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HS.SDA3.MemberEnrollment

serial class HS.SDA3.MemberEnrollment extends HS.SDA3.SuperClass

MemberEnrollment is neither parsed from HL7, nor is it stored to the Viewer Cache.

Property Inventory

Properties

property Business as HS.SDA3.CodeTableDetail.Business;
Property methods: BusinessGet(), BusinessGetObject(), BusinessGetObjectId(), BusinessGetSwizzled(), BusinessIsEmpty(), BusinessIsValid(), BusinessNewObject(), BusinessSet(), BusinessSetObject(), BusinessSetObjectId(), BusinessUnSwizzle()
property CarrierSpecificMemberID as %String;
Unique, internal identification assigned by the carrier or its designee to the Member.
This can be used to link Claim Lines to eligibility segments.
Property methods: CarrierSpecificMemberIDDisplayToLogical(), CarrierSpecificMemberIDGet(), CarrierSpecificMemberIDIsValid(), CarrierSpecificMemberIDLogicalToDisplay(), CarrierSpecificMemberIDLogicalToOdbc(), CarrierSpecificMemberIDNormalize(), CarrierSpecificMemberIDSet()
property CoverageLevelCode as HS.SDA3.CodeTableDetail.CoverageLevel;
A code that reports relationships which are covered under the benefits during the time-period of this eligibility segment.
Property methods: CoverageLevelCodeGet(), CoverageLevelCodeGetObject(), CoverageLevelCodeGetObjectId(), CoverageLevelCodeGetSwizzled(), CoverageLevelCodeIsEmpty(), CoverageLevelCodeIsValid(), CoverageLevelCodeNewObject(), CoverageLevelCodeSet(), CoverageLevelCodeSetObject(), CoverageLevelCodeSetObjectId(), CoverageLevelCodeUnSwizzle()
property CoverageType as HS.SDA3.CodeTableDetail.CoverageType;
A code that reports the risk-type of the carrier the Member is covered under during the time-period stated on this eligibility segment.
Property methods: CoverageTypeGet(), CoverageTypeGetObject(), CoverageTypeGetObjectId(), CoverageTypeGetSwizzled(), CoverageTypeIsEmpty(), CoverageTypeIsValid(), CoverageTypeNewObject(), CoverageTypeSet(), CoverageTypeSetObject(), CoverageTypeSetObjectId(), CoverageTypeUnSwizzle()
property DentalCoverage as %String (DISPLAYLIST = ",Yes,No,Unknown,Other,NotApplicable", VALUELIST = ",1,2,3,4,5");
Numeric indicator that reports if the Member has dental coverage as a benefit during the time-period of this eligibility segment.
Property methods: DentalCoverageDisplayToLogical(), DentalCoverageGet(), DentalCoverageIsValid(), DentalCoverageLogicalToDisplay(), DentalCoverageLogicalToOdbc(), DentalCoverageNormalize(), DentalCoverageSet()
property Extension as HS.Local.SDA3.MemberEnrollmentExtension;
Property methods: ExtensionGet(), ExtensionGetObject(), ExtensionGetObjectId(), ExtensionGetSwizzled(), ExtensionIsEmpty(), ExtensionIsValid(), ExtensionNewObject(), ExtensionSet(), ExtensionSetObject(), ExtensionSetObjectId(), ExtensionUnSwizzle()
property Guarantor as HS.SDA3.Guarantor;
Property methods: GuarantorGet(), GuarantorGetObject(), GuarantorGetObjectId(), GuarantorGetSwizzled(), GuarantorIsEmpty(), GuarantorIsValid(), GuarantorNewObject(), GuarantorSet(), GuarantorSetObject(), GuarantorSetObjectId(), GuarantorUnSwizzle()
property HealthFund as HS.SDA3.HealthFund;
The primary program or plan underwriter or payor. This may represent insurance or non-insurance agreements, such as patient-pay agreements. If there is more than one relevant underwriter or payor, the non-primary entities may be represented in the OtherPayors property
Property methods: HealthFundGet(), HealthFundGetObject(), HealthFundGetObjectId(), HealthFundGetSwizzled(), HealthFundIsEmpty(), HealthFundIsValid(), HealthFundNewObject(), HealthFundSet(), HealthFundSetObject(), HealthFundSetObjectId(), HealthFundUnSwizzle()
property IndividualRelationshipCode as HS.SDA3.CodeTableDetail.Relationship;
Numeric indicator to define the Member's relationship to the Subscriber.
834: loop2000().INS:IndividualRelationshipCode
Property methods: IndividualRelationshipCodeGet(), IndividualRelationshipCodeGetObject(), IndividualRelationshipCodeGetObjectId(), IndividualRelationshipCodeGetSwizzled(), IndividualRelationshipCodeIsEmpty(), IndividualRelationshipCodeIsValid(), IndividualRelationshipCodeNewObject(), IndividualRelationshipCodeSet(), IndividualRelationshipCodeSetObject(), IndividualRelationshipCodeSetObjectId(), IndividualRelationshipCodeUnSwizzle()
property InsuranceTypeOrProductCode as HS.SDA3.CodeTableDetail.InsuranceType;
A code that defines the type of insurance applied to the claim line.
This value can be derived from the claim as submitted by the provider or reassigned by the carrier or its designee.
Property methods: InsuranceTypeOrProductCodeGet(), InsuranceTypeOrProductCodeGetObject(), InsuranceTypeOrProductCodeGetObjectId(), InsuranceTypeOrProductCodeGetSwizzled(), InsuranceTypeOrProductCodeIsEmpty(), InsuranceTypeOrProductCodeIsValid(), InsuranceTypeOrProductCodeNewObject(), InsuranceTypeOrProductCodeSet(), InsuranceTypeOrProductCodeSetObject(), InsuranceTypeOrProductCodeSetObjectId(), InsuranceTypeOrProductCodeUnSwizzle()
property InsuredGroup as HS.SDA3.CodeTableDetail.InsuredGroup;
Employer account identifier.
Property methods: InsuredGroupGet(), InsuredGroupGetObject(), InsuredGroupGetObjectId(), InsuredGroupGetSwizzled(), InsuredGroupIsEmpty(), InsuredGroupIsValid(), InsuredGroupNewObject(), InsuredGroupOrPolicyNumberDisplayToLogical(), InsuredGroupOrPolicyNumberGet(), InsuredGroupOrPolicyNumberIsValid(), InsuredGroupOrPolicyNumberLogicalToDisplay(), InsuredGroupOrPolicyNumberLogicalToOdbc(), InsuredGroupOrPolicyNumberNormalize(), InsuredGroupOrPolicyNumberSet(), InsuredGroupSet(), InsuredGroupSetObject(), InsuredGroupSetObjectId(), InsuredGroupUnSwizzle()
property InsuredGroupOrPolicyNumber as %String;

