J_5_DCMWC_Claimant_Eligibility_File_Layout.xlsx

XLSX spreadsheet 24 KB Posted Aug 24, 2021

Attached to: Pharmacy Benefits Management Services-OWCP-DCMWC a
Solicitation number: 1605C3-21-R-00011
Issued by: Not on record

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Claimant Eligibility Extract

	CLAIMANT ELIGIBILITY EXTRACT (Record Length = 568 Bytes)				CBPS File Aid Reference : IMDOLR05
	Originator: DCMWC
	CBPS FIELD NAME	ASP COLUMN NAME	ASP TABLE NAME	FIELD DESCRIPTION	FORMAT	SAMPLE DATA	DATA TYPE	SIZE	VALID VALUES
	Header Record: (1 Header Line Only)
	RECORD-TYPE	Record_type		Indicates Record Type		0	CHAR(1)	1	Value = 0 for Header
	HDR-FILE-NAME	File Name		The full name of the Elig Update Extract File. The File name has 1 space at the end to make it 30 characters wide.
00N - N is the file seq no	BLDO-ELIGUPD-00N-CCYYMMDD.TXT	"BLDO-ELIGUPD-001-20041103.TXT "	CHAR(30)	30
	FILLER	FILLER					CHAR(1)	1	Space
	HDR-CREATE-DATE	File Creation Date		The Date when the file was created	CCYY-MM-DD	2004-11-03	CHAR(10)	10
	FILLER	FILLER					CHAR(1)	1	Space
	HDR-CREATE-TIME	File Creation Time		The Time when the file was created	HH:MM:SS	16:52:38	CHAR(8)	8
	FILLER	FILLER					CHAR(517)	517	Spaces
	Data Record: ( Primary Key Columns in Bold style)
	RECORD-TYPE	Record_type		Indicates the Record Type		2	CHAR(1)	1	Value = 2 for Data
	RECORD-STATUS
Part of CLMNT-CASE-STAT	Record_Status		Indicates the Record Status.		D	CHAR(1)	1	D -Determination

T - Treatment X - Denied/Deleted

	CASE-NUMBER	Computed Field	clm_master	Case Number assigned to the Claim		BLCDE-2018012	CHAR(16)	16
	MINER-SSN	miner_ssn	clm_master	Miner Social Security Number		123456789	CHAR(9)	9
	CLAIMANT-TYPE	claim_type	clm_master	Claim Type		LM	CHAR(2)	2	Valid values are taken from the val_claim_type table
	CLAIM-RECORD-NO	claim_record_no	clm_master	Record Number of the Claim		01	INTEGER	2
	CLAIM-APP-DATE	claim_app_date	clm_master	The date the claimant's application was received in a U.S. Government office	MM/DD/CCYY	1/1/00	DATE	10
	ENTITLEMENT-DATE	entitlement_date	clm_master	The date from which benefits are payable to the claimant	MM/DD/CCYY	1/20/00	DATE	10
	CLAIMANT-DOB	miner_dob	clm_master	Miner's date of birth.	MM/DD/CCYY	1/1/50	DATE	10
	CLAIMANT-DOD	miner_dod	clm_master	Miner's date of death	MM/DD/CCYY	1/1/00	DATE	10
	CLAIMANT-LNAME	claimant_lname	clm_master	The last name of the person who filed the claim		JOHNNY	CHAR(20)	20
	CLAIMANT-FNAME	claimant_fname	clm_master	The first name of the person who filed the claim		MINER	CHAR(15)	15
	CLAIMANT-MNAME	claimant_mname	clm_master	The middle name of the person who filed the claim		Q	CHAR(15)	15
	CLAIMANT-ADDR-1	claimant_addr_1	clm_master	The first line of the claimant's mailing address		1 INFINITE LOOP	CHAR(30)	30
	CLAIMANT-ADDR-2	claimant_addr_2	clm_master	The second line of the claimant's mailing address			CHAR(30)	30
	CLAIMANT-CITY	claimant_city	clm_master	The city portion of the claimant's mailing address		ANYWHERE	CHAR(20)	20
	CLAIMANT-STATE-CD	claimant_state_cd	clm_master	The state portion of the claimant's mailing address		MN	CHAR(2)	2
	CLAIMANT-ZIP-CD	claimant_zip_cd	clm_master	The zip code portion of the claimant's address		123458888	CHAR(10)	10
	CLAIMANT-PROVINCE	clm_province	clm_master	Province Name for a foreign address		ONTARIO	CHAR(20)	20
	CLAIMANT-COUNTRY-NAME	clm_country_name	clm_master	Country Name for a foreign address only.		CANADA	CHAR(40)	40
	CLAIMANT-COUNTRY-CODE	clm_country_code	clm_master	Country Code for a foreign address		CA	CHAR(2)	2
	CLAIMANT-CONSULAR-CODE	clm_consular_code	clm_master	Consular Code for a foreign address		953	CHAR(3)	3
	CLAIMANT-PHONE	claimant_phone	clm_master	The Claimant's phone number		1234567890	CHAR(10)	10
	BENE-TYPE
Part of CLMNT-CASE-STAT	bene_type	be_master	A code identifying the source of benefit payments made to the payee		T	CHAR(1)	1	R = Responsible Coal Mine Operator

