Pathways EB Potentials File to EB.xlsx

This is an Interface Specification document for the Pathways EB Potentials File, a data exchange mechanism between the MMIS (Medicaid Management Information System) and the EB (External Body) for the State of Indiana's Title XIX program. The interface provides potential Pathways member data on a Monday through Friday frequency via secure FTP in a compressed file format (PEBPotentialyyyymmdd.nnnn.zip). The specification details a comprehensive record layout containing member identification, managed care assignments, eligibility information, Medicare plan details, authorized representative information, and NEMT (Non-Emergency Medical Transportation) and MCE (Managed Care Entity) data. The document includes revision history dating from March 2023 through October 2025, reflecting ongoing updates to accommodate MLTSS 6G requirements, Medicare Hospice reason codes, and additional contract and plan identification fields.

The interface specification defines record structure and field requirements for members holding HCC Future Pathways Hold, FFS Future Pathways Hold, Native American Hold, or HP-FFS Pathways Current-Future-Hospice Hold status. The file layout spans 3,205 characters including detailed fields for recipient identification, reason codes for holds, health subprogram coding, effective and end dates for various aid categories and waiver programs, and up to six authorized representative records with complete contact and demographic information. The specification includes mandatory fields (never null) such as Medicaid ID, date added, managed care indicator, reason codes, health subprogram code, and MCE NEMT information, along with conditional fields for Medicare data, plan information, and authorized representative details. The document serves as the technical standard for data validation and exchange between Indiana's Medicaid system and the receiving entity.