Accumulator File Data Elements

The Extract Identifier code for this file is AC.

 

Refer to Appendix B, “Eligibility Accumulator Data-Map Process,” for details on how accumulator records are added or updated in the Healthx database

 

Field #

Field Name

Req.

Len

Type

Notes

1

VersionNumber

K

10

AN

Spec Version Number:  3.04

2

GroupNumber

K

20

AN

Group Number

3

MemberID

K

64

AN

ID Number of the Member (on their ID card)

4

SSN

R

9

AN

Member’s SSN

5

DependentNumber

K

64

AN

Dependent’s ID Number – Should be populated for dependent records only.

6

Name

K

100

AN

Accumulator display name

7

Accum_Desc

O

255

AN

Full text description of the accumulator record

8

CoverageType

K

25

AN

‘M’ – Medical

‘D’ – Dental

‘V’ – Vision

‘O’ – Ortho

‘C’ – Chiropractic

‘P’ – Psych

‘A’ – Accident

‘H’ – Hospital

‘E’ – ER

9

SpecificType

K

20

AN

‘DED’ – Deductible

‘OOP’ – Out of Pocket

‘LIF’ – Lifetime Max

‘COP’ – Copay

‘COI’ – CoInsurance

‘MAX’ - Maximum

10

CurrentAmount

R

12

DE

Current value or ‘amount met’ associated with accumulator

11

MaximumAmount

R

12

DE

Maximum value associated with accumulator

12

InNetwork

K

1

AN

‘0’ for out of network accumulators

‘1’ for in network accumulators

‘2’ for out of area accumulators

‘3’ for no network accumulators

13

IndividualAccum

K

1

AN

True (‘1’) for individual accumulators and False (‘0’) for family accumulators

14

CountMet

R

4

NU

For counter based accumulators.  This would be the count that has been met.

15

CountRequired

R

4

NU

For counter based accumulators.  This would be the required maximum count.

16

CountType

R

2

AN

‘D’ – Days

‘V’ – Visits

‘Y’ – Year

‘M’ – Month

‘W’ – Weeks

‘I’ – Individuals

17

DateRange

K

20

AN

Date range over which the accumulator is valid.  Can be either an effective date, or an actual date range.

18

ClaimSystemCode

O

20

AN

Identifies the bucket that amounts are accumulated to.  May be the same for In and Out of Network, if these are combined.

19

BnftPlan

O

50

AN

Member/Dependent Benefit Plan


 

Field #

Field Name

Req.

Len

Type

Notes

20

BenefitCode

R

10

AN

Unique code that identifies the accumulator

21

PlanYear

O

4

NU

The plan year.  This is different from the Date Range field.  Date Range should indicate the dates of the plan year, especially if the plan year does not begin on January 1.

22

ActionFlag

R

1

AN

D = Delete

R = Restrict

Blank = Load/Update



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