HHW HCC EB Assignment File to MMIS.xls
XLS spreadsheet 67 KB Posted
- Solicitation number
- RFP 27-87793
- Issued by
- Marion County, Indiana
About this file
This is an Interface Specification document for the HHW HCC Member Assignment File from the Enrollment Broker, prepared for the Indiana Family and Social Services Administration (FSSA) Office of Medicaid Policy and Planning in support of the state's Medicaid managed care programs. The specification details the technical requirements for daily data file exchanges between the Enrollment Broker (EB) and DXC regarding member requests for Managed Care Entity (MCE) assignments across Hoosier Healthwise (HHW) and Hoosier Care Connect (HCC) programs. The interface uses secure File Transfer Protocol (FTP) delivery with a standardized file naming convention (EBASSIGNyyyymmdd.nnnn) and processes 130-character record layouts containing member demographic information, assignment reasons, provider details, health subprogram codes, transaction types, and state region codes. The specification document includes a modification log documenting technical changes made between December 2013 and June 2014, primarily adjusting field positions for Provider ID and Group Provider ID fields.
The file layout comprises detail records and trailer records with defined field specifications including character lengths, start and end positions, data formats, and source table references. The specification includes comprehensive assignment reason codes for both start and stop transactions, covering scenarios such as newborn pre-selection, self-selection, member-initiated disenrollments, approved changes citing specific justifications (network limitations, quality of service issues, physician unavailability, pregnancy-related circumstances), and error corrections. Additional codes address eligibility warnings and errors including dual eligibility conflicts, invalid county assignments, provider panel capacity issues, gender matching requirements, and database processing errors. Transaction types supported are Add (A), Change or Termination (C), and Delete (D), with Delete transactions indicating termination prior to effective date or eligibility errors requiring record removal from the system.
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Interface Spec Overview
| Interface Specification Overview | |
| Interface name: HHW HCC Member Assignment File from EB | |
| Description: This file will be sent to DXC from the Enrollment Broker (EB) regarding member requests for MCE assignment. | |
| Record Selection Criteria: MC_FTS_MGDJD130 | |
| Frequency: Daily | |
| Sender: EB | |
| Receiver: DXC | |
| Business Unit Ownership: Managed Care | |
| Error Handling/Special Processing: N/A | |
| Interface Exchange Method: Secure FTP | |
| File Name: EBASSIGNyyyymmdd.nnnn | |
| Modification Log | |
| Change Description | Date |
| Assignment Reason 50 changed to 49. (Historical records will show 49. New records are expected to show 49.) | 12/23/13 |
| Provider ID from character 9 to character 10 | 3/20/14 |
| Group Provider ID from character 9 to character 10 | 3/20/14 |
| Remove Provider / Service Location field and one space | 3/20/14 |
| Provider ID from character 10 to character 15 | 6/9/14 |
| Group Provider ID from character 10 to character 15 | 6/9/14 |
Interface Specs Layout
