Section Ins 4009.01 - Subscriber and Member Identification Data Elements(a) The following table lists the subscriber and member identifiers that must be identical when reporting information about a subscriber or a member: Table 1: Matching Requirements for Subscriber/Member Identifiers Across Files |
Data Element Name* | Subscriber and Member Identifiers |
Member Eligibility | Medical Claims** | Dental Claims | Pharmacy Claims |
Subscriber Social Security Number | ME008 | MC007 | DC007 | PC007 |
Plan Specific Contract Number | ME009 | MC008 | DC008 | PC008 |
Member Suffix or Sequence Number | ME010 | MC009 | DC009 | PC009 |
Member Identification Code | ME011 | MC010 | DC010 | PC010 |
Subscriber Last Name | ME101 | MC101 | DC101 | PC101 |
Subscriber First Name | ME102 | MC102 | DC102 | PC102 |
Subscriber Middle Initial | ME103 | MC103 | DC103 | PC103 |
Member Last Name | ME104 | MC104 | DC104 | PC104 |
Member First Name | ME105 | MC105 | DC105 | PC105 |
Member Middle Initial | ME106 | MC106 | DC106 | PC106 |
*The NHCHIS preprocessor hashes these data elements as part of the file encryption and transmission process. |
**Also pertains to Behavioral Health. |
(b) The NHCHIS preprocessor application will hash all subscriber and member identification codes and names before data are transmitted to the department's designee. To ensure consistent hashing, subscriber and member identifiers should not be encrypted or hashed on the initial extract loaded into the preprocessor.(c) If a third-party administrator does not collect the social security numbers for its members, the third-party administrator shall provide the social security number of the subscriber and assign a discrete two digit suffix for each member under the subscriber's contract using the following criteria: (1) If the subscriber's social security number is not collected by the third-party administrator, the subscriber's certificate or contract number shall be used in its place. This data element is de-identified by the NHCHIS preprocessor application.(2) The discrete two-digit suffix shall also be used with the certificate or contract number. This data element is de-identified by the NHCHIS preprocessor application.(3) The certificate or contract number with the two-digit suffix shall be at least 11, but no more than 30 characters in length. This data element is de-identified by the NHCHIS preprocessor application.N.H. Admin. Code § Ins 4009.01
Derived From Volume XXXV Number 32, Filed August 13, 2015, Proposed by #10877, Effective 7/10/2015, Expires7/10/2025.Amended by Volume XL Number 50, Filed December 10, 2020, Proposed by #13136, Effective 11/24/2020, Expires 11/24/2030