Exhibit_1_-_Technical_Specification_-_Policy_Notification.pdf

DoD

Defense Manpower Data Center Defense Enrollment Eligibility Reporting System/

Military Health System (DEERS/MHS)

Technical Specification for

Policy Notification

Version 3.01 March 1229, 2012

Technical Specification for Policy Notification

DMDC iiVersion 3.0 Version 3.1 – March 29, 2012 March 29, 2012 March 12, 2012

Document History

Document Version Date Change(s)

3.0 March 12, 2012 Medical Policy Notification (PNT) - Premium version

Draft Release.

Edits to replace the Enrollment Fee Information with

Enrollment Premium Information.

Added Premium Override Information and Payment

Factor Information sections to the transfer record format.

3.1 March 29, 2012 Added “When a plan change (e.g., Individual to Family) within the same Contractor occurs, the PNT will contain one Enrollment Premium Information segment each for the terminated policy and the new policy. The PNT will not return fee data effective prior to FY13. If a PNT contains a policy termination effective prior to FY13, the Contractor should check its internal fee system to determine refunds required.” to Section 3.5, Enrollment Premium Information.

Added Enrollment Premium Quantity section with Enrollment Premium Segment Quantity to PNT layout to account for the possibility of multiple Enrollment Premium Information segments.

Added Health Care Delivery Program Plan Coverage Code to Enrollment Premium Information section of the PNT layout to identify the policy when multiple premium segments are required.

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Contents

1.0 DOCUMENT PURPOSE 1

2.0 REFERENCED DOCUMENTS 1

3.0 TECHNICAL PROCESS FLOW 1

3.1 NO HISTORY 1

3.2 SINGLE CONTRACTOR DATA 2

3.3 POLICY INFORMATION 2

3.4 CHANGE OF ENROLLMENTS 2

3.5 ENROLLMENT PREMIUM INFORMATION 3

3.6 TRANSFER OF ENROLLMENT 3

3.7 MAILING ADDRESS INFORMATION 4

3.8 PENDING CHANGES 4

4.0 SECURITY 4

4.1 ENCRYPTION APPROACH 4

5.0 COMMUNICATIONS 4

6.0 IDENTIFICATION 5

7.0 INPUT: POLICY NOTIFICATION ACKNOWLEDGEMENT TRANSFER RECORD 6

8.0 OUTPUT: POLICY NOTIFICATION TRANSFER RECORDS 7

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1.0 Document Purpose

This document is a specification for the Policy Notification process and transfer records. The intended audiences for this document are Contractors

Policy Notifications are sent from the Defense Enrollment Eligibility Reporting System (DEERS) to Contractor systems containing current data for a specific beneficiary.

The TRICARE Systems Manual (TSM) described several purposes for Policy Notifications.

Policy Notifications are sent to update Contractor billing and correspondence systems and to inform Contractors of enrollment changes made using the Beneficiary Web Enrollment (BWE) application.

2.0 Referenced Documents

This Technical Specification references and/or contains information from Chapter 3 of the TSM.

3.0 Technical Process Flow

DEERS sends a Policy Notification when current or future enrollment data, or certain demographic information for a beneficiary changes in DEERS. The Contractor may also request that DEERS send a Policy Notification for a beneficiary at any time by issuing the corresponding command in the Defense Online Enrollment System (DOES) software program.

3.1 No History

Each Policy Notification provides information for a beneficiary and sponsor that is current as of the specified effective time. The Contractor must discard any data specified in earlier Policy Notifications when DEERS sends a more recent Policy Notification for the same beneficiary.

The Contractor must not save data in previous Policy Notification records to build a record of historical information for the beneficiary.

Any field in a Policy Notification may contain an updated or corrected value compared to what was contained in a previous Policy Notification for the same beneficiary. The Policy Notification does not indicate the reason for the change, and the Contractor must accept the new value even if the reason for the change cannot be inferred.

For example, a beneficiary may be assigned a new primary care physician at the same military health care facility as the previous primary care physician. This assignment may not cause a Policy Notification to be sent. After this change, future Policy Notifications for this beneficiary will contain a changed value for PCM_SLCT_BGN_DT, but an unchanged value for PCM_EDVSN_DMIS_ID, compared to the contents of earlier Policy Notifications.

