MEDICARE MODERNIZATION ACT (MMA)
STATE FILE SPECIFICATIONS AND
DATA DICTIONARY
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0958. The time required to complete this information collection is estimated to average 10 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Baltimore, Maryland 21244-1850. cms-10143
DECEMBER 2006
Technical Instructions for Submitting State Data for Medicare Modernization Act (MMA) Provisions
CMS data collection needs from the states for MMA implementation will be met by a single monthly file submittal. This file will address the following program needs:
Dual Eligible Enrollment
The file will include all Medicare/Medicaid dual eligibles in the state (full benefit as well as QMB, SLMB, and QI), and will allow CMS to establish the low-income-subsidy status of dual eligibles, and to perform auto-assignment of individuals to Medicare Part D plans. THIS FILE WILL ALSO BE MODIFIED, EFFECTIVE AUGUST 2006, TO INCLUDE INDIVIDUALS IN STATE MEDICAID PROGRAMS WHO ARE NOT KNOWN TO BE FULL DUAL ELIGIBLES, BUT ARE MEDICAID ELIGIBLES APPROACHING AN AGE OR DISABILITY STATUS THAT IS LIKELY TO LEAD TO A FUTURE DETERMINATION OF FULL DUAL ELIGIBILITY.
Phased Down State Calculation
The file will be used to count the number of enrollees for the phased-down state contribution payment.
State Applications
The file will also include records for those individuals for whom the state has made an enrollment determination for the Part D low income subsidy, and is used to convey information on that subsidy determination to CMS. This file must include a record for each Medicare Part D low income subsidy application processed by the state. For states that have no low income subsidy applications processed for the month, the file will include no records with the application fields populated.
This specification document defines the process for this file submittal process in the following sections:
State Enrollment File Specifications
Enrollment Return File Specifications
The monthly State Enrollment File will be transferred using Connect:Direct electronic file transfer. This file transfer medium and naming convention is the same as that used for the Medicare Drug Card File transfer. The Enrollment Return File from CMS will be transferred to the State using the same Connect:Direct medium.
Refer technical support questions regarding file specifications or the submittal process to our technical assistance mailbox at:
File transmission issues should also be sent to [email protected] and called to 1 800-924-4736
SECTION 1 - State Enrollment File
This file must include a person-month record for each Medicare/Medicaid dual eligible actively enrolled in the state Medicaid program for the reporting month. This includes those eligible for Medicare and comprehensive Medicaid benefits (whether eligible through the state plan or a section 1115 demonstration), as well as those for whom the State pays Medicare cost sharing (QMB, SLMB, and QI). The file will also include a record for each individual for whom the state has made an eligibility determination for Medicare Part D low income subsidy. Effective August, 2006, this file will also include records for individuals not yet known to be full dual eligibles, but who are approaching an age or disability status that is likely to lead to a future determination of full dual eligibility (see section on Prospective Dual Eligibles). The Record Identifier field in the detail record will identify if the record is an enrollment detail record (“DET”) for a known dual eligible (“DET”), a prospective full dual (“PRO”) or a low-income subsidy determination (“LIS”) record. Medically-needy and other spend-down individuals who have not met their incurred liability for the month and are in inactive enrollment status for the reporting month are not to be included.
Note that the data fields populated for this file will differ for records representing dual eligible enrollment and low income subsidy application determinations. The application determination data fields at the end of this record will be filled with a default value for the dual eligible enrollment records, as specified in the detailed field specifications.
Prospective Full Dual Eligibles
One of the concerns related to the monthly MMA reporting cycle is the effect on Medicaid-only individuals who transition to dual eligible status and the difficulty in ensuring a seamless transition in drug coverage. Effective August, 2006 States are to include individuals on the monthly file who may not be known full dual eligibles, but are:
Medicaid eligibles age 64 and 7 months or older in the reporting month., or
likely to reach the end of their Medicare 24-month disability waiting period. There are different options for identifying these individuals:
Limit to Medicaid disabled
Use CMS’ “finder file monthly batch file process,” which provides information related to prospective Medicare eligibility
Match to Title II (which includes SSDI cash benefits) data sent separately by SSA to states. [Individuals who qualify for Medicare based on disability have a 24-month waiting period for Medicare benefits, but only a five-month waiting period for SSDI cash benefits.]
