Schedule F9- Data Feed-Dental.xls
XLS spreadsheet 33 KB Posted
- Attached to
- Health Insurance Database Management System
- Solicitation number
- RFP-171-250000003097-2
- Issued by
- Michigan
About this file
The document is a detailed technical specification (Schedule F9) for a Data Feed-Dental file format for the Michigan Office of Retirement Services, specifically related to a Health Insurance Database Management System involving Delta Dental and Truven. The file provides an extensive 1,750-character data layout specification for dental claim processing, outlining a comprehensive schema for capturing dental claim details including patient information, service dates, provider details, claim types, and financial transactions.
The specification includes granular field definitions for tracking claim-related data such as subscriber information, procedure codes, provider licensing, participation indicators, and payment details. The document covers multiple dental program types including Delta Care, Delta Dental PPO, Healthy Kids Dental/MiChild, and various other dental plan variants. The data feed appears designed to support complex dental insurance claims processing, with fields for tracking claim status, payment amounts, coordination of benefits, orthodontic indicators, and client-specific custom fields. The technical specification serves as a precise technical requirements document for data exchange and claims management within the Michigan state retirement services dental insurance ecosystem.
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Other files
| File | Type | Posted |
|---|---|---|
| 250000003097 - Health Insurance Database Management System RFP.docx | DOCX document | |
| Schedule F10- Data Feed- Vision.xlsx | XLSX spreadsheet | |
| Schedule F3- Data Feed-Medicare Medical.csv | CSV file | |
| Schedule F6- Data Feed-Hearing.xlsx | XLSX spreadsheet | |
| Schedule F7- Data Feed- Non Medicare Pharmacy.xlsx | XLSX spreadsheet | |
| Schedule H Quarterly Vendor Reconciliation Report.xlsx | XLSX spreadsheet | |
| Schedule B - Healthcare Database.xlsx | XLSX spreadsheet | |
| Schedule F2-Data Feed Non-Medicare Medical.csv | CSV file | |
| Schedule F5- Data Feed-Medicare Lab.csv | CSV file | |
| Schedule F8- Data Feed- Medicare Pharmacy.xls | XLS spreadsheet | |
| Schedule J Software Table.xlsx | XLSX spreadsheet | |
| RFP 250000003097 - Bidder Question and Answer Response.xlsx | XLSX spreadsheet | |
| Schedule F4- Data Feed- Non-Medicare Lab.csv | CSV file | |
| Schedule G Service Availability.xlsx | XLSX spreadsheet | |
| Schedule I Sample Validation Report.xlsx | XLSX spreadsheet | |
| Schedule F1- Data Feed-ORS.xls | XLS spreadsheet |
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Text version
Schedule F9- Data Feed Dental
| Request for Proposal No. 250000003097 | |||
| Health Insurance Database Management System for the Michigan Office of Retirement Services | |||
| Delta Dental/Truven file layout | 1750 length | ||
| Field Length | Start position | Field Name | Description |
| 20 | 1 | claimid | claim number |
| 2 | 21 | ctrltyp | claim type -- I - In For Pay |
PP - Predetermination In For Pay P - Predetermination
| 9 | 23 | empssn | subscriber ssn | ||
| 2 | 32 | emprel | 01-employee, 02-spouse, 03-dependent | ||
| 24 | 34 | lastname | patient last name | ||
| 24 | 58 | firstname | patient first name | ||
| 17 | 82 | null | patient middle name | ||
| 8 | 99 | patdob | patient date of birth | ||
| 1 | 107 | gender | patient gender | ||
| 8 | 108 | svcdt | date of service | ||
| 8 | 116 | paiddt | check issue date | ||
| 5 | 124 | proccd | procedure code | ||
| 2 | 129 | null | delimiter code | ||
| 2 | 131 | Currently null but we can populate this | tooth code 1 | ||
| 2 | 133 | Currently null but we can populate this | tooth code 2 | ||
| 2 | 135 | Currently null but we can populate this | surface 1 | ||
| 2 | 137 | Currently null but we can populate this | surface 2 | ||
| 2 | 139 | Currently null but we can populate this | surface 3 | ||
| 2 | 141 | Currently null but we can populate this | surface 4 | ||
| 2 | 143 | Currently null but we can populate this | surface 5 | ||
| 2 | 145 | Currently null but we can populate this | surface 6 | ||
| 10 | 147 | old providerlicense | scrambled provider license number | ||
| 9 | 157 | old businesstaxid | scrambled business tax id | ||
| 10 | 166 | providerlicense | true provider license number | ||
| 10 | 176 | provnpi | true prov NPI number | ||
| 50 | 186 | null | provname | ||
| 24 | 236 | provlastname | provider last name | ||
| 24 | 260 | provfirstname | provider first name | ||
| 10 | 284 | filler | filler | ||
| 30 | 294 | providercity | provider city | ||
| 2 | 324 | providerstate | provider state | ||
| 9 | 326 | providerzip | provider zip code | ||
| 3 | 335 | providertype | provider specialty code | ||
| 1 | 338 | participationindicator | B,O = DPO provider, P = Premier provider, N = non-par provider | ||
| 7 | 339 | groupnumber | group primary identifier | ||
| 9 | 346 | subgroupnumber | group subgrouping identifier | ||
| 2 | 355 | programtype | *See below | ||
| 2 | 357 | claimlinenumber | line number | ||
| 1 | 359 | null | paidordeniedcode | ||
| 9 | 360 | submitted | submitted | ||
| 9 | 369 | allowed | allowed | switched these two fields | |
| 9 | 378 | null | approved | ||
| 9 | 387 | plan pay | plan pay | netpay | |
| 9 | 396 | r_and_d_amount | no more r and d, value always zero | ||
| 9 | 405 | deductibleamount | deductible applied amount | ||
| 9 | 414 | copayment | amount attributed to patient copay | ||
| 6 | 423 | copaypercent | copay % for this procedure | ||
| 1 | 429 | orthoindicator | ortho claim Y or N | ||
| 2 | 430 | orthocode | I initial, O only, L last, 1-99 monthly payments | ||
| 2 | 432 | null | ortho num months | ||
| 1 | 434 | cobindicator | cob claim Y or N | ||
| 25 | 435 | null | cob carrier name | ||
| 10 | 460 | null | cob group | ||
| 9 | 470 | null | third party | ||
| 3 | 479 | null | policy number 1 | ||
| 3 | 482 | null | policy number 2 | ||
| 3 | 485 | null | policy number 3 | ||
| 8 | 488 | receiptdate | receipt date | ||
| 24 | 496 | subscriber_last_name | subscriber_last_name | ||
| 24 | 520 | subscriber_first_name | subscriber_first_name | ||
| 1 | 544 | submit_or_replace_code | R - replaced line submit lines not included | ||
| 1 | 545 | null | submit_or_replace_set | ||
| 2 | 546 | null | reason_code | ||
| 1 | 548 | adjustment_ind | adjustment_ind | ||
| 1 | 549 | adjustment_count | always 0 | ||
| 30 | 550 | subscriber_addr_1 | subscriber_addr_1 | ||
| 30 | 580 | subscriber_addr_2 | subscriber_addr_2 | ||
| 30 | 610 | subscriber_city | subscriber_city | ||
| 2 | 640 | subscriber_state | subscriber_state | ||
| 9 | 642 | subscriber_zip | subscriber_zip | ||
| 10 | 651 | null | check number | ||
| 7 | 661 | null | service office number | ||
| 1 | 668 | line status2 | Line status 2 - D = Denied P = Paid | ||
| 1049 | 669 | null | filler | ||
| 1 | 1718 | null | check action code | ||
| 10 | 1719 | clientfield_1 | client specific 1 | ||
| 10 | 1729 | clientfield_2 | client specific 2 | ||
| 12 | 1739 | clientfield_3 | client specific 3 | ||
| 1751 | |||||
| * Program Type | |||||
| 40 | 'Delta Care' | ||||
| 20 | 'Delta Dental PPO' | ||||
| 30 | 'Delta Dental PPO (Point-of-Service)' | ||||
| 70 | 'Delta Dental PPO (Point-of-Service/R%)' | ||||
| 10 | 'Delta Dental Premier' | ||||
| 28 | 'Healthy Kids Dental/MiChild' | ||||
| 35 | 'Delta Dental Premier/OSU Clinic' | ||||
| 60 | 'Indiana Traditional' | ||||
| 0 | 'Renaissance Classic' | ||||
| 20 | 'Renaissance PPO' | ||||
| 20 | 'Renaissance PPO Non Par' |
File details come from the government source that posted it. Updated .