| Enter one line for each field on the table. All columns must be completed for all rows. Add lines as needed. Add tables as needed. Only related subsystem tables should be in the same spreadsheet. | See Interface Spec Process & Interface Spec Documentation Instructions | ||||||||
| Record Type | FIELD | FIELD SIZE | Field Start | Field End | FORMAT | TABLE NAME | COLUMN | DESCRIPTION | NOTES |
| Record Type | Field name | number of characters | Start Position | End Position | field type | table of origin/destination | column name | Any relevant information such as where field originated, unique or identifying information, acronymns speeled out. | |
| Detail | ID_MEDICAID | 12 | 1 | 12 | CHAR | t_re_pmp_assign | sak_recip | Identifies Member (RID) | |
| Detail | Filler | 1 | 13 | 13 | space | ||||
| Detail | DATE_EFFECTIVE | 8 | 14 | 21 | NUMBER | t_re_pmp_assign | DTE_EFFECTIVE | Start Date in health sub program, for HIP no start date is sent with new enrollment additions as it is not known until the Recipient makes the first POWER account payment, HIP normal Changes will include effective dates. TBD: MAXIMUS proposes that AIM tell us the effective date of transactions for other programs. | |
| Detail | Filler | 1 | 22 | 22 | space | ||||
| Detail | CODE_REASON_START | 2 | 23 | 24 | CHAR | t_re_pmp_assign | cde_rsn_mc_start | Reason started in health sub program, HIP-specific reasons TBD | See Assignment Reasons Tab |
| Detail | Filler | 1 | 25 | 25 | space | ||||
| Detail | DATE_END | 8 | 26 | 33 | NUMBER | t_re_pmp_assign | dte_end | End Date of Member in health program | New enrollment on 1st and 15th only; HPES default END OF TIME date is 22991231 |
| Detail | Filler | 1 | 34 | 34 | space | ||||
| Detail | CODE_REASON_STOP | 2 | 35 | 36 | CHAR | t_re_pmp_assign | cde_rsn_mc_stop | Reason health program was stopped for Member, HIP-specific codes TBD | See Assignment Reasons Tab, |
Mandatory if transaction type is C or D
| Detail | Filler | 1 | 37 | 37 | space | ||||
| Detail | PROVIDER ID | 15 | 38 | 52 | CHAR | t_re_pmp_assign | sak_prov_mbr | Provider ID | Spaces for HIP |
| Detail | Filler | 1 | 53 | 53 | space | ||||
| Detail | CODE_HEALTH_SUBPGM | 1 | 54 | 54 | CHAR | T_PMP_SVC_LOC | sak_pub_hlth | Health program member assigned | sak_pub_hlth->t_pub_hlth_pgm. Cde_pgm_health to interface field mapping: HH:R, HIPMC:H, HCC:A |
| Detail | Filler | 1 | 55 | 55 | space | ||||
| Detail | PROVIDER_GROUP_ID | 15 | 56 | 70 | CHAR | T_PMP_SVC_LOC | sak_prov_group | Group Provider ID if group applies to the doc | Spaces for HIP, or when provider is not a member of a group |
| Detail | Filler | 1 | 71 | 71 | space | ||||
| Detail | MCE_ID | 9 | 72 | 80 | CHAR | T_PMP_SVC_LOC | sak_mco | Managed Care Entity ID assigned to the provider or group provider | |
| Detail | Filler | 1 | 81 | 81 | space | ||||
| Detail | CODE_STATE_REGION | 1 | 82 | 82 | CHAR | t_re_pmp_assign | cde_mc_region | State Region code (group of counties) and out of state providers, not available for HIP, Not Null for other programs | One through Nine; Space for HIP |
| Detail | Filler | 1 | 83 | 83 | space | ||||
| Detail | EB_TRANS_ID | 12 | 84 | 95 | NUMBER | t_hip_redeterm | eb_trans_id | HPES returns when supplied,otherwise filled with Spaces (AIM auto Assignments, AIM Auto Disenrollments) | Null when sendinig an AIM Assignment Update file, Not Null when EB is sending transactions to HPES |
| Detail | Filler | 1 | 96 | 96 | space | ||||