Only submit prospective records for individuals with full Medicaid benefits; i.e., individuals who, if they have Medicare coverage, would be FULL dual eligibles. DO not include individuals who would only represent PARTIAL dual eligibles; i.e., QMB-only, SLMB-only, or QI s. In the DUAL STATUS CODE field in the PRO record, include a dual eligible code for full dual eligible status which best describes the dual status assuming that individual is Medicare eligible; i.e., codes 02-QMB plus, 04-SLMB plus, or 08-Other.
These records are reported on the file with a Record Identifier code of “PRO” (for prospective dual eligible) and are REPORTED ONLY BASED ON CURRENT MONTH ELIGIBILITY (i.e.; Do not include retroactive or prospective eligibility months). Based on this coding, these records will be subjected to special processing. This processing will bypass counting for the phased-down State contribution but will allow us to prospectively auto-enroll these individuals and to establish an appropriate Part D low-income subsidy level. These records will also be excluded from the file acceptance threshold for a 90-percent Medicare match rate.
The information on Medicare status (for Medicare Parts A, B, and D) will be returned to the State in the normal response file format. For records which do not match Medicare records, the Medicare enrollment information will be blank. For records having current Medicare enrollment all available enrollment information will be returned on the response file, including any prospective enrollment dates derived from the SSA prospective enrollment information. Submittal of monthly records for these individuals in subsequent months will allow us to return the updated plan enrollment and subsidy information to the State on subsequent return files. NOTE that Medicare enrollment systems can only return auto-enrollment information for prospective periods two months prior to the enrollment effective date.
Once an individual is identified as a prospective full dual, the person should be submitted with a Record Identifier of “DET” in the first month Medicare eligibility is effective. If an individual is identified on the response file as having current or retroactive Medicare coverage, submit retroactive “DET” records covering the missed months of dual eligibility status. Full duals submitted as “DET” records should not be submitted as “PRO” records for the same eligibility month.
Beginning with the August 2006 monthly dual eligible enrollment file, CMS has requested that states include individuals who are not yet known to be enrolled in Medicare, but are likely to be enrolled in Medicare in the next few months. This includes individuals aged 64 years and 7 months or older, and individuals likely to reach the end of their Medicare 24 month disability waiting period.
By including these individuals on the monthly files we will be able to return information to the States on the response files for individuals already in Medicare and those projected to get Medicare coverage in the near future. We will also be able to set up subsidy status and auto-enroll individuals so that their Part D coverage will be in place when they become Part D eligible.
This is a process that has been advocated by many States to help minimize the transitional drug coverage issues for individuals becoming eligible for Part D. This process also provides an opportunity to better synchronize State information on Medicare enrollment.
As part of implementation over the last months, we would like to clarify some key elements that are part of the submission, as well as processing, of these Prospective records.
In order for CMS to successfully process a PRO record the following conditions must be met/elements must be in place:
PRO records should be generated for full-duals each month from the first month conditions are met until the condition is no longer met :
Age is 64 years, 7 months with no known Medicare coverage
24-month disability waiting period is likely to be met shortly with no known Medicare coverage
OR
Disability wait status information is not available to state, but member is known to be disabled and is not known to be a dual
Record must contain ‘PRO’ in the first positions of the record, as well the CURRENT eligibility month/ year of submission , i.e. in the November 2006 File, CMS will only process PRO records containing the valid month/year combination of 11/2006. CMS will not process post or future dates. Those records will be ignored.
Record must contain a valid, two byte dual status code (position 116-118) of a ‘02’, ‘04’ or ‘08’. The absence of a code or another code would prompt CMS to ignore the record.
Record must contain a valid SSN (may not be 9-filled or blank).
