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How to read a MAP/MAP Basic identification card
The presence of a member card does not guarantee coverage. Providers are responsible for verifying active coverage prior to rendering services.
Details on coverage verification can be found here.
MAP/MAP Basic Card Legend
- ID#: Member’s Master Record Number.
- Group ID: Program Group Numeric Identifier
- Medical Access Program (MAP): 53210000
- MAP Basic: 53230000
- MAP Basic Dental-only: 53220000
- Group: Program Name
- Plan: Program Plan Level (determines service line copayments*)
- MAP Plans: MAP 000/100
- MAP Basic Plans: Basic 000/100/150/175/200
- MAP Basic Dental-only Plans: CUC 000/100/150/175/200<
- EFF: Coverage effective date (format: MM/DD/YYYY).
- EXP: Coverage expiration date (format: MM/DD/YYYY)
- Member’s name (format: first middle last name).
- DOB: Member’s date of birth (format: MM/DD/YYYY)
- PCP: Member’s Assigned Primary Care Clinic System
- Members may access services at other primary care facilities.
- MAP Basic Dental-only members do not have an assigned PCP.
- PCP appointment scheduling phone number.
- This field is not listed on MAP Basic Dental-only member cards
- PCP/SPC/UC: Primary care (PCP), specialty care (SPC), and urgent care (UC) copayments. The copay amount to be requested from the member at the time of service.*
- MAP Basic members do not have urgent care benefits. UC is not listed on the member card.
- MAP Basic Dental-only members do not have primary care, specialty care, and urgent care benefits.
- OP/ER/IP: Outpatient (OP), Emergency Room (ER), and Inpatient (IP) copayments. The copay amount to be requested from the member at the time of service.*
- Outpatient (OP) copays apply to services such as imaging and durable medical equipment.
- MAP Basic and MAP Basic Dental-only members do not have outpatient (OP), Emergency Room (ER), and Inpatient (IP) benefits. These fields will not be listed on the member cards.
- MAP Basic members may be eligible for Seton Charity Care for hospital-based services.
- RX: Form/NonForm: Formulary and Non-Formulary copayment amounts per eligible prescription to be collected from the member.*
- DEN/SPDEN: Primary Dental (DEN) and Specialty Dental (SPDEN) copayments. The copay amount to be requested from the member at the time of service.*
- RX BIN & PCN: Script Care pharmacy claims BIN and PCN identifier numbers.
- BIN: 019462
- PCN: CHC1
- GPN ID: Field used for purposes not affiliated with MAP, MAP Basic, or MAP Basic Dental-only.
For further information regarding click here for co-payments, groups, and plans.