Attachment_-_Updated_Claimant_Eligibility_File_Layout.xlsx

XLSX spreadsheet 33 KB Posted Jun 12, 2018

Attached to: Office of Workers' Compensation Programs (OWCP) Pharmacy Benefits Management (PBM) Services
Solicitation number: 1605DC-18-R-00020
Issued by: Department of Labor Office of the Assistant Secretary for Administration and Management

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Attachment - Updated Claimant Eligibility File Layout

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File	Type	Posted
Questions_and_Answers_-_PBM_Amd_0005_of_Solicitation_1605DC-18-R-00020.pdf	PDF	Jun 4, 2019
Attachment_5_-_REV_1_-_DOL_Utilization_Data_-_Drug_-_Compounds_-_DME_-_DST.xlsx	XLSX spreadsheet	Jun 4, 2019
Attachment_4_-_REV_1_-_Future_Spend_and_Price_Evaluation_Guidance.pdf	PDF	Jun 4, 2019
Attachment_4_-_Future_Spend_and_Price_Evaluation_Guidance.pdf	PDF	May 29, 2019
Attachment_5_-_DOL_Utilization_Data_-_Drug_-_Compounds_-_DME_-_DST.xlsx	XLSX spreadsheet	May 29, 2019
Attachment_6_-_PBM_Discount_Calculation_Workbook.xlsx	XLSX spreadsheet	May 29, 2019
Questions_and_Answers_-_PBM_Solicitation_1605DC-18-R-00020.pdf	PDF	Jun 29, 2018
Amendment_0004_-_PBM_Solicitation_1605DC-18-R-00020.pdf	PDF	Jun 29, 2018
Attachment 4- Pharmacy Transaction Data_NPI_NDC.csv	CSV file	Jun 12, 2018
Amendment_0003_-_PBM_Solicitation_1605DC-18-R-00020.pdf	PDF	Jun 12, 2018
Amendment_0001_-_PBM_Solicitation_1605DC-18-R-00020.pdf	PDF	May 9, 2018
Questions_and_Answers_-_PBM_Solicitation_1605DC-18-R-00020.pdf	PDF	May 9, 2018
Attachment_2_-_Claimant_Eligibility_File_Layout.xlsx	XLSX spreadsheet	May 9, 2018
Attachment_3_-_Pharmacy_Transaction_Data.xlsx	XLSX spreadsheet	May 9, 2018
PBM_Solicitation_Number_1605DC-18-R-00020.pdf	PDF	Apr 20, 2018

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FECA

Column name Type Value iFECS Comments Example Data Format/Option

* action char(1) "C" “C”hange or “D”elete C C - Change D - Delete

* case_no	char(9)	d01_case_no	Case.case_number		012345678	char(9)
case_type	char(1)	d01_case_type	Implied from case.case_id and case.master_case_id.	“M”aster, “S”ubsidiary, or “I”ndependent	I	I - Independent

M - Master S - Subsidiary

			Case_id = master_case_id is “M”	See left. For Subsidiary, the case.master_case_id holds the case_id of it’s Master case.
			Master_case_id = 0 is “I”
			Master_case_id <>0 and Case_id <> master_case_id is “S”
case_ref	char(9)	d01_case_ref	Case.case_number	Master case number if this is Subsidiary case, otherwise blank	char(9)

For S

			(linked back from Master_case_id to case_number)
name_last	char(20)	d01_name_last	Person.last_name		JACKSON	20
name_frst	char(10)	d01_name_frst	Person.first_name		DAVID	10
name_mid	char(10)	d01_name_mid	Person.middle_name		LEE	10
ssn	char(9)	d02_ssn	Person.ssn		123456789
status	char(2)	"01" if d01_rpt_acc_flag = "C", else "00"	Check ncmf_legacy_data.accepted_condition_flag for “C” ???	“Reported Accepted Condition”	00	00

01 - Short Form Closure [C]

				“C”=Short Form Closure
				How is Short Form Closure represented in iFECS?
street1	char(35)	d01_street	Address.address_line_1		2888 FIRST RD	35
street 2	char(35)	blank	Address.address_line_2			35
street 3	char(35)	blank	Address.address_line_3			35
city	char(20)	d01_city	Address.city		BALTIMORE	20
state	char(2)	d01_state	Address.state_cd		MD	2
zip_code	char(9)	d01_zip_code (+4 blanks)	Address.zip_cd		21220	9
doi	date	d01_doi	Case.injured_on_dt		08/23/2011
curr_locn	char(3)	d01_curr_locn	Case_location.location_cd	Are codes the same in iFECS?	OLI	3
			(where case_location_thru_dt IS NULL)
do_num_code	char(2)	d01_adj_st_2nd (if blank then d01_curr_locn[2,3])	District_office.district_office_number WHERE district_office.party_id = case_district_office.district_office_party_id AND case_district_office.case_id = case.case_number		16	2
* change_date	datetime year to minute	d01_dat_last_chg (mm/dd/yyyy 00:00)		YYYY-MM-DD 00:00 format ?	2017-11-18 00:00