Record must contain a “Y” in the ELIGIBILITY STATUS field (position 10)
Record must contain a valid date of birth and may not be 9-filled or blank. If date of birth is unknown, enter best available data. This policy applies to DET records as well. Records containing no date of birth will be ignored.
Records may be submitted in any order within the monthly MMA File; they may be intermingled with the monthly DET records or separated. CMS will sort the file upon receipt and process each record per the record descriptor located in the first 3 bytes of the record (i.e. DET, PRO, etc).
Once the state has submitted their PRO records to CMS for processing, CMS will respond by returning a PRO record for each PRO record submitted, regardless if found on CMS Database. A state will receive PRO statistics in the FILE SUMMARY RECORD. The layout has been changed to accommodate PRO processing, please note highlighted fields in the record layout on the next page.
According to match result, VALID MATCHED records are marked as a ‘000000’ or ‘000001’ in the RECORD RETURN CODE FIELD, VALID records for which no match was found are marked with a ‘000003’ in positions 229-234. VALID DUPLICATE RECORDS shall contain a ‘000010’ in that same position. INVALID, and thus NON-MATCHED, records shall contain a ‘000009’ in this return code field.
Valid PRO records that have been matched to the database will contain the same information as matched DETail records: PART A/B Entitlement dates, HIC, SSNs, and ESRD, PART C, Part D and TPL Enrollment periods, etc.
For matched PRO records, a state should submit a DET record once the period of current dual eligibility has been reached and the beneficiary is assigned to a PDP. This information is contained in the Eligibility Information for Parts A/B and D in the MMA Response File. If, for example, a PRO record is returned in the December Response File as matched (return code = ‘0000001 or ‘000000’) and the Part A/ B/D Entitlement Start Date is 01/01/2007, it is anticipated that a DETail record will be submitted for this beneficiary in the January 2007 File.
Valid PRO records which were matched and are found to be PART A/B entitled within two months of submission, will be auto-assigned to a PDP. Auto-assignment may only occur up to two months into the future. For example, in a December 2006 state submission, any PRO record with entitlement no later than March 2007 would be submitted to the next available auto-assignment process (first days in January 2007). The enrollment information would be available for the January 2007 Response File. If the eligibility date is more than two months into the future, CMS will not auto-assign them until the appropriate time frame has been reached (for this example, any record with a future entitlement date beyond March 2007). Deeming, however, will occur immediately for the appropriate time span, regardless if onset is more than two months into the future.
For example, if a beneficiary PRO record was submitted in the December 2006 State File and was found to be PART A/B /D entitled 04/01/2007, the member would be submitted to the deeming process in early January with a deeming onset date of 4/1/2007. This information would be sent back to the state in their January Response File (given that this same member is submitted by the state in the January File as well). The client would not, however, be submitted to the auto-assignment process by CMS until early February 2007, with an enrollment date of 4/1/2007. The enrollment information would be available in the February Response File (given the client is submitted by the state in February). This auto-assignment would occur even if the member is not resubmitted after December’s submission.
Already existing eligibility / enrollment may be returned for individuals submitted by a state on a PRO record that a state was otherwise not aware of. When that occurs, the state should submit retroactive monthly DET records covering the newly-identified period of dual eligibility in the following month’s MMA file submission.
Each month’s enrollment file is created no earlier than the 15th and received at CMS between the 15th and the 25th of the enrollment month. HOWEVER, CMS WILL CONTINUE TO ACCEPT FILES RECEIVED BY THE END OF THE ENROLLMENT MONTH. RECEIPT BY THE 25TH OF EACH MONTH IS STRONGLY RECOMMENDED TO ALLOW FOR RESUBMITTAL OF FILES THAT HAVE TRANSMISSION OR SPECIFICATION ISSUES.
This monthly file submittal will include all enrollment accretions and updates to state enrollment through the file creation date. The monthly file submittal will also include all state applications for Part D enrollment processed through the file creation date. Any accretions or updates after the creation date for the last accepted state file will be included in the subsequent month’s file submittal.
