EDGE Server XML and XSD: Zip File Contents Job Aid
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1 EDGE Server XML and XSD: Zip File Contents Job Aid Inbound File: EDGE Server Enrollment Submission (ESES) Inbound Enrollment File example.xml EdgeServerEnrollmentSubmission.xsd Enrollment.xsd InsuredMember.xsd Enrollee InsuredMemberProfile.xsd Enrollment Period Inbound File: EDGE Server Pharmacy Claims Submission (ESPCS) Inbound Pharmacy Claim File example.xml EdgeServerPharmacyClaimSubmission.xsd PharmacyClaim.xsd PharmacyClaimInsurance.xsd PharmacyClaimDetail.xsd Claim Inbound File: EDGE Server Medical Claims Submission (ESMCS) Inbound Medical Claim File example.xml EdgeServerMedicalClaimSubmission.xsd MedicalClaim.xsd MedicalClaimInsurance.xsd MedicalClaimDetail.xsd Claim MedicalClaimDetailServiceLine.xsd Claim Line MedicalClaimServiceLine.xsd Claim Line Inbound File: EDGE Server Supplemental Diagnosis File Submission (ESSFS) Inbound Supplemental Diagnosis File example.xml EdgeServerSupplementalFileSubmission.xsd IncludedSupplementalDiagnosis.xsd IncludedSupplementalDiagnosis.xsd IncludedSupplementalDiagnosisDetail.xsd Detail 12/19/14 1
2 Outbound File: EDGE Server File Accept Reject Report (ESFAR) Outbound_Enrollment AcceptReject_Example.xml Outbound_Pharmacy AcceptReject_Example.xml Outbound_Medical AcceptReject_Example.xml Outbound_Supplemental AcceptReject_Example.xml CommonOutboundFile.xsd FileProcessingResultStatus.xsd Outbound File: EDGE Server Summary Enrollment File Accept Reject Error Report (ESSEFE) Outbound_Enrollment_Summary_AcceptReject_Example.xml CommonOutboundFile.xsd ErrorCodeCounts.xsd EnrollmentSummaryAcceptReject.xsd EnrollmentSummary.xsd Enrollmentyear.xsd Year EnrollmentMonth.xsd Month Enrollment.xsd Enrollmentyear.xsd Year EnrollmentMonth.xsd Month Outbound File: EDGE Server Summary Pharmacy Claim File Accept Reject Error Report (ESSPFE) Outbound_Pharmacy_Claim_Summary_AcceptReject_Example.xml CommonOutboundFile.xsd ErrorCodeCounts.xsd PharmacyClaimSummaryAcceptReject.xsd PharmacyClaimSummary.xsd PharmacyClaimYear.xsd Year PharmacyClaimMonth.xsd Month PharmacyClaimSummary.xsd PharmacyClaimYear.xsd Year PharmacyClaimMonth.xsd Month 12/19/14 2
3 Outbound File: EDGE Server Summary Medical Claim File Accept Reject Error Report (ESSMFE) Outbound_Medical_Claim_Summary_AcceptReject_Example.xml CommonOutboundFile.xsd ErrorCodeCounts.xsd MedicalClaimSummaryAcceptReject.xsd MedicalClaimFormTypeSummary.xsd Form Type MedicalClaimSummary.xsd MedicalClaimYear.xsd Year MedicalClaimMonth.xsd Month MedicalClaimMonthFormType.xsd Month Form MedicalClaimSummary.xsd MedicalClaimYear.xsd Year MedicalClaimMonth.xsd Month MedicalClaimFormType.xsd Month Form Outbound File: EDGE Server Summary Supplemental Diagnosis File Accept Reject Error Report (ESSSFE) Outbound_Supplemental_Diagnosis_Summary_AcceptReject_Example.xml CommonOutboundFile.xsd ErrorCodeCounts.xsd SupplementalFileSummaryAcceptReject.xsd SupplementalSummary.xsd SupplementalYear.xsd Year SupplementalMonth.xsd Month SupplementalSummary.xsd SupplementalYear.xsd Year SupplementalMonth.xsd Month 12/19/14 3
