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