Once a file has been accepted, any subsequent submission in the same month will be rejected. Replacement submittals of files that are rejected based on data quality validation must be received by CMS by the last day of the month. If no file is successfully submitted for the month, CMS will project enrollment from the prior month’s file and apply retroactive updates based on subsequent months’ submittals for the purpose of the phasedown calculation.
This file will include one record for each actively enrolled (or potential prospective) dual eligible for the current reporting month. Each month’s submittal is a complete monthly dual eligible enrollment file; i.e., NOT a file including only file accretions and deletions. Additionally, the file will include a full person-month record to report information on changes in the circumstances for individuals that were effective in a prior month. These records are referred to as “retroactive” records and will be identified in the monthly file by the effective month and year to which the retroactive record data are to be applied. Illustrative examples of possible situations that would lead to retroactive changes include:
an individual not previously reported who was determined by the state to be retroactively eligible three months prior to the reporting month,
an individual having a change in dual status code two months prior to the reporting month, but for whom the state was not aware of the change until the reporting month.
an individual who was previously reported eligible who is deceased or ineligible for another reason.
In each of these cases, the state file will include a complete person-month record for that individual for the current month, and a second (or more, as needed) record providing a replacement record for the effective month and year of the change. For example, in the April 2006 reporting month file due by April 30, a dual eligible that became retroactively eligible in January 2006 would have to have a full, complete record for each month of eligibility through the reporting month i.e., 4 records (January-April 2006). Since this is a replacement record, the record will include data in all required fields; not just those fields that have changed. A person who was reported eligible for March but was discovered in April to be deceased during the full month of March would have a change record for March showing an eligibility status of ineligible (coded value of “N”) for the March enrollment month.
CMS has requested that no retroactive record before June 2005 be submitted.
The Enrollment File will include all dual eligibles including full-benefit dual eligibles who are eligible for comprehensive benefits under the state plan or section 1115 demonstration, and those dual eligibles for which the state is providing only Medicare premium or limited coinsurance or deductible payments. One of the purposes for which the state’s monthly MMA file submission will be used is to calculate the state’s phasedown contribution payment. The phasedown process requires a monthly count of all full benefit dual eligibles with active Part D plan enrollment in the month. CMS will make this selection of records using dual eligibility status codes contained in the person-month record to identify all full-benefit dual eligibles (codes 02, 04 and 08 as described in the data dictionary).
SPECIAL USER TIPS
We have received feedback indicating confusion regarding the definition or interpretation of a number of fields, and hope to clarify just a few of the following:
• BENE BIRTH DT (beneficiary date of birth)
Key field used to corroborate match between State incoming beneficiary record to CMS’ MBD (Master Beneficiary Database), which receives this date from the Social Security Administration’s MBR (Master Beneficiary Record)
PRIMARY MATCHING Criteria is based on the following algorithm:
SSN---------------------------------------------------------5.0 points
BENE CAN Number (1st 9 positions of HIC)------3.5 points
BENE BIC CODE--------------------------------------- 1.2 points
BENE DOB YY-------------------------------------------3.25 points
BENE DOB MM------------------------------------------3.0 points
BENE DOB DD-------------------------------------------2.25 points
GENDER --------------------------------------------------2.5 points
Note: The first attempt is made with the HICN/DOB/Gender and the second attempt is made with SSN/DOB/Gender.
A score of 12.25 must be attained for a record to be successfully matched.
• INSTITUTIONAL STATUS IND
(Indicator of nursing facility, ICFMR or inpatient psychiatric hospital)
Values are ‘Y’ or ‘N’ – A value of ‘Y’ indicates that the individual was enrolled in a Medicaid paid institution for the full reporting month, or is projected by the state to remain in the institution for the remainder of the month.
