HI 00825.907 Sample HIM Reply to Combined MBR/HIM Query
Example 1:
Regular Reply
HH REPLY HMQ EVHIR THOMAS, C 123456789A DC99 PD060577 UN01
SEXM PAE0775E PBE0775Y DOB010101 SB1 PCLYES FRZYES LAFS1
XCN 987654321B1 CBN THOMAS, CHARLES, T
PAT 0776 PBT 0776
PPA 0973 0175Y PPB 0773 0175Y
ENT 1
ADD 149 ELM ST, NEW BELMONT NH 08210
Example 2:
Skeleton Reply (inactive health insurance tape)
HH REPLY HMQ EVHIR THOMAS,C
123456789A DC99 PD060577 UN00
SEXM PAE PBE DOE010101 SBI PCL FRZ LAF
CBN THOMAS,CHARLES,T DOD 0776
LINE 1 REGULAR REPLY
HH—Prefix
REPLY—TYPE OF REPLY
HMQ—QUERY INPUT (HI/MBR STATUS QUERY)
EVHIR—DO ROUTING INDICATOR
THOMAS,C—BENEFICIARY NAME AS INPUT BY THE DO
123456789A—CLAIM NUMBER QUERIED ON
DC99—DISPOSITION CODE (99)
PD060577—BDP PROCESSING DATE (060577)
UN01—UNIT IDENTIFIER (01)
LINE 2
SEXM—SEX CODE (M = MALE F = FEMALE)
PAE0775E—PART A ENTITLEMENT AND OPTION CODE (0775-DATE E-OPTION CODE)
PBE0775Y—PART B ENTITLEMENT AND OPTION CODE
DOB010101—DATE OF BIRTH (010101)
SBI1 —STATE BUY-IN (CODE 01)
PCLYES—HI CARD PRECLUSION (YES)
FRZYES—PART A RECORD FROZEN (YES = RECORD FROZEN)
LAFS1 —BENEFICIARY'S LEDGER ACCOUNT FILE (S1 = LAF CODE)
LINE 3 TRAILERS
XCN-987654321B1—CROSS-REFERENCE CLAIM NUMBER UNDER WHICH THE HEALTH INSURANCE RECORD IS MAINTAINED
CBN THOMAS,CHARLES,T—BENEFICIARY NAME AS MAINTAINED IN THE HEALTH INSURANCE RECORD
LINE 4 TRAILERS
PAT 0776—PART A TERMINATION DATE (0776)
PBT 0776—PART B TERMINATION DATE (0776)
LINE 5 TRAILERS
PPA 0773 0175 Y—PRIOR PART A DATES (0773-0175) AND OPTION CODE (Y)
PPB 0773 0175 Y—PRIOR PART B DATES (0773—BEGINNING DATE—0175—ENDING DATE)
LINE 6
ENT 1 REASON FOR ENTITLEMENT (1 = CODE)
ADD 149 ELM ST—BENEFICIARY ADDRESS