5. 200000001275 - Schedule K â¿¿ FBMC Adjudication File Description (ZB609D01).docx

40 KB Posted

Attached to
Flexible Spending Accounts
Solicitation number
RFP 171 200000001275 2
Issued by
Grand Traverse County, Lansing City, Michigan

About this file

Written by GovTribe AI ·

This is a technical file specification document for the State of Michigan's Department of Management and Budget, specifically detailing the FBMC (Flexible Benefit Management Center) Adjudication File format dated December 17, 2004. The file describes a data exchange standard in CSV format with fixed record length of 500 characters in ASCII mode that will be encrypted prior to FTP transmission. The specification defines four record types: Header Records (Type 10) containing client and file identification information for the State of Michigan (Client Number 0299); Employee Records (Type 20) capturing social security numbers and employee identification data; Enrollment Records (Type 40) documenting current benefit enrollment status with employee and social security number references; and Benefit Records (Type 50) detailing specific benefit types including medical, dental, and vision coverage with plan effective dates and benefit codes. The file concludes with Trailer Records (Type 90) that provide record counts for all employee, dependent, and total records processed. Each record type maintains filler fields and specific field lengths to ensure system compatibility with the Lawson payroll and benefits management system.

The file establishes technical requirements for vendor data submission to the State of Michigan's benefits administration system, with all records maintaining fixed spacing and delimiter characters in positions 499 and 500 for proper file processing. The specification requires vendors to maintain the defined field structure precisely, with unused fields populated with spaces or zeroes as applicable. This file serves as the technical interface documentation for benefits data adjudication, enabling the state to process employee benefit enrollment, coverage levels, plan effective dates, and termination information through a standardized data format. No pricing, contract term, or procurement timeline information is included in this technical specification document.

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SCHEDULE K – FBMC ADJUDICATION

date
PAGE
FILE DESCRIPTION
12/17/2004
1
USER FILE Name
RECORD

Adjudication File

DEPARTMENT
OFFICE
DIVISION
MANAGEMENT & BUDGET
MAIN
HRS (HRMN)
File Identifier
file MEDIA
RECORD SIZE

ZB609D01

FILE ORGANIZATION
CSV
FIXED
OTHER
SEQUENCE

REMARKS

Varying Record Types File is defined in Lawson pgmdef work file as (498) sequential.

Filler fields at the end of each record must be maintained for vendor.

First, the file will be changed to fixed record length of 500 characters in ASCII mode with delimiters (<CR><LF>) in 499 and 500. Second, the file will be encrypted prior to FTP.

From
ThrU
DESCRIPTION
FORMAT
Length

RECORD TYPE 10 - HEADER RECORD

1
2
RECORD TYPE - ‘10’
9(2)
2
3
52
CLIENT NAME - ‘STATE OF MICHIGAN’
X(50)
50
53
56
CLIENT NUMBER - ‘0299’
9(4)
4
57
106
PROVIDER NAME – Not Used
X(50)
50
107
114
FILE TYPE – ‘CURRBENE’
X(8)
8
115
122
DATE FILE CREATED YYYYMMDD
9(8)
8
123
498
FILLER – Spaces
X(376)
376

RECORD TYPE 20 – EMPLOYEE RECORD

1
2
RECORD TYPE – ‘20’
9(2)
2
3
11
SOCIAL SECURITY NUMBER
9(9)
9
12
20
EMPLOYEE NUMBER
9(9)
9
21
26
Filler
X(6)
6
27
46
LAST NAME
X(20)
20
47
50
LAST NAME SUFFIX
X(4)
4
51
65
FIRST NAME
X(15)
15
66
66
MIDDLE INITIAL
X(1)
1
67
96
Address Line 1 – not used
X(30)
30
97
126
Address Line 2 – not used
X(30)
30
127
151
City – not used
X(25)
25
152
153
State – not used
X(2)
2
154
162
Zip Code – not used
X(9)
9
163
170
Date of Birth – not used (zeroes)
9(8)
8
171
171
Gender – not used
X(1)
1
172
172
Marital Status – not used
X(1)
1
173
182
Home Telephone Number – not used
X(10)
10
183
192
Home Fax Number – not used
X(10)
10
193
202
Work Phone Number – not used
X(10)
10
203
210
Date of Employment – not used (zeroes)
9(8)
8
211
219
Annual Salary – not used (zeroes)
9(9)
9
220
227
Work Location – not used
X(8)
8
228
233
Bargaining Unit – not used
X(6)
6
234
234
Union member – not used
X(1)
1
235
240
Pay Code – not used
X(6)
6
241
242
Number of payrolls per year – not used (zeroes)
9(2)
2
243
244
# of payrolls per year with reductions – not used (zeroes)
9(2)
2
245
246
Employee Status – not used
X(2)
2
247
254
Leave Start Date (YYYYMMDD) (zeroes)
9(8)
8
255
262
Leave Return Date (YYYYMMDD) (zeroes)
9(8)
8
263
270
Date of Termination (YYYYMMDD) (zeroes)
9(8)
8
271
272
Termination Code – not used
X(2)
2
273
281
Federal Employer Tax ID Number – not used (zeroes)
9(9)
9
282
282
W4 Tax Filing Status – not used
X(1)
1
283
284
Number of W4 Exemptions – not used (zeroes)
9(2)
2
285
291
Additional Withholding Per Pay – not used (zeroes)
9(7)
7
292
341
Employee Email Address – not used
X(50)
50
342
350
Incorrect Social Security – not used (zeroes)
9(9)
9
351
498
Filler - spaces
X(148)
148
499
500
Record Delim
X(2)
2