This is a key field in establishing correct beneficiary copays. As operational issues associated with copay have evolved, we now need to ensure that States submit not only accurate current-month institutional status, but retroactive records reflecting institutional status changes in prior months. This is necessary to ensure that there is closure on the Part D plan’s responsibility for copay amounts during the span of coverage. We ask that States submit retroactive records in their files to cover any unreported past changes in institutional status. For example, if a State has reported an individual for the first time as having institutional status in February, even though the first full month in the institution was January, we need a retroactive enrollment record showing this update
• MEDICARE PART D FINDER CODE
(Part D Payment Switch or MARx Payment Switch)
Value will be ‘0’ for dual eligibles who are enrolled in a Part D plan during eligibility month/year
Value will be ‘1’ for dual eligibles who are not enrolled in a Part D Plan during eligibility month/year
As of the March Response Files, rare occurrences have been observed whereby the Finder Code is set to “1” (not enrolled) yet a beneficiary is enrolled in an MA PD
(H Plan # can be found as an MA PD on the latest Spreadsheet of Part D plans) receiving Part D benefits- this situation will be corrected promptly and only affects information in the response file, not the beneficiary’s actual benefit
PACE programs and Demonstrations had not been required to submit individual PBP data prior to onset of PART D, thus for beneficiaries enrolled in either type of program, this indicator was erroneously set to a ‘1’, although beneficiary had Part D drug coverage. Situation will be ameliorated as of 03/2006, with PACE and Demonstration programs submitting PART D identifiable PBP information to the MARx enrollment system and allowing correct Part D enrollment information to be shared.
• GROUP HEALTH ORGANIZATION: GHO (10 OCCURRENCES)
(Prior to the onset of Part D benefits, this part of this part of the record only contained Part C MA Organizations
(This area of the response file contains both Medicare Advantage Plans, PACE and Demo Enrollments offering and not offering Part D drug benefits. The information represents the overall contract/organization within which a beneficiary may have a choice of plans (PBPs). If a rollover from a non drug covering plan into one that did occurs, the enrollment effective date of the GHO/GHP would not change but the enrollment periods of the effected PBPs would be updated)
The first occurrence is the active (current or future) or most recent Medicare Group Health Organization coverage (i.e. plan enrollment). Presently, this section is populated with Medicare Part C and Medicare Part D Organizations enrollments. The organizations can be distinguished by the first position of ‘BENE GHO CNTRCT NUM’:
H# is for local MA and MA-PDs; PACE, Cost Plans, and Demos
S# is for STAND ALONE PDP'S
R# is for Regional MA and MA-PDs
[9 in the first position may denote a Demo Plan; or a Chronic Care Improvement Pilot]
E# -- Starting with contract year 2007, a contract number starting with E indicates an employer sponsored prescription drug plan.
• MBD PLAN BENEFIT PACKAGE ELECTION (10 OCCURRENCES)
(This area of the response file describes the various PBP (plan) enrollments within the given GHO periods mentioned above)
The most active plan enrollment will reside in occurrence 1, followed by historical enrollments.
Presently, this section is populated with Medicare Part C offering no drug overage as well as offering drug coverage and Part D standalone plans
It is possible for a beneficiary to have two open enrollment periods, one signifying a managed care plan offering no drug coverage and a PDP standalone. In that case, the GHP contract numbers will be different.
Updated list of values for the
MBD PBP CVRG TYPE CD:
NF=pay bill option was not found for the contract
3 =CCP - COORDINATED CARE PLAN
5 = PFFS - PRIVATE FEE FOR SERVICE
6 = PACE - PACE PGM OF ALL INCLSVE CARE FOR THE ELDERLY
8 =DEMO - DEMONSTRATION
9 = FFS - FEE FOR SERVICE
10 = Cost/HCPP -COST/HEALTH CARE PREPAYMENT PLAN
11=PDP - Part D Drug Plan ELECTION
• PART D PLAN BENEFIT PACKAGE (10 Occurrences)
(This portion of the record will list the Part D Plans which also trigger the MEDICARE PART D FINDER CODE to reflect a ‘0’, denoting “Part D Enrollment found”
(This area of the response file describes the various PBP (plan) enrollments within the given PDP only periods)
The most active plan enrollment will reside in occurrence 1, followed by historical enrollments.
