COVERAGE_MEMBER_LIST

Description:

The COVERAGE_MEMBER_LIST 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.

Primary Key

Column Name	Ordinal Position
COVERAGE_ID	1
LINE	2

Column Information

	Name	Type	Discontinued?
1	COVERAGE_ID	NUMERIC	No
	The unique identifier for the coverage record.
2	LINE	INTEGER	No
	The line number used to identify each member of a coverage record.
3	PAT_ID	VARCHAR	No
	The unique ID assigned to the patient record (EPT .1).
4	MEM_COVERED_YN	VARCHAR	No
	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). May contain organization-specific values: No Category Entries: Covered Not Covered Pending In Question Invalid
5	MEM_REL_TO_SUB_C_NAME	VARCHAR	No
	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. May contain organization-specific values: Yes Category Entries: Self Spouse Child Employee Unknown
6	MEM_REL_TO_GUAR_C_NAME	VARCHAR	No
	The category value associated with the relationship of the patient to the guarantor. The category values for this column were already listed for column: MEM_REL_TO_SUB_C_NAME
7	DEPENDENT_TYPE_C_NAME	VARCHAR	No
	For members whose relationship to the subscriber is unclear, this column specifies how the member is covered by the subscriber. May contain organization-specific values: No Category Entries: Child Dependent Adult Dependent Non-Dependent Unknown, Flag for Follow-Up
8	COURT_DECREE_C_NAME	VARCHAR	No
	For members that are children involved in divorce scenarios, if a court has decreed exactly which of the parents is responsible for the child's medical expenses, then this column specifies how this subscriber is involved in that court decree. May contain organization-specific values: Yes Category Entries: Not Applicable (no court decree concerning healthcare expenses) Subscriber is the parent responsible for healthcare expenses Subscriber is the spouse of the parent responsible for healthcare expenses Subscriber is a parent jointly responsible for healthcare expenses Subscriber is the spouse of a parent jointly responsible for healthcare expenses Subscriber is the parent not responsible for healthcare expenses Subscriber is the spouse of the parent not responsible for healthcare expenses
9	CUSTODY_C_NAME	VARCHAR	No
	For members that are children involved in divorce scenarios, this column specifies what type of custody the subscriber has over the child member. May contain organization-specific values: Yes Category Entries: Not Applicable (parents married, widowed parent, etc) Subscriber is the custodial parent Subscriber is a joint custody parent Subscriber is the spouse of the custodial parent Subscriber is the spouse of a joint custody parent Subscriber is the non-custodial parent Subscriber is the spouse of the non-custodial parent
10	MEM_PAYOR_NAME	VARCHAR	No
	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.
11	MEM_VERIFICATION_ID	NUMERIC	No
	The verification record for the coverage member.
12	MEM_NUMBER	VARCHAR	No
	The identification number assigned to the member for the coverage.
13	MEM_PERSON_CODE	VARCHAR	No
	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".
14	ELIGIBILITY_CLAR_C_NAME	VARCHAR	No
	Clarifies the eligibility of the patient when sending an Rx Adjudication message (i.e. Student). This item is populated in ambulatory pharmacy. May contain organization-specific values: No Category Entries: Not Specified No Override Override Full Time Student Disabled Dependent Dependent Parent Significant Other
15	MEM_APP_DATE	DATETIME	No
	The date on which the member applied for coverage.
16	MEM_APP_TIME	DATETIME (Local)	No
	The time on which the member applied for coverage.
17	MEM_EFF_FROM_DATE	DATETIME	No
	The date on which the coverage goes into effect for the member.
18	MEM_STUDENT_YN	VARCHAR	No
	If the member is a full time student this column contains the value “Y”. If the member is not a full time student, as determined by the member’s Employment Status, this column contains the value “N”.
19	MEM_MEDICARE_NUM	VARCHAR	No
	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).
20	MEM_ENROLL_RSN_C_NAME	VARCHAR	No
	The member's reason for enrollment. May contain organization-specific values: Yes
21	HIX_EN_ADDL_MAINT_RSN_C_NAME	VARCHAR	No
	This item stores the additional maintenance reason from an incoming ANSI 834 enrollment file. May contain organization-specific values: Yes
22	MEM_EFF_TO_DATE	DATETIME	No
	The date after which the coverage is no longer in effect for the member and the member becomes ineligible for benefits.
23	MEM_TERM_REASON_C_NAME	VARCHAR	No
	The reason the member was terminated from the coverage. May contain organization-specific values: Yes
24	MEM_SCHED_DISCON_DT	DATETIME	No
	The member scheduled discontinuation date.
25	MEM_LATE_ENROLL_YN	VARCHAR	No
	Y – the member applied for coverage after open enrollment. N – the member did not apply for the coverage after the open enrollment period. May contain organization-specific values: No Category Entries: Yes No
26	MEM_VERIF_STAT_C_NAME	VARCHAR	No
	The last saved value of the member's verification status. May contain organization-specific values: Yes
27	LAST_VERIF_DATE	DATETIME	No
	The date the member on the coverage was last verified.
28	PCN_OVERRIDE	VARCHAR	No
	The processor control number (PCN) for this member. This PCN overrides the PCN at the plan or payor level for this member only.
