MCE Provider File to EB.xlsx
XLSX spreadsheet 54 KB Posted
- Solicitation number
- RFP 27-87793
- Issued by
- Marion County, Indiana
About this file
This is an Interface Specification Document prepared by EDS for Indiana's Title XIX program, documenting the technical specifications for the MCE Provider File data exchange between DXC and the EB (EB system). The document establishes the process for creating and managing interface specifications when fields or files are added, changed, or deleted in external vendor communications. The MCE Provider File contains managed care provider network information transmitted daily and quarterly via Secure FTP from DXC to the EB system, with the file named in the format PROVIDERyyyymmdd.nnnn or PROVIDER*.zip. The specification details 42 data fields organized in detail and trailer records, including provider identifiers, service location information, specialty codes, panel sizes, and program participation codes. Key modifications to the interface include updates to Provider ID, Group ID, and MCO ID field sizes (increased to 15 characters as of December 2014), addition of HIPMC as a valid Location Program code (August 2017), and inclusion of Statewide as a State Region Code option (May 2021). The document specifies field sizes, start and end positions, data formats, source tables, and detailed descriptions for each element, along with an age restriction code table (AA through LL) used to define acceptable patient age ranges by provider.
The specification is owned by the System Engineer and Managed Care Business Unit, with affected processes including Change Order, Technical Design, and Unit and System Integration Testing. The interface has no special error handling requirements noted. The document includes revision history documentation managed by various stakeholders including Tracy Hickman, Hong Gao, Darryl Wells, and C. Nielsen. The file layout specifications are maintained in Excel format on the L:\Systems\SE\DSS\ folder on the LAN and synchronized with the MMIS File Transfers documentation on the Project Workbook Cycle Page. The specification process is triggered by business design needs and requires completion of Interface Spec Documentation, Technical Design walkthrough with external vendors, and synchronization across multiple systems documentation, including PWB job name and script identification for I/O files in the Business Processes General Systems Documentation procedure.
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Text version
Interface Spec Process Instrux
| DELETE THIS WORKSHEET (and Example Worksheet) FROM THE CO DELIVERABLE | |
| Interface Specification Process & Step Action Chart | |
| Process Overview | This process is to document the process of creation an Interface Spec and to documents the process flow of the life of an Interface Spec. |
| Process Trigger | Business Design determines there is an add, change, or delete of a field or file received or sent by an external vendor. |
| Inputs | Business Design |
| Outputs | Interface Specs |
| Owner | System Engineer |
| Affected Project Phases | Technical Design |
| Affected Documents | Interface Specs/Specifications |
| Affected Processes | Change Order process |
| · Technical Design process | |
| · Unit Testing process | |
| · System Integrated Testing process |
| Step Action Chart | ||
| Step | Performed By | Step Description |
| 1 | SE | Business Design determines one scenario of the following is needed: |
Field or file add, change or delete of a file received from an external vendor Field or file add, change, or delete of a file sent to an external vendor 2 SE Complete Interface Spec Documentation and Interface Spec See worksheets in this workbook:
Instructions for completing documentation can be found in worksheet
| 3 | SE | Review Interface Spec Documentation and Interface Spec in Technical Design walkthrough with external vendor |
| 4 | SE | Synchronize all documentation: |
1 - Update the MMIS File Transfers document, found on PWB Cycle Page, if this is a new inbound, outbound, or real-time file 2 - Save this Interface Specifications documentation on the L\Systems\SE\DSS folder on the LAN with proper file name 3 - Update the MMIS File Transfers document, referenced above, with the file name of the layout saved on the LAN 4 - if this is a file received or sent to external vendor, then the job name/script documentation in PWB needs to identify this I/O file (See PWB, Subsystems, Systems Maint Mod, Business Processes for General Systems Documentation procedure) 5 SE Enter one line for each field on the table;
All columns must be completed for all rows;
The table name and column name identify where the data is to be pulled ;
Add lines as needed, and add tables as needed. ;
Only related subsystem tables should be in the same Word document.;
Include the full file extract layout; to include all fields. Identify the new, deleted, or modified fields, with NOTES / HIGHLIGHTS included to describe the update;
For existing files, review [ L:\Systems \ SE\ DSS\ Vendor Name ] to find the existing file layout to be used to populate this template; and then update the version in this directory, to reflect the changes made;
Data Management team prefers the file layouts, saved in L\ Systems\ SE\ DSS\, be in excel format, to import to Access as necessary;
Also, upate the MMIS File Transfers documentation found on Project Workbook - Cycle Page; it includes the file name, job name, and file layout name saved on L\Systems\SE\DSS folder
| REVISION HISTORY | 3/20/11 | Initial Creation Tracy Hickman |
| 11/15/11 | Revisions made at Hong Gao's request (OMPP): added record selection, added interface exchange, enhanced the 'description' field to include usage scenarios and other minor revisions | |
| 10/23/12 | Darryl Wells added step 4 above, to document all the different systems documentation affected by interface specifications document | |
| 3/9/13 | Darryl Wells clarified the fact this worksheet is a process instruction and should be deleted when the deliverable is produced for a project; added HP Business Unit ownership to template at request of OV&V C.Nielsen; also expanded the error handling instructions and considerations |
Interface Spec Overview
| Interface Specification Overview |
| Interface name: MCE Provider File to EB |
| Description: This file contains the MCE Provider network information sent from DXC to the EB. |
| Record Selection Criteria: MC_FTS_MGDJS609 |
| 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: PROVIDERyyyymmdd.nnnn, PROVIDER*.zip |
| Modification Log | |
| Change Description | Date |
| Provider ID from 10 to 15 | 6/9/14 |
| Group ID from 10 to 15 | 6/9/14 |
| MCO ID from 10 to 15 | 12/18/14 |
| Added 'H' (HIPMC) as one of the values for Location Program (Health Subprogram Code) | 8/9/17 |
| State Region Code - Added S - Statewide as a valid option | 5/19/21 |
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 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 | Provider/PMP ID | 15 | 1 | 15 | CHAR | t_pr_identifier | id_provider | State Assigned Medicaid provider number - provider number is the same across locations. Called Legacy Provider ID (LPI) |
Element of Unique Identifier
| Detail | filler | 1 | 16 | 16 | space | |||
| Detail | Group ID | 15 | 17 | 31 | CHAR | t_pr_identifier | id_provider | State Assigned Group Provider number - LPI |
Element of Unique Identifier, EB fill with 000000000 when null from AIM