Presently, this section is populated with Medicare Part C offering drug coverage as well as Part D standalone plans
It is possible for a beneficiary to have two open enrollment periods, one signifying a managed care plan offering no drug coverage and a PDP standalone. In that case, the GHP contract numbers will be different.
Updated list of values coverage type code:
-Values for Enrollment Type Code:
A - Beneficiary was auto-enrolled thru CMS (full duals)
B - Beneficiary elected plan (overrides auto enrolled plan)
C - Facilitated enrollment: CMS facilitates enrollment of partial duals
into a PDP (eff. 3/2006)
D - System (plan’s) generated enrollment: the beneficiary is in a plan and either the contract or PBP # is changing and they are rolled over automatically into the new number. This usually occurs at the end of the calendar year (which coincides with contract year), when contracts/plans may transition to new numbers.
Data Types:
9(x) = Numeric characters; where “9” indicates a numeric data type and “x” is the
field length
X(x) = Alphanumeric characters with field length (x)
DATES = ALL DATES WILL BE IN MMDDCCYY FORMAT (month, day, century, year)
NOTE: Entries of numeric data fields will be right-justified within the field and entries alphanumeric data fields will be left-justified within the field.
File Format:
File naming standard – P#DDP.#DDP3.CMS.IN.ELIGIBLE.ss
Where “ss” represents the FIPS State abbreviation, see table below:
Mainframe EBCDIC file format, FB
Record Lengths:
HEADER LRECL= 180, (40 + 140 space filled),
DETAIL LRECL=180,
TRAILER LRECL=180, (40 + 140 space filled).
-Where “FB” = Fixed Block, and “LRECL” = Record Length
STATE CODE ABRREVIATIONS TABLE
State Code - Valid Code
Alabama AL Missouri MO
Alaska AK Montana MT
Arizona AZ Nebraska NE
Arkansas AR Nevada NV
California CA New Hampshire NH
Colorado CO New Jersey NJ
Connecticut CT New Mexico NM
Delaware DE New York NY
District of North Carolina NC
Columbia DC North Dakota ND
Florida FL Ohio OH
Georgia GA Oklahoma OK
Hawaii HI Oregon OR
Idaho ID Pennsylvania PA
Illinois IL Rhode Island RI
Indiana IN South Carolina SC
Iowa IA South Dakota SD
Kansas KS Tennessee TN
Kentucky KY Texas TX
Louisiana LA Utah UT
Maine ME Vermont VT
Maryland MD Virginia VA
Massachusetts MA Washington WA
Michigan MI West Virginia WV
Minnesota MN Wisconsin WI
Mississippi MS Wyoming WY
ENROLLMENT FILE TO CMS
Header Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
RECORD IDENT CODE X(03) 001 003
STATE CODE X(02) 004 005
CREATE MONTH 9(02) 006 007
CREATE YEAR 9(04) 008 011
FILLER X(169) 012 180
ENROLLMENT FILE TO CMS
Header Record Data Element Specifications
DATA ELEMENT NAME SPECIFICATIONS
RECORD IDENT CODE
|
Always contains value of “MMA” |
STATE CODE
|
State Code - Valid Code Alabama AL Missouri MO Alaska AK Montana MT Arizona AZ Nebraska NE Arkansas AR Nevada NV California CA New Hampshire NH Colorado CO New Jersey NJ Connecticut CT New Mexico NM Delaware DE New York NY District of North Carolina NC Columbia DC North Dakota ND Florida FL Ohio OH Georgia GA Oklahoma OK Hawaii HI Oregon OR Idaho ID Pennsylvania PA Illinois IL Rhode Island RI Indiana IN South Carolina SC Iowa IA South Dakota SD Kansas KS Tennessee TN Kentucky KY Texas TX Louisiana LA Utah UT Maine ME Vermont VT Maryland MD Virginia VA Massachusetts MA Washington WA Michigan MI West Virginia WV Minnesota MN Wisconsin WI Mississippi MS Wyoming WY
