KY MMIS 834 Companion Guide - Kymmis.com

Commonwealth of Kentucky – MMISKY MMIS 834 Companion Guide834 Benefit Enrollment and Maintenance40 1000A N1 N103 - Identification CodeQualifier‘FI’ – Federal TaxpayerIdentification Number40 1000A1 N1 N104 – Sponsor Identifier ‘610600439’41 1000B N1 N101 – Entity Identifier Code ‘IN’ - Insurer41 1000B N1 N102 - Insurer NameThis is the 10 digit TradingPartner ID of the MCO42 1000B N1 N103 - Identification CodeQualifier‘FI’ – Federal TaxpayerIdentification Number42 1000B N1 N104 – Insurer Identification Code This is the 9 digit FederalTaxpayer IdentificationNumber of the MCO48 2000 INS INS01 - Member Indicator ‘Y’ - Yes48 2000 INS INS02 - Individual RelationshipCode‘18’ – Self49 2000 INS INS03 – Maintenance Type Code ‘001’ – Change‘021’ – Addition‘024’ – Cancellation orTerminationOne of these codes will besent per Loop 2000 on thedaily transaction‘030’ – Audit or CompareThis code is always sent onthe monthly transactionDMS Approved 12/02/2011 Page 10