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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
1.ID#: Member’s Master Record Number.
2. Group ID: Program Group Numeric Identifier
- Medical Access Program (MAP): 53210000
- MAP BASIC: 53230000
- MAP BASIC Dental-only: 53220000
3. Group: Program Name
4. 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
5. EFF: Coverage effective date (format: MM/DD/YYYY).
6. EXP: Coverage expiration date (format: MM/DD/YYYY)
7. Member’s name (format: first middle last name).
8. DOB: Member’s date of birth (format: MM/DD/YYYY)
9. 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.
10. PCP appointment scheduling phone number.
- This field is not listed on MAP BASIC Dental-only member cards
11. 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.
12. 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.
13. RX: Form/NonForm: Formulary and Non-Formulary copayment amounts per eligible prescription to be collected from the member.*
14. DEN/SPDEN: Primary Dental (DEN) and Specialty Dental (SPDEN) copayments. The copay amount to be requested from the member at the time of service.*
15. RX BIN & PCN: Script Care pharmacy claims BIN and PCN identifier numbers.
- BIN: 019462
- PCN: CHC1
16. 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.