Summary

This is an Interface Specification document for the Pathways Weekly Eligibility File to EB, detailing data exchange procedures between the Indiana Medicaid Management Information System (MMIS) and the Enrollment Broker (EB) for the state's Medicaid Pathways program. The interface specification defines the technical requirements for transmitting weekly Pathways member eligibility data to the EB, effective July 1, 2024. The file is transmitted weekly on Mondays via Secure FTP in a compressed format (PEBEligibilityWyyyymmdd.misshh.zip) and is managed by the Managed Care Business Unit. The document was initially prepared on November 28, 2023, by Victor A. and establishes the record layout and field specifications for eligible member data transmission.

The specification defines a detailed record structure containing 3,199 character positions per record, including mandatory fields such as Medicaid ID, Medicare ID, managed care organization information, eligibility dates, aid categories, and authorized representative contact information. The file supports up to six authorized representatives per member record and includes both current and future eligibility information with hard-coded values for the weekly future eligibility extract (future MCE effective date of 20240701 and end date of 22991231). Aid categories include aged (A), blind (B), disabled (D), working disabled through MEDWORKS programs (DI, DW), parent/caretaker (GF), and SSI-related categories (SI), along with waiver categories for aged and disabled HCBS programs. Member type coding identifies new Pathways members as "PM," and the file includes trailer records with physical record counts for validation purposes.