Coverage File Data Elements

The Extract Identifier code for this file is COV.

 

If you would like Healthx to contain historical coverage information, please send multiple coverage records for each coverage type for each member, with the corresponding coverage effective and coverage termination dates.  This will create coverage segments within the database.  You must send all coverage records you wish to have displayed each time you send the eligibility for a member, as all coverage records are deleted and reloaded each time we receive a member’s eligibility.

 

Refer to Appendix B, “Eligibility Coverage Data-Map Process,” for details on how coverage 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

ProdID

K/O

50

AN

Production Directory ID

7

CovTypeName

R

50

AN

Coverage Item Name

8

CovTypeDesc

R

500

AN

Coverage Item Description

9

CovEffDate

R

8

DT

Coverage Item Effective Date

10

CovTermDate

R

8

DT

Coverage Item Termination Date

11

CovVolume

O

12

NU

Coverage Item Volume

12

CovNotes

O

500

AN

Coverage Item Notes

13

CovTier

R

25

AN

E = Employee Only

S = Emp/Spouse

C = Emp/Child(ren)

F = Family

14

CovPlan

R

25

AN

Coverage Item Plan

15

CovClass

O

25

AN

Coverage Item Class

16

CurYearElig

O

5

AN

Current Plan Year Eligibility

17

PrevYearElig

O

5

AN

Previous Plan Year Eligibility

18

UserDefinedDate1

O

8

DT

User Defined Date Field 1

19

UserDefinedDate2

O

8

DT

User Defined Date Field 2

20

UserDefinedDate3

O

8

DT

User Defined Date Field 3

21

UserDefinedText1

O

255

AN

User Defined Text Field 1

22

UserDefinedText2

O

255

AN

User Defined Text Field 2

23

UserDefinedText3

O

255

AN

User Defined Text Field 3

 

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