29	MEMBER_VERF_USER_ID	VARCHAR	No
	The ID of the user who last verified this member's status.
30	MEMBER_VERF_USER_ID_NAME	VARCHAR	No
	The name of the user record. This name may be hidden.
31	MEMBER_ID_FROM_FILE	VARCHAR	No
	The member ID received on the source file for the member on the coverage.
32	CARRIER_IDENTIFIER	VARCHAR	No
	Used for prescription adjudication in ambulatory pharmacy. Carrier code assigned in Workers' Compensation Program (327-CR).
33	CLAIM_IDENTIFIER	VARCHAR	No
	Used for prescription adjudication in ambulatory pharmacy. Identifies the claim number assigned by Workers' Compensation Program (435-DZ).
34	FACILITY_IDENTIFIER	VARCHAR	No
	Used for prescription adjudication in ambulatory pharmacy. ID assigned to the patient's clinic/host party (336-8C).
35	HOME_PLAN	VARCHAR	No
	Used for prescription adjudication in ambulatory pharmacy. Code identifying the Blue Cross or Blue Shield plan ID which indicates where the member's coverage has been designated. Usually where the member lives or purchased their coverage (314-CE).
36	PLAN_IDENTIFIER	VARCHAR	No
	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).
37	RX_BILLING_INFO_ID	INTEGER	No
	Contains the default prescription billing information on this coverage like default values to send during claim adjudication.
38	HIX_APP_ID	VARCHAR	No
	The application ID of exchange coverages.
39	HIX_ORIGIN	VARCHAR	No
	The origin type of exchange coverages.
40	MEM_MAIL_CITY	VARCHAR	No
	The member's mailing city.
41	MEM_MAIL_STATE_C_NAME	VARCHAR	No
	The member's mailing state. May contain organization-specific values: Yes
42	MEM_MAIL_ZIP	VARCHAR	No
	The member's mailing ZIP code.
43	MEM_MAIL_COUNTY_C_NAME	VARCHAR	No
	The member's mailing county. May contain organization-specific values: Yes
44	MEM_MAIL_COUNTRY_C_NAME	VARCHAR	No
	The member's mailing country. May contain organization-specific values: Yes
45	MEM_MAIL_ADDR_LN_1	VARCHAR	No
	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.
46	MEM_MAIL_ADDR_LN_2	VARCHAR	No
	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.
47	MEM_CUSTO_NAME	VARCHAR	No
	The name of the member's custodial parent.
48	MEM_CUSTO_CITY	VARCHAR	No
	The city of the member's custodial parent.
49	MEM_CUSTO_STATE_C_NAME	VARCHAR	No
	The state of the member's custodial parent. The category values for this column were already listed for column: MEM_MAIL_STATE_C_NAME
50	MEM_CUSTO_ZIP	VARCHAR	No
	The ZIP code of the member's custodial parent.
51	MEM_CUSTO_COUNTY_C_NAME	VARCHAR	No
	The county of the member's custodial parent. The category values for this column were already listed for column: MEM_MAIL_COUNTY_C_NAME
52	MEM_CUSTO_COUNTRY_C_NAME	VARCHAR	No
	The country of the member's custodial parent. The category values for this column were already listed for column: MEM_MAIL_COUNTRY_C_NAME
53	MEM_CUSTO_EMAIL	VARCHAR	No
	The e-mail address of the member's custodial parent.
54	MEM_CUSTO_ADDR_LN_1	VARCHAR	No
	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.
55	MEM_CUSTO_ADDR_LN_2	VARCHAR	No
	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.
56	MEM_COVERED_C_NAME	VARCHAR	No
	Stores the category identifier of member's covered status, such as whether their coverage is currently valid or in question. This column is commonly used to join to ZC_COVERED_STATUS. The category values for this column were already listed for column: MEM_COVERED_YN
57	MEM_APPL_DTTM	DATETIME (Local)	No
	The date and time on which the member applied for coverage.
58	MEM_PAYOR_SEX_C_NAME	VARCHAR	No
	The member's sex as it is recorded in the payor's system. May contain organization-specific values: Yes Category Entries: Female Male Unknown Nonbinary X Other
59	MEM_MEDICARE_NUM_COVERAGE	VARCHAR	No
	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.
60	MEM_LEGACY_HICN_COVERAGE	VARCHAR	No
	If there is a HICN available for the member (e.g. known prior to receiving their MBI), this column stores the HICN from the coverage. 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 (PATIENT_4.LEGACY_HICN) may be different since it is used primarily for Registration.
61	MEM_MAIL_HOUSE_NUM	VARCHAR	No
	The house number of the member's mailing address.
62	MEM_MAIL_DISTRICT_C_NAME	VARCHAR	No
	The district category ID of the member's mailing address. May contain organization-specific values: Yes
63	MEM_CUSTO_HOUSE_NUM	VARCHAR	No
	The house number of the member's custodial parent's address.
64	MEM_CUSTO_DISTRICT_C_NAME	VARCHAR	No
	The district category ID of the member's custodial parent's address. The category values for this column were already listed for column: MEM_MAIL_DISTRICT_C_NAME
65	MEM_ADDR_IS_UNDELIV_YN	VARCHAR	No
	Indicates if member mailing address is undeliverable. May contain organization-specific values: No Category Entries: No Yes
66	MEM_MEDICAID_NUM	VARCHAR	No
	The Medicaid Number for a member on a given coverage.
67	MEM_EFF_DT_CHNG_RSN_C_NAME	VARCHAR	No
	The effective date change reason at the member level. May contain organization-specific values: Yes No Entries Defined
68	MEMBER_PAYER_BIRTH_DATE	DATETIME	No
	This item stores the member's date of birth as it is recorded in the payer's system.
69	MEM_ALT_IDENT	VARCHAR	No
	The alternate card identification number assigned to the member for the coverage.