The Input and Response File Data Layouts Clause Samples
The Input and Response File Data Layouts clause defines the required structure and formatting for data files exchanged between parties, typically specifying how input data should be organized and how response files should be formatted. This may include details such as file types, field names, data types, and the order in which information must appear within each file. By establishing clear data layout requirements, the clause ensures compatibility between systems, reduces the risk of data processing errors, and facilitates efficient and accurate data exchange.
The Input and Response File Data Layouts. The business rules for use of the Input File immediately follow the data file layout itself. If the partner sends more than one Input File in one day, the system will process the files without terminating, or abending, the job. If the first Input File passes its edit checks, it is processed, and a Response File is sent to the partner, per current processes. If second and subsequent input files sent that day pass their edit checks, they are added to a multiple file submissions report for review by the BCRC.
The Input and Response File Data Layouts. A – The SPAP Input File. This is the data set transmitted from an SPAP partner to CMS (the BCRC) on a monthly basis. It is used to report information regarding the SPAP enrollees – people who are eligible for and enrolled in an SPAP and receive coverage through such a plan. Full file replacement is the method used to update eligibility files. Each month’s transmitted file will fully replace the previous month’s file. The business rules for use of the SPAP Input File immediately follow the data file layout itself. Please note that the SPAP Data Sharing Agreement makes reference to the SPAP Input File as Attachment A. The layout in this version of the User Guide represents the most current version of this Attachment. If the partner sends more than one SPAP Input File in one day, the system will process the files without terminating. If the first input file passes its edit checks, it is processed, and a response file is sent to the partner, per current processes. If second and subsequent input files sent that day pass their edit checks, they are added to a multiple file submissions report for review by the BCRC.
The Input and Response File Data Layouts. A. The PAP Input File: This is the data set transmitted from a PAP partner to the COBC on a monthly basis. It is used to report information regarding PAP enrollees – individuals who are eligible for and enrolled in a PAP and receive pharmaceutical coverage through such a plan. Full file replacement is the method used to update eligibility files. Each month’s transmitted file will fully replace the previous month’s file. The business rules for use of the PAP Input File immediately follow the data file layout itself.
1. SSN 9 1-9 Numeric Social Security Number. If unavailable, fill with spaces.
2. HICN 12 10-21 Alpha-Numeric Medicare Health Insurance Claim Number (HICN). Required if SSN not provided. If unavailable, fill with spaces.
3. Surname 6 22-27 Text Surname of Covered Individual – Required.
4. First Initial 1 28-28 Text First Initial of Covered Individual – Required.
5. DOB 8 29-36 Date Date of Birth of Covered Individual – Required. CCYYMMDD 6. Sex Code 1 37-37 Numeric Sex of Covered Individual – Required. 0: Unknown 1: Male 2: Female
7. Effective Date 8 38-45 Date Effective Date of PAP Coverage – Required. CCYYMMDD
8. Termination Date* 8 46-53 Date Termination Date of PAP Coverage – Required. CCYYMMDD *Use all zeros if open-ended 9. N-Plan ID 10 54-63 Filler Future use; for National Health Plan Identifier. Fill with spaces only.
10. Rx ID/Policy Number 20 64-83 Text Populate this field with all 9s. Required.
The Input and Response File Data Layouts. A – The MSP (Medicare Secondary Payer) Input File. This is the data set transmitted from a VDSA partner to CMS that is used to report information regarding Active Covered Individuals – people who are currently working (not carried as retired), and a spouse and (or) other dependents, and who are enrolled in and covered by an employer group health plan (GHP). At a minimum, we require the partner to include information about all Active Covered Individuals who are at least 55 years of age, and older. We have found that about ninety-seven percent of all Medicare beneficiaries are 55 and above.
The Input and Response File Data Layouts. If the partner sends more than one PAP Input File in one day, the system will process the files without terminating, or abending, the job. If the first input file passes its edit checks, it is processed, and a response file is sent to the partner, per current processes. If second and subsequent input files sent that day pass their edit checks, they are added to a multiple file submissions report for review by the BCRC.
