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X12-834 Transaction Enrollment Data

Source: R/aaa-classes-834.R
EnrollmentData.Rd

Data needed for risk adjustment and Medicaid coverage tracking. Supports California DHCS Medi-Cal 834 format with FAME fields.

Usage

EnrollmentData(
  source = character(0),
  report_date = .Date(numeric(0L)),
  member_id = character(0),
  mbi = character(0),
  medicaid_id = character(0),
  hic = integer(0),
  cin = integer(0),
  cin_check_digit = integer(0),
  first_name = character(0),
  last_name = character(0),
  middle_name = character(0),
  dob = .Date(numeric(0L)),
  age = integer(0),
  sex = character(0),
  race = character(0),
  language = character(0),
  death_date = .Date(numeric(0L)),
  address = character(0),
  city = character(0),
  state = character(0),
  zip = character(0),
  phone = character(0),
  maintenance_type = character(0),
  maintenance_reason_code = character(0),
  benefit_status_code = character(0),
  coverage_period = c(.Date(numeric(0L)), .Date(numeric(0L))),
  has_medicare = logical(0),
  has_medicaid = logical(0),
  dual_elgbl_cd = character(0),
  is_full_benefit_dual = logical(0),
  is_partial_benefit_dual = logical(0),
  medicare_status_code = character(0),
  medi_cal_aid_code = character(0),
  medi_cal_eligibility_status = character(0),
  fame_county_id = character(0),
  case_number = character(0),
  fame_card_issue_date = .Date(numeric(0L)),
  fame_redetermination_date = .Date(numeric(0L)),
  fame_death_date = .Date(numeric(0L)),
  primary_aid_code = character(0),
  carrier_code = character(0),
  fed_contract_number = character(0),
  client_reporting_cat = character(0),
  res_addr_flag = character(0),
  reas_add_ind = character(0),
  res_zip_deliv_code = character(0),
  orec = character(0),
  crec = character(0),
  snp = logical(0),
  low_income = logical(0),
  lti = logical(0),
  new_enrollee = logical(0),
  medicare_prt_a = logical(0),
  medicare_prt_b = logical(0),
  medicare_prt_d = logical(0),
  hcp_code = character(0),
  hcp_status = character(0),
  amount_qualifier = character(0),
  amount = numeric(0),
  hcp_history = list()
)

Arguments

source

ISA-06 Interchange sender ID

report_date

GS-04 Transaction date

member_id

REF*0F Unique identifier for the member

mbi

REF*6P Medicare Beneficiary Identifier

medicaid_id

REF*23 Medicaid/Medi-Cal ID number

hic

REF*F6 Medicare HICN

cin

REF*3H Client Index Number

cin_check_digit

REF*3H CIN check digit

first_name

NM1-04 Member first name

last_name

NM1-03 Member last name

middle_name

NM1-05 Member middle name

dob

DMG-02 Date of birth (YYYY-MM-DD)

age

Calculated age

sex

DMG-03 Member sex (M/F)

race

DMG-05 Race/ethnicity code

language

LUI-02 Preferred language

death_date

INS-12 Date of death if applicable

address

N3-01 Street address line 1

city

N4-01 City

state

N4-02 State code

zip

N4-03 Postal code

phone

PER-04 Phone number

maintenance_type

INS-03

  • 001: Change

  • 021: Add

  • 024: Cancel

  • 025: Reinstate

  • 030: Audit/Compare

maintenance_reason_code

INS-04 Maintenance reason

benefit_status_code

INS-05

  • A: Active

  • C: COBRA

  • S: Surviving Insured

  • T: TEFRA

coverage_period

Coverage effective date range

has_medicare

Member has Medicare coverage

has_medicaid

Member has Medicaid coverage

dual_elgbl_cd

Dual eligibility status code (00,01-08)

is_full_benefit_dual

Full Benefit Dual (uses CFA_/CFD_ prefix)

is_partial_benefit_dual

Partial Benefit Dual (uses CPA_/CPD_ prefix)

medicare_status_code

INS-06 QMB, SLMB, QI, QDWI, etc.