RECORD TYPE 40 – ENROLLMENT RECORD

1
2
RECORD TYPE – ‘40’
9(2)
2
3
11
SOCIAL SECURITY NUMBER
9(9)
9
12
26
EMPLOYEE NUMBER
X(15)
15
27
28
ENROLLMENT STATUS – ‘CB’ Current Benefit
X(2)
2
29
37
Rep Code – not used
X(9)
9
38
45
Form Last Completed Date YYYYMMDD – not used (zeroes)
9(8)
8
46
51
Form Last Completed Time HHMMSS Use Eastern Standard Time – not used (zeroes)
9(6)
6
52
61
Form Last Completed By – not used
X(10)
10
62
69
Date Last Confirmation Notice Sent – not used (zeroes)
9(8)
8
70
70
Last Confirmation Notice Delivery Method – not used
X(1)
1
71
71
Disabled Account Y/N - not used
X(1)
1
72
79
PIN Number – not used
X(8)
8
80
96
Session ID – not used
X(17)
17
97
97
EE opts out of the EZ Reimburse Card - not used
X(1)
1
98
498
FILLER - spaces
X(401)
401

RECORD TYPE 50 – BENEFIT RECORD

1
2
RECORD TYPE – ‘50’
9(2)
2
3
11
SOCIAL SECUIRTY NUMBER
9(9)
9
12
26
EMPLOYEE NUMBER
X(15)
15
27
32
Slot ID Code – not used
X(6)
6
33
38
Slot Definition Code – not used
X(6)
6
39
53
Client Payroll Code – not used
X(15)
15
54
59
BENEFIT TYPE – ‘MAJMED’, ‘DENTAL’, ‘VISION’
X(6)
6
60
65
BENEFIT CODE
X(6)
6
66
71
BENEFIT PROVIDER – Spaces
X(6)
6
72
73
Benefit Coverage Level – not used
X(2)
2
74
74
Benefit Pre-tax Indicator – not used
X(1)
1
75
84
Benefit Level – not used (zeroes)
9(10)
10
85
90
Benefit Misc. Information – not used
X(6)
6
91
98
Deduction Amount – not used (zeroes)
9(8)
8
99
106
PLAN EFFECTIVE DATE – YYYYMMDD
9(8)
8
107
114
Payroll Effective Date – YYYYMMDD not used (zeroes)
9(8)
8
115
134
Medical PCP# of Facility Code – not used
X(20)
20
135
135
Existing Patient – not used
X(1)
1
136
165
Doctor’s Name – not used
X(30)
30
166
173
FSA Annualized Amount – not used (zeroes)
9(8)
8
174
181
Plan Termination Date YYYYMMDD – not used (zeroes)
9(8)
8
182
189
Payroll termination Date YYYYMMDD – not used (zeroes)
9(8)
8
190
498
FILLER – spaces
X(309)
309

RECORD TYPE 90 – TRAILER RECORD

1
2
RECORD TYPE – ‘90’
9(2)
2
3
6
CLIENT NUMBER – ‘0299’
9(4)
4
7
14
TOTAL NUMBER OF EMPLOYEES RECORDS (Rec type 20)
9(8)
8
15
22
Total Number of Dependent Records (Rec type 60) – not used (zeroes)
9(8)
8
23
30
TOTAL NUMBER OF ALL RECORDS FOR CLIENT (all rec types)
9(8)
8
31
498
FILLER – Spaces
X(468)
468

File details come from the government source that posted it. Updated .