Domain

Data Elements

Definition

Ready for Prototype

Unique Identifiers

Sponsor ID

Refers to a unique identification number for the entity who is funding the coverage. This could include a private employer, government, self-pay, union, etc.

No

Plan ID

A unique identification number for the entity that has responsibility for paying the claim. The plan and sponsor may be the same organization.

No

Enrollee Identifier

Unique Identification number for the members of a plan. The enrollee and dependents would each have a unique ID.

No

Primary Health Care Provider ID

Member’s physician selected at time of enrollment. Unique ID of Primary Care Physician.

No

Member

Eligibility Status

Identifies whether the member is on or eligible for Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI).

Yes

Date of Birth

Member’s birthday.

Yes

Marital Status

The marital status of the member at time of enrollment (to be updated) using categories compatible with U.S. Census.

Yes

Gender

Sex of member.

Yes

Race

Origins of the member using U.S. census categories.

Yes

Hispanic Origin

Origins of the member using U.S. census categories.

Yes

Member Continued

Residence

Zip code (Plan would need full address).

Yes

Living Arrangement

The member’s usual living arrangement indicating whether they live alone, with relatives or non-related persons.

Yes

Residential Arrangement

The member’s usual residential arrangement which includes on the street or in a shelter, private residence, jail or correctional facility, other residential arrangement or other institutional setting.

Yes

Years of Schooling

Educational level attained at time of admission.

Yes

Employment

Status at time of enrollment using U.S. Census categories.

Yes

Occupational Code

Most recent occupation of member.

Yes

Primary Language

Member identifies language most frequently used in conversation.

No

Plan

Date Enrollment Begins

The date on which the member becomes eligible for coverage.

Yes

Date Enrollment Ends

The date on which a member’s eligibility for coverage is terminated.

Yes

Health Status

Self Reported Health Status

Global measure of health status at time of enrollment using the National Health Interview Survey (five category rating from excellent to poor).

Yes

Health Status Continued

Functional Status

Global rating of the member’s overall abilities to care for self.

No

Disenrollment Reason

Primary reason for member discontinuing coverage.

No

Cause of Death

Cause of death to include suicide, accident or other (to be determined).

No