In the example above, DEERS may not send a Policy Notification to the Contractor as a result of the PCM change if both the old and new physician selections had the same PCM_EDVSN_DMIS_ID value.

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3.2 Single Contractor Data

The Policy Information and Enrollment Process Information sections of a Policy Notification only include information about the latest enrollment with the receiving Contractor. For example, when a beneficiary moves from one region to another, DEERS will send the Contractor serving the beneficiary’s old region a Policy Notification showing that the enrollment has ended, but this Policy Notification will not contain any information about the beneficiary’s new enrollment with the Contractor serving the beneficiary’s new region.

Note that if two Contractors choose to use the same server to receive Policy Notifications, the system must examine the HCDP_EMC_CD field of each Policy Notification to determine which Contractor is the intended recipient.

For TRICARE Reserve Select (TRS) and TRICARE Retired Reserve (TRR), DEERS will send all PNTs to the Contractor managing the region in which the sponsor resides.

For Extended Care Health Option (ECHO), DEERS will send PNTs to the Contractor that performed the registration.

3.3 Policy Information

Each Policy Notification will contain one Policy Information segment, with information about the latest policy. If the enrollment is not terminated and a future policy enrollment period exists in DEERS, this segment will contain information about the future policy enrollment period. The Policy Begin Date in the PNT is always the actual Policy Begin Date on DEERS.

3.4 Change of Enrollments

It is possible for two enrollments for the same beneficiary in the same region to be modified at the same time. This may happen when one enrollment begins the day after another enrollment ends. For example, an enrollment may be terminated and a new enrollment added to begin immediately following the old enrollment.

DEERS will only send one Policy Notification, for the later enrollment. DEERS will set the PRIOR_EMC_ENRL_ERSN_CD field to indicate the reason for the termination of the prior enrollment and the fact that the prior enrollment was terminated one day before the enrollment begin date on the PNT.

DEERS will set the PRIOR_EMC_ENRL_ERSN_CD only when both enrollments have been modified, and when the previous enrollment either was with the same Contractor or was terminated with a transfer of enrollment.

In the event of a cancellation and reinstatement of a prior enrollment, or replacement of a new enrollment, the notification will identify the previous enrollment (the one to be kept) and the PRIOR_EMC_ENRL_ERSN_CD will indicate cancellation (“E” status). In these cases, the Contractor should cancel the enrollment on file and accept the notification for the reinstated or replacement enrollment.

In the event of a cancellation and reinstatement of a prior enrollment, or replacement of a new enrollment and the Contractor holds both enrollments, the notification will identify the previous enrollment (the one to be kept) and the PRIOR_EMC_ENRL_ERSN_CD will indicate

DMDC 3Version 3.0 Version 3.1 – March 29, 2012 March 29, 2012 March 12, 2012 cancellation (“E” status). In these cases, the Contractor should cancel the enrollment on file and accept the notification for the reinstated or replacement enrollment.

Similarly, a Policy Notification may indicate that a primary care physician selection has been terminated and a new selection will begin the day after the terminated selection ends. In this case, DEERS will set the PRIOR_PCM_SLCT_ERSN_CD to indicate the reason for the termination of the prior selection and the fact that the prior PCM was terminated one day previous to the PCM begin date on the PNT. Cancellation of PCM changes will require the reinstatement of the prior PCM or that a replacement PCM is assigned. The behavior is similar to cancelling an enrollment and reinstating the prior enrollment or replacing with a new enrollment.

PRIOR_PCM_SLCT_ERSN_CD will indicate cancellation of a PCM change (“E” status). In these cases, the Contractor should cancel the PCM on file and accept the notification for the reinstated or replacement PCM.

3.5 Enrollment Premium Information

If DEERS has any enrollment premium information for the policy, DEERS will send one segment containing the cumulative premium payment information for the policy in DEERS. The receiving system must accept this payment data. When a plan change (e.g., Individual to Family) within the same Contractor occurs, the PNT will contain one Enrollment Premium Information segment each for the terminated policy and the new policy. The PNT will not return fee data effective prior to FY13. If a PNT contains a policy termination effective prior to FY13, the Contractor should check its internal fee system to determine refunds required.

