Pathways EB Selection Assign Response File to EB.xlsx
XLSX spreadsheet 42 KB Posted
- Solicitation number
- RFP 27-87793
- Issued by
- Marion County, Indiana
About this file
This is an Interface Specification Document for the Pathways Pending Selection Assignment Response File, managed by the State of Indiana's EDS (Electronic Data Systems) under Title XIX Medicaid administration, defining the technical requirements for data exchange between the MMIS (Medicaid Management Information System) and EB (Enrollment Broker). The interface specification establishes the structure and validation rules for a secure FTP file transmission that occurs daily, in which MMIS sends response data regarding pending Managed Care Entity (MCE) selection assignments to the EB. The file format includes detailed record layouts specifying field names, sizes, positions, and data types for member identification, selection dates, MCE assignments, demographic information, transaction details, and associated error or warning codes. The specification accommodates up to ten separate error reasons per rejected record and includes disposition codes indicating whether transactions were successfully processed without warnings (S), received and stored (R), successfully processed with warnings (W), or rejected (E).
The document outlines comprehensive validation and error handling procedures with 28 distinct error codes (E101-E128) and three warning codes (W101-W103) that address missing or invalid data elements, date validation requirements, MCE eligibility verification, Medicaid ID matching, and recipient demographic confirmation. Modifications to the interface specification were documented through multiple revisions dated March 2023 through August 2025, including expansions to field sizes for first names (35 characters), last names (60 characters), and error codes, along with the addition of FIDE-SNP MCE rejection criteria. The trailer record structure includes a count of detail records and fixed spacing to match record lengths, supporting integration between Indiana's Medicaid managed care enrollment processes and pathway-specific selection assignment workflows.
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Text version
Interface Spec Overview
| Interface Specification Overview |
| Interface name: Pathways Pending Selection Assignment Response File to EB |
| Description: This is the PEBPendASSIGN response file that MMIS will send to EB |
| Record Selection Criteria: |
| Frequency: Daily |
| Sender: MMIS |
| Receiver: EB |
| Business Unit Ownership: Managed Care |
| Error Handling/Special Processing: N/A |
| Interface Exchange Method: Secure FTP |
| File Name: PEBPendASSIGNResponse.yyyymmdd.hhmiss PEBSelectASSIGNResponse.yyyymmdd.hhmiss |
| Modification Log |
| Change Description |
| Initial Document, 20230330- Lee, J |
| Revisions to: 20230412 - Victor A. |
First Name Expanded to 35 Last Name Expanded to 60 Error Code Expanded to 4 (10 Times)
| Added Dispostion Types 20230428 |
| Revisions to: 20230518 - Victor A. |
Trailer Record - Increased size to match detail record length
| Change file name and description. |
| Revision: 10/22/2024 |
Edit E1118 Deprecated VA - Revision: 8/11/2025 Added FIDE-SNP MCE Reject Code
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 | ID_MEDICAID | 12 | 1 | 12 | CHAR | t_re_base | id_medicaid | Identifies Member | |
| Detail | Filler | 1 | 13 | 13 | space | ||||
| Detail | SELECTION DATE | 8 | 14 | 21 | NUMBER | t_re_pmp_assign | dte_effective | Selection Date | |
| Detail | Filler | 1 | 22 | 22 | space | ||||
| Detail | CODE_REASON_START | 2 | 23 | 24 | CHAR | t_re_pmp_assign | cde_rsn_mc_start | Selection Reason | |
| Detail | Filler | 1 | 25 | 25 | space | ||||