| Detail | filler | 1 | 32 | 32 | space | |||
| Detail | Group Name | 38 | 33 | 70 | CHAR | t_pr_nam | name | Name of Group provider |
| Detail | filler | 1 | 71 | 71 | space | |||
| Detail | MCE ID | 15 | 72 | 86 | CHAR | t_pr_identifier | id_provider | LPI of the health plan - association of the health plan to the doctor |
Element of Unique Identifier
| Detail | filler | 1 | 87 | 87 | space | |||
| Detail | County | 2 | 88 | 89 | CHAR | T_PMP_SVC_LOC | CDE_COUNTY_PSEUDO | Values supplied by EDS - 9-14-2007 |
| Detail | filler | 1 | 90 | 90 | space | |||
| Detail | Provider Name* | 39 | 91 | 129 | CHAR | t_pr_nam | name | Provider/Organization Name, AIM does not separate physician names by First, MI, Last. MAXIMUS will parse the names for our database |
| Detail | filler | 1 | 130 | 130 | space | |||
| Detail | Service Location Street 1 | 30 | 131 | 160 | CHAR | t_pr_adr | adr_mail_strt1 | |
| Detail | filler | 1 | 161 | 161 | space | |||
| Detail | Service Location Street 2 | 30 | 162 | 191 | CHAR | t_pr_adr | adr_mail_strt2 | |
| Detail | filler | 1 | 192 | 192 | space | |||
| Detail | Service Location City* | 15 | 193 | 207 | CHAR | t_pr_adr | adr_mail_city | |
| Detail | filler | 1 | 208 | 208 | space | |||
| Detail | Service Location State | 2 | 209 | 210 | CHAR | t_pr_adr | adr_mail_state | |
| Detail | filler | 1 | 211 | 211 | space | |||
| Detail | Service Location Zip* | 5 | 212 | 216 | CHAR | t_pr_adr | adr_mail_zip | |
| Detail | filler | 1 | 217 | 217 | space | |||
| Detail | Service Location Zip 4 | 4 | 218 | 221 | CHAR | t_pr_adr | adr_mail_zip_4 | |
| Detail | filler | 1 | 222 | 222 | space | |||
| Detail | After Hrs Phone # | 10 | 223 | 232 | CHAR | T_PMP_SVC_LOC | num_pho_24_hour | Number member calls to make an appointment (mislabeled) |
| Detail | filler | 1 | 233 | 233 | space | |||
| Detail | Provider Primary Specialty | 3 | 234 | 236 | CHAR | t_pr_spec | cde_prov_spec | Primary Specialty at Service Location - codes have been provided |
| Detail | filler | 1 | 237 | 237 | space | |||
| Detail | Provider Type | 2 | 238 | 239 | CHAR | t_pr_spec | cde_prov_type | *New Network Provider Data Element - codes have been provided |
| Detail | filler | 1 | 240 | 240 | space | |||
| Detail | Provider Sub-Specialty | 3 | 241 | 243 | CHAR | t_pr_spec | cde_prov_subspec | codes have been provided |
| Detail | filler | 1 | 244 | 244 | space | |||
| Detail | Panel Size | 9 | 245 | 253 | CHAR | T_PMP_PNL_SIZE | num_max_recips | *Need to have regularly/daily updated data when we do enrollment in our system |
*New MMIS Provider Data Element
| Detail | filler | 1 | 254 | 254 | space | |||
| Detail | Current Panel Members | 9 | 255 | 263 | CHAR | T_PMP_ACT_PNL | num_actual | *New Network Provider Data Element |
*Need to have regularly/daily updated data when we do enrollment in our system - we do not maintain current enrollment counts as auto assignments and automatic disenrollments are performed in AIM.
| Detail | filler | 1 | 264 | 264 | space | |||
| Detail | Panel Size Hold | 1 | 265 | 265 | CHAR | T_PMP_ACT_PNL | ind_panel_hold | *New provider Data Element - 3 options: no hold, hold or stop |
| Detail | filler | 1 | 266 | 266 | space | |||
| Detail | UPIN | 6 | 267 | 272 | CHAR | t_pr_prov | num_upin | Optional, complete if known |
| Detail | filler | 1 | 273 | 273 | space | |||
| Detail | Provider Classification | 1 | 274 | 274 | CHAR | t_pr_prov | cde_prov_class | *New Network Provider Data Element - from UPIN table (B - Billing, R- Rendering Only, G- Group, D - Dual-Role) |
| Detail | filler | 1 | 275 | 275 | space | |||
| Detail | PMP Indicator | 1 | 276 | 276 | CHAR | N/A | N/A | This provider serves as a PMP for this plan at this location. |
EDS to provide code values - (Y/N, treat a blank as a No)
