| | | | | | | | | | | |
| | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | |
| | DTP01 | 374 | Date/Time Qualifier | M | ID | 3/3 | | |
| | | | Description: Code specifying type of date or time, or both date and time |
| | | | | Code | Name_______________________________ |
| | | | | 286 | Retirement |
| | | | | | Description: Date on which the subscriber became retired |
| | | | | 296 | Return to Work |
| | | | | 297 | Date Last Worked |
| | | | | 300 | Enrollment Signature Date |
| | | | | | Description: Date subscriber or dependent signed policy enrollment card |
| | | | | 301 | Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event |
| | | | | | Description: Date of the qualifying event which initiated COBRA benefits |
| | | | | 303 | Maintenance Effective |
| | | | | | Description: Date on which the maintenance is effective |
| | | | | 336 | Employment Begin |
| | | | | | Description: Date on which the subscriber or dependent became employed |
| | | | | 337 | Employment End |
| | | | | | Description: Date on which the subscriber or dependent ceased to be employed |
| | | | | 338 | Medicare Begin |
| | | | | | Description: Date on which Medicare benefits went into effect |
| | | | | 339 | Medicare End |
| | | | | | Description: Date on which Medicare benefits ceased to be in effect |
| | | | | 340 | Consolidated Omnibus Budget Reconciliation Act (COBRA) Begin |
| | | | | | Description: Date on which COBRA benefits begin |
| | | | | 341 | Consolidated Omnibus Budget Reconciliation Act (COBRA) End |
| | | | | | Description: Date on which COBRA benefits end |
| | | | | 350 | Education Begin |
| | | | | | Description: Date on which the subscriber or dependent became a student |
| | | | | 351 | Education End |
| | | | | | Description: Date on which the subscriber or dependent ceased to be a student |
| | | | | 356 | Eligibility Begin |
| | | | | | Description: Date on which eligibility begins |
| | | | | 357 | Eligibility End |
| | | | | | Description: Date on which eligibility ends |
| | | | | 383 | Adjusted Hire |
| | | | | | Description: Date of rehire is adjusted to give an employee credit for prior years of service, after a break in service has occurred |
| | | | | 393 | Plan Participation Suspension |
| | | | | | Description: Date the participant is suspended from the plan |
| | | | | 394 | Rehire |
| | | | | | Description: Date the participant is rehired, after termination |
| | | | | 473 | Medicaid Begin |
| | | | | | Description: Date patient became eligible for Medicaid benefits |
| | | | | 474 | Medicaid End |
| | | | | | Description: Date patient no longer eligible for Medicaid benefits |
| | DTP02 | 1250 | Date Time Period Format Qualifier | M | ID | 2/3 | | |
| | | | Description: Code indicating the date format, time format, or date and time format |
| | | | | Code | Name_______________________________ |
| | | | | D8 | Date Expressed in Format CCYYMMDD |
| | DTP03 | 1251 | Date Time Period | M | AN | 1/35 | | |
| | | | Description: Expression of a date, a time, or range of dates, times or dates and times |
