KY MMIS 834 Companion Guide - Kymmis.com

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Commonwealth of Kentucky – MMISKY MMIS 834 Companion GuideData Element Description Position with HD04Data ElementValid Values/Format/Comments‘LKD’ for Linked Members InformationHD04-02 (always present)The HD04-01 segment number. Ifthere are 3 occurrences of the anyHD04-1 values, first HD04-2occurrence will have the value of 01,2nd occurrence will have the value of02 and the 3rd occurrence will havethe value of 03.Position 4 - 5 01 to 99For each Loop 2300 HD segment a Loop 2300 DTPsegment will be sent for the begin date and anotherLoop 2300 DTP segment for the end date. Only 1DTP segment will be sent for the PRG Loop 2300HD.HD04-03 (when applicable)The program code assignmentmaintained by senderPosition 6 - 7Value may be present for all coverage types"ELG", "MNC", "MCA", "MCB", “DJJ”, “GUA”,“FST”, “PRG”, "HSP", “IST”HD04-04 (when applicable)The IM ID assigned to the member bysenderPosition 8 - 9Value may only be present for coverage type"ELG"HD04-05 (when applicable)The status associated with the membereligibilityPosition 10 - 11Value may only be present for coverage type"ELG"HD04-06 (when applicable)The liability indicator assigned whenmember has patient liabilityPosition 12Value of "space"DMS Approved 12/02/2011 Page 23
Commonwealth of Kentucky – MMISKY MMIS 834 Companion GuideData Element Description Position with HD04Data ElementValid Values/Format/CommentsHD04-07 (when applicable)The Long Term Care indicator Position 13assigned when the member is in a LTCfacilityValue of "space"HD04-08 (when applicable)The Institutional Status Code assignedwhen the member is in an InstitutionalsettingPosition 14 - 15Value may only be present for coverage type"HSP", “IST”HD04-09 (when applicable) The Long Term Care PA indicator Position 16 Value of "space"HD04-10 (when applicable) The co-pay indicator Position 17 Value may only be present for coverage type"ELG"HD04-11 (when applicable)The transaction date associated withthis eligibility informationPosition 18 - 25Value may be present for all coverage types"MNC", "MCA", "MCB", “DJJ”, “GUA”, “FST”,“PRG”, “HSP”, “IST” , “LKD”Format: CCYYMMDDDMS Approved 12/02/2011 Page 24
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