HIP Member Demographic File to EB.xlsx

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Attached to
RFP 27-87793 FSSA OMPP Enrollment Broker ServicesBid Documents
Solicitation number
RFP 27-87793
Issued by
Marion County, Indiana

About this file

Written by GovTribe AI ·

This is an interface specification document for the HIP Member Demographic File to EB (Eligibility and Benefits), a data exchange mechanism between DXC (sender) and the EB system (receiver) under the Indiana Title XIX Managed Care program administered by EDS. The interface transmits member demographic information for HIP (Healthy Indiana Plan) members on a daily and quarterly basis via secure FTP using the file naming convention HRECIPyyyymmdd.nnnn or RECIPIENT*.zip. The specification defines a fixed-format record structure containing 511 characters per line, with detail records including member identification, personal demographic data (name, address, contact information, date of birth, Social Security number, sex, marital status), health program enrollment status, managed care classification, aid category information, pregnancy indicators, medically frail status, and spouse identification. The file includes both current and future program segment data with effective and end dates for eligibility transitions. Record selection is based on criteria MC_FTS_MGDJS613, with business unit ownership assigned to Managed Care and error handling managed through standard interface protocols.

The specification has undergone multiple modifications since its initial implementation, most significantly with HIP 2.0 enhancements added on May 5, 2015, which introduced pregnancy-related fields and medically frail assessment indicators, and subsequent updates on May 11, 2015, and May 19, 2021, that expanded field sizes for recipient name, address, and case worker information to accommodate longer data strings. The trailer record includes a physical record count and line feed character for file validation. Valid values for certain coded fields, such as marital status (with codes ranging from A for common law to X for legally separated), are provided in reference tables included within the specification document. No pricing terms, contract award dates, or procurement timelines are specified in this technical interface specification.

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Att N (Addendum #1) - Performance Exhibit.docx DOCX document
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Interface Spec Overview

Interface Specification Overview
Interface name: HIP Member Demographic File to EB
Description: This file contain the member demographic information for HIP members sent from HP to the EB.
Record Selection Criteria: MC_FTS_MGDJS613
Frequency: Daily and Quarterly
Sender: DXC
Receiver: EB
Business Unit Ownership: Managed Care
Error Handling/Special Processing: N/A
Interface Exchange Method: Secure FTP
File Name: HRECIPyyyymmdd.nnnn, RECIPIENT*.zip
Modification Log
Change DescriptionDate
HIP 2.0 Changes : fields "Indicator PMP paper", "Potential Plus Indicator","Pregnancy Indicator", "Pregnancy Start Date","Pregnancy End Date", "Pregnancy Estimated Delivery Date", "Medically Frail Confirmation Code", "Medically Frail Last Confirmed Assessment Date" added5/5/15
T_RE_BASE column size changes5/11/15
Recip Last Name - Size 15 changed to Size 60
Recip First Name - Size 13 changed to Size 35
Recip Addr City - Size 15 changed to Size 30
Recip County - Size 2 changed to Size 10
Recip Language - Size 1 changed to Size 3
Recip County Ward - Size 2 changed to Size 10
Case Number - Size 10 changed to Size 12
ID_Case_Worker - (REMOVED)
Street Address 1 - Size 30 changed to Size 55
Street Address 2 - Size 30 changed to Size 55
Current Recip Aid Category - Size 2 changed to Size 5
Future Recip Aid Category - Size 2 changed to Size 5
Recip Marital Code update - added See Maritial Status Code tab for valid value5/19/21