| Detail | MCE_ID | 9 | 26 | 34 | CHAR | t_re_pmp_assign | sak_mco | Managed Care Entity ID assigned to the provider or group provider | |
| Detail | Filler | 1 | 35 | 35 | space | ||||
| Detail | RECIP FIRST NAME | 35 | 36 | 70 | CHAR | t_re_base | nam_first | stored on a match table if there is no Medicaid ID | |
| Detail | Filler | 1 | 71 | 71 | space | ||||
| Detail | RECIP LAST NAME | 60 | 72 | 131 | CHAR | t_re_base | nam_last | stored on a match table if there is no Medicaid ID | |
| Detail | Filler | 1 | 132 | 132 | |||||
| Detail | ID_MEDICARE | 12 | 133 | 144 | NUMBER | id-Medicare | |||
| Detail | Filler | 1 | 145 | 145 | |||||
| Detail | ID_APPLICATION | 10 | 146 | 155 | CHAR | t_re_appln_path | id_application | ||
| Detail | Filler | 1 | 156 | 156 | |||||
| Detail | SSN | 9 | 157 | 165 | NUMBER | t_re_base | num_ssn | stored on a match table if there is no Medicaid ID | |
| Detail | Filler | 1 | 166 | 166 | |||||
| Detail | DTE_BIRTH | 8 | 167 | 174 | NUMBER | t_re_base | stored on a match table if there is no Medicaid ID | ||
| Detail | Filler | 1 | 175 | 175 | dte_dob | ||||
| Detail | SEX | 1 | 176 | 176 | CHAR | t_re_base | sex | stored on a match table if there is no Medicaid ID | |
| Detail | Filler | 1 | 177 | 177 | newline character | ||||
| Detail | Enrollment ID (Transaction ID) | 12 | 178 | 189 | CHAR | n/a | n/a | returns when supplied otherwise filled with spaces | |
| Detail | Filler | 1 | 190 | 190 | space | ||||
| Detail | TRANSACTION TYPE | 1 | 191 | 191 | CHAR | n/a | n/a | Source is from EB | A(Add), C(Change) |
| Detail | Filler | 1 | 192 | 192 | space | ||||
| Detail | Transaction Disposition | 1 | 193 | 193 | CHAR | n/a | n/a | Selection Transaction Disposition | S(Successfully Processed No Warnings ), R(Record Stored), W(Successfully Processed with a Warning), E (Record Rejected) |
| Detail | Filler | 1 | 194 | 194 | space | ||||
| Detail | Number of Errors | 2 | 195 | 196 | NUMBER | n/a | n/a | Number of Errors if Rejected. | One through Ten |
| Detail | Filler | 1 | 197 | 197 | space | ||||
| Detail | Error Reason 1 (If Rejected) | 4 | 198 | 201 | CHAR | n/a | n/a | Error Reason Number One | Error Reason size 4, |
| Detail | Filler | 1 | 202 | 202 | space | ||||
| Detail | Error Reason 2 (If Rejected) | 4 | 203 | 206 | CHAR | n/a | n/a | Error Reason Number Two | |
| Detail | Filler | 1 | 207 | 207 | space | ||||
| Detail | Error Reason 3 (If Rejected) | 4 | 208 | 211 | CHAR | n/a | n/a | Error Reason Number Three | |
| Detail | Filler | 1 | 212 | 212 | space | ||||
| Detail | Error Reason 4 (If Rejected) | 4 | 213 | 216 | CHAR | n/a | n/a | Error Reason Number Four | |
| Detail | Filler | 1 | 217 | 217 | space | ||||
| Detail | Error Reason 5 (If Rejected) | 4 | 218 | 221 | CHAR | n/a | n/a | Error Reason Number Five | |
| Detail | Filler | 1 | 222 | 222 | space | ||||
| Detail | Error Reason 6 (If Rejected) | 4 | 223 | 226 | CHAR | n/a | n/a | Error Reason Number Six | |
| Detail | Filler | 1 | 227 | 227 | space | ||||
| Detail | Error Reason 7 (If Rejected) | 4 | 228 | 231 | CHAR | n/a | n/a | Error Reason Number Seven | |
| Detail | Filler | 1 | 232 | 232 | space | ||||
| Detail | Error Reason 8 (If Rejected) | 4 | 233 | 236 | CHAR | n/a | n/a | Error Reason Number Eight | |
| Detail | Filler | 1 | 237 | 237 | space | ||||
| Detail | Error Reason 9 (If Rejected) | 4 | 238 | 241 | CHAR | n/a | n/a | Error Reason Number Nine | |
| Detail | Filler | 1 | 242 | 242 | space | ||||
| Detail | Error Reason 10 (If Rejected) | 4 | 243 | 246 | CHAR | n/a | n/a | Error Reason Number Ten | |
| Detail | Filler | 1 | 247 | 247 | newline character |
| Trailer | Filler | 3 | 1 | 3 | TRL' constant | |
| Trailer | Record Count | 11 | 4 | 14 | NUMBER | number of detail records |
| Trailer | Filler | 232 | 15 | 246 | spaces | |
| Trailer | Filler | 1 | 247 | 247 | newline character |
