InsuranceCoverageMemberDetails
The table contains information about the members associated with each coverage record. Since one coverage record can have multiple members, each row in the table corresponds to one member and is noted by the coverage ID and the line number.
| Column Name | Type | Description |
|---|---|---|
| MemberCustodialParentCounty | VARCHAR | The county of the member's custodial parent. |
| MemberEnrollmentReason | INTEGER | The member's reason for enrollment. |
| MemberMedicaidNumber | VARCHAR | The Medicaid Number for a member on a given coverage. |
| CoverageMemberLastVerificationDate | DATETIME | The date the member on the coverage was last verified. |
| MemberTerminationReasonCode | INTEGER | The reason the member was terminated from the coverage. |
| CoverageMemberMedicareNumber | VARCHAR | Stores the patient's Medicare number from the patient record, if applicable. This stored value may be a HICN or a MBI. This data is used primarily for Registration and will match PATIENT_4.LEGACY_HICN. However, it may be different from MEM_MEDICARE_NUM_COVERAGE, which is maintained through Enrollment and Eligibility infrastructure (preferred for managed care scenarios). |
| MemberCustodialParentCity | VARCHAR | The city of the member's custodial parent. |
| MemberCustodialParentAddressLineTwo | VARCHAR | This item contains line two of the member's custodial parent address (the entirety of which is stored in CVG-18962). The purpose of this item is to provide the ability for reporting administrators to retrieve line two of the address without having to join the member custodial parent address table. |
| MemberMailingCounty | VARCHAR | The member's mailing county. |
| MemberMailingCity | VARCHAR | The member's mailing city. |
| SourceFileMemberIdentifier | VARCHAR | The member ID received on the source file for the member on the coverage. |
| MemberCustodialParentAddressLineOne | VARCHAR | This item contains line one of the member's custodial parent address (the entirety of which is stored in CVG-18962). The purpose of this item is to provide the ability for reporting administrators to retrieve line one of the address without having to join the member custodial parent address table. |
| MemberProcessorControlNumberOverride | VARCHAR | The processor control number (PCN) for this member. This PCN overrides the PCN at the plan or payor level for this member only. |
| MemberCoverageEffectiveFromDate | DATETIME | The date on which the coverage goes into effect for the member. |
| MemberIsCoveredIndicator | VARCHAR | The member’s covered status for the coverage, such as Y – the coverage is verified and in effect, or N – the coverage was invalidated manually. Note: 3 – Pending (not verified, but in effect), 4 – In Question (was verified, but recent carrier information omitted this coverage), 5 – Invalid (never verified, not effective). |
| MemberCustodyTypeCode | INTEGER | For members that are children involved in divorce scenarios, this column specifies what type of custody the subscriber has over the child member. |
| CoverageMemberIdentificationNumber | VARCHAR | The identification number assigned to the member for the coverage. |
| Member | DATETIME | The UTC date and time when the custodial parent address was last validated. |
| MemberPayorLegalSex | VARCHAR | The member's sex as it is recorded in the payor's system. |
| CoverageMemberEligibilityClarificationCode | INTEGER | Clarifies the eligibility of the patient when sending an Rx Adjudication message (i.e. Student). This item is populated in ambulatory pharmacy. |
| MemberCustodialAddressLastValidatedByUserIdentification | VARCHAR | The unique ID of the end user that last validated the custodial parent address. |
| MemberCustodialAddressLastValidatedDateTime | DATETIME | The local date and time when the custodial parent address was last validated. |
| MemberCoverageApplicationDate | DATETIME | The date on which the member applied for coverage. |
| MemberMailingAddressLineTwo | VARCHAR | This item contains line two of the member's mailing address (the entirety of which is stored in CVG-18930). The purpose of this item is to provide the ability for reporting administrators to retrieve line two of the address without having to join the member address table. |
| CoverageMemberMailingAddressDistrictCategoryID | INTEGER | The district category ID of the member's mailing address. |
| CoverageIdentifier | NUMERIC | The unique identifier for the coverage record. |
| HealthInsuranceExchangeOriginType | VARCHAR | The origin type of exchange coverages. |
| CoverageMemberMedicareNumber | VARCHAR | Stores the member's Medicare number from the coverage, if applicable. This stored value may be a HICN or a MBI. This data is maintained through the standard Enrollment and Eligibility infrastructure (i.e. should be accurate for managed care scenarios). The number stored on the patient's record (MEM_MEDICARE_NUM or PATIENT.MEDICARE_NUM) may be different since it is used primarily for Registration. |
| MemberMailingAddressValidationMethodCategory | INTEGER | The category ID which indicates the validation method by which this member's mailing address was validated. |
