09/26/11. ITN for Health Insurance Management Information System (HIMIS) Attachment F(a)-Enrollment File Layout (drug plan) Subscriber File

Transcription

1 ITN for Health Insurance Management Information System (HIMIS) Attachment F(a)-Enrollment File Layout (drug plan) Subscriber File Header Record Name Description FILE NAME 3 X 1-3 Defines which type of file is being sent FILLER 1 X 4 RECORD COUNT 9 N 5-13 Number of records on the enrollment file FILLER 1 X 14 CREATE DATE 8 N Date the enrollment file was created FILLER 1 X 23 COVERAGEPERIOD 6 N Insurance coverage period the file is for SUB (Hardcode) GENERATED GENERATED (MMDDYYYY) MMYYYY - Following month for end of month file (ex: File being sent at end of January 2012 should have in this field) - Current month for weekly file (ex: File being sent in January 2012 besides the one send at the end of January should have in this field) Subscriber Record Name Description SSN 9 N 1-9 SSN of the subscriber NAME 21 X Name of the subscriber FORMAT: Last name[,]first name[space]middle Initial If field value is more than 21 characters when concatenated, truncate field from right end will be all UPPER ADDRESS 42 X subscriber s address will be all UPPER CITY 14 X City of the subscriber s will be all UPPER address STATE 2 X State of the subscriber s address ZIP 5 X Zip code of the subscriber s address will be all UPPER

2 Name Description SEX 1 X 94 Subscriber s sex M = Male, F = Female space = unknown COVERAGE DATE 8 N Subscriber s coverage FORMAT: MMDDYYYY effective date COVERAGE CODE 2 N Subscriber s coverage code 01 = Active Employee Individual, 02 = Active Employee Family, 22 = Spouse Program, 09 = COBRA Individual, 10 = COBRA Family, 11 = COBRA Extension Individual, 12 COBRA Extension Family, 61 = Early Retiree Individual, 62 = Early Retiree Family, 63 = Medicare I, 64 = Medicare II, 65 = Medicare III BIRTH DATE 8 N Subscriber s birth date FORMAT: MMDDYYYY EMP DATE 8 N Subscriber s state hire date or date the employment status changed for the subscriber DEPARTMENT 4 X Agency where the subscriber works; OLO code with the exception of benefits only individuals FORMAT: MMDDYYYY 2100 = JAC - Justice Administrative Commission 2200 = SCS - State Courts System 3100 = EOG - Office of the Governor 3600 = LOT - Lottery 3700 = DEP - Environmental Protection 4000 = DEO Economic Opportunity 4100 = DLA - Legal Affairs 4200 = DACS - Agriculture & Consumer Service 4300 = DFS - Financial Services 4500 = DOS - State 4800 = DOE - Education 4890 = FSDB - Florida School Deaf & Blind 5000 = DVA - Veterans Affairs 5500 = DOT - Transportation 5700 = CIT - Citrus 6000 = DCF - Children and Families 6100 = PSC - Public Service Commission 6200 = DMA - Military

3 Name Description Affairs 6400 = DOH - Health 6500 = DOEA - Elder Affairs 6700 = APD - Persons w/disabilities 6800 = AHCA - Agency for Health Care Administration 7000 = DC - Corrections 7100 = FDLE - Law Enforcement 7200 = DMS - Management Services 7296 = NSRC - Shared Resource Center 7297 = DOAH - Administrative Hearings 7298 = SSRC - Shared Resource Center 7300 = REV - Revenue 7600 = HSMV - Highway Safety & Motor Vehicle 7700 = FWC Fish & Wildlife Conservation Commission 7800 = FPC - Parole Commission 7900 = DBPR - Business & Professional Regulations 8000 = DJJ - Juvenile Justice 4910 = UF - U of Florida 4920 = FSU - Florida State 4930 = FAMU - Florida A&M 4940 = UCF - U of Central FL 4950 = USF -U of South FL 4955 = NCF - New College of FL 4960 = FAU - FL Atlantic U 4970 = UWF - U of West FL 4980 = FIU - FL International U 4990 = UNF - U of North FL 4995 = FGCU - FL Gulf Coast U 1100 = LEG Legislature 0010 = SBA - State Board of Administration\ 0020 = FBBE - FL Board of BE 0050 = FIN - FL Inland Navigation