					This represents the date/time when the raw data last changed.
	date of death	date	d01_dod	Person.death_dt
	date of birth	date	d01_dob	Person.birth_dt		06/01/1970
	Responsible CE ID	char(3)	d01_resp_ex_id	Assigned_ce.district_ce_id		CBE	3
				(where assigned_ce_thru_dt is Null)
	Sex	char(1)	d01_sex	Person.sex		F	M/F
	Agency Code	char(6)	d01_dept_agcy_code	Agency.department_cd concatenated with	Are codes the same ESAFEC to iFECS?	6578KP	6
				Agency.agency_cd ???
	Short form dollar limit	char(7)	"0150000" if d01_rpt_acc_flag = "C", else "0000000"		Need to check Short Form Closure flag.	0000000
0150000 for C	7
	Telephone Number	char(10)	d01_phone_no	Phone_number.phone_number	Clarification: Claimant’s phone number.	9871234567	10
				(where phone_number_thru_dt is Null)
	Third Party Liability Flag	char(1)	"Y" if d01_thrd_prty_ind = "1", "2" or "7", else "N"		Use ncmf_legacy_data.third_party_ind ???	N	Y/N
	Agency Plan	char(2)	"01" (Oklahoma City); "02" (East Africa Bombings);	???	Use case number logic from Endnote 1?	00	00/01/02/03/04
			"03" (September 11); "04" (Anthrax); else "00" (See Endnote[i])		Or is there another indicator in iFECS?
	Check/Savings Account Indicator	Char(1)	blank			C
	Bank Routing Number	char(10)	blank			111000099	10
	Account Number	char(10)	blank			12345671234567890	10? 17***
	Current Status 1	char(2)	d01_curr_stat		Use case_status table with Pay_status_cd and ..from_dt and ..thru_dt to calculate all these	MC	MC/PR/DR …
					Current Status 1 to 10 sections???

Do case status codes match from ESAFEC to IFECS ie DE, DR, MC, … RT.???

These codes are in “v04” in ESAFEC.

Current Status 1 Begin Date	Date	(See Endnote[i])	Date format ???	03/01/2017
Current Status 1 End Date	Date	"9999999999"	Date format ???	99/99/9999
Current Status 2	char(2)	d01_prev_stat		PS
Current Status 2 Begin Date	Date	d01_doi		03/01/2017
Current Status 2 End Date	Date	(See Endnote 2)		03/01/2017
Current Status 3	char(2)	blank
Current Status 3 Begin Date	Date	blank
Current Status 3 End Date	Date	blank
Current Status 4	char(2)	blank
Current Status 4 Begin Date	Date	blank
Current Status 4 End Date	Date	blank
Current Status 5	char(2)	blank
Current Status 5 Begin Date	Date	blank
Current Status 5 End Date	Date	blank
Current Status 6	char(2)	blank
Current Status 6 Begin Date	Date	blank
Current Status 6 End Date	Date	blank
Current Status 7	char(2)	blank
Current Status 7 Begin Date	Date	blank
Current Status 7 End Date	Date	blank
Current Status 8	char(2)	blank
Current Status 8 Begin Date	Date	blank
Current Status 8 End Date	Date	blank
Current Status 9	char(2)	blank
Current Status 9 Begin Date	Date	blank
Current Status 9 End Date	Date	blank
Current Status 10	char(2)	blank
Current Status 10 Begin Date	Date	blank
Current Status 10 End Date	Date	blank
Adjudication Status 1	char(2)	d01_curr_stat (if d01_curr_stat = P, MC, DR, O or DE, else “99”)	Use case_status table with adjudication_status_cd and ..from_dt and ..thru_dt to calculate all these

Adjudication Status 1 to 10 sections???

Do status codes match from ESAFEC to IFECS ie AC, AD, AF, AL, …SU,.???

These codes are in “v27” in ESAFEC.