4 Outbound File: EDGE Server Detail Enrollment Error Report (ESDEE) Outbound_Enrollment_Detail_Error_Report_Example.xml CommonOutboundFile.xsd EnrollmentDetail.xsd EnrollmentProcessingResult.xsd InsuredMemberProcessingResult.xsd InsuredMemberProfileProcessingResult.xsd Outbound File: EDGE Server Detail Pharmacy Claim Error Report (ESDPCE) Outbound_Pharmacy_Detail_Error_Report_Example.xml CommonOutboundFile.xsd PharmacyClaimDetail.xsd PharmacyClaimProcessingResult.xsd PharmacyClaimProcessingResult.xsd PharmacyClaimProcessingResult.xsd Outbound File: EDGE Server Detail Medical Claim Error Report (ESDMCE) Outbound_Medical_Detail_Error_Report_Example.xml CommonOutboundFile.xsd MedicalClaimDetail.xsd MedicalClaimProcessingResult.xsd MedicalClaimProcessingResult.xsd MedicalClaimProcessingResult.xsd MedicalClaimServiceLineProcessingResult.xsd Outbound File: EDGE Server Detail Supplemental Diagnosis File Error Report (ESDSFE) Outbound_Supplemental_Diagnosis_Detail_Error_Report_Example.xml CommonOutboundFile.xsd SupplementalDiagnosisDetail.xsd SupplementalDiagnosisProcessingResult.xsd SupplementalDiagnosisProcessingResult.xsd SupplementalDiagnosisProcessingResult.xsd Processing Result 12/19/14 4
5 Outbound File: Enrollee (Without) Claim Detail (ECD) EnrolleeWithoutClaimsDetail.xml EnrolleeClaimsWithWithoutDetailReport.xsd EnrolleeClaimsWithWithoutDetailCategory.xsd EnrolleeClaimsWithWithoutDetailEnrolleeCategory.xsd Enrollee EnrolleeClaimsWithWithoutDetailClaimCategory.xsd Claim Outbound File: Enrollee (Without) Claim Summary (ECS) EnrolleeWithoutClaimsSummary.xml EnrolleeClaimsWithWithoutSummaryReport.xsd EnrolleeClaimsWithWithoutSummaryCategory.xsd Outbound File: RA Claim Selection Detail Report (RACSD) RAClaimSelectionDetailReport.xml ClaimSelectionDetailReport.xsd RARICommonOutboundFile.xsd ClaimSelectionDetailCalendarYearCategory.xsd Calendar Year ClaimSelectionDetailCategory.xsd ClaimSelectionDetailBillTypeCategory.xsd Bill Type ClaimSelectionDetailServiceCodeCategory.xsd Service Code ClaimSelectionDetailReasonCodeCategory.xsd Reason Code ClaimSelectionDetailMedicalClaimCategory.xsd Medical Claim Outbound File: RA Risk Score Detail Report (RARSD) RARiskScoreDetailReport.xml RiskScoreDetailReport.xsd RARICommonOutboundFile.xsd RiskScoreDetailCategory.xsd RiskScoreDetailRatingAreaCategory.xsd RiskScoreDetailRatingAreaHccDroppedCategory.xsd HCC Dropped RiskScoreDetailEnrolleeCategory.xsd Enrollee RiskScoreDetailDiagnosisCodeCategory.xsd Diagnosis Code RiskScoreDetailPaymentHccCategory.xsd Payment HCC RiskScoreDetailSeverityLevelCategory.xsd Severity Level RiskScoreDetailHCCGroupCategory.xsd HCC Group RiskScoreDetailEnrolleeHccDroppedCategory.xsd HCC Dropped RiskScoreDetailEnrolleePeriodCategory.xsd Enrollment Period 12/19/14 5
6 Outbound File: RI Detail Enrollee Report (RIDE) RIDetailEnrolleeReport.xml RiDetailEnrolleeReport.xsd RARICommonOutboundFile.xsd RiDetailEnrolleeReportEnrolleeCategory.xsd RiDetailEnrolleeReportCategory.xsd RiDetailEnrolleeReportClaimCategory.xsd Outbound File: RI Summary Report (RISR) RISummaryReport.xml RISummaryReport.xsd RARICommonOutboundFile.xsd Enrollee Claim Outbound File: RA Risk Score Summary Report (RARSS) RARiskScoreSummaryReport.xml RiskScoreSummaryReport.xsd RARICommonOutboundFile.xsd RiskScoreSummaryCategory.xsd RiskScoreSummaryDiagnosisCodeCategory.xsd