
50
Group or policy number (not the number that uniquely identifies the subscriber)
7
ME007
Coverage Level Code
Text
3
Benefit Coverage Level
CHD Children Only
DEP Dependents Only
ECH Employee and Children
EMP Employee Only
ESP Employee and Spouse
FAM Family
IND Individual
SPC Spouse and Children
SPO Spouse Only
8
ME008
Subscriber Social Security Number
Text
9
Subscriber's social security number. Do not include dashes. Leave blank if not available.
9
ME009
Plan Specific Contract Number
Text
50
Plan assigned contract number. Leave blank if Plan Specific Contract Number is subscriber's social security number. If this is a Medicaid member, provide Medicaid ID
10
ME010
Member Suffix or Sequence Number
Text
20
Uniquely identifies the member within the contract
11
ME011
Member Social Security Number
Text
9
Member's social security number. Do not include dashes. Leave blank if not available.
12
ME012
Individual Relationship Code
Text
2
See Table 4010.6 (b) Relationship Codes
13
ME013
Member Gender
Text
1
M Male
F Female
U Unknown
O Other
14
ME014
Member Date of Birth
Date
8
Date of birth of member
15
ME015
Member City Name
Text
30
City name of member
16
ME016
Member State or Province
Text
2
As defined by the US Postal Service
17
ME017
Member ZIP Code
Text
9
ZIP Code of member – may include non- US codes. Do not include dash.
18
ME018
Medical Coverage
Text
1
Y Yes
N No
19
ME019
Prescription Drug Coverage
Text
1
Y Yes, member has prescription drug coverage in the period defined with this payer
N No, member does not have prescription drug coverage in the period defined with this payer
20
ME020
Dental Coverage
Text
1
Y Yes, member has dental coverage in the period defined with this payer
N No, member does not have dental coverage in the period defined with this payer
21
ME021
Race 1
Text
6
See Table 4010.6 (c) Race 1/Race 2
22
ME022
Race 2
Text
6
See Table 4010.6 (c) Race 1/Race 2
23
ME023
Placeholder
24
ME024
Hispanic Indicator
Text
1
Y Yes, member is Hispanic/Latino/Spanish
N No, member is not Hispanic/Latino/Spanish
U Unknown
25
ME025
Ethnicity 1
Text
6
See Table 4010.6 (d): Ethnicity 1/ Ethnicity 2
26
ME026
Ethnicity 2
Text
6
See Table 4010.6 (d): Ethnicity 1/ Ethnicity 2
27
ME027
Placeholder
20
28
ME028
Primary Insurance Indicator
Text
1
Y Yes, this is the member’s primary insurance
N No, this is not the member’s primary insurance
29
ME029
Coverage Type
Text
3
ASW Self-funded plans that are administered by a third party administrator, where the employer has purchased stop-loss, or group excess insurance coverage
ASO Self-funded plans that are administered by a third party administrator, where the employer has not purchased stop-loss, or group excess insurance coverage
STN Short-term non-renewable health insurance, as defined pursuant to RSA 415:5 III
MCD Medicaid
MCR Medicare
UND Plans underwritten by the carrier
OTH Any other plan. Carriers and third-party administrators using this code shall obtain prior approval from the N.H. Insurance Department
30
ME030
Market Category
Text
4
Three or four digit character code for identifying market category. Employer size is based on the number of eligible employees in the group as define in INS 4100, (INS 4103.03 (g) for the Small Group market, INS 4104.03 (i) for the Large Group market)
IND Policies sold and issued directly to individuals, other than those sold on a franchise basis, as defined pursuant to RSA 415:19, or as group conversion Policies as defined pursuant to RSA 415:18 VII (a)
FCH Policies sold and issued directly to individuals on a franchise basis as defined pursuant to RSA 415:19
GCV Policies sold and issued directly to individuals as group conversion Policies as required pursuant to RSA 415:18 VII (a)
GS1 Policies sold and issued directly to employers having exactly one employee
GS2 Policies sold and issued directly to employers having between 2 and 9 employees
GS3 Policies sold and issued directly to employers having between 10 and 25 employees
GS4 Policies sold and issued directly to employers having between 26 and 50 employees
GLG1 Policies sold and issued directly to employers having between 51 and 99 employees
GLG2 Policies sold and issued directly to employers having 100 or more employees
GSA Policies sold and issued directly to small employers through a qualified association trust
OTH Policies sold to other types of entities. Carriers and third-party administrators using this market code shall obtain prior approval from the NH Insurance Department