99
Adjudication Status 1 Begin Date	date	d01_curr_stat_date (if d01_curr_stat = P, MC, DR, O or DE, else “99/99/9999”)	(9/30/2009:See NOTES section below)	11/26/2017
Adjudication Status 1 End Date	date	d01_curr_stat_date (if d01_curr_stat = P, MC, DR, O or DE, else “99/99/9999”)		99/99/9999
Adjudication Status 2	char(2)	blank
Adjudication Status 2 Begin Date	date	blank
Adjudication Status 2 End Date	Date	blank
Adjudication Status 3	char(2)	blank
Adjudication Status 3 Begin Date	date	blank
Adjudication Status 3 End Date	Date	blank
Adjudication Status 4	char(2)	blank
Adjudication Status 4 Begin Date	date	blank
Adjudication Status 4 End Date	Date	blank
Adjudication Status 5	char(2)	blank
Adjudication Status 5 Begin Date	Date	blank
Adjudication Status 5 End Date	Date	blank
Adjudication Status 6	char(2)	blank
Adjudication Status 6 Begin Date	date	blank
Adjudication Status 6 End Date	Date	blank
Adjudication Status 7	char(2)	blank
Adjudication Status 7 Begin Date	date	blank
Adjudication Status 7 End Date	Date	blank
Adjudiction Status 8	Char(2)	Blank
Adjudication Status 8 Begin Date	date	blank
Adjudication Status 8 End Date	Date	blank
Adjudication Status 9	Char(2)	blank
Adjudication Status 9 Begin Date	date	blank
Adjudication Status 9 End Date	Date	blank
Adjudication Status 10	Char(2)	blank
Adjudication Status 10 Begin Date	date	blank
Adjudication Status 10 End Date	date	blank
ICD-9 Code 1	char(5)	d01_rpt_acc_cond[1,5] if positions 1-3 are numeric, else "99999"	Use accepted_condition table with icd9_cd and ..from_dt and ..thru_dt to calculate all these	097173

10H833X3 1099998 5? 9*** 09/10 + ICD Code ICD-9 1 to 10 sections???

Do ICD-9 codes match from ESAFEC to IFECS???

ICD-9 code “99998” (from Note 3 below) is a special code used to authorize Diagnostice Testing in ESAFEC?

