KY MMIS 834 Companion Guide - Kymmis.com

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Commonwealth of Kentucky – MMISKY MMIS 834 Companion Guide834 Benefit Enrollment and Maintenance49 2000 INS INS04 - Maintenance ReasonCode‘07’ Termination of Benefits’25’ – Change in IdentifyingData Elements‘28’ – Initial Enrollment‘33’ – Personnel Data‘AI’ – No Reason Given‘XN’ Notification Only51 2000 INS INS05 – Benefit Status Code ‘A’ - Active51 2000 INS INS06-1 - Medicare Plan Code ‘A’ – Medicare Part A‘B’ – Medicare Part B‘C’ – Medicare Part A andMedicare Part B‘ E‘ – No Medicare52 2000 INS INS08 - Employment Status Code 'FT' - Fulltime‘TE’ - Temporary53 2000 INS INS10 - Handicap Indicator ‘N’ – No53 2000 INS INS11 – Date/Time Period FormatQualifier‘D8’ - Date Expressed inFormat CCYYMMDD54 2000 INS INS12 - Member Individual Death Member date of deathDate55 2000 REF REF01 – Reference IdentificationQualifier‘0F’ – Member Number55 2000 REF REF02 - Member Identifier Members current Medicaid IDDMS Approved 12/02/2011 Page 11
Commonwealth of Kentucky – MMISKY MMIS 834 Companion Guide834 Benefit Enrollment and Maintenance56 2000 REF REF01 – Reference IdentificationQualifier‘1L’ – Member PolicyNumber56 2000 REF REF02 - Member Group or PolicyNumberMember SSN57 2000 REF REF01 – Reference IdentificationQualifierThis occurrence of the REFsegment can repeat up to 5times. One for each of thefollowing:‘‘F6’ – HIC Number‘3H’ – Case Number‘Q4’ – Prior ID Number‘23’ – Client Number’17‘ – Client ReportingCategory58 2000 REF REF02 - Member SupplementalIdentifierF6 = Member HIC Number3H = Member Case NumberQ4 = Member PreviousMedicaid ID23 = Member Original ID17 = MCO Selection TypeA = Auto-assignedM = Member Selected59 2000 DTP DTP01 – Date Time Qualifier ‘356’ – Eligibility Begin Date60 2000 DTP DTP02 – Date Time Period FormatQualifier‘D8’ – indicates formatCCYYMMDD61 2000 DTP DTP03 – Eligibility Begin Date Date Medicaid EligibilityBegins59 2000 DTP DTP01 – Date Time Qualifier ‘357’ – Eligibility End Date60 2000 DTP DTP02 – Date Time Period FormatQualifier‘D8’ – indicates formatCCYYMMDDDMS Approved 12/02/2011 Page 12
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KY MMIS 834 Companion Guide - Kymmis.com

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