| Detail | filler | 1 | 277 | 277 | space | |||
| Detail | Location Program | 1 | 278 | 278 | CHAR | T_PMP_SVC_LOC | cde_health_subpgm | Code of Program PMP is participating in: C(are Select), X(Medicaid Select), R(Hoosier Healthwise), A(Hoosier Care Connect), H(HIPMC) |
| Detail | filler | 1 | 279 | 279 | space | |||
| Detail | Location Effective Date | 8 | 280 | 287 | CHAR | T_PMP_SVC_LOC | dte_effective | Note: May receive provider with a future effective date. YYYYMMDD |
| Detail | filler | 1 | 288 | 288 | space | |||
| Detail | Location End Date | 8 | 289 | 296 | DATE | T_PMP_SVC_LOC | dte_end | YYYYMMDD |
| Detail | filler | 1 | 297 | 297 | space | |||
| Detail | Admit Privileges | 1 | 298 | 298 | CHAR | T_PMP_SVC_LOC | CDE_ADMIT_PRIV | * New Network Provider Data Element - Privileges or Relationship - not important for EB because does not tell us which hospital has given privileges (P=Privileges, R = Relationship) |
| Detail | filler | 1 | 299 | 299 | space | |||
| Detail | Delivery Privileges | 1 | 300 | 300 | CHAR | T_PMP_SVC_LOC | CDE_DELIV_PRIV | * New Network Provider Data Element - Privileges or N/A - not important for EB because does not tell us which hospital has given privileges ( A= Admission, P=Privileges, R=Relationship) |
| Detail | filler | 1 | 301 | 301 | space | |||
| Detail | Accepts obstetrics indicator | 1 | 302 | 302 | CHAR | T_PMP_SVC_LOC | IND_OBSTETRICS | *New Network Provider Data Element - Indicates FP or GP accepts obstetrics patients (Y/N) |
| Detail | filler | 1 | 303 | 303 | space | |||
| Detail | Age Range | 2 | 304 | 305 | CHAR | T_PMP_SVC_LOC | CDE_AGE_RESTR | Age range for patients accepted - convert to Age Low and Age High for EB Product. AA , BB , CC , DD ,EE , FF , GG , HH , II , JJ , KK , LL - See Age Restrictions tab |
| Detail | filler | 1 | 306 | 306 | space | |||
| Detail | Gender Accepted by Doctor | 1 | 307 | 307 | CHAR | T_PMP_SVC_LOC | cde_sex | Gender of patients accepted. M = male, F =female, B = both, Space = Both |
| Detail | filler | 1 | 308 | 308 | space | |||
| Detail | All Women (OB/GYN only) indicator: | 1 | 309 | 309 | CHAR | T_PMP_SVC_LOC | IND_WOMEN_ONLY | *New Network Provider Data Element - If a doctor practices ob/gyn but does not want to see just pregnant women - will see pregnant and non-pregnant (Y/N indicator) |
* Y = see all women N = only OB
| Detail | filler | 1 | 310 | 310 | space | |||
| Detail | State Region Code | 1 | 311 | 311 | CHAR | t_county | cde_state_region | 1 -9 State Region code (8 group of counties and out of state providers); S - Statewide |
*New County Table Data Element - Used by Hoosier Healthwise, no rules related to choice of PMP Detail filler 1 312 312 Newline, "\n". Return at end of line
| Trailer | Trailer Constant | 3 | 1 | 3 | TRL' constant | |
| Trailer | Record Count | 11 | 4 | 14 | NUMBER | Physical Record count (not including trailer), right justify the number |
| Trailer | filler | 282 | 15 | 296 | Spaces. To fill out the rest of the record | |
| Trailer | linefeed | 1 | 297 | 297 | Newline, "\n". Return at end of line |
&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
Age Restrictions
| EB Response File Error Codes | |||
| CODE | Description of Age Restriction | MIN AGE | MAX AGE |
| AA | NO AGE RESTRICTIONS | 0 | 999 |
| BB | 0 - 12 YEARS OF AGE | 0 | 12 |
| CC | 13 - 20 YEARS OF AGE | 13 | 20 |
| DD | AGE 21 AND OVER | 21 | 999 |
| EE | 0 - 20 YEARS OF AGE | 0 | 20 |
| FF | AGE 13 AND OVER | 13 | 999 |
| GG | 0 - 2 YEARS OF AGE | 0 | 2 |
| HH | 0 - 17 YEARS OF AGE | 0 | 17 |
| II | 13 - 17 YEARS OF AGE | 13 | 17 |
| JJ | AGE 3 AND OVER | 3 | 999 |
| KK | AGE 17 AND OVER | 17 | 999 |
| LL | AGE 65 AND OVER | 65 | 999 |
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