HHW HCC HIP Member Assignment File Update to EB.xlsx
XLSX spreadsheet 41 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 HIP Member Assignment File Update, detailing the technical requirements for data exchange between HPE (Hewitt) and the Enrollment Broker (EB) for Medicaid managed care member updates in Indiana's Title XIX program. The specification defines a daily file transfer mechanism that communicates member enrollment, changes, and terminations across the Healthy Indiana Plan (HIP), Healthy Connections (HCC), and Hoosier Health (HH) programs. The interface utilizes secure FTP for file transmission with standardized naming conventions (ASSIGN, HASSIGN, QASSIGN, QHASSIGN with date and sequence stamps), and the specification has been in use since January 2017, with the most recent review completed in May 2021. The file structure consists of detail records containing 130 characters per line, including member identification, effective and end dates, assignment reasons, provider information, transaction types (Add, Change/Termination, or Delete), and recipient name information to facilitate verification and debugging.
The specification establishes a comprehensive record layout with 22 defined fields organized by record type, field size, start and end positions, and format requirements, with data sourced from and mapped to specific database tables including T_RE_BASE, T_RE_PMP_ASSIGN, and T_PR_IDENTIFIER. Assignment and stop reason codes are provided for both self-selection/manual assignments and auto-assignments, encompassing 95 distinct codes covering scenarios such as approved changes, member-initiated disenrollments, redeterminations, judicial custody matters, and annual enrollment actions. The document includes a modification history documenting structural changes to provider ID field sizes and assignment reason codes, with particular attention to HIP-specific processing where effective dates and provider information may not be available at enrollment. The trailer record format provides record counting functionality with right-justified, zero-leading-digit suppression, ensuring accurate batch accounting and processing validation.
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Interface Spec Overview
| Interface Specification Overview |
| Interface name: HHW HCC HIP EB Assignment Update File to EB |
| Description: This daily update file will be sent from HPE to the Enrollment Broker (EB) regarding MCE member updates for EB assignments. |
| Record Selection Criteria: MC_FTS_MGDJD130 |
| Frequency: Daily, Quarterly |
| Sender: DXC |
| Receiver: EB |
| Business Unit Ownership: Managed Care |
| Error Handling/Special Processing: N/A |
| Interface Exchange Method: Secure FTP |
| File Names: ASSIGNyyyymmdd.nnnn, HASSIGNyyyymmdd.nnnn, QASSIGNyyyymmdd.nnnn, QHASSIGNyyyymmdd.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 |
| Changed EB Update record layout from 120 to 130 | 1/6/17 |
| Reviewed | 5/19/21 |
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_BASE | sak_recip | Identifies Member | |
| 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 Member 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_RE_PMP_ASSIGN | 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_RE_PMP_ASSIGN | 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_PR_IDENTIFIER | id_provider | Managed Care Entity ID assigned to the provider or group provider | using first nine digits only for MCE ID |
| 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_RE_PMP_ASSIGN | id_eb_txn | 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 | A_T_RE_PMP_ASSIGN | cde_action | 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 Member 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 Member 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 Member name to facilitate verification and debugging, MAXIMUS concurs |
| Detail | Linefeed | 1 | 130 | 130 | newline character |
| Trailer | Filler | 3 | 1 | 3 | TRL' constant | ||
| Trailer | Record Count | 11 | 4 | 14 | NUMBER | number of records excluding Trailer record | Right Justified - no leading zeroes |
| Trailer | Filler | 115 | 15 | 129 | spaces | ||
| Trailer | Linefeed | 1 | 130 | 130 | newline character |
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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 |
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