Member List Report - Data Specification

Member List Report - Data Specification Document

File Name

Member List Report

Table View

Member List

File Accessibility

Available through the Outcomes Client Reporting Platform to authorized users.

Last Updated

11/5/2026

Data Refresh Frequency

Near Real Time

Purpose

Provide key details for members who are, or have been, active in the platform. Information includes basic demographic data; enrollment and term dates; last CMR received; and primary pharmacy assignments.

Intended Use

Drive business functions such as evaluating MTM program membership, activity of CMR provision on eligible members, and routing of members to various pharmacies across the network.

Element Number

Element Name

Business Definitions

Example

Notes

1

Client ID

Identifier for the client associated with the member eligibility record.

234

2

Client Name

Name of the client associated with the member eligibility record.

Outcomes Health Plan

3

Policy ID

Identifier for the policy associated with the member eligibility record.

42

4

Policy Name

Name of the policy associated with the member eligibility record.

Outcomes Medicare Policy

5

CMS Contract

CMS contract associated with the member.

H1234

6

PBP

Plan Benefit Package associated with the member.

001

7

Carrier

Carrier value associated with the member.

ABC67

8

Account

Account value associated with the member.

ZYX42042

9

Group

Group value associated with the member.

GG1130GK4E

10

Program Name

Name of the program associated with the claim.

OC Disease Management

11

Member ID

Member identifier from patient data.

OC4242

12

Patient ID

Outcomes internal patient identifier.

987654321

Not available for Client role.

13

MBI

Medicare Beneficiary Identifier

OKM052507BI

14

First Name

Member’s first name

THOMAS

15

Last Name

Member’s last name

HUNTER

16

Gender

Member’s gender

M

17

DOB

Member’s date of birth

01/21/1967

18

Primary Language

Member’s primary language coming from the payer eligibility file data. This does not include any alternative language data that may be coming from a plan ad-hoc.

ENGLISH

19

Preferred Written Language Name

Preferred language of the patient as is documented in the patient preferences drawer of the patient profile within the OutcomesOne platform

English

20

Preferred Accessible Format

Preferred accessible format (braille, large print, audio CD) of the patient as is documented in the patient preferences drawer of the patient profile within the OutcomesOne platform

LARGE PRINT

21

Address 1

Member primary street address.

123 ALPHA ST

22

Address 2

Additional member address information, when applicable.

APT 67

23

City

Member city.

YUMA

24

State

Member state.

AZ

25

Zip Code

Member ZIP Code.

85365

26

Phone

Member phone number.

5553331122

27

Earliest Outcomes Active Date

First date of the calendar year that the member became active in Outcomes, or the most recent date in prior year(s)

01/05/2026

28

Current Outcomes Active Date

Most recent date that the member became active in Outcomes, or the most recent date in prior year(s). This date can be a later date than the “Earliest Outcomes Active Date” for members who have disenrolled, then re-enrolled into the program.

01/05/2026

29

Outcomes End Date

Date the member was/will be removed from the Outcomes platform

12/31/2026

30

OptOut Date

Date the health plan terminates for the member; if plan termination (opt out code is provided to Outcomes, it will be noted here).

12/31/2026

31

OptOut Reason

Reason the member was termed due to opt out

Plan dis-enrollment

32

MTMP Targeting Date

Date the member met targeting criteria for MTM programs (MTMP)

11/05/2026

33

MTMP Enrollment Date

Date the member was enrolled into the MTMP

11/05/2026

34

ARB Enrollment Date

Date the member was designated as an “At-risk Beneficiary” in the calendar year

01/05/2026

35

MTMP Enrollment Thru Date

Date through which the member will be enrolled in the MTM program; the earliest of the Plan Term Date or the Outcomes End Date

12/31/2026

36

Current TIP Opportunities

Number of current TIP opportunities for this member * This data field is not tied to the selected plan year and will be drawn from the most current data in Outcomes

2

37

CMR Eligibility Start Date

First date of the calendar year that the member became eligible for a CMR in Outcomes

01/05/2026

38

Currently Eligible for CMR?

Indicates if a CMR can be documented for this member as of the date the report is pulled
i.e. Member who can have a successful CMR documented (the Document CMR button is present) regardless of if the member displays “CMR” on the queue of the Outcomes dashboard

Y

39

Currently Flagged for CMR?

Indicates if the member is targeted for a CMR as of the date the report is pulled
i.e. The member will display “CMR” when looking at the member from the queue available on the Outcomes dashboard

Y

40

Currently Scheduled for CMR?

Indicates if the member is scheduled for a CMR as of the date the report is pulled

Y

41

CMR Scheduled Date

For Currently Scheduled for CMR = Y, date the CMR is scheduled for

11/10/2026

42

CMR Scheduled Center NCPDP

For Currently Scheduled for CMR = Y, center NCPDP that has the scheduled CMR

BB99B688YY

43

CMR Scheduled Center Name

For Currently Scheduled for CMR = Y, center Name that has the scheduled CMR

Semoctuo Pharmacy

44

CMR Eligible Last Year

N

45

Last CMR Result Date

Date of the most recent CMR result.

08/09/2025

46

Last CMR Result Name

Name or description of the most recent CMR result.

CMR - No drug therapy problems identified

47

Last CMR Claim ID

48

Last CMR Result MTM Center NCPDP

Last CMR Result MTM Center NCPDP

424242

49

Last CMR Result MTM Center Name

Name of the center associated with the most recent CMR result.

Semoctuo Pharmacy

50

Primary Pharmacy NCPDP

Pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

1142116711

51

Primary Pharmacy Name

Pharmacy Name for the patient’s primary pharmacy as it appears in the most recent NCPDP file

Semoctuo Pharmacy

52

Primary Pharmacy Contracted and Trained

Contracted and trained status of pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

Y

53

Primary Pharmacy Address 1

Address of pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

1 SUN WAY

54

Primary Pharmacy Address 2

Address of pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

SUITE 100

55

Primary Pharmacy City

City of pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

SAINT LOUIS

56

Primary Pharmacy State

State of pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

MO

57

Primary Pharmacy ZIP Code

ZIP Code of pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

63121

58

Primary Pharmacy Phone

Phone number of pharmacy where the majority of prescriptions are filled for this member within the last six (6) months

5553331133

May contain parenthesis, spaces, and dashes.

59

Secondary Pharmacy NCPDP

7654321

60

Secondary Pharmacy Name

Hometown Pharmacy

61

Secondary Pharmacy Contracted and Trained

Y

62

Secondary Pharmacy Address 1

456 2ND STREET

63

Secondary Pharmacy Address 2

APT 167

64

Secondary Pharmacy City

HOMETOWN

65

Secondary Pharmacy State

IA

66

Secondary Pharmacy ZIP Code

12345

67

Secondary Pharmacy Phone

789-456-1230

May contain parenthesis, spaces, and dashes.

68

Tertiary Pharmacy NCPDP

550011

69

Tertiary Pharmacy Name

Blue Sky Pharmacy

70

Hospice Indicator

71

Run Year

2026