Member Program Eligibility Report - Data Specification 

Member Program Eligibility Report - Data Specification Document

File Name

Member Program Eligibility Report

File Accessibility

Available through the Outcomes Client Reporting Platform to authorized users. Outcomes Patient ID is internal only.

Last Updated

11/3/2026

Data Refresh Frequency

Near Real Time

Purpose

Provide member-level program eligibility dates, payer hierarchy, opt-out details, and TIP counts by status for a selected reporting year.

Intended Use

Support eligibility monitoring, program population analysis, TIP activity review, and authorized member-level operational reporting.

Element Number

Element Name on Report

Business Definitions

Example

Historical Mapping

1

Client ID

Identifier for the client associated with the member eligibility record.

234

External and Internal.

2

Client Name

Name of the client associated with the member eligibility record.

Example Health Plan

External and Internal.

3

Policy ID

Identifier for the policy associated with the member eligibility record.

2061

External and Internal.

4

Policy Name

Name of the policy associated with the member eligibility record.

Example Medicare Policy

External and Internal.

5

Program ID

Identifier associated with the program.

10025

External and Internal.

6

Program

Name of the program.

Medication Adherence Program

External and Internal.

7

Earliest Program Eligibility Start Date

First date the member became eligible for the program in the reporting year.

01/01/2026

External and Internal.

8

Current Program Eligibility Start Date

Most recent date the member became eligible for the program in the reporting year. This differs from the earliest date after an eligibility gap.

04/01/2026

External and Internal.

9

Program Eligibility End Date

Date the member’s eligibility ended in the reporting year. Blank indicates current eligibility for visualization purposes.

10/31/2026

External and Internal.

10

CMS Contract

CMS contract associated with the member.

H1234

External and Internal.

11

PBP

Plan Benefit Package associated with the member.

001

External and Internal.

12

Carrier

Carrier value associated with the member.

Carrier A

External and Internal.

13

Account

Account value associated with the member.

Account 100

External and Internal.

14

Group

Group value associated with the member.

Group 25

External and Internal.

15

Member ID

Member identifier from patient data.

M00012345

External and Internal.

16

Patient ID

Outcomes internal patient identifier.

987654321

Internal only.

17

First Name

Member first name.

TAYLOR

External and Internal.

18

Last Name

Member last name.

MORGAN

External and Internal.

19

DOB

Member date of birth.

03/15/1955

External and Internal.

20

Opt Out

Indicates whether the member opted out, using Member List Report logic.

No

External and Internal.

21

Opt Out Reason

Reason associated with the member opt-out, using Member List Report logic.

Not applicable

External and Internal.

22

Total TIP Count

Total TIPs for the program and reporting year; sum of all component status fields.

12

External and Internal.

23

Completed TIPs

Count of completed TIPs for the program and reporting year.

5

External and Internal.

24

Unsuccessful TIPs

Count of unsuccessful TIPs for the program and reporting year.

2

External and Internal.

25

Available TIPs

Count of available TIPs for the program and reporting year.

3

External and Internal.

26

Unfinished / Review Resubmit TIPs

Combined count of unfinished and review/resubmit TIPs for the program and reporting year.

1

External and Internal.

27

Withdrawn / Rejected TIPs

Combined count of withdrawn and rejected TIPs for the program and reporting year.

1

External and Internal.