Hospital Claims Detail Sample Clauses

Hospital Claims Detail. 10. Drug Claims

Hospital Claims Detail. Drug Claims • Total Medical Expense( non-claims payment) • Biometrics and Health Assessment ( provisional) If Contractor does not maintain such information and/or is unable to produce such information in the file format requested by the Exchange, Contractor shall coordinate with the Exchange with a plan to address data gaps or format preferences prior to the to develop a plan for Contractor’s submission of such information by the fourth quarter of 2014. For any non-paid claims for capitated services, the Contractor shall provide full and complete encounter data. first.

Hospital Claims Detail. Drug Claims Total Medical Expense( non-claims payment) Formatted: List Bullet Biometrics and Health Assessment ( provisional) Plan Layout Field # Field Name Description Field Type/ Format Length Notes 1 Plan_Name Plan Name Character 30 2 Plan_CCCode Covered California plan ID number for carrier (to be assigned) Character 8 3 Group_No Plan-assigned Group number Character 15 CC Exchange- specific number 4 Group_No_Suffix Plan-assigned Group number with Suffix if applicable Character 15 Optional 5 Product_Type Health Plan Product: P=PPO, E=EPO, H= HMO or S= POS Character 1 6 Benefit_Design Coding TBD pending selection of plan designs/alt plans Character 2 7 Metal Metal level associated with benefit design Character 10 8 HealthAssessment Name of Health Assessment tool or vendor (list Internal if internally developed) Character 40 Member File Layout Field # Field Name Description Field Type/ Format Length Notes 1 CC_MemberID Unique code assigned by CC to the member Character 20 2 Plan_MemberID Unique code assigned by health plan to identify a member Character 20 3 Dep_Suffix Unique code assigned by the health plan to identify dependents (spouse, children, etc.) Character 5 4 SSN Member’s SSN Character 9 5 Group_No Plan-assigned Group number Character 15 6 Group_No_Suffix Plan-assigned Group number with Suffix if applicable Character 15 7 M_Lname Member’s last name Character 30 8 M_Fname Member’s first name Character 20 9 M_MI Member’s middle initial Character 5 10 M_DOB Member’s date of birth Date; mmddyyyy 8 11 M_Gender Member’s Gender: M=male F=female U=unknown Character 1 12 M_Language Member Primary Language Character 10 Use ICEforHealth standard abbreviations 13 M_Race Member Race Character 10 14 M_Ethnicity Member Ethnicity Character 10 15 M_Addr1 Member's Street Address Character 40 16 M_Addr2 Member's Street Address2 Character 40 17 M_City Member's City Character 40 18 M_State Member's State Character 2 19 M_Zip Member zip code Character 5 5 digit zip 20 M_ZipSuffix Member zip code suffix Character 4 4 digit zip suffix 21 M_Phone Member phone Character 15 22 Eff_Date Effective date of coverage Date; mmddyyyy 8 Current effective date of coverage with benefit design 23 Term_Date Termination date - Last day of continuous coverage Date; mmddyyyy 8 Member File Layout Field # Field Name Description Field Type/ Format Length Notes 24 Eff_Date_Init Original effective date of coverage Date; mmddyyyy 8 Same as Eff_Date unless there is a break in coverage 25 Subsi...