| Detail | TRANSACTION TYPE | 1 | 97 | 97 | CHAR | MAXIMUS and HPES HIP team would like to add transaction type for clarity. HPES will send "Deletes" when the Assignment is removed from the table. (The whole record is removed from AIM, rather than a closure or disregard.) This occurs when a person received eligibility in error. MAXIMUS will treat these as disenrollments on the same day as the enrollment effective date from our point of view. MAXIMUS will also send Deletes to AIM when a person changes their plan and/or PMP selection prior to that selection becoming effective. | A(Add), C(Change or Termination), or D(Deleted = Termination prior to effective date or due to error in eligibility) | ||
| Detail | Filler | 1 | 98 | 98 | space | ||||
| Detail | RECIP FIRST NAME | 13 | 99 | 111 | CHAR | t_re_base | nam_first | HPES HIP team would like to add recipient name to facilitate verification and debugging, MAXIMUS concurs | |
| Detail | Filler | 1 | 112 | 112 | space | ||||
| Detail | RECIP MI | 1 | 113 | 113 | CHAR | t_re_base | nam_mid_init | HPES HIP team would like to add recipient name to facilitate verification and debugging, MAXIMUS concurs | |
| Detail | Filler | 1 | 114 | 114 | CHAR | space | |||
| Detail | RECIP LAST NAME | 15 | 115 | 129 | CHAR | t_re_base | nam_last | HPES HIP team would like to add recipient name to facilitate verification and debugging, MAXIMUS concurs | |
| Detail | End of Record | 1 | 130 | 130 | newline character | ||||
| Trailer | Filler | 3 | 1 | 3 | TRL' constant | ||||
| Trailer | Record Count | 11 | 4 | 14 | NUMBER | number of detail records | Right Justified - no leading zeroes | ||
| Trailer | Filler | 105 | 15 | 119 | spaces | ||||
| Trailer | Filler | 1 | 120 | 120 | newline character |
&L&G&C&"Arial,Bold"&12Interface Specification Document&R&8&D &L&8&F&C&8&P of &N &R&8EDS - Indiana Title XIX 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204
Assignment Reasons
| Valid Reasons EB may send when making Assignments | ||||
| Code Start Reason | Code Stop Reason | Description | ||
| Newborn pre-selection Assignments | 26 | Mom selects PMP prior to birth of child | ||
| Code Start Reason | Code Stop Reason | Description | ||
| Self Selection/Manual Assignments | 01 | 01 | Approved Change | |
| 02 | New Eligible | |||
| 03 | 03 | 6 Month PMP change | ||
| 04 | 04 | Newborn auto-assign change | ||
| 05 | 05 | Member Initiated - MCE Disenrollment | ||
| 06 | 06 | Redetermination | ||
| 07 | Death | |||
| 08 | Disenroll from Managed Care | |||
| 09 | Expired Managed Care Segment. | |||
| 30 | Voluntary county enrollment | |||
| 31 | 31 | Aprvd. Chng. - Member Choice Auto Assignment | ||
| 33 | 33 | Aprvd. Chng. - Untimely Communication | ||
| 35 | Aprvd. Chng. - PMP Panel Full | |||
| 40 | 40 | Aprvd. Chng. - PCCM PMP Disenrolled | ||
| 41 | 41 | Aprvd. Chng. - MCE PMP Disenrolled | ||
| 42 | 42 | Aprvd. Chng. - Error in Assignment | ||
| 43 | 43 | Aprvd. Chng. - MCE Ancillary Service Access Issues | ||
| 44 | 44 | Aprvd. Chng. - PCCM Ancillary Svc Access Issues | ||
| 45 | 45 | Aprvd. Chng. - Quality of Service Issues | ||
| 46 | Aprvd. Chng. - Third Party Liability | |||
| 47 | 47 | Aprvd. Chng. - Network Limitations | ||
| 49 | 49 | Aprvd. Chng. - Inconvenient Location | ||
| 51 | 51 | Aprvd. Chng. - Member Moved | ||
| 52 | 52 | Aprvd. Chng. - Transportation Problems | ||
| 53 | 53 | Aprvd. Chng. - Appointment Delays | ||
| 54 | 54 | Aprvd. Chng. - Office Waiting Time | ||
| 55 | 55 | Aprvd. Chng. - Treatment by staff | ||