|
CREATE MONTH
|
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12)
|
CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created
|
ENROLLMENT FILE TO CMS
State Enrollment File Record Layout
FIELD NAME FORMAT <------POSITION------>
START END
RECORD IDENT CODE X(03) 001 003
ELIGIBILITY MONTH/YEAR 9(06) 004 009
ELIGIBILITY STATUS X(01) 010 010
HIC/RRB X(15) 011 025
HIC-RRB IND X(01) 026 026
SOCIAL SECURITY NUM 9(09) 027 035
SMA IDENTIFIER X(20) 036 055
FIRST NAME X(12) 056 067
LAST NAME X(20) 068 087
MIDDLE NAME X(15) 088 102
SUFFIX NAME X(04) 103 106
SEX X(01) 107 107
DATE OF BIRTH 9(08) 108 115
DUAL STATUS CODE 9(02) 116 117
FPL % IND 9(01) 118 118
DRUG COVERAGE IND 9(01) 119 119
INSTITUTIONAL STATUS IND X(01) 120 120
NOTE: The following fields are based on Part D Subsidy applications processed by the state
PART D SUBSIDY APPRVD X(01) 121 121
PART D SUBSIDY APPRVD
DATE 9(08) 122 129
PART D SUBSIDY START
DATE 9(08) 130 137
PART D SUBSIDY END
DATE 9(08) 138 145
PART D % OF FPL 9(03) 146 148
PART D SUBSIDY LEVEL 9(03) 149 151
INCOME USED FOR
DETERMINATION X(01) 152 152
RESOURCE LEVEL X(01) 153 153
BASIS OF PART D
SUBSIDY DENIAL X(01) 154 154
RESULT OF AN APPEAL X(01) 155 155
CHANGE TO PREVIOUS
DETERMINATION X(01) 156 156
DETERMINATION CANCLD X(01) 157 157
FILLER X(23) 158 180
ENROLLMENT FILE TO CMS
State Enrollment Record Data Element Specifications
DATA ELEMENT NAME SPECIFICATIONS
PART D % OF FPL
|
RECORD TYPE – LIS
For those individuals who apply for the low income subsidy, identify the specific percent of Federal Poverty Level, as defined by Federal LIS income determination policy. Do not fill this out for those individuals who receive any Medicaid benefits, including payment of Medicare cost-sharing obligations. N/A=’999’.
|
PART D SUBSIDY LEVEL
|
RECORD TYPE – LIS
Identifies portion of Part D premium subsidized, based on sliding scale linked to %FPL. If person is under 135% FPL, enter 100. If person is 136-140% FPL, enter 075. If person is 141-145% FPL, enter 050. If person is 146-149% FPL, enter 025. If person has 150% FPL, enter 000. N/A=’999’.
|
INCOME USED FOR DETERMINATION |
RECORD TYPE – LIS
Income Used Indicator 1=Individual, 2=Couple N/A=’9’
|
RESOURCE LEVEL |
RECORD TYPE – LIS
Resource Level 1=over limit, 2=under limit N/A=’9’.
|
BASIS OF PART D SUBSIDY DENIAL
|
RECORD TYPE – LIS
Denial codes 1=NAB (Not enrolled in Medicare Part A or B), 2=NUS (Does not reside in the USA), 3=FTC (Failure to Cooperate), 4=RES (Resources too High), 5=INC (Income too High). 9 = N/A
|
RESULT OF AN APPEAL
|
RECORD TYPE – LIS
Appeal Result Y=yes, N=no (Only populated if appeal is filed). N/A=’9’.
|
CHANGE TO PREVIOUS DETERMINATION
|
RECORD TYPE – LIS
Change to Previous Determination Indicator Y=yes, N=no. Enter Y if this record changes a determination sent in a previous transmission. Default is N. N/A=’9’.