DEERS will return (in the fee waiver entitlement section) all fee waiver entitlement data for the family that affects the policy in the current fiscal year, future fiscal years, or up to five fiscal years in the past. Waiver data is marked active or inactive. Active segments are used to determine waiver periods in a fiscal year that should be applied to the policy. Inactive segments represent previously calculated entitlements that have been subsequently determined to no longer apply to any policy. If an active or an inactive entitlement is sent, Contractor must make necessary adjustments.

Waiver entitlement periods can span multiple policies and multiple fiscal years. DEERS may return multiple entitlements (i.e. a family may have a Medicare waiver and a cat cap waiver simultaneously). DEERS will only send waiver data on PNTS for enrollments that require premiums.

If the enrollment policy qualifies for Medically Retired and Survivor prime policies may be exempt from annual fee increases. In these cases, DEERS will return one Premium Override Information segment to inform the Contractor of the applicable fee rate for the policy.

DEERS will assign a payment factor for the policy that corresponds to the sponsor’s DFAS salary data. This factor will determine the enrollment fees required for the policy. DEERS will send one Payment Factor Information segment for each Payment Factor information segment in DEERS that overlaps the policy in the PNT.

3.6 Transfer of Enrollment

When a transfer of enrollment between two Contractors is performed, the Policy Notification DEERS sends to the gaining Contractor will contain a PRIOR_EMC_ENRL_ERSN_CD value

DMDC 4Version 3.0 Version 3.1 – March 29, 2012 March 29, 2012 March 12, 2012 of “T”. This Policy Notification will also contain an Enrollment Fee Premium Information segment containing information on the fees already paid to the policy.

When a transfer of enrollment and change of enrollment plan are done simultaneously, the PNT will contain a PRIOR_EMC_ENRL_ERSNX_CD value of “T1”. This Policy Notification will also contain an Enrollment Fee Premium Information segment containing information on the fees already paid to the policy.

3.7 Mailing Address Information

There will be one Mailing Address Information segment for each residence (primary) or mailing (secondary) address stored for the beneficiary in DEERS. Temporary addresses will not be sent.

3.8 Pending Changes

The Contractor must process all PNTs, both pending and non-pending, coming from Beneficiary Web Enrollment (BWE) as soon as they receive them. DEERS may not send all data contained on the initial pending PNT after approval by the Contractors, for example, prior end reason codes.

4.0 Security

4.1 Encryption Approach

DEERS sends all Policy Notifications, and the Contractor must send all Policy Notification acknowledgement transfer records over the Military Health System (MHS) Business-to-Business (B2B) gateway secured by Virtual Private Network (VPN). The VPN will use encryption to provide a secure channel for data transmission. The MHS administers the B2B gateway and VPN, including components that are physically located at the Contractor’s site. The Contractor must upgrade and comply with changes to the standard MHS VPN solution. The Contractor must provide information required to support the B2B Gateway to MHS. The requirements for the B2B Gateway may change over time, and the Contractor must upgrade and comply accordingly.

The goal of TMA security administration is to minimize maintenance of user IDs and passwords across the network and to accommodate future security strategies through current procedures.

The Contractor must comply with current DoD and MHS security requirements, as well as future enhancements based on technological advances that include, but are not limited to, Machine-to- Machine certification and authentication, Public Key Infrastructure (PKI), and other encryption options.

5.0 Communications

The Contractor will operate a server that accepts TCP connection requests on a fixed port number. The Government will supply the Contractor with a list of source IP addresses used to establish connections over the B2B gateway. The server running on the Contractor system must accept connection requests from the IP addresses provided in order to receive Policy Notification data transferred through the VPN and the Business-to-Business Gateway.

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When policy notification transfer records are available in DEERS, DEERS will initiate a connection with the Contractor server. Once a TCP connection is established, DEERS will send a number of Policy Notification transfer records. The Contractor server will reply to each Policy Notification transfer record by sending a Policy Notification acknowledgement transfer record.

DEERS will close the connection after there are no more Policy Notification transfer records to send and the final acknowledgement transfer record has been received. After the connection is closed, DEERS may initiate another connection at any time to send more Policy Notification transfer records.

If a connection cannot be established between DEERS and the Contractor server system, DEERS will periodically retry to establish a connection. When the connection is established, DEERS will send all Policy Notification transfer records that have not yet been sent and acknowledged.

Records will be sent in the same order in which they would have been sent had there been no failed connections.