Deprecated. Use either the InsuredGroup property, or the PolicyPlan property.

Deprecated property description: The carrier assigned group / policy number for this claim line.
This information is often filed as reported by the provider.
834: loop2000().REF():RefId

Property methods: InsuredGroupOrPolicyNumberDisplayToLogical(), InsuredGroupOrPolicyNumberGet(), InsuredGroupOrPolicyNumberIsValid(), InsuredGroupOrPolicyNumberLogicalToDisplay(), InsuredGroupOrPolicyNumberLogicalToOdbc(), InsuredGroupOrPolicyNumberNormalize(), InsuredGroupOrPolicyNumberSet()
property MarketCategoryCode as HS.SDA3.CodeTableDetail.MarketCategory;
A code that reports the market the policy is sold into by the carrier or its designee during the time-period of this eligibility segment.
Use this code to map to individuals and group sizes.
Property methods: MarketCategoryCodeGet(), MarketCategoryCodeGetObject(), MarketCategoryCodeGetObjectId(), MarketCategoryCodeGetSwizzled(), MarketCategoryCodeIsEmpty(), MarketCategoryCodeIsValid(), MarketCategoryCodeNewObject(), MarketCategoryCodeSet(), MarketCategoryCodeSetObject(), MarketCategoryCodeSetObjectId(), MarketCategoryCodeUnSwizzle()
property MedicalCoverage as %String (DISPLAYLIST = ",Yes,No,Unknown,Other,NotApplicable", VALUELIST = ",1,2,3,4,5");
Numeric indicator that reports if the Member has medical coverage as a benefit during the time-period of this eligibility segment.
Property methods: MedicalCoverageDisplayToLogical(), MedicalCoverageGet(), MedicalCoverageIsValid(), MedicalCoverageLogicalToDisplay(), MedicalCoverageLogicalToOdbc(), MedicalCoverageNormalize(), MedicalCoverageSet()
property MemberEnrollmentNumber as %String (MAXLEN = 220);
A unique string to identify Member Enrollment
For 834, it takes the form payerIdCode_subscriberId_memberId_coveragePeriod:
payerIdCode: loop1000B.N1
subscriberId: loop2000.REF():RefId
memberId: loop2000.REF():RefId
coveragePeriod: loop2000.loop2300().DTP()
Property methods: MemberEnrollmentNumberDisplayToLogical(), MemberEnrollmentNumberGet(), MemberEnrollmentNumberIsValid(), MemberEnrollmentNumberLogicalToDisplay(), MemberEnrollmentNumberLogicalToOdbc(), MemberEnrollmentNumberNormalize(), MemberEnrollmentNumberSet()
property MemberPolicyAmounts as list of HS.SDA3.MemberPolicyAmount;
Amounts for supported policies provided in an 834 eligibility message.
Property methods: MemberPolicyAmountsBuildValueArray(), MemberPolicyAmountsCollectionToDisplay(), MemberPolicyAmountsCollectionToOdbc(), MemberPolicyAmountsDisplayToCollection(), MemberPolicyAmountsGet(), MemberPolicyAmountsGetObject(), MemberPolicyAmountsGetObjectId(), MemberPolicyAmountsGetSwizzled(), MemberPolicyAmountsIsValid(), MemberPolicyAmountsOdbcToCollection(), MemberPolicyAmountsSet(), MemberPolicyAmountsSetObject(), MemberPolicyAmountsSetObjectId()
property NationalPlanID as %String;
This is a unique identifier as outlined by Centers for Medicare and Medicaid Services (CMS) for Plans or Sub plans 834: loop2000().loop2300().REF(1):RefId
Property methods: NationalPlanIDDisplayToLogical(), NationalPlanIDGet(), NationalPlanIDIsValid(), NationalPlanIDLogicalToDisplay(), NationalPlanIDLogicalToOdbc(), NationalPlanIDNormalize(), NationalPlanIDSet()
property OtherPayors as list of HS.SDA3.CodeTableDetail.HealthFund;
Additional program or plan underwriters or payors including both insurance and non-insurance agreements, such as patient-pay agreements. The primary underwriter/payor should be identified in the HealthFund property
Property methods: OtherPayorsBuildValueArray(), OtherPayorsCollectionToDisplay(), OtherPayorsCollectionToOdbc(), OtherPayorsDisplayToCollection(), OtherPayorsGet(), OtherPayorsGetObject(), OtherPayorsGetObjectId(), OtherPayorsGetSwizzled(), OtherPayorsIsValid(), OtherPayorsOdbcToCollection(), OtherPayorsSet(), OtherPayorsSetObject(), OtherPayorsSetObjectId()
property PlanSpecificSubscriberID as %String;