ICD-9 Code 1 Modifier	char(1)	d01_rpt_acc_cond[6,6] if positions 1-3 are numeric, else blank			R	B/L/R
ICD-9 Code 1 Start Date	date	d01_doi (See Endnote [i])			03/01/2017
ICD-9 Code 1 End Date	date	"12/31/2050" (See Endnote 3)			12/31/2050
ICD-9 Code 2	char(5)	d01_rpt_acc_cond[8,12] if positions 1-3 are numeric,
		else if the last 5 characters in the d01_rpt_acc_cond string = “99998” then “99998”, else blank
ICD-9 Code 2 Modifier	char(1)	d01_rpt_acc_cond[13,13] if positions 1-3 are numeric, else blank
ICD-9 Code 2 Start Date	date	d01_doi (if ICD-9 Code 2 not blank, else blank) (See Endnote 3)
ICD-9 Code 2 End Date	date	"12/31/2050" (if ICD-9 Code 2 not blank, else blank) (See Endnote 3)
ICD-9 Code 2	char(5)	d01_rpt_acc_cond[8,12] if positions 1-3 are numeric, else blank
ICD-9 Code 2 Modifier	char(1)	d01_rpt_acc_cond[13,13] if positions 1-3 are numeric, else blank
ICD-9 Code 2 Start Date	date	d01_doi (if ICD-9 Code 2 not blank, else blank) (See Endnote 3)
ICD-9 Code 2 End Date	date	"12/31/2050" (if ICD-9 Code 2 not blank, else blank) (See Endnote 3)
ICD-9 Code 3	char(5)	d01_rpt_acc_cond[15,19] if positions 1-3 are numeric, else blank
ICD-9 Code 3 Modifier	char(1)	d01_rpt_acc_cond[20,20] if positions 1-3 are numeric, else blank
ICD-9 Code 3 Start Date	date	d01_doi (if ICD-9 Code 3 not blank, else blank) (See Endnote 3)
ICD-9 Code 3 End Date	date	"12/31/2050" (if ICD-9 Code 3 not blank, else blank) (See Endnote 3)
ICD-9 Code 4	char(5)	d01_rpt_acc_cond[22,26] if positions 1-3 are numeric, else blank
ICD-9 Code 4 Modifier	char(1)	d01_rpt_acc_cond[27,27] if positions 1-3 are numeric, else blank
ICD-9 Code 4 Start Date	date	d01_doi (if ICD-9 Code 4 not blank, else blank) (See Endnote 3)
ICD-9 Code 4 End Date	date	"12/31/2050" (if ICD-9 Code 4 not blank, else blank) (See Endnote 3)
ICD-9 Code 5	char(5)	d01_rpt_acc_cond[29,33] if positions 1-3 are numeric, else blank
ICD-9 Code 5 Modifier	char(1)	d01_rpt_acc_cond[34,34] if positions 1-3 are numeric, else blank
ICD-9 Code 5 Start Date	date	d01_doi (if ICD-9 Code 5 not blank, else blank) (See Endnote 3)
ICD-9 Code 5 End Date	date	"12/31/2050" (if ICD-9 Code 5 not blank, else blank) (See Endnote 3)
ICD-9 Code 6	char(5)	d01_rpt_acc_cond[36,40] if positions 1-3 are numeric, else blank
ICD-9 Code 6 Modifier	char(1)	d01_rpt_acc_cond[41,41] if positions 1-3 are numeric, else blank
ICD-9 Code 6 Start Date	date	d01_doi (if ICD-9 Code 6 not blank, else blank) (See Endnote 3)
ICD-9 Code 6 End Date	date	"12/31/2050" (if ICD-9 Code 6 not blank, else blank) (See Endnote 3)
ICD-9 Code 7	char(5)	blank
ICD-9 Code 7 Modifier	char(1)	blank
ICD-9 Code 7 Start Date	date	blank
ICD-9 Code 7 End Date	date	blank
ICD-9 Code 8	char(5)	blank
ICD-9 Code 8 Modifier	char(1)	blank
ICD-9 Code 8 Start Date	date	blank
ICD-9 Code 8 End Date	date	blank
ICD-9 Code 9	char(5)	blank
ICD-9 Code 9 Modifier	char(1)	blank
ICD-9 Code 9 Start Date	date	blank
ICD-9 Code 9 End Date	date	blank
ICD-9 Code 10	char(5)	blank
ICD-9 Code 10 Modifier	char(1)	blank
ICD-9 Code 10 Start Date	date	blank
ICD-9 Code 10 End Date	date	blank
ICD-9 Code 11	char(5)	blank
ICD-9 Code 11 Modifier	char(1)	blank
ICD-9 Code 11 Start Date	date	blank
ICD-9 Code 11 End Date	date	blank
ICD-9 Code 12	char(5)	blank
ICD-9 Code 12 Modifier	char(1)	blank
ICD-9 Code 12 Start Date	date	blank
ICD-9 Code 12 End Date	date	blank
CA16_From_Date_1	date	d11_from_date_1st (where d11_case_no = d01_case_no)	???	“d11” table represents authorization for certain types of medical treatment (ie Physical Therapy) in ESAFEC.	05/23/2017
CA16_To_Date_1	date	d11_to_date_1st (where d11_case_no = d01_case_no)	???		07/22/2017
CA16_From_Date_2	date	d11_from_date_2nd (where d11_case_no = d01_case_no)	???
CA16_To_Date_2	Date	d11_to_date_2nd (where d11_case_no = d01_case_no)	???
MBE Code					MAE	MAE/MCD/MDD/MCE/MDE/MAD

only for Line 00

MED_Value	char(5)	Calcualted MED from iFECS	96
Line End			00	00

01/02 - For up to 99 ICD

Example Data

FECA	Example Data	Format/Option
* action	C	C - Change

D - Delete

* case_no	012345678	char(9)
case_type	I	I - Independent

M - Master S - Subsidiary case_ref char(9) For S

name_last	JACKSON	20
name_frst	DAVID	10
name_mid	LEE	10
ssn	123456789
status	00	00

01 - Short Form Closure [C]