The format of the transfer records is specified later in this document.

6.0 Identification

The keys used to uniquely identify the beneficiary who is the subject of a Policy Notification are DEERS_FAM_ID and DEERS_BNFRY_ID. DEERS assigns these keys. The Contractor should not use any other Policy Notification fields to identify the subject of the Policy Notification.

For example, if the date of birth for a beneficiary changes in DEERS, DEERS will send a Policy Notification for this person containing a new PN_BRTH_DT value, so this attribute cannot be used for identification.

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7.0 Input: Policy Notification Acknowledgement Transfer Record This record is sent by a Contractor system to DEERS in response to a Policy Notification transfer record.

Note: Character-defined attributes are ASCII characters, left justified, and space filled. Numerical-defined attributes are right justified and zero filled.

Section Name No. Attribute Name Size Index System Name Notes Usage* Header Transfer Type Code 3 0 XFER_TYP_CD "EAT" – Policy Notification

Acknowledgement R

Transfer Version Identifier 2 3 XFER_VRSN_ID "01" R Transfer Effective Calendar

Date 8 5 XFER_EFF_DT Date transfer sent R

Transfer Effective Time 6 13 XFER_EFF_TM Time transfer sent R Health Care Delivery Program

System Identifier

7 19 HCDP_SYS_ID R

Transfer Return Code 3 26 XFER_RT_CD “000” for success, any positive numeric value for error.

R

Length Total 29

* R = Required field, O = Optional field, S = Situational field

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8.0 Output: Policy Notification Transfer Records

This record is sent from DEERS to Contractor systems.

Note: Character-defined attributes are ASCII characters, left justified, and space filled. Numerical-defined attributes are right justified and zero filled.

Every Policy Notification Transfer Record is preceded by 5 ASCII digit characters containing the length of the record to follow. (For example, “01610” indicates that the following Policy Notification is 1,610 bytes long.)

Section Name No. Lvl. Attribute Name Size System Name Notes Header Transfer Type Code 3 XFER_TYP_CD “PNT” – Policy

Notification Transfer Version Identifier 2 XFER_VRSN_ID “05” Transfer Effective Calendar Date 8 XFER_EFF_DT Date transfer sent Transfer Effective Time 6 XFER_EFF_TM Time transfer sent Health Care Delivery Program System

Identifier 7 HCDP_SYS_ID The system to which the notification is being sent.

Transfer Return Code 3 XFER_RT_CD “000” Length Subtotal 29

Contractor Information

1 Contractor Operator Identifier 8 CNTC_OPER_ID

Length Subtotal 8 Sponsor Identification

2 1 Sponsor DEERS Family Identifier 9 SPN_DEERS_FAM_ID

3 2 Sponsor DEERS Beneficiary Identifier 2 SPN_DEERS_BNFRY_ID Length Subtotal 11

Sponsor Control

4 1 Sponsor Patient Identifier 10 SPN_DOD_EDI_PN_ID

5 2 Sponsor Person Identifier 9 SPN_PN_ID 6 3 Sponsor Person Identifier Type Code 1 SPN_PN_ID_TYP_CD

Length Subtotal 20 Sponsor Person

7 1 Sponsor Person Last Name 26 SPN_PN_LST_NM

8 2 Sponsor Person First Name 20 SPN_PN_1ST_NM

Formatted: Swedish (Sweden)

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9 3 Sponsor Person Middle Name 20 SPN_PN_MID_NM 10 4 Sponsor Person Cadency Name 4 SPN_PN_CDNCY_NM 11 5 Sponsor Person Birth Calendar Date 8 SPN_PN_BRTH_DT YYYYMMDD.

Defaults to 19000101 if sponsor is deceased and birth date is unknown.

12 6 Sponsor Person Death Calendar Date 8 SPN_PN_DTH_DT YYYYMMDD Length Subtotal 86

Sponsor Pay 13 Sponsor Rank Code 6 RANK_CD Length Subtotal 6

14 1 Member Category Code 1 MBR_CAT_CD 15 2 Service Branch Classification Code 1 SVC_CD

Length Subtotal 2 Policy Information

16 1 Health Care Delivery Program Plan Coverage Code

3 HCDP_PLN_CVG_CD

17 2 Health Care Delivery Program Policy Enrollment Period Begin Calendar Date

8 HCDP_PLCY_BGN_DT YYYYMMDD

18 3 Health Care Delivery Program Policy Enrollment Period End Calendar Date

8 HCDP_PLCY_END_DT YYYYMMDD

Length Subtotal 19 Fee Waiver Entitlement Quantity

19 Fee Waiver Entitlement Segment Quantity 3 TXN_SEG_QY Dollar sign followed by count of enrollment fee segments, for example “$02”.