Unique, internal identification assigned by the carrier or its designee to the Subscriber.
This can be used to link Claim Lines to eligibility segments.
834: loop2000().REF():RefId
Property methods: PlanSpecificSubscriberIDDisplayToLogical(), PlanSpecificSubscriberIDGet(), PlanSpecificSubscriberIDIsValid(), PlanSpecificSubscriberIDLogicalToDisplay(), PlanSpecificSubscriberIDLogicalToOdbc(), PlanSpecificSubscriberIDNormalize(), PlanSpecificSubscriberIDSet()
property PolicyPlan as HS.SDA3.CodeTableDetail.PolicyPlan;
Business concept used by a health plan to describe its benefit offerings.
Property methods: PolicyPlanGet(), PolicyPlanGetObject(), PolicyPlanGetObjectId(), PolicyPlanGetSwizzled(), PolicyPlanIsEmpty(), PolicyPlanIsValid(), PolicyPlanNewObject(), PolicyPlanSet(), PolicyPlanSetObject(), PolicyPlanSetObjectId(), PolicyPlanUnSwizzle()
property PrescriptionCoverage as %String (DISPLAYLIST = ",Yes,No,Unknown,Other,NotApplicable", VALUELIST = ",1,2,3,4,5");
Numeric indicator that reports if the Member has prescription drug coverage as a benefit during the time-period of this eligibility segment.
Property methods: PrescriptionCoverageDisplayToLogical(), PrescriptionCoverageGet(), PrescriptionCoverageIsValid(), PrescriptionCoverageLogicalToDisplay(), PrescriptionCoverageLogicalToOdbc(), PrescriptionCoverageNormalize(), PrescriptionCoverageSet()
property PrimaryCareFacility as HS.SDA3.CodeTableDetail.HealthCareFacility;
Primary Care Facility
Property methods: PrimaryCareFacilityGet(), PrimaryCareFacilityGetObject(), PrimaryCareFacilityGetObjectId(), PrimaryCareFacilityGetSwizzled(), PrimaryCareFacilityIsEmpty(), PrimaryCareFacilityIsValid(), PrimaryCareFacilityNewObject(), PrimaryCareFacilitySet(), PrimaryCareFacilitySetObject(), PrimaryCareFacilitySetObjectId(), PrimaryCareFacilityUnSwizzle()
property PrimaryCareProvider as HS.SDA3.CodeTableDetail.CareProvider;
Primary Care Provider 834: loop2000().loop2300().loop2310()
Property methods: PrimaryCareProviderGet(), PrimaryCareProviderGetObject(), PrimaryCareProviderGetObjectId(), PrimaryCareProviderGetSwizzled(), PrimaryCareProviderIsEmpty(), PrimaryCareProviderIsValid(), PrimaryCareProviderNewObject(), PrimaryCareProviderSet(), PrimaryCareProviderSetObject(), PrimaryCareProviderSetObjectId(), PrimaryCareProviderUnSwizzle()
property PrimaryInsuranceIndicator as %String (DISPLAYLIST = ",Yes,No,Unknown,Other,NotApplicable", VALUELIST = ",1,2,3,4,5");
Numeric indicator that reports if the Member's eligibility is for primary insurance during the time-period of this eligibility segment.
Property methods: PrimaryInsuranceIndicatorDisplayToLogical(), PrimaryInsuranceIndicatorGet(), PrimaryInsuranceIndicatorIsValid(), PrimaryInsuranceIndicatorLogicalToDisplay(), PrimaryInsuranceIndicatorLogicalToOdbc(), PrimaryInsuranceIndicatorNormalize(), PrimaryInsuranceIndicatorSet()
property Source as %String;
The source, e.g., 834 etc.
Property methods: SourceDisplayToLogical(), SourceFormatGet(), SourceFormatGetObject(), SourceFormatGetObjectId(), SourceFormatGetSwizzled(), SourceFormatIsEmpty(), SourceFormatIsValid(), SourceFormatNewObject(), SourceFormatSet(), SourceFormatSetObject(), SourceFormatSetObjectId(), SourceFormatUnSwizzle(), SourceGet(), SourceIsValid(), SourceLogicalToDisplay(), SourceLogicalToOdbc(), SourceNormalize(), SourceSet()
property SpecialCoverage as HS.SDA3.CodeTableDetail.SpecialCoverage;
A code that reports special coverage type under Commonwealth Care or the Health Safety Net during the time-period of this eligibility segment.
Value of N/A indicates any other type of coverage.
Property methods: SpecialCoverageGet(), SpecialCoverageGetObject(), SpecialCoverageGetObjectId(), SpecialCoverageGetSwizzled(), SpecialCoverageIsEmpty(), SpecialCoverageIsValid(), SpecialCoverageNewObject(), SpecialCoverageSet(), SpecialCoverageSetObject(), SpecialCoverageSetObjectId(), SpecialCoverageUnSwizzle()
property Status as HS.SDA3.CodeTableDetail.FinancialResourceStatus;