| MemberAlternateIdentificationNumber | VARCHAR | The alternate card identification number assigned to the member for the coverage. |
| MemberCustodialParentName | VARCHAR | The name of the member's custodial parent. |
| MemberMailingAddressHouseNumber | VARCHAR | The house number of the member's mailing address. |
| LastMemberStatusVerifyingUserIdentifier | VARCHAR | The ID of the user who last verified this member's status. |
| MemberNameAsKnownToPayor | VARCHAR | Stores the patient name as known to the Payor. This item is used to keep the name that is stored in the Patient master file separate from the name that the Payor is expecting. |
| MemberPersonCode | VARCHAR | This contains the person code for a member ID on a coverage. For a member ID of 12345-01, the person code would be "01". |
| MemberScheduledDiscontinuationDate | DATETIME | The member scheduled discontinuation date. |
| PatientRecordIdentifier | VARCHAR | The unique ID assigned to the patient record (EPT .1). |
| PhysicalDeploymentOwnerIdentifier | VARCHAR | ID of the physical deployment owner for this record. Physical owners will be where the data is hosted, either on the cross-over server or the owner deployment. |
| MemberMailingAddressLastValidatedByUserIdentifier | VARCHAR | The unique ID of the end user that last validated the member's mailing address. |
| MemberCustodialParentZipCode | VARCHAR | The ZIP code of the member's custodial parent. |
| MemberCoverageEffectiveDateChangeReason | INTEGER | The effective date change reason at the member level. |
| PrescriptionAdjudicationFacilityIdentifier | VARCHAR | Used for prescription adjudication in ambulatory pharmacy. ID assigned to the patient's clinic/host party (336-8C). |
| MemberCoverageApplicationDateTime | DATETIME | The date and time on which the member applied for coverage. |
| PrescriptionBillingInformationIdentifier | INTEGER | Contains the default prescription billing information on this coverage like default values to send during claim adjudication. |
| MemberCustodialParentCountry | VARCHAR | The country of the member's custodial parent. |
| WorkersCompensationClaimIdentifier | VARCHAR | Used for prescription adjudication in ambulatory pharmacy. Identifies the claim number assigned by Workers' Compensation Program (435-DZ). |
| CoveragePlanAdjudicationIdentifier | VARCHAR | Used for prescription adjudication in ambulatory pharmacy. Assigned by the processor to identify a set of parameters, benefits, or coverage criteria used to adjudicate a claim (524-FO). |
| MemberCustodialParentState | VARCHAR | The state of the member's custodial parent. |
| MemberApplicationTime | DATETIME | The time on which the member applied for coverage. |
| IsMemberLateEnrollment | VARCHAR | Y – the member applied for coverage after open enrollment. N – the member did not apply for the coverage after the open enrollment period. |
| MemberCustodialParentSocialSecurityNumber | VARCHAR | The SSN of the member's custodial parent. |
| MemberMailingAddressLineOne | VARCHAR | This item contains line one of the member's mailing address (the entirety of which is stored in CVG-18930). The purpose of this item is to provide the ability for reporting administrators to retrieve line one of the address without having to join the member address table. |
| HealthInsuranceExchangeApplicationIdentifier | VARCHAR | The application ID of exchange coverages. |
| MemberRelationshipToSubscriberCategory | INTEGER | Stores the category identifier of the member's relationship to the subscriber. This column is commonly used to join to ZC_MEM_REL_TO_SUB. |
| MemberMailingAddressIsValidatedCategory | INTEGER | The category ID which indicates whether the member's mailing address has been validated. |
| MemberCustodialDistrictCategory | INTEGER | The district category ID of the member's custodial parent's address. |
| MemberRelationshipToGuarantorCategory | INTEGER | The category value associated with the relationship of the patient to the guarantor. |
| ClaimsLastMemberVerificationDate | DATETIME | Stores the date when the member on the coverage was last verified. This data is only intended to be used when VRX verification is used in an AP Claims instance, otherwise it will be NULL and COVERAGE_MEMBER_LIST.LAST_VERIF_DATE should be used. |
| MemberMailingState | VARCHAR | The member's mailing state. |
| MemberCoverageTerminationDate | DATETIME | The date after which the coverage is no longer in effect for the member and the member becomes ineligible for benefits. |
| MemberMailingAddressLastValidatedUniversalTimeCoordinateDateTime | DATETIME | The UTC date and time when the member's mailing address was last validated. |
| WorkersCompensationProgramCarrierIdentifier | VARCHAR | Used for prescription adjudication in ambulatory pharmacy. Carrier code assigned in Workers' Compensation Program (327-CR). |
| CoverageMemberLogicalDeploymentOwnerIdentifier | VARCHAR | ID of the logical deployment owner for this record. Logical owners show the deployment where the record was created but doesn't represent if the record is a part of version skew. |