Minimum of 0, maximum of 99.

Length Subtotal 3 Fee Waiver Entitlement Information

20 1 Sponsor DEERS Beneficiary Identifier 2 DEERS_BNFRY_ID 00 for family entitlements; actual ID of member enrolled for individual entitlements.

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21 2 Fee Waiver Entitlement Type Code 1 FWVR_ENTL_TYP_CD 22 3 Fee Waiver Entitlement Begin Date 8 FWVR_ENTL_BGN_DT YYYYMMDD 23 4 Fee Waiver Entitlement End Date 8 FWVR_ENTL_END_DT YYYYMMDD 24 5 Fee Waiver Entitlement Status Code 1 FWVR_ENTL_STAT_CD 25 6 Fee Waiver Entitlement Status Date 8 FWVR_ENTL_STAT_DT YYYYMMDD

Length Subtotal 28 Enrollment Premium Quantity

26 Enrollment Premium Segment Quantity 3 TXN_SEG_QY Dollar sign followed by count of enrollment fee segments, for example “$02”.

Minimum of 0, maximum of 02.

Length Subtotal 3 Enrollment Premium Information

27 1 Health Care Delivery Program Plan Coverage Code

3 HCDP_PLN_CVG_CD

Enrollment Premium Information

28 2 Health Care Delivery Program Contractor Code

2 HCDP_CNTC_CD This will generally be the TDP contract’s

HCDP_CNTC_CD

unless DEERS recalculates the paid thru period (in which case it would be “00”)

29 3 Paid Thru Period Begin Date 8 PAID_PERD_BGN_DT YYYYMMDD 30 4 Paid Thru Period End Date 8 PAID_PERD_END_DT YYYYMMDD 31 5 Health Care Delivery Program Premium Action

Code

1 HCDP_PREM_ACTN_CD

32 6 Health Care Delivery Program Premium Payment Type Code

1 HCDP_PREM_PMT_TYP_CD Formatted: Swedish (Sweden)

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33 7 Health Care Delivery Program Premium Payment Amount

8 HCDP_PREM_PMT_AM Last Premium Payment for the Policy.

Will not include dollar sign and decimal point, and may be negative.

Examples: $1024.50 will be displayed as "102450", -$50.00 will be displayed as "-5000".

34 8 Health Care Delivery Program Premium Credit Amount

8 HCDP_PREM_CRDT_AM Will not include dollar sign and decimal point.

Example: "2450" for $24.50.

Length Subtotal 39 Premium Override Information

35 1 Premium Override Action Code 1 PREM_OVRD_ACTN_CD

36 2 Premium Override Source Code 1 PREM_OVRD_SRC_CD 37 3 Premium Override Reason Code 1 PREM_OVRD_RSN_CD 38 4 Premium Override Effective Date 8 PREM_OVRD_EFF_DT YYYYMMDD 39 5 Premium Override End Date 8 PREM_OVRD_END_DT YYYYMMDD 40 6 Premium Override End Reason Code 1 PREM_OVRD_ERSN_CD

Length Subtotal 20 Payment Factor Quantity

41 Payment Factor Segment Quantity 3 PMT_FCTR_SEG_QY Dollar sign followed by count of payment factor segments, for example "$02".

Minimum of 0, maximum of 99.