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 TypeFIELDFIELD SIZEField StartField EndFORMATTABLE NAMECOLUMNDESCRIPTIONNOTES
Record TypeField namenumber of charactersStart PositionEnd Positionfield typetable of origin/destinationcolumn nameAny relevant information such as where field originated, unique or identifying information, acronymns speeled out.
DetailMember ID12112CHART_RE_BASEid_medicaidUnique Identifier for the Member. This is the number assigned by ICES.
DetailFiller11313blank space
DetailMember Last Name601473CHART_RE_BASEnam_lastThe last name of a Member.
DetailFiller17474blank space
DetailMember First Name3575109CHART_RE_BASEnam_firstThe first name of a Member.
DetailFiller1110110blank space
DetailMember Middle Initial1111111CHART_RE_BASEnam_mid_initThe middle initial of the Member.
DetailFiller1112112blank space
DetailMember Addr City30113142CHART_RE_BASEadr_cityThe city where the Member resides.
DetailFiller1143143blank space
DetailMember Addr State2144145CHART_RE_BASEadr_stateThe state where the Member resides.
DetailFiller1146146blank space
DetailMember Addr Zip Code5147151CHART_RE_BASEadr_zip_codeThe five character zip code for the Member.
DetailFiller1152152blank space
DetailMember Addr Zip Code Ext4153156CHART_RE_BASEadr_zip_code_4The zip plus four of the Member.
DetailFiller1157157blank space
DetailMember SSN9158166CHART_RE_BASEnum_ssnThe social security number for the Member.May be blank for HIP Pending cases
DetailFiller1167167blank space
DetailMember Birth Date8168175NUMBERT_RE_BASEdte_birthThe date of birth for the Member.May be blank for HIP Pending cases
DetailFiller1176176blank space
DetailMember Death Date8177184NUMBERT_RE_BASEdte_deathThe date of death for the Member.
DetailFiller1185185blank space
DetailMember Sex1186186CHART_RE_BASEcde_sexIndicates the sex of the Member.May be blank for HIP Pending cases
DetailFiller1187187blank space
DetailMember Marital Code1188188CHART_RE_BASEcde_maritalIndicates the marital status of a Member.
See Maritial Status Code tab for valid valuesMay be blank for HIP cases
DetailFiller1189189blank space
DetailMember County10190199CHART_RE_BASEcde_countyIndicates the county where the Member resides. Two digit County Code value provided.May be blank for HIP Pending cases
DetailFiller1200200blank space
DetailMember Language3201203CHART_RE_BASEcde_languageIndicates the primary language for the Member.Spanish or Space for English
DetailFiller1204204blank space
DetailMember Ward Type1205205CHART_RE_BASEcde_ward_typeThis is the code that represents the type of ward.'Y' - yes, 'N' - no, 'C' - chins, 'D' - court order, 'P' - parent termBlank for HIP
DetailFiller1206206blank space
DetailMember County Ward10207216CHART_RE_BASEcde_county_wardThis is the county associated with a ward.
Blank for HIP
DetailFiller1217217blank space
DetailMember Ind Active1218218CHART_RE_BASEind_activeIndicates if the Member Medicaid ID is active or purged because of a link. When two Medicaid IDs are linked one of them is no longer valid an will have an 'N' - no. All others are active and will have a 'Y' - yes.Y = Current ID or N=Inactive ID
DetailFiller1219219blank space
DetailCase Number12220231CHART_RE_CASEnum_caseThe ICES case number assigned to the Member.Blank for HIP until case is open (HIP status = Eligible)
DetailFiller1232232blank space
DetailStreet Address 155233287CHART_RE_BASEadr_street_1First street address for Member
DetailFiller1288288blank space
DetailStreet Address 255289343CHART_RE_BASEadr_street_2Second street address for Member
DetailFiller1344344blank space
DetailCurrent Health Care Program1345345CHARAlways H = HIPNew, current only
DetailFiller1346346blank space
DetailCurrent Managed Care Status in Current Program1347347CHARM = Mandatory for all HIP Applicants and most HIP Eligibles.
X = Excluded from Managed Care for All HIP Eligibles who participate in the emergency services for undocumented aliens portion of the program.New, current only
DetailFiller1348348blank space
DetailCurrent Member Aid Category5349353CHART_CDE_AIDcde_aid_categoryIdentifies the type of aid for which the Member is currently eligible, only available when the HIP person becomes eligibleCurrent Segment only
DetailFiller1354354blank space
DetailCurrent Aid Elig Effective Date8355362NUMBERT_RE_AID_ELIGdte_effectiveThe date that the Medicaid Member became eligible for the corresponding current aid category. Only available when the HIP person becomes eligibleCurrent Segment only
DetailFiller1363363blank space
DetailCurrent Aid Elig End Date8364371NUMBERT_RE_AID_ELIGdte_endThe date that the Medicaid Member is no longer eligible for the corresponding aid category. Only completed when the HIP person loses HIP eligibility.Current Segment only
DetailFiller1372372blank space
DetailFuture Health Care Program1373373CHARFuture Program for which the Member will be eligible: R = RBMC, C = Care Select, X = Medicaid Select, H = HIP (depending on the aid category and roll-out, future may differ from current program)New, Future Segment only
DetailFiller1374374blank space
DetailFuture Managed Care Status in Future Program1375375CHARM = Mandatory, V = Voluntary, X = Excluded from Managed Care in the Future programNew, Future Segment only
DetailFiller1376376blank space
DetailFuture Member Aid Category5377381CHART_CDE_AIDcde_aid_categoryIdentifies the type of aid for which the Member will be eligible in the near future.New, Future Segment only
DetailFiller1382382blank space
DetailFuture Aid Elig Effective Date8383390NUMBERT_RE_AID_ELIGdte_effectiveThe date that the Medicaid Member becomes eligible for the corresponding future aid category.New, Future Segment only
DetailFiller1391391blank space
DetailFuture Aid Elig End Date8392399NUMBERT_RE_AID_ELIGdte_endThe date that the Medicaid Member will no longer be eligible for the corresponding future aid category.New, Future Segment only
DetailFiller1400400blank space
DetailPhone Number10401410CHART_RE_BASEnum_phoneCase Phone Number with Area Code
DetailFiller1411411blank space
DetailHIP Status1412412CHART_RE_CDE_APPLN_STATUScde_application_statusIdentifies the Member's eligibility application status based on application type.
Pending, Conditional, Eligible, Denied, Potential Plus (P, C, E, D, S )New, for HIP only.
DetailFiller1413413blank space
DetailSpouse Member ID12414425CHART_RE_BASEid_medicaidRID for the spouse of the Member. This is only filled if the Member is married.New, for HIP only.
DetailFiller1426426
DetailDebt Indicator1427427CHART_MC_HIP_REFUNDamt_debt_incur
dte_debt_clearY(es) or N(o)

