Potentials File to EB.xls

This is an Interface Specification Document prepared by EDS - Indiana for the Title XIX program, detailing the technical requirements for a data exchange interface called the Potentials File to EB (Enrollment Broker). The interface facilitates the transfer of potential HCC (Health Care Cooperative) member data from CoreMMIS to the EB system on a Monday through Friday frequency using secure FTP transmission. The system processes recipient identification data, managed care assignment indicators, reason codes for enrollment determinations, and health subprogram classifications. The file structure includes detail records containing 12-character Medicaid IDs, date-added timestamps, managed care assignment indicators, reason codes categorized from A-Z and 1-9, and reason code determination fields, with each record formatted to specific character positions and field lengths. A trailer record provides the physical record count for validation purposes.

The interface specification includes comprehensive reason code definitions that categorize recipients into various enrollment scenarios, including autoassignment determinations, pending manual assignments, Medicare beneficiaries, voluntary and mandatory managed care plan enrollments, newborn assignments, and disenrollment processing. The document reflects revisions dating from February 2020 through April 2022, indicating ongoing system updates and logo changes reflecting vendor transitions from DXC to Gainwell. The specification maintains alignment with current operational file layouts and includes removal of HHW and HIP processes as of the April 2022 revision. The managed care process is owned by the Managed Care Business Unit, with no special error handling protocols noted beyond standard interface validation procedures.