The Input and Response File Data Layouts. A – The MSP (Medicare Secondary Payer) Input File. This is the data set transmitted from a VDSA partner to CMS that is used to report information regarding Active Covered Individuals – people who are currently working (not carried as retired), and a spouse and (or) other dependents, and who are enrolled in and covered by an employer group health plan (GHP). At a minimum, we require the partner to include information about all Active Covered Individuals who are at least 55 years of age, and older. We have found that about ninety-seven percent of all Medicare beneficiaries are 55 and above.
1. HIC Number 12 1-12 Alpha- Numeric Beneficiary’s Health Insurance Claim Number. Required if SSN not provided. Populate with spaces if unavailable.
2. Beneficiary Surname 6 13-18 Text Beneficiary’s Last Name – Required.
3. Beneficiary First Initial 1 19-19 Alpha Beneficiary’s First Initial – Required.
4. Beneficiary Date of Birth 8 20-27 Date Beneficiary’s DOB (CCYYMMDD) – Required.
5. Beneficiary Sex Code 1 28-28 Numeric Beneficiary’s Sex – Required. Valid Values: 0 = Unknown 1 = Male 2 = Female
6. DCN 15 29-43 Text Document Control Number; assigned by the VDSA partner. Mandatory. Each record shall have a unique DCN.
7. Transaction Type 1 44-44 Numeric Type of Maintenance – Required. Valid Values: ‘0’ = Add Record ‘1’ = Delete record ‘2’ = Update record
8. Coverage Type 1 45-45 Alpha- Numeric Type of Insurance – Required. Valid Values: ‘J’ = Hospital Only ‘K’ = Medical Only ‘A’ = Hospital and Medical ‘U’ = Drug Only (network Rx) ‘V’ = Drug with Major Medical Field Name Size Displacement Data Type Description (non-network Rx) ‘W’ = Comprehensive Coverage –Hosp/Med/Drug (network Rx) ‘X’ = Hospital and Drug (network Rx) ‘Y’ = Medical and Drug (network Rx) ‘Z’ = Health Reimbursement Account (non-network Rx) ‘4’ = Comprehensive Coverage –Hosp/Med/Drug (non-network Rx) ‘5’ = Hospital and Drug (non- network Rx) ‘6’ = Medical and Drug (non- network Rx)
9. Beneficiary Social Security Number 9 46-54 Numeric Beneficiary’s SSN – Required if HICN not provided. Populate with 9 spaces if unavailable.
10. Effective Date 8 55-62 Date Start Date of Covered Individual’s Primary Coverage by Insurer. (CCYYMMDD) – Required.
11. Termination Date 8 63-70 Date End Date of Covered Individual’s Primary Coverage. CCYYMMDD, Required. *Use all zeros if open-ended.
12. Relationship Code 2 71-72 Numeric Covered Individual’s Relation to Policy Holder – Required. Valid values: ‘01’ = Covered Individual ...
The Input and Response File Data Layouts. A – The SPAP Input File. This is the data set transmitted from an SPAP partner to CMS (the BCRC) on a monthly basis. It is used to report information regarding the SPAP enrollees – people who are eligible for and enrolled in an SPAP and receive coverage through such a plan. Full file replacement is the method used to update eligibility files. Each month’s transmitted file will fully replace the previous month’s file. SPAP partners are required to continue to include coverage records for 3 years after the termination date of the coverage. The business rules for use of the SPAP Input File immediately follow the data file layout itself. Please note that the SPAP Data Sharing Agreement makes reference to the SPAP Input File as Attachment A. The layout in this version of the User guide represents the most current version of this Attachment. If the partner sends more than one SPAP Input File in one day, the system will process the files without terminating. If the first input file passes its edit checks, it is processed, and a response file is sent to the partner, per current processes. If second and subsequent input files sent that day pass their edit checks, they are added to a multiple file submissions report for review by the BCRC.
The Input and Response File Data Layouts. The business rules for use of the PAP Input File immediately follow the data file layout itself. If the partner sends more than one PAP Input File in one day, the system will process the files without terminating, or abending, the job. If the first input file passes its edit checks, it is processed, and a response file is sent to the partner, per current processes. If second and subsequent input files sent that day pass their edit checks, they are added to a multiple file submissions report for review by the BCRC.