Length Subtotal 3 Payment Factor Information

42 1 Health Care Delivery Program Payment Factor Code

1 HCDP_PMT_FCTR_CD

43 2 Health Care Delivery Program Payment Factor Effective Date

8 HCDP_PMT_FCTR_EFF_DT YYYYMMDD

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44 3 Health Care Delivery Program Payment Factor End Date

8 HCDP_PMT_FCTR_END_DT YYYYMMDD

45 4 Health Care Delivery Program Payment Factor End Reason Code

1 HCDP_PMT_FCTR_ERSN_CD

Length Subtotal 18

Family Member Identification

46 1 DEERS Family Identifier 9 DEERS_FAM_ID

47 2 DEERS Beneficiary Identifier 2 DEERS_BNFRY_ID Length Subtotal 11

Family Member Control

48 1 Patient Identifier 10 DOD_EDI_PN_ID

49 2 Person Identifier 9 PN_ID 50 3 Person Identifier Type Code 1 PN_ID_TYP_CD

Length Subtotal 20 Family Member Information

51 1 Person Last Name 26 PN_LST_NM

52 2 Person First Name 20 PN_1ST_NM 53 3 Person Middle Name 20 PN_MID_NM 54 4 Person Cadency Name 4 PN_CDNCY_NM 55 5 Person Birth Calendar Date 8 PN_BRTH_DT YYYYMMDD 56 6 Person Sex Code 1 PN_SEX_CD 57 7 Person Association Reason Code 2 PNA_RSN_CD

Length Subtotal 81 Enrollment Process Information

58 1 Health Care Delivery Program Enrollment Management Contractor Code

2 HCDP_EMC_CD

59 2 Health Care Delivery Program Enrollment Management Contractor Plan Status Code

1 HCDP_EMC_PLN_STAT_CD

60 3 Health Care Delivery Program Enrollment Management Contractor Plan Status Date

8 HCDP_EMC_PLN_STAT_DT YYYYMMDD

61 4 Enrollment Management Contractor Enrollment Begin Date

8 EMC_ENRL_BGN_DT YYYYMMDD

62 5 Enrollment Management Contractor Enrollment End Date

8 EMC_ENRL_END_DT YYYYMMDD

Formatted: Swedish (Sweden)

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63 6 Enrollment Management Contractor Enrollment End Reason Code

1 EMC_ENRL_ERSN_CD

64 7 Enrollment Management Contractor Enrollment Extended Reason Code

2 EMC_ENRL_ERSNX_CD This field will be populated if the

EMC_ENRL_ERSN

_CD = “X”.

65 8 Prior Enrollment Management Contractor Enrollment End Reason Code

1 PRIOR_EMC_ENRL_ERSN_CD Set only if the prior enrollment terminated due to transfer (“T”) or if prior enrollment was with the same Contractor. Not set if the prior enrollment has not changed.

66 9 Prior Enrollment Management Contractor Enrollment Extended Reason Code

2 PRIOR_EMC_ENRL_ERSNX_CD This field will be populated if the

PRIOR_EMC_ENRL

_ERSN_CD = “X”.

67 10 Enrollment Management Contractor Enrollment Residence Mailing Address US Postal Region ZIP Code

5 EMC_ENRL_RMA_ZIP_CD

68 11 Sponsor Enrollment Management Contractor Enrollment Residence Mailing Address US Postal Region ZIP Code

5 SPN_EMC_MA_ZIP_CD

69 12 Enrollment Management Contractor Enrollment Work Mailing Address US Postal Region ZIP Code

5 EMC_ENRL_WMA_ZIP_CD

70 13 Enrollment Card Request Code 1 ECRD_RQST_CD Refers to the most recent card request per the enrollment.

Blank when no card request is found.

71 14 Enrollment Card Request Calendar Date 8 ECRD_RQST_DT YYYYMMDD 72 15 Enrollment Card Status Code 1 ECRD_STAT_CD Refers to the most recent card request per the enrollment.

Blank when no card request is found.

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73 16 Enrollment Card Status Error Code 2 ECRD_STAT_ERR_CD Refers to the most recent card request per the enrollment.

Blank when no card request is found.

74 17 Enrollment Card Request Calendar Date 8 ECRD_STAT_DT YYYYMMDD 75 18 Enrollment Card Vendor Status Code 1 ECRD_VNDR_STAT_CD Refers to the most recent card request per the enrollment.

Blank when no card request is found.

76 19 Enrollment Card Vendor Mailing Calendar Date

8 ECRD_VNDR_MAIL_DT YYYYMMDD

77 20 Enrollment Management Contractor Health Care Delivery Program Enrollment Application Received Calendar Date

8 EMC_HCDP_APPL_RCVD_DT YYYYMMDD

78 21 TRICARE Service Center Health Care Delivery Program Enrollment Application Received Calendar Date

8 TSC_HCDP_APPL_RCVD_DT YYYYMMDD

79 22 Health Care Delivery Program Enrollment Notification Type Code

1 HCDP_EN_TYP_CD Refers to the most recent letter request per the enrollment.

Blank when no letter request is found.

