Code of Maine Rules
90 - INDEPENDENT AGENCIES
590 - MAINE HEALTH DATA ORGANIZATION (MHDO)
Chapter 243 - UNIFORM REPORTING SYSTEM FOR HEALTH CARE CLAIMS DATA SETS
Appendix 590-243-C-2 - Maine Health Data Organization Member Eligibility File Mapping to National Standards

Universal Citation: 90 ME Code Rules ยง 590-243-C-2
Current through 2024-13, March 27, 2024

Data Element #

Data Element Name

HIPAA Reference ASC X12N/005010 Transaction Set/Loop/ Segment ID/Code Value/ Reference Designator

ME001

Submitter

N/A

ME002

Payer

N/A

ME003

Insurance Type/Product Code

271/2110C/EB/04, 271/2110D/EB/04

ME004

Year

N/A

ME005

Month

N/A

ME006

Insured Group or Policy Number

271/2100C/REF/1L/02, 271/2100C/REF/IG/02, 271/2100C/REF/6P/02, 271/2100D/REF/1L/02, 271/2100D/REF/IG/02, 271/2100D/REF/6P/02,

ME007

Coverage Level Code

271/2110C/EB/02, 271/2110D/EB/02

ME008

Subscriber Social Security Number

271/2100C/REF/SY/02

ME009

Plan Specific Contract Number

271/2100C/NM1/MI/09

ME010

Member Suffix or Sequence Number

271/2100C/REF/49/02, 271/2100D/REF/49/02

ME011

Member Identification Code

271/2100C/REF/SY/02, 271/2100D/REF/SY/02

ME012

Individual Relationship Code

271/2100C/INS/Y/02, 271/2100D/INS/N/02

ME013

Member Gender

271/2100C/DMG/03, 271/2100D/DMG/03

ME014

Member Date of Birth

271/2100C/DMG/D8/02, 271/2100D/DMG/D8/02

ME015

Member City Name

271/2100C/N4/01, 271/2100D/N4/01

ME016

Member State or Province

271/2100C/N4/02, 271/2100D/N4/02

ME017

Member ZIP Code

271/2100C/N4/03, 271/2100D/N4/03

ME018

Medical Coverage

N/A

ME019

Prescription Drug Coverage

N/A

ME020

Dental Coverage

N/A

ME021

Race 1

N/A

ME022

Race 2

N/A

ME023

Race 3

N/A

ME024

Hispanic Indicator

N/A

ME025

Ethnicity 1

N/A

ME026

Ethnicity 2

N/A

ME027

Ethnicity 3

N/A

ME028

Primary Insurance Indicator

N/A

ME029

Coverage Type

N/A

ME030

Market Category Code

N/A

ME031

Special Coverage

N/A

ME032

Group Name

271/2100C/REF/18/03, 271/2100D/REF/28/03, 271/2100C/REF/6P/03, 271/2100D/REF/6P/03, 271/2100C/REF/N6/03, 271/2100D/REF/N6/03

ME101

Subscriber Last Name

271/2100C/NM1/ /03

ME102

Subscriber First Name

271/2100C/NM1/ /04

ME103

Subscriber Middle Name

271/2100C/NM1/ /05

ME104

Member Last Name

271/2100C/NM1/ /03, 271/2100D/NM1/ /03

ME105

Member First Name

271/2100C/NM1/ /04, 271/2100D/NM1/ /04

ME106

Member Middle Name

271/2100C/NM1/ /05, 271/2100D/NM1/ /05

ME107

Member Address Line 1

271/2100C/N3/01, 271/2100D/N3/01

ME108

Member Address Line 2

271/2100C/N3/02, 271/2100D/N3/02

ME109

Member Country Code

271/2100C/N4/04, 271/2100D/N4/04

ME110

Placeholder

N/A

ME111

Subscriber MBI

271/2100C/NM1/MI/09

ME112

Placeholder

N/A

ME113

Member MBI

271/2100D/NM1/MI/09, 271/2100D/REF/F6/02

ME114

Plan Begin Date

(Member Effective Date)

271/2100C/DTP/346/D8, 271/2100D/DTP/346/D8

ME115

Plan End Date

(Member Cancellation Date)

271/2100C/DTP/347/D8, 271/2100D/DTP/347/D8

ME899

Record Type

N/A

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