	street1	2888 FIRST RD	35
	street 2		35
	street 3		35
	city	BALTIMORE	20
	state	MD	2
	zip_code	21220	9
	doi	08/23/2011
	curr_locn	OLI	3
	do_num_code	16	2
	* change_date	2017-11-18 00:00
	date of death
	date of birth	06/01/1970
	Responsible CE ID	CBE	3
	Sex	F	M/F
	Agency Code	6578KP	6
	Short form dollar limit	0000000
0150000 for C	7
	Telephone Number	9871234567	10
	Third Party Liability Flag	N	Y/N
	Agency Plan	00	00/01/02/03/04
	Check/Savings Account Indicator	C
	Bank Routing Number	111000099	10
	Account Number	12345671234567890	10? 17***
	Current Status 1	MC	MC/PR/DR …
	Current Status 1 Begin Date	03/01/2017
	Current Status 1 End Date	99/99/9999
	Current Status 2	PS
	Current Status 2 Begin Date	03/01/2017
	Current Status 2 End Date	03/01/2017
	Current Status 3
	Current Status 3 Begin Date
	Current Status 3 End Date
	Current Status 4
	Current Status 4 Begin Date
	Current Status 4 End Date
	Current Status 5
	Current Status 5 Begin Date
	Current Status 5 End Date
	Current Status 6
	Current Status 6 Begin Date
	Current Status 6 End Date
	Current Status 7
	Current Status 7 Begin Date
	Current Status 7 End Date
	Current Status 8
	Current Status 8 Begin Date
	Current Status 8 End Date
	Current Status 9
	Current Status 9 Begin Date
	Current Status 9 End Date
	Current Status 10
	Current Status 10 Begin Date
	Current Status 10 End Date
	Adjudication Status 1	99
	Adjudication Status 1 Begin Date	11/26/2017
	Adjudication Status 1 End Date	99/99/9999
	Adjudication Status 2
	Adjudication Status 2 Begin Date
	Adjudication Status 2 End Date
	Adjudication Status 3
	Adjudication Status 3 Begin Date
	Adjudication Status 3 End Date
	Adjudication Status 4
	Adjudication Status 4 Begin Date
	Adjudication Status 4 End Date
	Adjudication Status 5
	Adjudication Status 5 Begin Date
	Adjudication Status 5 End Date
	Adjudication Status 6
	Adjudication Status 6 Begin Date
	Adjudication Status 6 End Date
	Adjudication Status 7
	Adjudication Status 7 Begin Date
	Adjudication Status 7 End Date
	Adjudiction Status 8
	Adjudication Status 8 Begin Date
	Adjudication Status 8 End Date
	Adjudication Status 9
	Adjudication Status 9 Begin Date
	Adjudication Status 9 End Date
	Adjudication Status 10
	Adjudication Status 10 Begin Date
	Adjudication Status 10 End Date
	ICD-9 Code 1	097173

10H833X3 1099998 5? 9*** 09/10 + ICD Code

ICD-9 Code 1 Modifier	R	B/L/R
ICD-9 Code 1 Start Date	03/01/2017
ICD-9 Code 1 End Date	12/31/2050
ICD-9 Code 2
ICD-9 Code 2 Modifier
ICD-9 Code 2 Start Date
ICD-9 Code 2 End Date
ICD-9 Code 2
ICD-9 Code 2 Modifier
ICD-9 Code 2 Start Date
ICD-9 Code 2 End Date
ICD-9 Code 3
ICD-9 Code 3 Modifier
ICD-9 Code 3 Start Date
ICD-9 Code 3 End Date
ICD-9 Code 4
ICD-9 Code 4 Modifier
ICD-9 Code 4 Start Date
ICD-9 Code 4 End Date
ICD-9 Code 5
ICD-9 Code 5 Modifier
ICD-9 Code 5 Start Date
ICD-9 Code 5 End Date
ICD-9 Code 6
ICD-9 Code 6 Modifier
ICD-9 Code 6 Start Date
ICD-9 Code 6 End Date
ICD-9 Code 7
ICD-9 Code 7 Modifier
ICD-9 Code 7 Start Date
ICD-9 Code 7 End Date
ICD-9 Code 8
ICD-9 Code 8 Modifier
ICD-9 Code 8 Start Date
ICD-9 Code 8 End Date
ICD-9 Code 9
ICD-9 Code 9 Modifier
ICD-9 Code 9 Start Date
ICD-9 Code 9 End Date
ICD-9 Code 10
ICD-9 Code 10 Modifier
ICD-9 Code 10 Start Date
ICD-9 Code 10 End Date
ICD-9 Code 11
ICD-9 Code 11 Modifier
ICD-9 Code 11 Start Date
ICD-9 Code 11 End Date
ICD-9 Code 12
ICD-9 Code 12 Modifier
ICD-9 Code 12 Start Date
ICD-9 Code 12 End Date
CA16_From_Date_1	05/23/2017
CA16_To_Date_1	07/22/2017
CA16_From_Date_2
CA16_To_Date_2
MBE Code	MAE	MAE/MCD/MDD/MCE/MDE/MAD

only for Line 00 Line End 00 00 01/02 - For up to 99 ICD

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