KY MMIS 834 Companion Guide - Kymmis.com

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Commonwealth of Kentucky – MMISKY MMIS 834 Companion Guide834 Benefit Enrollment and Maintenance73 2100A DMG DMG05-1 – Race or EthnicityCode73 2100A DMG DMG05-2 – Code List QualifierCode74 2100A DMG DMG05-3 – Race or EthnicityCodeThis is the Member’s racecode‘7’ - Not Provided‘8’ – Not Applicable‘A’ - Asian or Pacific Islander‘B’ - Black‘C’ - Caucasian‘D’ – Subcontinent AsianAmerican‘E’ – Other Race or Ethnicity‘F’ – Asian Pacific American‘G’ – Native American‘H’ - Hispanic‘I’ - American Indian orAlaskan Native‘J’ – Native Hawaiian‘N’ - Black (Non-Hispanic)‘O’ - White (Non-Hispanic)‘P’ – Pacific Islander‘Z’ – Mutually Defined‘RET’ – Classification ofRace or EthnicityMember Ethnicity Code79 2100A ICM ICM01 – Frequency Code ‘4’ – Monthly80 2100A ICM ICM02 – Wage Amount Monthly Income84 2100A LUI LUI01 - Identification CodeQualifier‘LE’ – Language CodeDMS Approved 12/02/2011 Page 15
Commonwealth of Kentucky – MMISKY MMIS 834 Companion Guide834 Benefit Enrollment and Maintenance85 2100A LUI LUI02 – Language Code ISO 639 Language Codes whichinclude:‘SPA’ – Spanish‘ARM’ – Armenian‘KHM’ – Khmer‘TGL’ – Tagalog‘LAO’ – Laotian‘UNK’ – Unknown‘IRA’ – Iranian (Other)‘RUS’ – Russian‘ARA’ – Arabic‘JPN’ – Japanese‘ENG’ – English‘KOR’ – Korean‘POR’ – Portuguese‘UND’ – Undetermined‘VIE’ – Vietnamese‘FRE’ – French‘GER’ – German‘ITA’ – Italian86 2100B NM1 NM101- Entity Identifier Code ‘70’ – Prior Incorrect Insured87 2100B NM1 NM102 – Entity Type Qualifier ‘1’ – Person87 2100B NM1 NM103 – Prior Incorrect MemberLast NameMember Last NameIf the member last name haschanged since the last filesent, this field will bepopulatedDMS Approved 12/02/2011 Page 16
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KY MMIS 834 Companion Guide - Kymmis.com

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