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Dispostion Codes
| ADDITIONAL RESPONSE CODES for PHASE 2 will be ADDED. Phase 2 is adding the Member Type Code to the Pending Assignment Interface. | ||||
| Dispostion Type | Disp Code | Description | Explanation | Comments |
| S | Successfully Processed | MCE Assignment added to Application | ||
| R | Record Received | No Application found for the Assignment Record. Record will be stored. | ||
| W | W101 | Successfully Processed -Member SSN does not match MMIS | WARNING INCOMMING SSN DOES NOT MATCH CORE MMIS | The warning codes will be displayed at the error codes position 1-3 |
| W | W102 | Successfully Processed -Member DOB does not match MMIS | WARNING INCOMING DOB DOES NOT MATCH CORE MMIS | The warning codes will be displayed at the error codes position 1-3 |
| W | W103 | Successfully Processed -Member Medicare ID does not match MMIS | WARNING INCOMING MEDICARE ID DOES NOT MATCH CORE MMIS | The warning codes will be displayed at the error codes position 1-3 |
| E | E101 | MISSING SELECTION DATE | SELECTION DATE is Spaces or Zeroes | |
| E | E102 | INVALID SELECTION DATE | SELECTION DATE value is invalid | |
| E | E103 | DATE SELECTION IS GREATER OR EQUAL THAN 120 DAYS | SELECTION DATE is Greater (older) or equal than 120 Days | |
| E | E104 | DATE SELECTION IS GREATER THAN CYCLE DATE | SELECTION DATE is greater than current cycle date | |
| E | E105 | INCOMING SELECTION DATE IS LESS THAN THE EXISTING APPLICATION SELECTION DATE | SELECTION DATE is less than the applications MCE selection date value | |
| E | E106 | INVALID MCE REASON START CODE | CODE_REASON_START is invalid | Valid Values P1,P2,P3,P4,P5,P6,P0 |
| E | E107 | MISSING MCE REASON START CODE | CODE_REASON_START is Spaces or Zeroes | |
| E | E108 | MCE ID IS MISSING | MCE_ID is Spaces or Zeroes | |
| E | E109 | MCE ID SUBMITTED IS NOT A PATHWAYS MCE ID | MCE_ID is not a PATHWAYS Valid MCE | |
| E | E110 | INCOMING MCE SELECTION MATCHES APPLICATION MCE | MCE_ID is the same MCE ID From the Pathways application | |
| E | E111 | MISSING FIRST NAME | RECIP FIRST NAME is Spaces or Zeroes | |
| E | E112 | MISSING LAST NAME | RECIP LAST NAME is Spaces or Zeroes | |
| E | E113 | MISSING SSN | SSN is Spaces or Zeroes | |
| E | E114 | DOB IS MISSING | DTE_BIRTH is Spaces or Zeroes | |
| E | E115 | DOB IS INVALID | DTE_BIRTH has an invalid value | |
| E | E116 | GENDER IS MISSING | SEX is Spaces or Zeroes | |
| E | E117 | ID MEDICAID NOT FOUND IN CORE MMIS | Incoming ID Medicaid was not found in CORE MMIS | |
| E | E118 | RECIPIENT ID MEDICAID DOES NOT MATCH RECIPIENT FROM APPLICATION ID | Recipient from the incoming Medicaid ID is different from the recipient of the Application ID | |
| E | E119 | APPLICATION ID DOES NOT MATCH CORE MMIS | Incoming application ID was not found in CORE MMIS | |
| E | E120 | APPLICATION ID IS NOT A PATHWAYS APPLICATION | Incoming Application ID is not a Pathways application | |
| E | E121 | PATHWAYS APPLICATION IS NOT IN PENDING STATUS | Incoming Application ID is not an application that has a status of pending | |
| E | E122 | MEDICAID ID NOT PRESENT WHEN APPLICATION ID IS PRESENT | ID Medicaid is missing when the Application ID is present | |
| E | E123 | MULTIPLE RECIPIENTS FOUND FOR THE SAME DEMO INFO | CORE MMIS found multiple recipient with the same demographic information received | |
| E | E124 | MEMBER TYPE IS SPACES OR ZEROS | ||
| E | E125 | MEMBER TYPE IS INVALID | ||
| E | E126 | ID MEDICAID NOT PRESENT FOR AN ELIGIBLE SELECTION RECORD | ||
| E | E127 | DATE OF BIRTH IS NOT BETWEEN 19000101 AND 22991231 | ||
| E | E128 | MCE SELECTED NOT THE MEMBERS FIDE-SNP MCE | Incomming MCE Selection is different from the FIDE-SNP on File |
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