4 Name Description HMO CODE 1 X 125 Indicates if the subscriber was with an HMO before electing BCBS PPO 0080 = WCIN - West Coast Inland Navigation 0110 = MDX - Miami Dade Express 0120 = TR - Tri-Rail 0130 = OOCEA 6666 = Vested Legislator 7777 = COBRA 8888 = Retired Teacher 9999 = Retiree 3333 = Layoff P = means they were in a State HMO plan before electing to be in the State PPO plan, space = means they were not in a State HMO plan before electing to be in the State PPO plan PLAN OPTION 1 X 126 Not used N/A PLAN EFF DATE 8 N Effective date of when the subscriber enrolled in the PPO plan FORMAT: MMDDYYYY SERVICE COUNTY 2 N County where the subscriber lives 01 = ALACHUA 02 = BAKER 03 = BAY 04 = BRADFORD 05 = BREVARD 06 = BROWARD 07 = CALHOUN 08 = CHARLOTTE 09 = CITRUS 10 = CLAY 11 = COLLIER 12 = COLUMBIA 13 = DADE 14 = DESOTO 15 = DIXIE 16 = DUVAL 17 = ESCAMBIA 18 = FLAGLER 19 = FRANKLIN 20 = GADSDEN 21 = GILCHRIST 22 = GLADES 23 = GULF 24 = HAMILTON 25 = HARDEE 26 = HENDRY 27 = HERNANDO 28 = HIGHLANDS 29 = HILLSBOROUGH 30 = HOLMES 31 = INDIAN RIVER 32 = JACKSON

5 Name Description SAMAS-ORG 8 N First 8 characters of the subscriber s SAMAS org code should be for retired teachers, for all other retirees, for Vested Legislators, for COBRA participants for Laid Off subscriber s 33 = JEFFERSON 34 = LAFAYETTE 35 = LAKE 36 = LEE 37 = LEON 38 = LEVY 39 = LIBERTY 40 = MADISON 41 = MANATEE 42 = MARION 43 = MARTIN 44 = MONROE 45 = NASSAU 46 = OKALOOSA 47 = OKEECHOBEE 48 = ORANGE 49 = OSCEOLA 50 = PALM BEACH 51 = PASCO 52 = PINELLAS 53 = POLK 54 = PUTNAM 55 = ST JOHNS 56 = ST LUCIE 57 = SANTA ROSA 58 = SARASOTA 59 = SEMINOLE 60 = SUMTER 61 = SUWANNEE 62 = TAYLOR 63 = UNION 64 = VOLUSIA 65 = WAKULLA 66 = WALTON 67 = WASHINGTON 99 = OUT OF STATE blank = UNKNOWN If employee status is Retiree, field is populated with Else if employee status is Retired Teacher, field is populated with Else if employee status is Vested Legislator, field is populated with Else if employee status is COBRA, field is populated with Else if employee status is Laid Off, field is populated with Else if employee is an Active Employee field is

6 Name Description WORK COUNTY 2 N County where the subscriber works populated with information based on where they work at. 01 = ALACHUA 02 = BAKER 03 = BAY 04 = BRADFORD 05 = BREVARD 06 = BROWARD 07 = CALHOUN 08 = CHARLOTTE 09 = CITRUS 10 = CLAY 11 = COLLIER 12 = COLUMBIA 13 = DADE 14 = DESOTO 15 = DIXIE 16 = DUVAL 17 = ESCAMBIA 18 = FLAGLER 19 = FRANKLIN 20 = GADSDEN 21 = GILCHRIST 22 = GLADES 23 = GULF 24 = HAMILTON 25 = HARDEE 26 = HENDRY 27 = HERNANDO 28 = HIGHLANDS 29 = HILLSBOROUGH 30 = HOLMES 31 = INDIAN RIVER 32 = JACKSON 33 = JEFFERSON 34 = LAFAYETTE 35 = LAKE 36 = LEE 37 = LEON 38 = LEVY 39 = LIBERTY 40 = MADISON 41 = MANATEE 42 = MARION 43 = MARTIN 44 = MONROE 45 = NASSAU 46 = OKALOOSA 47 = OKEECHOBEE 48 = ORANGE 49 = OSCEOLA 50 = PALM BEACH 51 = PASCO

7 Name Description PLAN CODE 4 N Plan Subscriber is enrolled in: Shows Standard Plans and High Deductible Health Plans Available ( ) 52 = PINELLAS 53 = POLK 54 = PUTNAM 55 = ST JOHNS 56 = ST LUCIE 57 = SANTA ROSA 58 = SARASOTA 59 = SEMINOLE 60 = SUMTER 61 = SUWANNEE 62 = TAYLOR 63 = UNION 64 = VOLUSIA 65 = WAKULLA 66 = WALTON 67 = WASHINGTON 99 = OUT OF STATE blank = UNKNOWN (or no work county since retirees would not have a work county) 0100 = STATE PPO PLAN 0101 = STATE PPO PLAN 0105 = STATE HIHP PPO PLAN 0106 = STATE HIHP PPO PLAN 0270 = AVMED HMO 0271 = AVMED HMO 0275 = AVMED HIHP HMO 0276 = AVMED HIHP HMO 0300 = UNITED HEALTHCARE HMO 0301 = UNITED HEALTHCARE HMO 0305 = UNITED HEALTHCARE HIHP HMO 0306 = UNITED HIHP HMO 0400 = CAPITAL HEALTH PLAN HMO 0405 = CAPITAL HEALTH PLAN HIHP HMO 0500 = FLORIDA HEALTH CARE PLAN HMO 0505 = FLORIDA HEALTH CARE PLAN HIHP HMO 0650 = COVENTRY HEALTH CARE HMO