Diagnosis Code RiskScoreSummaryPaymentHccCategory.xsd Payment HCC RiskScoreSummarySeverityLevelCategory.xsd Severity Level RiskScoreSummaryHccGroupCategory.xsd HCC Group RiskScoreSummaryHccInteractionCategory.xsd HCC Interaction RiskScoreSummaryCsrFactorCategory.xsd CSR Factor RiskScoreSummaryHccDropCategory.xsd HCC Dropped RATransferCategory.xsd Transfer RiskScoreSummaryRatingAreaCategory.xsd RiskScoreSummaryDiagnosisCodeCategory.xsd RiskScoreSummaryPaymentHccCategory.xsd RiskScoreSummaryHccGroupCategory.xsd RATransferRatingAreaCategory.xsd Outbound File: RA Claim Selection Summary Report (RACSS) RAClaimSelectionSummaryReport.xml ClaimSelectionSummaryReport.xsd RARICommonOutboundFile.xsd ClaimSelectionSummaryCalendarYearCategory.xsd Year ClaimSelectionSummaryCategory.xsd ClaimSelectionSummaryBillTypeCategory.xsd Bill Type ClaimSelectionSummaryServiceCodeCategory.xsd Service Code ClaimSelectionSummaryReasonCodeCategory.xsd Reason Code 12/19/14 6
7 Outbound File: RA Transfer Elements Extract (RATEE) RATransferElementsExtract.xml RARICommonOutboundFile.xsd RATransferReport.xsd RATransferCategory.xsd RATransferRatingAreaCategory.xsd Rating Area Outbound File: RADV Population Summary Statistics Report (RADVPS) RADVPopulationSummaryStatisticsReport.xml RARICommonOutboundFile.xsd radvpopulationsummarystatistics.xsd radvpspopulationstratumindicatorcategory.xsd Stratum Indicator Outbound File: RA User Fee (RAUF) RAUserFee.xml RARICommonOutboundFile.xsd RAUserFeeReport.xsd RaUserFeeCategory.xsd Outbound File: Frequency by Data Element for Enrollment Accepted Files Report (FDEEAF) EnrollmentFrequencyReport.xml RARICommonOutboundFile.xsd EnrollmentFrequencyReport.xsd EnrollmentFrequencyActivityIndicatorCategory.xsd Activity Indicator EnrollmentFrequencyInsuredMemberGenderCategory.xsd Activity Indicator Outbound File: Frequency by Data Element for Pharmacy Accepted Files Report (FDEPAF) PharmacyFrequencyReport.xml RARICommonOutboundFile.xsd PharmacyFrequencyReport.xsd PharmacyFrequencyVoidReplaceCategory.xsd Void Replace PharmacyFrequencyDerivedAmountIndicatorCategory.xsd Derived Amount Indicator 12/19/14 7
8 Outbound File: Frequency by Data Element for Medical Accepted Files Report (FDEMAF) MedicalFrequencyReport.xml RARICommonOutboundFile.xsd MedicalFrequencyReport.xsd MedicalTypeFrequencyClaimCategory.xsd MedicalFrequencyBillTypeClaimCategory.xsd Bill Type MedicalFrequencyDiagnosisQualifierCategory.xsd Diagnosis Qualifier MedicalFrequencyDischargeStatusCodeCategory.xsd Discharge Status Code MedicalFrequencyDerivedAmountCategory.xsd Derived Amount Indicator MedicalFrequencyDiagnosisCodeCategory.xsd Diagnosis Code Outbound File: Frequency by Data Element for Supplemental Accepted Files Report (FDESAF) SupplementalFrequencyReport.xml RARICommonOutboundFile.xsd SupplementalFrequencyReport.xsd SupplementalFrequencyAddDeleteVoidCategory.xsd Add Delete Void SupplementalFrequencyDiagnosisQualifierCategory.xsd Supplemental Diagnosis Qualifier SupplementalFrequencyDiagnosisSourceCategory.xsd Supplemental Diagnosis Source SupplementalFrequencyDiagnosisCodeCategory.xsd Supplemental Diagnosis Code Qualifier 12/19/14 8
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