| 56 | 56 | Aprvd. Chng. - Unsatisfactory Communication | ||
| 57 | 57 | Aprvd. Chng. - Unsatisfactory quality of care | ||
| 58 | 58 | Aprvd. Chng. - Unsatisfactory emergency response | ||
| 59 | 59 | Aprvd. Chng. - Unable to obtain referral | ||
| 60 | 60 | Aprvd. Chng. - Insufficient after-hours coverage | ||
| 61 | 61 | Aprvd. Chng. - Physician no longer Medicaid | ||
| 62 | 62 | Aprvd. Chng. - Physician no longer in practice | ||
| 63 | 63 | Aprvd. Chng. - Physician Patient rltnshp unacpt | ||
| 64 | 64 | Aprvd. Chng. - Med condition not approp to pvdr | ||
| 65 | 65 | Aprvd. Chng. - Physician Requests Member Reassign | ||
| 66 | 66 | Aprvd. Chng. - Speclty not consistent with cond. | ||
| 67 | 67 | Aprvd. Chng. - Preg. related - ante-partum change | ||
| 68 | 68 | Aprvd. Chng. - Preg. related - post-partum change | ||
| 69 | 69 | Aprvd. Chng. - Other | ||
| 70 | 70 | Disenroll - ICES County Change | ||
| 71 | 71 | Disenroll - Residency Change | ||
| 72 | 72 | Disenroll - Third Party Liability Issues | ||
| 73 | 73 | Disenroll - Continuity of Care Issues | ||
| 74 | Disenroll - Member Determined to be Illegal Alien | |||
| 75 | 75 | Disenroll - Member Eligible for Waiver Program | ||
| 76 | 76 | Disenroll - Member Choice - Ward or Foster Child | ||
| 77 | Disenroll - Network Limitations | |||
| 78 | 78 | Disenroll - More than one RID # linked from ICES | ||
| 79 | Disenroll - Member became Eligible for Hospice | |||
| 80 | Disenroll - Member Ineligible Due To Age | |||
| 81 | Eligibility was Terminated | |||
| 82 | 82 | PMP DSNRL/REENR-Individ to Group loc | ||
| 83 | 83 | PMP DSNRL/REENR-Group to individ loc | ||
| 84 | 84 | PMP DSNRL/REENR-individ to diff individ loc | ||
| 85 | 85 | PMP DSNRL/REENR-group to diff group loc | ||
| 86 | 86 | Manual Reassignment | ||
| 87 | 87 | MCE Mass Change | ||
| 88 | 88 | JC-lack medically necessary serv under MCO (43) | ||
| 89 | 89 | JC-MCO non-covered for moral or religious reasons (50) | ||
| 90 | 90 | JC-Member risk related serv not avail MCO network (49) | ||
| 91 | 91 | JC-lack access provider for mbr health care need (49) | ||
| 92 | 92 | JC-Poor quality of care | ||
| 93 | 93 | JC-Family member change | ||
| 94 | 94 | Annual Enrollment | ||
| 95 | 95 | JC-Self Select <= 2 month break eligibility | ||
| 98 | 98 | Disenroll - Ineligible for Auto Assignment | ||
| 99 | Open | |||
| 1A | Opt in | Care Select | ||
| 1B | Opt out - No Reason | Care Select | ||
| 1C | Opt out - No Disease State | Care Select | ||
| 1D | Opt out - No PMP Available | Care Select | ||
| 1E | Terminated due to new rules | Care Select | ||
| 1F | Opt out - PMP not in Care Select | Care Select | ||
| 1G | 1G Opt out - Eligibility Ending | Care Select | ||
| 3Q | 3Q | HP Dsnrl- MCE PMP Svc Location No Longer Active | ||
| 3R | 3R | HP Dsnrl- Prov. Medicaid Eligibility Terminated | ||
| 3S | 3S | HP Dsnrl- Group Medicaid Eligibility Terminated | ||
| 3T | 3T | HP Dsnrl- PMP Service Location No Longer Active | ||
| 3U | 3U | HP Dsnrl- PMP Group Mbr Location No Longer Active | ||
| 3V | 3V | HP Dsnrl- PMP no longer practices at this Svc Loc | ||
| CODES Sent to EB | Code Start Reason | Code Stop Reason | Description | |
| HPES will send these reasons to EB | 10 | 10 | PCCM Voluntary PMP Disenroll | |
| INVALID CODES TO SEND TO HPES | 11 | 11 | MCE Voluntary PMP Disenroll | |
| 12 | 12 | PCCM Mandatory PMP Disenroll | ||
| 13 | 13 | MCE Mandatory PMP Disenroll | ||