T = Trust Fund I = Interim Payments

	MBO-OFFSET-CODE	mbo_offset_code	be_master	Med offset code indicates all or some of the medical benefits are paid by external sources such as a state program		Y	CHAR(1)	1	Valid codes are: "N", "Y", or "P" for Part C, LM claims. "N" for all other Part C claims.
	MBO-OFFSET-DATE	mbo_offset_date	be_master	Date the Medical Benefits Offset ends because the external source ceases paying medical benefits (offset)	MM/DD/CCYY	1/1/00	DATE	10
	PAYEE-NAME-1	payee_name_1	be_master	The first payee name.		MINER JOHNNY	CHAR(35)	35
	PAYEE-NAME-2	payee_name_2	be_master	The second payee name.			CHAR(35)	35
	BE-PAYEE-ADDR-1	be_payee_addr_1	be_master	The first line of the payee's mailing address		1 INFINITE LOOP	CHAR(30)	30
	BE-PAYEE-ADDR-2	be_payee_addr_2	be_master	The first second line of the payee's mailing address		SUITE 4A	CHAR(30)	30
	BE-PAYEE-CITY	be_payee_city	be_master	The city of the payee's mailing address.		ANYWHERE	CHAR(19)	19
	BE-PAYEE-STATE-CD	be_payee_state_cd	be_master	The 2 character state code of the payee's mailing address		MN	CHAR(2)	2
	BE-PAYEE-ZIP-CODE	be_payee_zip_code	be_master	The zip code of the payee's mailing address.		12345	CHAR(10)	10
	BE-PROVINCE	be_province	be_master	Province Name for a foreign address		ONTARIO	CHAR(20)	20
	BE-COUNTRY-NAME	be_country_name	be_master	Country Name for a foreign address only.		CANADA	CHAR(40)	40
	BE-COUNTRY-CODE	be_country_code	be_master	Country Code for a foreign address		CA	CHAR(2)	2
	BE-CONSULAR-CODE	be_consular_code	be_master	Consular Code for a foreign address		953	CHAR(3)	3
	EFT-IND
Part of EFT-TRANS-CODE	eft_ind	be_master	EFT indicator, if the payment was made via EFT.		Y	CHAR(1)	1	Y or N
	ACCT-TYPE
Part of EFT-TRANS-CODE	acct_type	be_master	Account type		C	CHAR(1)	1	Valid codes are:

C = Checking S = Savings

ACCT-NO	acct_no	be_master	Beneficiary's account number	123456789	CHAR(17)	17
ROUTING-NO	routing_no	be_master	Financial Institution Routing Number	123123123	CHAR(9)	9
STATION-CODE	station_code	clm_folder	Claim Location code	CH	CHAR(2)	2	Valid values are taken from the val_acces_loc table
PRIMARY-LUNG-FLAG	primary_lung_ind	be_master	Primary Lung Indicator	Y	CHAR(1)	1	Y or N
LUNG-TRANSPLANT-IND	Computed Field	clm_diary	Lung Trnasplant Indicator	Y	CHAR(1)	1	Y or N
FINAL-ADJUDICATION-DATE	Computed Field	clm_adjudication	Final Adjudication Date	4/1/18	DATE	10
Trailer Record: (1 Trailer Line Only)
RECORD-TYPE	Record_type		Indicates Record Type	9	CHAR(1)	1	Value = 9
DETAIL-RECORD-COUNT	Data Record Count		The line carries the Count of Type 2 Data Records	0000000005	INTEGER	10	The count is 10 digits
FILLER	FILLER				CHAR(557)	557	Spaces

Please refer to the document EX11000XB02 (Claimant Eligibility Conversion Plan) for the latest updates.

Sample

0BLDO-ELIGUPD-001-20041103.TXT 2004-11-03 16:52:38

2XXXXXXXXXXXXXXXXXXXXXXXX X represents data

2XXXXXXXXXXXXXXXXXXXXXXXX

90000000005 A 10 digit record count with Leading zeros

Note: In 2018, the fields CLAIMANT-NAME and BE-MAIL-IND were deleted. New fields in Blue color have been added.

06/2018 - Changed Province to be character 20. Adjust Filler length. Changes in Red color.

02/2019 - Changed Claimant & Benefit Zip code from CHAR(9) to CHAR(10). Record Size is now 568 characters

&F Page &P of &N &D

File details come from the government source that posted it. Updated Aug 24, 2021.