It is important that pharmacy services be captured with the correct member information. There are three key steps to assure the member's information is correct.
The on-line claims processing system determines a member's eligibility by:
- Matching the HMSA membership number with the person code and relation code submitted on the claims,
- Applying a birth-date (MMYY) edit, and
- Returning the name of the member for each claim. Pharmacies should validate that the name matches the name on the prescription to manage the accuracy of prescriptions dispensed to the correct person.
| Person codes | |
|---|---|
| Subscriber | 01 |
| Spouse | 02 |
| Dependent | Last 2 digits of the child's birth year |
| Relation codes | |
|---|---|
| Subscriber | 1 |
| Spouse | 2 |
| Dependent | 3 |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |