Schedule J Data Vendor File Layout.xlsx

XLSX spreadsheet 98 KB Posted Sep 24, 2025

Attached to: Vision Insurance Administration Services for MPSERS
Solicitation number: RFP-171-250000002307-2
Issued by: Grand Traverse County, Lansing City, Michigan

About this file

Written by GovTribe AI · Sep 26, 2025

This document is a detailed data vendor file layout specification for Schedule J from Merative, covering vision claims data submission requirements. The file layout provides comprehensive technical instructions for submitting vision claims data, including formatting specifications for fixed-record length ASCII files containing detail and trailer layouts. The specification outlines precise requirements for data elements such as financial fields, date formats, character handling, and numeric field representations, with specific guidelines for handling professional claims, provider information, and claim adjustments.

The document emphasizes critical data submission parameters, including handling of capitated services, encounter records, and fee-for-service claims. Key financial relationship definitions are provided, detailing how various monetary fields should be populated, such as charge submitted, allowed amount, copayment, and net payment. The specification requires unique provider identifiers, preferring TAX ID and NPI, and mandates specific formatting for financial data, such as right-justification, zero-filling for missing values, and an implied two-digit decimal point for monetary amounts. The file layout includes 51 distinct data fields in the detail layout and a separate trailer layout, designed to enable precise tracking and reporting of vision claims data for healthcare administrative purposes.

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Proposal Instructions Vendor Question Wksht.docx	DOCX document	Sep 24, 2025
Schedule 1 Definitions.docx	DOCX document	Sep 24, 2025
Schedule K Service Availability.xlsx	XLSX spreadsheet	Sep 24, 2025
Non-Disclosure Agreement.docx	DOCX document	Sep 24, 2025
Schedule B Pricing.xlsx	XLSX spreadsheet	Sep 24, 2025
Schedule F Plan Design.docx	DOCX document	Sep 24, 2025
Schedule H Geo Access.xlsm	XLSM spreadsheet	Sep 24, 2025
Hybrid Contract Terms.docx	DOCX document	Sep 24, 2025
Schedule C Insurance Requirements.docx	DOCX document	Sep 24, 2025
Schedule N Census.xlsx	XLSX spreadsheet	Sep 24, 2025
Exhibit 2 to Schedule E HIPAA BAA.docx	DOCX document	Sep 24, 2025
Schedule A Statement of Work REVISED.docx	DOCX document	Sep 24, 2025
Schedule D Service Level Agreements for Hybrid Purchases.docx	DOCX document	Sep 24, 2025
Schedule E Data Security Requirements.docx	DOCX document	Sep 24, 2025
Schedule G Section 2 Software Table.xlsx	XLSX spreadsheet	Sep 24, 2025
Schedule I ORS File Layouts.docx	DOCX document	Sep 24, 2025
Schedule L Contractor Performance Evaluation Survey.doc	DOC document	Sep 24, 2025
Schedule M Vision Disruption Analysis.xlsx	XLSX spreadsheet	Sep 24, 2025
Schedule O Claims Repricing.xlsx	XLSX spreadsheet	Sep 24, 2025

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RFP No.: 250000002307

Schedule J - Data Vendor File Layout

General Information

DESCRIPTION/GENERAL INFORMATION

This interface is designed to produce a vision claims file for plan participants administered through <Data Supplier>.

FILE/DATA FORMATTING AND SUBMISSION
DATA SUBMISSION	[To be determined] Merative supports a number of file submission options including FTP and Web Submission.

The data will be submitted to Merative on a <monthly/quarterly> basis. <Monthly/Quarterly> files should be submitted on or before the 15th of the month following the close of each <month/quarter>.

FILE FORMAT	• Fixed-Record Length, ASCII File
	• Contains Detail (Data) Layout and Trailer Layout for each layout group
CHARACTER FIELDS	• Includes A - Z (lower or upper case), 0 - 9, and spaces

• Left justified, right blank/space filled

• Unrecorded or missing values in character fields are blank/spaces

DATE FIELDS	• Format of all dates should be MM/DD/CCYY
NUMERIC FIELDS	• All numeric fields should be right-justified and left zero-filled

• Unrecorded or missing values in numeric fields should be set to zero

FINANCIAL FIELDS • All financial fields should be right-justified and left zero-filled

• Merative prefers to receive both dollars and cents, with an implied decimal point before the last two digits in the data. For example: "1234567" would represent $12,345.67 Please do not include an actual decimal point in the data.

• Negative signs should be the leading value in the first position. For example: "-1234567" would represent -$12,345.67

• Unrecorded or missing values in numeric fields should be zero (000 to accommodate the 2-digit implied decimal)

INVALID CHARACTERS Please note that the following characters should not be included in the data or the descriptions in the data dictionary.

* ! ? % _ (under score) , (comma)

&"Calibri,Bold" Eligibility Functional Specifications for File Layout

&"Calibri,Bold"&9 Vision Claims Functional Specifications for File Layout

&9© Copyright Merative 2023 &9Merative Confidential &9&P

Discussion Topics

DEFINITIONS
�	Fee-for-service claims: Claims records for services that result in direct payment to providers on a service-specific basis.
�	Encounter records: Utilization records for services provided under capitation arrangements (i.e., plans in which a provider is paid based on the number of enrollees rather than the services rendered.) These records enable documentation of all services provided regardless of whether or not direct payment was made to the provider.

� Professional Data: Professional data includes all services rendered by a physician or other professional provider, including dental, vision and hearing. The basis for the requirements of professional data is the information found on the standard CMS-1500 claim form.

�	Fee-for-Service Equivalents: Financial amounts for services rendered under a capitated arrangement found within encounter records.
DENIED CLAIMS
Fully denied claims should be removed from the extract of claims prior to submission, while partially denied claims should be included. Merative defines denied claims as follows:

�	Fully denied claim: The entire claim has been denied (typical reasons include an ineligible member, an ineligible provider, or a duplicate claims).
�	Partially denied claim: The claim contains one or more service lines that are denied, but some that are paid. All service lines should be included on the file.

DISCUSSION ITEMS
�	If both fee-for-service claims and encounter records are included on the data file, Merative will rely on the data supplier to explain how to differentiate them, preferably using the field Capitated Service Indicator.

�	If encounter records contain fee-for-service equivalents, it is essential for Merative to understand which fields contain these amounts.
�	Financial fields should be populated at the service line level, not at the claim level.
�	If the managed care program includes a risk-sharing arrangement with providers such that a portion of the approved payment amount is withheld from the provider payment and placed in a risk-sharing pool for later distribution, then the withhold amount should be recorded as a separate field and also included in the Charge Submitted, Allowed Amount and Net Payment fields.

PROFESSIONAL RECORD CONTENT
Merative does not store separate header/claim-level and detail/service-level information for professional claims. Merative requires the following:
�	Each record in the data file should represent one service (detail) line.
�	All financials and quantities on each record should pertain to that service only (as opposed to the entire claim).
�	The repeating of non-quantitative claim-level information (e.g., Claim ID, Provider ID, Provider Type, etc.) on each record is necessary.

One professional claim with two service lines

CLAIM LEVEL INFORMATION			SERVICE LEVEL DETAIL
Claim Id	Provider Id	Provider Type	Line Number	Procedure Code	Service Count	Net Payment
13331	621262121	100	1	D1201	1	$ 100.00
13331	621262121	100	2	D1330	1	$ 150.00

&"Calibri,Bold"&9 Vision Claims Functional Specifications for File Layout

&9© Copyright Merative 2023 &9Merative Confidential &9&P

Provider Data

DISCUSSION ITEMS - PROVIDER
�	Merative requires unique provider identifiers and associated names. Merative would like both the identifier and the name to be specific to each provider, rather than group level information. TAXID is preferred for the identifier.

�	If providers within group practices use a single TAXID, Merative would prefer an additional qualifier that would make each identifier and name unique.
�	If only the group name is available with the associated TIN, and a qualifier is not available, Merative prefers another identifier for professional claims and the TAXID for the facility claims. NPI is preferred for the alternate identifier. In this case the TAXID is still requested in addition to the NPI or alternate identifier.

Provider Example 1 When providers in group practices use the same TAXID, a qualifier is needed to insure unique provider names.

Claim ID	TAXID	Qualifier	Provider Name	Prov Type	Service Count	Net Payment
11111	121212121	2222	Dr. Brown	25	2	$ 2,000.00
22222	121212121	3333	Dr. Smith	35	1	$ 100.00

Provider Example 2 The following is an example of what is not desired.

Claim ID	TAXID	Provider Name	Prov Type	Svc Count	Net Payment
11111	121212121	Dr. Brown	25	2	$ 2,000.00
22222	121212121	Dr. Smith	35	1	$ 100.00
33333	232323232	XYZ	25	1	$ 125.00
22222	232323232	XYZ	35	1	$ 110.00

Provider Example 3 When only the groups name is available with TAXID, NPI is requested in addition to TAXID.

Claim ID	TAXID	Group Name	NPI	Prov Name	Prov Type	Svc Count	Net Payment
11111	121212121	XYZ Pediatrics	2222222222	Dr Brown	25	2	$ 2,000.00
22222	121212121	XYZ Pediatrics	3333333333	Dr Smith	35	1	$ 100.00

Vision Claims Functional Specifications for File Layout

&9© Copyright Merative 2023 &9Merative Confidential &9&P

Financials and Corrections

FINANCIAL RELATIONSHIP
Merative defines the relationship among financial fields as follows. Those marked with an asterisk are desirable, but not required for the data extract.
	Charge Submitted
	Not Covered Amount *		Charge Covered *
			Discount Amount	Allowed Amount
				Coinsurance
				Copayment	Net Payment
				Deductible
				Penalty/Sanction Amount *
				Third Party Amount
CORRECTIONS TO PAID CLAIMS
Data suppliers generally use either Void/Replacement or Adjustment records to make corrections to paid claims. Merative defines these as follows:
		VOID / REPLACEMENT

A void is a claim that reverses or backs out a previously paid one. All financials and quantities are negated on the void record. A replacement record that contains the corrected information generally follows it. The original, void and replacement need not appear in the same file. After adjudication, a paid claim with a $25 Copay and $50 Net Pay, a correction was necessary. The correction contains a $10 Copay and $65 Net Pay.

	Record Type	Svc Count	Charge Submitted	Copay	Deductible	Net Payment
	Original	1	$ 75.00	$ 25.00	$ - 0	$ 50.00
	Void	-1	$ (75.00)	$ (25.00)	$ - 0	$ (50.00)
	Replacement	1	$ 75.00	$ 10.00	$ - 0	$ 65.00
ADJUSTMENT

A financial adjustment is a claim line where one or more of the financial fields display the difference between the original amount and the final amount. Any financial not being adjusted should be zero. All quantities should be zero on the adjustment as well. The original and adjustment need not appear in the same file. After a claim was adjudicated with a $25 Copay and $50 Net Pay, it was discovered that there should have been a $10 Copay and $65 Net Pay.

Record Type	Svc Count	Charge Submitted	Copay	Deductible	Net Payment
Original	1	$ 75.00	$ 25.00	$ - 0	$ 50.00
Adjustment	0	$ - 0	$ (15.00)	$ - 0	$ 15.00

Vision Claims Functional Specifications for File Layout

&9© Copyright Merative 2023 &9Merative Confidential &9&P

Detail Layout

Field Number	Field Name	Start	End	Length	Type	Data Element Description	Standard Field	Data Dictionary Needed	Data Supplier Instructions/Notes
Fixed-Record Length
0	ROW FOR CALCULATIONS ONLY	1	0	0
1	Adjustment Type Code	1	1	1	Character	Client-specific code for the claim adjustment type for example original, void or adjustment.	Yes	Yes	Adjustment Type values will be identified in the Data Dictionary.
2	Allowed Amount	2	11	10	Numeric	The maximum amount allowed by the plan for payment.	Yes		Format 9(8)v99 (2 - digit, implied decimal)
3	Capitated Service Indicator	12	12	1	Character	An indicator that this service (encounter record) was capitated	Yes		Applicable field values are "Y" for Capitated services and "N" for non-cap services.
4	Charge Submitted	13	22	10	Numeric	The submitted or billed charge amount	Yes		Format 9(8)v99 (2 - digit, implied decimal)
5	Claim ID	23	37	15	Character	The client-specific identifier of the claim.	Yes
6	Co-Insurance	38	47	10	Numeric	The coinsurance paid by the subscriber as specified in the plan provision.	Yes		Format 9(8)v99 (2 - digit, implied decimal)
7	Copayment	48	57	10	Numeric	The copayment paid by the subscriber as specified in the plan provision.	Yes		Format 9(8)v99 (2 - digit, implied decimal)
8	HRA Amount	58	67	10	Numeric	The amount paid from the HRA as a result of this claim.	Yes		Format 9(8)v99 (2 - digit, implied decimal)

On facility records, this field must be at the service/detail level as opposed to the header/claim level.

9 HSA Amount 68 77 10 Numeric The amount paid from the HSA as a result of this claim. Yes Format 9(8)v99 (2 - digit, implied decimal) On facility records, this field must be at the service/detail level as opposed to the header/claim level.

10 Date of Birth 78 87 10 Date The birth date of the person. MM/DD/CCYY format The member’s birth date is part of the Person ID key and is, therefore, critical to tagging claims to eligibility.

The four-digit year is required for date of birth. The century cannot be accurately assigned based on a two-digit year.

11	Date of First Service	88	97	10	Date	The date of the first service reported on the claim record.	Yes	MM/DD/CCYY format
12	Date of Last Service	98	107	10	Date	The date of the last service reported on the claim record.	Yes	MM/DD/CCYY format
13	Date Paid	108	117	10	Date	The date the claim or data record was paid.	Yes	MM/DD/CCYY format

This is the check date.

14	Deductible	118	127	10	Numeric	The amount paid by the subscriber through the deductible arrangement of the plan.	Yes	Format 9(8)v99 (2 - digit, implied decimal)
15	Diagnosis Code Principal	128	135	8	Character	The first or principal diagnosis code for a service, claim or lab result. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
16	Diagnosis Code 2 UB	136	143	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
17	Diagnosis Code 3 UB	144	151	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
18	Diagnosis Code 4 UB	152	159	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
19	Diagnosis Code 5 UB	160	167	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
20	Diagnosis Code 6 UB	168	175	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
21	Diagnosis Code 7 UB	176	183	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
22	Diagnosis Code 8 UB	184	191	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
23	Diagnosis Code 9 UB	192	199	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
24	Diagnosis Code 10 UB	200	207	8	Character	A secondary diagnosis code for the facility claim. Length expanded from 5 to 8 for future use.	Yes	No decimal point.
25	Discount	208	217	10	Numeric	The discount amount of the claim, applied to charges for any plan pricing reductions.	Yes	Format 9(8)v99 (2 - digit, implied decimal)
26	Family ID / Employee SSN	218	226	9	Character	The unique identifier (Social Security Number) for the subscriber (contract holder, employee) and their associated dependents.	Yes	The subscriber's social security number is part of the Person ID key and is, therefore, critical to tagging claims to eligibility.
27	Gender Code	227	227	1	Character	The member's gender code.	Yes	“M” or “F”

The member’s gender is part of the Person ID key and is, therefore, critical to tagging claims to eligibility.

28	Line Number	228	229	2	Numeric	The detail line number for the service on the claim	Yes
29	Net Payment	230	239	10	Numeric	The actual check amount for the record	Yes		Format 9(8)v99 (2 - digit, implied decimal)
30	Network Paid Indicator	240	240	1	Character	An indicator of whether the claim was paid at in-network or out-of-network level	Yes		Y or "N"
31	Network Provider Indicator	241	241	1	Character	Indicates if the servicing provider participates in the network to which the patient belongs	Yes		Y or "N"
32	Ordering Provider ID	242	254	13	Character	The ID number of the provider who referred the patient or ordered the test or procedure.	Yes		The ID should be the physician's Federal Tax ID (TIN).
33	Ordering Provider Name	255	284	30	Character	The Name of the provider who referred the patient or ordered the test or procedure.	Yes
34	Ordering Provider Zip Code	285	289	5	Character	The zip code of the provider who referred the patient or ordered the test or procedure.	Yes
35	PCP Responsibility Indicator	290	290	1	Character	An indicator signifying that the PCP is the physician considered responsible or accountable for this claim.	Yes
36	Place of Service Code	291	292	2	Character	Client-specific code for the place of service.	Yes	Yes	Place of Service values will be identified in the Data Dictionary.
37	Procedure Code	293	299	7	Character	The procedure code for the service record. Expanded from 5 to 7 for future use.	Yes		Standard CPT or HCPCS codes.
38	Procedure Modifier Code	300	301	2	Character	The 2-character code of the first procedure code modifier on the professional claim.	Yes
39	Provider ID	302	314	13	Character	The identifier for the provider of service.	Yes		This must be the federal tax ID in order to use the standard physician identifier lookup (Standard Physician)
40	Provider Type Code Claim	315	317	3	Numeric	Client-specific code for the provider type on the claim record.	Yes	Yes	Provider Type codes values will be identified in the Data Dictionary.
41	Provider Zip Code	318	322	5	Numeric	The 5-digit zip code corresponding to the Provider ID	Yes		Provider Location zip code
42	Third Party Amount	323	332	10	Numeric	The amount saved due to integration of third party liability (Coordination of Benefits) by all third party payers (including Medicare).	Yes		Format 9(8)v99 (2 - digit, implied decimal)
43	Units of Service	333	336	4	Numeric	Client-specific quantity of services or units	Yes
44	Provider Name	337	366	30	Character	The description or name corresponding to the Provider ID.	Yes
45	Funding Type Code	367	368	2	Numeric	Specifies whether the claim was paid under a fully or self-funded arrangement	Yes		“S” = Self-funded

“F” = Fully-funded

46	Account Structure	369	376	8	Character	Client-specific code for the account structure of the plan that the member is enrolled in. This is usually a group number.	TBD	TBD	Additional fields may be added to the layout if there is more than one component of the account structure.
47	Provider NPI Number	377	386	10	Character	The National Provider ID number for the provider.	Yes
48	Provider Address 1	387	436	50	Character	The current street address1 of the provider of service.	Yes
49	Provider Address 2	437	486	50	Character	The current street address2 of the provider of service.	Yes
50	ICD Version	487	487	1	Character	The ICD version or qualifier code that identifies either ICD-9 (9) or ICD-10 (0) diagnosis codes.	Yes	See Notes	If 0 and 9 not used, values defined in the Data Dictionary.
51	Filler	488	599	112	Character	Reserved for future use			Fill with blanks
52	Record Type	600	600	1	Character	Record type identifier			Hard Code to "D"
End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9 Vision Claims Functional Specifications for File Layout

&9© Copyright Merative 2023 &9Merative Confidential &9&P

Trailer Layout

Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes
Fixed-Record Length
0	ROW USED FOR CALCULATIONS	1	0	0
1	Data Start Date	1	10	10	Date	Data Start Date	MM/DD/CCYY format – i.e. 09/01/2014

This will represent the 1st day of the month for which data is provided.

2 Data End Date 11 20 10 Date Data End Date MM/DD/CCYY format – i.e. 09/30/2014

This will represent the last day of the month for which data is provided.

3	Record Count	21	30	10	Numeric	Number of Records on File	The count of records provided in the data including the Trailer Record.
4	Total Net Payments	31	44	14	Numeric	Total net payments on the file	The sum of net payments provided in the file
5	Filler	45	599	555	Character	Reserved for future use	Fill with Blanks
6	Record Type	600	600	1	Character	Record Type Identifier	Hard Code ‘T’
End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9 Vision Claims Functional Specifications for File Layout

&9© Copyright Merative 2023 &9Merative Confidential &9&P

Detail Layout (2)

	Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes	Standard
Advantage Field	Data Dictionary Needed	Population of Employee / Dependent Records
	Fixed-Record Length
	0	ROW FOR CALCULATIONS ONLY	1	0	0
	1	Field 1	1	4	4
	2	CUSTOM FIELD # (if applicable)	5	5	1
	3	Filler	6	499	494	Character	Reserved for future use	Fill with blanks		Member-Specific
	4	Record Type	500	500	1	Character	Record type identifier	Hard Code to "D"		Member-Specific
	End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9Eligibility Functional Specifications for File Layout --- &A ---

&G &9&P &9&A &F

Trailer Layout (2)

Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes	Advantage Field	Population of Employee / Dependent Records
Fixed-Record Length
0	ROW USED FOR CALCULATIONS	1	0	0
1	Start Date	1	10	10	Date	Start Date of the data within the file	MM/DD/CCYY format – i.e. 09/01/2015

This will represent the 1st day of the month for which data is provided.	N/A	N/A
	2	End Date	11	20	10	Date	End Date of the data within the file	MM/DD/CCYY format – i.e. 09/01/2015

This will represent the 1st day of the month for which data is provided.	N/A	N/A
	3	Record Count	21	30	10	Numeric	Number of Records on File	The count of records provided in the data including the Trailer Record.	N/A	N/A
	4	Total Dollars	31	40	10	Numeric	Total dollars on the file
	5	Filler	41	499	459	Character	Reserved for future use	Fill with Blanks	N/A	N/A
	6	Record Type	500	500	1	Character	Record Type Identifier	Hard Code ‘T’	N/A	N/A
	End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9Eligibility Functional Specifications for File Layout --- &A ---

&G &9&P &9&A

Detail Layout (3)

	Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes	Standard
Advantage Field	Data Dictionary Needed	Population of Employee / Dependent Records
	Fixed-Record Length
	0	ROW FOR CALCULATIONS ONLY	1	0	0
	1	Field 1	1	4	4	Character
	2	CUSTOM FIELD # (if applicable)	5	5	1	TBD	Additional Rows/Fields to be added as Custom Fields are identified.

Common custom fields include:

Employee Status Relationship Department

Accrual Rate(s)	TBD	N/A	TBD	TBD
	3	Filler	6	399	394	Character	Reserved for future use	Fill with blanks	Member-Specific
	4	Record Type	400	400	1	Character	Record type identifier	Hard Code to "D"	Member-Specific
	End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9Eligibility Functional Specifications for File Layout --- &A ---

&G &9&P &9&A

Trailer Layout (3)

Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes	Advantage Field	Population of Employee / Dependent Records
Fixed-Record Length
0	ROW USED FOR CALCULATIONS	1	0	0
1	Start Date	1	10	10	Date	Start Date of the data within the file	MM/DD/CCYY format – i.e. 09/01/2015

This will represent the 1st day of the month for which data is provided.	N/A	N/A
	2	End Date	11	20	10	Date	End Date of the data within the file	MM/DD/CCYY format – i.e. 09/01/2015

This will represent the 1st day of the month for which data is provided.	N/A	N/A
	3	Record Count	21	30	10	Numeric	Number of Records on File	The count of records provided in the data including the Trailer Record.	N/A	N/A
	4	Total Dollars	31	40	10	Numeric	Total dollars on the file
	5	Filler	41	399	359	Character	Reserved for future use	Fill with Blanks	N/A	N/A
	6	Record Type	400	400	1	Character	Record Type Identifier	Hard Code ‘T’	N/A	N/A
	End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9Eligibility Functional Specifications for File Layout --- &A ---

&G &9&P &9&A

Detail Layout (4)

	Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes	Standard
Advantage Field	Data Dictionary Needed	Population of Employee / Dependent Records
	Fixed-Record Length
	0	ROW FOR CALCULATIONS ONLY	1	0	0
	1	Field 1	1	4	4	Character
	2	CUSTOM FIELD # (if applicable)	5	5	1	TBD	Additional Rows/Fields to be added as Custom Fields are identified.

Common custom fields include:

Employee Status Relationship Department

Accrual Rate(s)	TBD	N/A	TBD	TBD
	3	Filler	6	399	394	Character	Reserved for future use	Fill with blanks	Member-Specific
	4	Record Type	400	400	1	Character	Record type identifier	Hard Code to "D"	Member-Specific
	End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9Eligibility Functional Specifications for File Layout --- &A ---

&G &9&P &9&A

Trailer Layout (4)

Field Number	Field Name	Start	End	Length	Type	Data Element Description	Data Supplier Instructions/Notes	Advantage Field	Population of Employee / Dependent Records
Fixed-Record Length
0	ROW USED FOR CALCULATIONS	1	0	0
1	Start Date	1	10	10	Date	Start Date of the data within the file	MM/DD/CCYY format – i.e. 09/01/2015

This will represent the 1st day of the month for which data is provided.	N/A	N/A
	2	End Date	11	20	10	Date	End Date of the data within the file	MM/DD/CCYY format – i.e. 09/01/2015

This will represent the 1st day of the month for which data is provided.	N/A	N/A
	3	Record Count	21	30	10	Numeric	Number of Records on File	The count of records provided in the data including the Trailer Record.	N/A	N/A
	4	Total Dollars	31	40	10	Numeric	Total dollars on the file
	5	Filler	41	399	359	Character	Reserved for future use	Fill with Blanks	N/A	N/A
	6	Record Type	400	400	1	Character	Record Type Identifier	Hard Code ‘T’	N/A	N/A
	End of Layout - Do not remove this row - All field additions to be inserted above the Filler row

&"Calibri,Bold"&9Eligibility Functional Specifications for File Layout --- &A ---

&G &9&P &9&A

Data

Style	Fixed
IntroSplash	NoShow

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File details come from the government source that posted it. Updated Sep 26, 2025.