Identifies the status of the coverage information for the FHIR Coverage resource.

To conform to the FHIR CARIN Blue Button Implementation Profiles, the Status.Code property requires the value set defined at http://hl7.org/fhir/ValueSet/fm-status. Refer to the HealthShare documentation for information on translating local codes into defined value sets.

When no value is supplied, the default is "active".

Property methods: StatusGet(), StatusGetObject(), StatusGetObjectId(), StatusGetSwizzled(), StatusIsEmpty(), StatusIsValid(), StatusNewObject(), StatusSet(), StatusSetObject(), StatusSetObjectId(), StatusUnSwizzle()
property SubscriberSSNOrProxy as %String;
Tax ID of the Subscriber.
Property methods: SubscriberSSNOrProxyDisplayToLogical(), SubscriberSSNOrProxyGet(), SubscriberSSNOrProxyIsValid(), SubscriberSSNOrProxyLogicalToDisplay(), SubscriberSSNOrProxyLogicalToOdbc(), SubscriberSSNOrProxyNormalize(), SubscriberSSNOrProxySet()
property SuffixOrSequenceNumber as %String;
Property methods: SuffixOrSequenceNumberDisplayToLogical(), SuffixOrSequenceNumberGet(), SuffixOrSequenceNumberIsValid(), SuffixOrSequenceNumberLogicalToDisplay(), SuffixOrSequenceNumberLogicalToOdbc(), SuffixOrSequenceNumberNormalize(), SuffixOrSequenceNumberSet()

Inherited Members

Inherited Properties

Inherited Methods

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