8 Name Description 0651 = COVENTRY HEALTH CARE HMO 0655 = COVENTRY HEALTH CARE HIHP 0656 = COVENTRY HEALTH CARE HIHP 0750 = AETNA HEALTH CARE HMO 0751 = AETNA HEALTH CARE HMO 0755 = AETNA HEALTH CARE HIHP 0756 = AETNA HEALTH CARE HIHP FILLER 4 X EMP STATUS 2 N Not Used N/A COBRA PREM 1 X 157 Indicates if the subscriber is a COBRA participant that has not paid their premium for the coverage period 1 means this is a COBRA participant who has not paid its premium for the coverage period, otherwise it is blank COB Effective Date 8 N COB Effective Date formatted MMDDYYYY COB Term Date 8 N COB Term Date formatted MMDDYYYY HICN 12 X HICN Coverage Term Date 8 N Coverage Term Date FORMAT MMDDYYYY If a subscriber was dropped in a month prior to the current coverage month, the Coverage Term Date will be passed on the file only once. If the subscriber is termed in the current month or is in a status of non-payment, the subscriber will continue on the file with the Term Date populated. First Name 40 X Subscriber s First Name Middle Initial 1 X 234 Subscriber s Middle Initial Last Name 40 X Subscriber s Last Name will be all UPPER will be UPPER will be all UPPER Dependent File

9 Header Record Name Description FILE NAME 3 X 1-3 Defines which type of file is being sent FILLER 1 X 4 RECORD COUNT 9 N 5-13 Number of records on the enrollment file FILLER 1 X 14 CREATE DATE 8 N Date the enrollment file was created FILLER 1 X 23 COVERAGE 6 N Insurance coverage PERIOD period the file is for DEP (Hardcode) GENERATED GENERATED (MMDDYYYY) MMYYYY - Following month for end of month file (ex: File being sent at end of January 2012 should have in this field) - Current month for weekly file (ex: File being sent in January 2012 besides the one send at the end of January should have in this field) Dependent Enrollment Record name Subscriber SSN Dependent SSN Dependent name Dependent relationship Description 9 N 1-9 SSN of the subscriber 9 N SSN of the dependent 28 X Name of the dependent 1 N 47 Relationship dependent has to the subscriber FORMAT: Last name[,]first name[space]middle Initial If field value is more than 28 characters when concatenated, truncate field from right end will be all UPPER 1 = Spouse 2 = Child 3 = Legal Guardianship 4 = Grandchild 5 = Child 6 = Foster Child 7 = Step Child 8 = Unborn Child 9 = Over-age dependent

10 name Dependent birth date Dependent ineligible date Dependent handicap Dependent control codes Control code Control date Dependent eligible date Dependent sex Filler COB Effective Date COB Term Date HICN Dependent First Name Description 8 N Birthday of the dependent 8 N Ineligible date of the dependent 1 N 64 Indicates if the dependent is handicap This field occurs three times with the following 2 fields 2 X Indicates the situation of the dependent s handicap 8 N Date for the control code 8 N Eligible date for the dependent Child FORMAT: MMDDYYYY FORMAT MMDDYYYY If the subscriber or dependent was dropped in a month prior to the current coverage month, the Coverage Term Date will be passed on the file only once. If the subscriber or dependent is termed in the current month or is in a status of non-payment, the record will continue on the file with the Dependent Ineligible Date populated. 1 = handicap, 0 = not handicap. If value is 1 the following two fields should always be populated. If value is 0 following two fields should be zero filled. 06 = under the age of 25 at initial enrollment 07 = over the age of 25 at initial enrollment Blank = not applicable FORMAT: MMDDYYYY FORMAT: MMDDYYYY 1 X 103 Sex of the dependent M = Male, F = Female, space = Unknown 29 X Space fill 8 N COB Effective Date 8 N COB Term Date 12 X HICN of the dependent 40 X Dependent First Name formatted MMDDYYYY formatted MMDDYYYY will be all UPPER

11 name Dependent Middle Initial Dependent Last Name Description 1 X 201 Dependent Middle Initial 40 X Dependent Last Name will be UPPER will be all UPPER For, N means Numeric and X means Alphanumeric.