BLC Policies sold and issued as blanket health insurance Policies to a common carrier
BLE Policies sold and issued as blanket health insurance Policies to an employer
BLV Policies sold and issued as blanket health insurance Policies to a volunteer fire department, first aid, or other such volunteer group
BLS Policies sold and issued as blanket health insurance Policies to a sports team or a camp
BLT Policies sold and issued as blanket health insurance Policies to a travel agency, or other organization that provides travel-related services
BLU Policies sold and issued as blanket health insurance Policies to a university or college
SLG Policies sold and issued as student major medical expense large group coverage to enrolled students at an accredited college, university, or other educational institution
STS Policies sold and issued as group short term student health insurance
SMG Policies sold and issued as student major medical group health insurance
SNM Policies sold and issued as student group health insurance that is not major medical coverage
SIM Policies sold and issued as student individual major medical health insurance
SIN Policies sold and issued as student individual health insurance that is not major medical coverage
31
ME031
NH Health Protection Program
Text
60
For enrollees in the New Hampshire Health Protection Program (NHHPP), indicate if enrollee is part of the Premium Assistance Program (PAP) or Health Insurance Premium Payment (HIPP). Leave blank if enrollee is not a member of the NHHPP
32
ME032
Group Name
Text
4
Name of the group that the member is covered by. If the member is part of a group of one or non-group, indicate I
33
ME101
Subscriber Last Name
Text
60
34
ME102
Subscriber First Name
Text
35
35
ME103
Subscriber Middle Initial
Text
1
36
ME104
Member Last Name
Text
60
37
ME105
Member First Name
Text
35
38
ME106
Member Middle Initial
Text
1
39
Placeholder
40
ME203
Member’s Assigned PCP
Text
20
National Provider ID of the member’s Primary Care Physician as designated by healthcare claims processor.
41
ME204
HIOS Plan ID
Text
16
The 16 character HIOS Plan ID (Standard component). Including a five digit issuer ID, two character state ID, three digit product number, four digit standard component number and two digit variant component ID. This field may not be available for all market segments;
42
ME205
Plan Effective Date
Date
8
For the plan reported in ME204, report the date eligibility started for this member under this plan type. The purpose of this data element is to maintain an eligibility span for each member.
43
ME206
Minimum Value
Number
3 (0)
For the plan reported in ME204, report the Minimum Value as described in Part Ins4009.03 (j). This is reported as a percentage.
44
ME207
Exchange Indicator
Text
1
The plan reported in ME204 was available on the Exchange Marketplace in the month and year reflected in ME004 and ME005
Y Yes
N No
45
ME208
High deductible health plan
Text
1
The plan reported in ME204 meets the IRS definition of a HDHP
Y Yes
N No
U Unknown
46
ME209
Active enrollment
Text
1
The plan reported in ME204 was open for enrollment in the year and month reflected in ME004 and ME005
Y Yes
N No
47
ME210
New Coverage
Text
1
The plan reported in ME204 was being offered for the first time in the reporting year reflected in ME004
Y Yes
N No
48
ME211
Placeholder
49
ME899
Record Type
Text
2
ME
50
ME900
Plan State
Text
2
State in which the plan is sold or used. State codes are maintained by the US Postal Service
51
ME901
Advanced Premium Tax Credit
Number
2(2)
Dollar value of Advanced Premium Tax Credit (APTC) subsidy
52
ME902
NAIC Number
Text
5
Number that the National Association of Insurance Commissioners (NAIC) assigns to each individual underwriting company
53
ME903
Grandfather Plan indicator
Text
1
Indicates if a plan qualifies as a “Grandfathered” or “Transitional Plan” under the Affordable Care Act (ACA). Please see definition for “grandfathered” and “transitional” in HHS rules 45-CFR-147.140: https://www.federalregister.gov/select- citation/2013/06/03/45-CFR-147. The values of the indicator are as follows: 1= Grandfathered; 2 = Non-Grandfathered; 3 =Transitional; 4 = Not Applicable
54
ME904
Metal Level
Text
10
The metal representation of the plan reported in ME204 on the Exchange Marketplace
Source. #10877, eff 7-10-15; ss by #13136, eff 11-24-20