| 14 | 14 | MCE dsnrl - PMP moved to oth MCE plan | ||
| 15 | 15 | MCE dsnrl - PMP moved to PCCM | ||
| 16 | 16 | MCE dsnrl - PMP dsnrl from program | ||
| 17 | 17 | MCE PMP moved to another MCE plan | ||
| 18 | 18 | MCE PMP moved to PCCM | ||
| 19 | 19 | PCCM PMP moved to an MCE plan | ||
| 20 | 20 | Auto Assigned - Newborn (Mom PMP) | ||
| 21 | 21 | Auto Assigned - Case Assignment | ||
| 22 | 22 | Auto Assigned - Previous PMP | ||
| 23 | 23 | Auto Assigned - Default Distance | ||
| 24 | 24 | Auto Assigned - PCCM PMP Disenrolled | ||
| 25 | 25 | Auto Assigned - MCE PMP Disenrolled | ||
| 26 | 26 | Auto Assigned - Newborn Preselection | ||
| 27 | HHPD - Other | |||
| 28 | 28 | Auto Assigned - Redetermination | ||
| 29 | 29 | Auto Assigned - Lockin - Previous PMP | ||
| 2A | 2A | Auto Assigned - Newborn Case (Mom MCE) | ||
| 2B | 2B | Auto Assigned - Newborn Group (Mom MCE) | ||
| 2C | 2C | Auto Assigned - Newborn Distance (Mom MCE Network) | ||
| 2D | 2D | Auto Assigned - Newborn Other (Mom MCE Network) | ||
| 2E | 2E | Auto Assigned - Newborn County (Mom MCE Network) | ||
| 2F | 2F | Auto Assigned - Newborn Distance (Mom MCE) | ||
| 2G | 2G | Auto Assigned - Newborn Other (Mom MCE) | ||
| 2H | 2H | Auto Assigned - Newborn County (Mom MCE) | ||
| 2I | 2I | Auto Assigned - Default Other | ||
| 2J | 2J | Auto Assigned - Default County | ||
| 2K | 2K | Auto Assigned - Previous PMP Group Location | ||
| 2L | 2L | Auto Assigned - Previous PMP Other Location | ||
| 2M | 2M | Auto Assigned - Previous MCE Case PMP | ||
| 2N | 2N | Auto Assigned - Previous MCE Case Group-Mbr PMP | ||
| 2O | 2O | Auto Assigned - Previous MCE Network Distance | ||
| 2P | 2P | Auto Assigned - Previous MCE Network Other | ||
| 2Q | 2Q | Auto Assigned - Previous MCE Distance | ||
| 2R | 2R | Auto Assigned - Previous MCE Other | ||
| 2S | 2S | Auto Assigned - Case Group Assignment | ||
| 2T | 2T | Auto Assigned - Lockin - Previous PMP Group | ||
| 2U | 2U | Auto Assigned - Lockin - Previous MCE | ||
| 2V | 2V | Auto Assigned - Lockin - Case Assignment | ||
| 2W | 2W | Auto Assigned - Lockin - Default | ||
| 2X | 2X | Previous PMP <2 month auto-assignment | Auto-assignment for less than a 2 month break in eligibility previous PMP | |
| 3A | 3A | Auto Assigned - Previous MCE | ||
| 3B | 3B | Auto Assigned - Companion Case ID | ||
| 3C | 3C | Auto Assigned - Previous RCP | ||
| 3D | 3D | Auto Assigned - Spouse (HIP) | ||
| 3F | 3F | Auto Assigned - Newborn (MOM MCE) | ||
| 3G | 3G | Auto Assigned - Member Choice | ||
| 3W | 3W | MCE Dsnrl- PMP no longer practices at this Svc Loc | ||
| 3X | 3X | MCE Dsnrl- PMP no longer contracted with MCE | ||
| 3Y | 3Y | MCE Dsnrl- PMP not in managed care at this Svc Loc | ||
| 3Z | 3Z | MCE Dsnrl- PMP deceased | ||
| A1 | A1 | MCE Auto Assigned - Previous PMP | ||
| A2 | A2 | MCE Auto Assigned - Case ID PMP | ||
| A3 | A3 | MCE Auto Assigned - PMP in Previous Group | ||
| A4 | A4 | MCE Auto Assigned - Case ID in Previous Group | ||
| A5 | A5 | MCE Default Auto Assignment | ||
| A6 | A6 | MCE PMP Disenrolled | ||
| A7 | A7 | MCE Member Request | ||
| A8 | A8 | MCE PMP Initiated | ||
| A9 | A9 | MCE Approved Change - PMP Panel Full |
Response Error Codes
| Error Code | Error code description |
| 10 | Aid category / dates not effective/valid |
| 20 | Warning - Calculated new Start Date |
| 20 | Error - Calculated new Start Date |
| 20 | Warning - Calculated new Start Date |
