HIP EB Assignment File to MMIS.xls
XLS spreadsheet 42 KB Posted
- Solicitation number
- RFP 27-87793
- Issued by
- Marion County, Indiana
About this file
This is an interface specification document prepared by the Indiana Family and Social Services Administration (FSSA) for the HIP Member Assignment File system, which facilitates the transfer of member managed care entity (MCE) selections from the Eligibility Broker (EB) to DXC through secure FTP on a daily basis. The specification outlines a detailed record layout for the HEBASSIGN file containing 12-character Medicaid IDs, effective dates, reason codes for enrollment starts and stops, 15-character provider and group provider IDs, MCE assignments, state region codes, transaction identifiers, transaction types (Add, Change/Termination, or Deletion), and recipient name information. The file accommodates three transaction types: Add (A) for new enrollments occurring on the 1st and 15th of each month, Change or Termination (C) for program modifications, and Deletion (D) for terminations prior to effective date or eligibility errors. Each detail record spans 130 characters and includes a trailer record documenting the count of detail records with right-justified formatting. The specification includes comprehensive modification history noting structural changes from December 2013 through June 2014, including adjustments to provider ID character positions and field removals.
The document provides an extensive assignment reasons table containing 65 valid reason codes for both enrollment starts and program terminations, covering scenarios such as death (50), ICES termination (99), MCE auto-assignments (A1-A9, AO-AJ), member-initiated changes (A7, A8, AR, AS), eligibility changes (EC, ET), plan changes (FE, PC, RP, TE, TN, TP), and various disenrollment reasons specific to provider status, managed care panel capacity, and relocation. The interface requires no special error handling or processing beyond the standard secure FTP transmission method. Historical records maintain a legacy assignment reason code of 49, with new records expected to reflect 49 rather than the previously used 50, reflecting system evolution and alignment with ongoing Medicaid managed care program operations for Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging.
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Text version
Interface Spec Overview
| Interface Specification Overview | |
| Interface name: HIP Member Assignment File from EB | |
| Description: This file will be sent from EB to DXC regarding member MCE selection. | |
| 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: HEBASSIGNyyyymmdd.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 | |
| Self Selection/Manual Assignments | 07 | Death | |
| 50 | ICES Termination | ||
| 99 | Open | ||
| 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 | |
| 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 | |
| AA | Auto Assign - Default | ||
| AB | Auto Assign - Previous Insurer HIP | ||
| AC | Auto Assign - Previous Insurer HHW | ||
| AD | Auto Assign - Spouse HIP | ||
| AE | Auto Assign - Spouse HHW | ||
| AF | Auto Assign - Case HIP | ||
| AG | Auto Assign - Case HHW | ||
| AH | Auto Assign - Companion Case HHW | ||
| AP | Auto Assigned - Previous Insurer | ||
| AR | Auto Assigned - Rotation | ||
| AS | Auto Assigned - Spouse | ||
| EB | EB | Enrollment Broker Assisted | |
| EC | Eligibility Change | ||
| ET | Eligibility Terminated | ||
| FE | FE | Plan Change - From ESP | |
| FR | Member failed redeterm | ||
| LT | Lifetime Limit Reached | ||
| MA | Moved to Active Enrollment | ||
| MP | Member did not return packet for processing | ||
| MS | Member Selection on Application | ||
| NP | Non-payment | ||
| OA | Over Age Limit | ||
| OH | Other health insurance obtained | ||
| OS | Out of State relocation | ||
| PC | PC | Plan Change - With Cause | |
| RP | Assigned to ESP | ||
| TE | TE | Plan Change - To ESP | |
| TN | TN | Plan Termination - Non Penalty | |
| TP | TP | Plan Termination - with Penalty | |
| VW | Voluntary Withdrawal | ||
| HS | HPE Adult - MCE Self Selection | ||
| HR | HPE Adult - MCE Rotational Assignment Selection | ||
| AO | Auto Assign - Current Open Assignment | ||
| AL | Auto Assign - Current Open Conditional/Deny Record | ||
| AI | Auto Assign - Previous HIP Plan with MS within 365 days | ||
| AJ | Auto Assign - Previous HHW Plan with MS within 365 days |
File details come from the government source that posted it. Updated .