if ( dte_debt_clear > 0 && amt_debt_incur > 0. ) ind_member_debt[0] = 'Y';

else ind_member_debt[0] = 'N';

DetailFiller1428428
DetailConditional Elig Date8429436NUMBERT_RE_APPLNdte_app_statusThis is the date of the application's current status.
DetailFiller1437437
DetailBenefit Effective Date8438445NUMBERT_MC_HIP_REFUNDdte_effective_insEffective date of the transaction.
DetailFiller1446446
DetailBenefit End Date8447454NUMBERT_MC_HIP_REFUNDdte_end_insEnd date of the transaction.
DetailFiller1455455
DetailInd pmp paper1456456CHART_RE_BASEind_pmp_paperY/N provider directory indicator
DetailFiller1457457
DetailPotential Plus Indicator1458458CHART_RE_ELIG_INFOind_pot_plusThis is the Potential Plus Indicator. Valid values are Y - Yes, N - No.
DetailFiller1459459
DetailPregnancy Indicator1460460CHART_RE_PREGNANCYY/N
DetailFiller1461461
DetailPregnancy start date8462469NUMBERT_RE_PREGNANCYdte_beginThis is the start date of pregnancy.
DetailFiller1470470
DetailPregnancy end date8471478NUMBERT_RE_PREGNANCYdte_endThis is the end date of pregnancy.
DetailFiller1479479
DetailPregnancy estimated delivery date8480487NUMBERT_RE_PREGNANCYdte_estimate_birthThis is the estimated delivery date.
DetailFiller1488488
DetailMedically Frail Confirmation Code1489489CHART_RE_FRAIL_ASSESScde_frail_confirmThis code indicates frail confirmation.

Y - Confirmed Frail N - Confirmed Not Frail U - Unconfirmed

DetailFiller1490490
DetailMedically Frail last confirmed assessment date8491498NUMBERT_RE_FRAIL_ASSESSdte_last_assessThis is the latest Medically Frail assessment date.
DetailFiller12499510
DetailLine feed1511511HEXnewline character
TrailerFiller313TRL' constant
TrailerRecord Count11414NUMBERPhysical Record count (not including trailer), right justify the number
TrailerFiller49615510Space. To fill out the rest of the record
TrailerLine feed1511511HEXnewline character

&G &"Arial,Bold"&12Interface Specification Document &8&D

&8&F &8&P of &N &8EDS - Indiana Title XIX 950 N. Meridian St., Suite 1150 Indianapolis, IN 46204

Martial Status Code

CDE_MARITALDSC_MARITAL
ACOMMON LAW
BREGISTERED DOMESTIC PARTNER
CNOT APPLICABLE
DDIVORCED
ISINGLE
KUNKNOWN
MMARRIED
RUNREPORTED
SSEPARATED
UUNMARRIED (SINGLE, DIVORCED OR WIDOWED)
WWIDOWED
XLEGALLY SEPARATED
Note:May be blank for HIP cases

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