Eligibility File

Participant level information to drive payments and claims logic.

NOTE: If an EF leaves any relevant field blank, the subscription inherits a value set at the AMT Contract or Partner Services table level.

Field	Description	Acceptable Values	Notes
payerID	Identifies the participant’s health plan. It reflects the health plan’s identity from CHC.		Maps to PartnerLookup Table Change Healthcare Claims Payer ID value.
groupID	Participant’s group number from health plan.
memberID	Participant's member number for their health plan. This should be a unique number for each patient/row.
Sex	Sex	Alpha
Birthdate	DOB
Address	Address
Subscription Type	Used in charge calculation and for reporting purposes.	Use: HSA, PPO, HMO, EPO, UNKNOWN, UNINSURED	Used in the AMT Optional Fallback Copays field to assign non-HSA plan type copay values.
contractedRate	Dollar amount expressed in cents for the per-visit contracted rate, which will be sent in a claim (for all plan types). Will also be the amount charged to a participant with a HDHP with HSA for a visit before their deductible is met.		If set to $0, all visits for HSAs will be $0 charge regardless of deductible level.
coinsurance	For participant with a HDHP with HSA, the percentage of patient responsibility for the contracted rate when the participant is in their coinsurance phase (has met their deductible), expressed as a decimal.		If blank value, partnerServices.coinsurancePercentageDefault value will be used.
copay	For participants not on a HDHP with HSA, the copay dollar amount expressed in cents charged to the patient for a visit before their out of pocket maximum is met.		Non-HSA plan types always pay the copay value for initial visits until OOP max is met.
waiver	Set to T or F (for True or False) to indicate that this participant’s cost share should always be $0 regardless of subscription type.		Enables customers to waive the patient charge for visits at the participant level (Supports regulatory requirements such as CARES Act). Impacts what the patient is charged for the visit. If claims are enabled, `contractedRate` is still sent in the claim as `totalCharge` to represent the cost/FMV of the service.