| 21 | Error - Future segment exists - send a delete then an add |
| 22 | dte eff not in future |
| 30 | Error - Assignment End date Invalid |
| 30 | Error - wrong value submitted |
| 31 | Assignment End date past eligibility end date |
| 40 | Assignment Start Reason Invalid |
| 50 | Assignment Stop Reason Invalid |
| 60 | Error - Assignment Transaction Type Invalid |
| 70 | Code Health Subprogram invalid not R, C, H or A |
| 80 | Error - wrong value submitted |
| 90 | HIP Add record does not have corresponding Change/Delete record |
| 100 | HIP Change/Delete record does not have corresponding Add record |
| 110 | Error - HIP Date end must consecutively follow date |
| 120 | Error - HIP Rejected due to errors on the corresponding change or add record. |
| 130 | MCE ID Invalid |
| 131 | Error - Member already assigned to this MCE |
| 132 | Error - Enrollment Broker cannot change plan to or from ESP |
| 133 | Error - MCE ID Spaces |
| 134 | Error - MCE ID does not match MCE ID in AIM for this recipient |
| 150 | Medicaid ID (RID) Invalid |
| 150 | Error - Medicaid ID (RID) Invalid |
| 150 | Medicaid ID (RID) Invalid |
| 160 | age limit on prov spec |
| 170 | age limit on prov spec |
| 180 | package C over age |
| 190 | age < 13 out of range allowed |
| 200 | younger age < 17 than allowed |
| 210 | age under 21 of what is allowed |
| 220 | age < 3 out of range allowed |
| 230 | age > 17 than allowed |
| 240 | age > 2 |
| 250 | age > 20 - out of range allowed |
| 260 | younger age than allowed |
| 270 | age older than 12 |
| 280 | age out of range 13 - 17 allowed |
| 290 | age out of range 13 - 20 allowed |
| 310 | Member has Dual eligibility and J, L aid category |
| 320 | Member has LOC (Level of Care) |
| 340 | Member has Medicare A or B |
| 350 | Member in invalid County/Region for health program |
| 360 | Member is a Ward/Foster |
| 370 | Warning - Member is already enrolled with the same PMP |
| 381 | Member requires Disease State |
| 400 | Member not legal alien or emergency services only |
| 430 | PMP ID or service Location Invalid or PMP does not have an active service location |
| 442 | PMP/Member not a good match on Gender |
| 444 | PMP/Member not a good match on Gender - Member not Female |
| 446 | PMP/Member not a good match - default reason - Member not Male |
| 460 | PMP Panel is Full / PMP Panel reached maximum capacity |
| 470 | PMP Panel on Hold/Stop |
| 490 | Provider Ineligible ( disenrolling ) |
| 600 | Error - Member locked in to current MCO - Send Just Cause start reason |
| 600 | Error - Member locked in to current MCE |
| 605 | Error - Invalid Start date sent for Open Enrollment period |
| 610 | Error - Member locked in to current MCO for Annual period |
| 620 | Warning - Annual enrollment stat date not 1st of month after AE end date |
| 625 | Error - After 25th of Month and near end of Annual OE period. |
| 630 | Error - Just Cause Reason not allowed |
| 693 | Error - OE reason 93 not allowed for Member |
| 694 | Error - Expecting a change of MCO or plan |
| 695 | Error - OE reason 95 not allowed for non BA Assistance members |
| 803 | UPDATE overlap date |
| 833 | Error - Record already has opt-out record |
| 834 | Error - wrong value submitted |
| 998 | Assignment not found |
| 999 | Error code number is a place holder for Member Z-stopped Reason SQL error - database did not update record for unknown reason SQL error |
File details come from the government source that posted it. Updated .