medi_cal_aid_code

California Medi-Cal aid code

medi_cal_eligibility_status

Active/Terminated/None

fame_county_id

REF*ZX|N4*CYFAME county ID

case_number

REF*1L Case number

fame_card_issue_date

FAME card issue date

fame_redetermination_date

REF*17 FAME redetermination date

fame_death_date

FAME death date

primary_aid_code

REF*RB Primary AID code

carrier_code

Carrier code

fed_contract_number

Federal contract number

client_reporting_cat

Client reporting category

res_addr_flag

Residential address flag from REF*6O

reas_add_ind

Reason address indicator from REF*6O

res_zip_deliv_code

Residential zip delivery code

orec

Original Reason for Entitlement Code

crec

Current Reason for Entitlement Code

snp

Special Needs Plan enrollment

low_income

Low Income Subsidy (Part D)

lti

Long-Term Institutionalized

new_enrollee

New enrollee status (<= 3 months)

medicare_prt_a

description

medicare_prt_b

description

medicare_prt_d

description

hcp_code

Current HCP code (HD-04 first part)

hcp_status

Current HCP status (HD-04 second part)

amount_qualifier

AMT-01 qualifier code:

  • B9: Co-insurance - Actual

  • C1: Co-Payment Amount

  • D2: Deductible Amount

  • EBA: Expected Expenditure Amount

  • FK: Other Unlisted Amount

  • P3: Premium Amount

  • R: Spend Down

amount

AMT-02 Monetary amount identified in AMT-01

hcp_history

List of <HCPCoveragePeriod>, historical HCP coverage periods

Value

An <hcc::EnrollmentData> S7 object

Examples

EnrollmentData()
#> <hcc::EnrollmentData>
#>  @ source                     : chr(0) 
#>  @ report_date                : 'Date' num(0) 
#>  @ member_id                  : chr(0) 
#>  @ mbi                        : chr(0) 
#>  @ medicaid_id                : chr(0) 
#>  @ hic                        : int(0) 
#>  @ cin                        : int(0) 
#>  @ cin_check_digit            : int(0) 
#>  @ first_name                 : chr(0) 
#>  @ last_name                  : chr(0) 
#>  @ middle_name                : chr(0) 
#>  @ dob                        : 'Date' num(0) 
#>  @ age                        : int(0) 
#>  @ sex                        : chr(0) 
#>  @ race                       : chr(0) 
#>  @ language                   : chr(0) 
#>  @ death_date                 : 'Date' num(0) 
#>  @ address                    : chr(0) 
#>  @ city                       : chr(0) 
#>  @ state                      : chr(0) 
#>  @ zip                        : chr(0) 
#>  @ phone                      : chr(0) 
#>  @ maintenance_type           : chr(0) 
#>  @ maintenance_reason_code    : chr(0) 
#>  @ benefit_status_code        : chr(0) 
#>  @ coverage_period            : iv<date> [1:1] [NA, NA)
#>  @ has_medicare               : logi(0) 
#>  @ has_medicaid               : logi(0) 
#>  @ dual_elgbl_cd              : chr(0) 
#>  @ is_full_benefit_dual       : logi(0) 
#>  @ is_partial_benefit_dual    : logi(0) 
#>  @ medicare_status_code       : chr(0) 
#>  @ medi_cal_aid_code          : chr(0) 
#>  @ medi_cal_eligibility_status: chr(0) 
#>  @ fame_county_id             : chr(0) 
#>  @ case_number                : chr(0) 
#>  @ fame_card_issue_date       : 'Date' num(0) 
#>  @ fame_redetermination_date  : 'Date' num(0) 
#>  @ fame_death_date            : 'Date' num(0) 
#>  @ primary_aid_code           : chr(0) 
#>  @ carrier_code               : chr(0) 
#>  @ fed_contract_number        : chr(0) 
#>  @ client_reporting_cat       : chr(0) 
#>  @ res_addr_flag              : chr(0) 
#>  @ reas_add_ind               : chr(0) 
#>  @ res_zip_deliv_code         : chr(0) 
#>  @ orec                       : chr(0) 
#>  @ crec                       : chr(0) 
#>  @ snp                        : logi(0) 
#>  @ low_income                 : logi(0) 
#>  @ lti                        : logi(0) 
#>  @ new_enrollee               : logi(0) 
#>  @ medicare_prt_a             : logi(0) 
#>  @ medicare_prt_b             : logi(0) 
#>  @ medicare_prt_d             : logi(0) 
#>  @ hcp_code                   : chr(0) 
#>  @ hcp_status                 : chr(0) 
#>  @ amount_qualifier           : chr(0) 
#>  @ amount                     : num(0) 
#>  @ hcp_history                : list()