80 23 Health Care Delivery Program Enrollment Status Code

1 HCDP_EN_STAT_CD Refers to the most recent notification request per the enrollment- Blank when no letter request is found.

81 24 Enrollment Management Contractor Lockout Period Code

1 EMC_LKOT_PERD_CD

82 25 Health Care Delivery Program Enrollment Free-Rider Code

1 HCDP_ENRL_FRDR_CD

Length Subtotal 97

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Primary Care Manager Information – This data will be blank for TRS and TRR except for the

PCM_RGN_CD

83 1 Primary Care Manager Plan Status Code 1 PCM_SLCT_STAT_CD

84 2 Primary Care Manager Plan Status Date 8 PCM_SLCT_STAT_DT YYYYMMDD 85 3 Primary Care Manager Region Code 2 PCM_RGN_CD

86 4 Primary Care Manager Enrolling Division DMIS Identifier

4 PCM_EDVSN_DMIS_ID

87 5 Primary Care Manager Network Provider Type Code

1 PCM_PROV_TYP_CD

88 6 Primary Care Manager Identifier 32 PCM_ID Only specified when

PCM_PROV_TYP_

CD is “C”.

89 7 Primary Care Manager Identifier Type Code 1 PCM_ID_TYP_CD Only specified when

PCM_PROV_TYP_

CD is “C”.

90 8 Civilian Primary Care Manager Place Of Care Sequence Identifier

3 CPCM_PLOC_SEQ_ID Only specified when

PCM_PROV_TYP_

CD is “C”.

91 9 Primary Care Manager Selection Begin Calendar Date

8 PCM_SLCT_BGN_DT YYYYMMDD

92 10 Primary Care Manager Selection End Calendar Date

8 PCM_SLCT_END_DT YYYYMMDD

93 11 Primary Care Manager Selection End Reason Code

1 PCM_SLCT_ERSN_CD

94 12 Prior Primary Care Manager Selection End Reason Code

1 PRIOR_PCM_SLCT_ERSN_CD

95 13 DMIS National Provider Identifier 10 DMIS_NP_ID Type 2 NPI 96 14 Primary Care Manager National Provider

Identifier

10 PCM_NP_ID

97 15 Primary Care Manager National Provider Identifier Type Code

1 PCM_NP_ID_TYP_CD

98 16 PCM Access to Care Waiver Code 1 PCM_ATC_WVR_CD Length Subtotal 92

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Email Address Information

99 1 Email Address Use Priority Code 1 EMA_USE_PRTY_CD

100 2 Email Address Text 80 EMA_TX Length Subtotal 81

Mailing Address Quantity

101 Mailing Address Segment Quantity 3 TXN_SEG_QY Dollar sign followed by count of mailing addresses, for example "$02".

Minimum of 0, maximum of 99.

Length Subtotal 3 Mailing Address Information

102 1 Mailing Address Type Code 1 MA_TYP_CD This information will repeat for each residence (primary) or mailing address a person has on

DEERS.

103 2 Mailing Address Effective Calendar Date 8 MA_DT YYYYMMDD 104 3 Mailing Address Line 1 Text 40 MA_LN1_TX 105 4 Mailing Address Line 2 Text 40 MA_LN2_TX 106 5 Mailing Address City Name 20 MA_CITY_NM 107 6 Mailing Address US Postal Region State Code 2 MA_ST_CD 108 7 Mailing Address US Postal Region ZIP Code 5 MA_PR_ZIP_CD 109 8 Mailing Address US Postal Region ZIP

Extension Code

4 MA_PR_ZIPX_CD

110 9 Mailing Address Country Code 2 MA_CTRY_CD 111 10 Mailing Address Quality Code 1 MA_QL_CD 112 11 Mailing Address Maintenance Source Code 3 MA_MAINT_SRC_CD

Length Subtotal 126 Telephone Number Information

113 1 Home Telephone Number Code 20 HM_TNUM_CD

114 2 Work Telephone Number Code 20 W_TNUM_CD 115 3 Fax Telephone Number Code 20 FAX_TNUM_CD

Length Subtotal 60