ATTACHMENT J-10 DMDC Eligibility File Layout.doc

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TRICARE Dual Eligible Fiscal Intermediary Contract (TDEFIC)
Solicitation number
HT9402-12-R-0005
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TDEFIC Draft Attachment J-10 Beneficiary Satisfaction Survey Methodology

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SECTION J-10

DMDC Eligibility File Layout

TDEFIC Medicare Crossover File Layout

Business Name
Length
Start
End

Comments

Patient ID
10
1
10
Person ID
9
11
19
Person ID Type Code
1
20
20
Person Sex Code
1
21
21
Person Birth Date
8
22
29

CCYYMMDD

Sponsor Person ID
9
30
38
Sponsor Person ID Type Code
1
39
39
Service Code
1
40
40
Finder Status Code
1
41
41
Beneficiary Health Insurance Claim Number
12
42
53
Person First Name
20
54
73
Person Middle Name (initial only)
1
74
74
Person Last Name
24
75
98
Person Cadency
4
99
102
Beneficiary Birth Date
8
103
110

CCYYMMDD

Beneficiary Part A Entitlement Start Date
8
111
118

CCYYMMDD

Beneficiary Part A Entitlement Termination Date
8
119
126

CCYYMMDD

Beneficiary Part A Entitlement Status Code
1
127
127
Beneficiary Part B Entitlement Start Date
8
128
135

CCYYMMDD

Beneficiary Part B Entitlement Termination Date
8
136
143

CCYYMMDD

Beneficiary Part B Entitlement Status Code
1
144
144
Beneficiary Entitlement Reason Code Change Date
8
145
152

CCYYMMDD

Beneficiary Entitlement Reason Code
1
153
153

TDEFIC Medicare Crossover File Layout

Business Name
Length
Start
End

Comments

Header Indicator
1
1
1

Default to 'H'

File Date
8
2
9

CCYYMMDD

Filler
144
10
153

Blanks

TDEFIC Medicare Crossover File Layout

Business Name
Length
Start
End

Comments

Trailer Indicator
1
1
1

Default to 'T'

File Date
9
2
10

CCYYMMDD

Record Count
9
11
19
Filler
134
20
153

Blanks

HT9402-12-R-0005

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