|
DETERMINATION CANCELLED
|
RECORD TYPE – LIS
Cancelled Indicator Y=yes, N=no. Default is N. Enter Y if this record cancels previous record sent. N/A=’9’.
|
ENROLLMENT FILE TO CMS
State Trailer Physical Record Layout
FIELD NAME FORMAT <------POSITION------>
START END
RECORD IDENT CODE X(03) 001 003
BENE RECORD COUNT 9(08) 004 011
STATE CODE X(02) 012 013
CREATE MONTH 9(02) 014 015
CREATE YEAR 9(04) 016 019
FILLER X(161) 020 180
ENROLLMENT FILE TO CMS
Trailer Record Data Element Specifications
DATA ELEMENT NAME SPECIFICATIONS
RECORD IDENT CODE |
Identifies Record as Trailer always = ‘TRL”
|
BENE RECORD COUNT |
Total number of records on the file
|
STATE CODE
|
State Code - Valid Code Alabama AL Missouri MO Alaska AK Montana MT Arizona AZ Nebraska NE Arkansas AR Nevada NV California CA New Hampshire NH Colorado CO New Jersey NJ Connecticut CT New Mexico NM Delaware DE New York NY District of North Carolina NC Columbia DC North Dakota ND Florida FL Ohio OH Georgia GA Oklahoma OK Hawaii HI Oregon OR Idaho ID Pennsylvania PA Illinois IL Rhode Island RI Indiana IN South Carolina SC Iowa IA South Dakota SD Kansas KS Tennessee TN Kentucky KY Texas TX Louisiana LA Utah UT Maine ME Vermont VT Maryland MD Virginia VA Massachusetts MA Washington WA Michigan MI West Virginia WV Minnesota MN Wisconsin WI Mississippi MS Wyoming WY
|
CREATE MONTH
|
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12
|
CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created
|
Section 2. Enrollment Return File Specifications
This file will be automatically returned to the state through the Connect:Direct file transfer process upon the successful processing of a State Enrollment File. There may be a delay in sending the response file based upon other scheduling issues.
The return data set name will be the same data set name that was used to return the Drug Card Return File, unless the state notifies CMS of an alternative name. This will ensure that CMS returns a file that complies with state system data set naming conventions. States that prefer to differentiate by the use of a different data set name must provide that name to CMS at least 2 weeks prior to Enrollment File submittal. . Please forward requests for data set name changes to the following e-mail address and include “Request for MMA Dataset Name Change” in your Subject Line:
Note that this file will have a much longer record length than the return file for the Drug Card File. The content of this file will include the following:
Header Record with identifying information, record count summaries, and a copy of the incoming header record
Detail Record
Copy of the incoming state detail record
Series of edit error return codes
Large section of data from the Medicare Beneficiary Database including enrollment and plan information
File summary including record validation and matching outcomes
Summary enrollment count record by month for each month of enrollment information on the incoming file, and
Trailer Record with identifying information and a copy of the incoming trailer record.
Each Section is identified by a Record-Identifier code in the first three positions of the record. The physical record layouts and field descriptions for these sections are provided below.
Header Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
RECORD IDENT CODE X(03) 0001 0003
FILE PROCESS TIMESTAMP X(26) 0004 0029
FILE ACCEPT IND X(01) 0030 0030
FILLER X(01) 0031 0031
RECORDS TOTAL 9(08) 0032 0039
RECORDS DUPLICATE 9(08) 0040 0047
RECORDS NONDUP 9(08) 0048 0055
RECORDS VALID 9(08) 0056 0063
RECORDS INVALID 9(08) 0064 0071
RECORDS MATCHED 9(08) 0072 0079
RECORDS NOT MATCHED 9(08) 0080 0087
FILE CREATE MONTH 9(02) 0088 0089
FILE CREATE YEAR 9(04) 0090 0093
FILLER X(22) 0094 0115
*********ORIG STATE HEADER REC 180 characters ****************************
RECORD IDENT CODE X(03) 0116 0118
STATE CODE X(02) 0119 0120
CREATE MONTH 9(02) 0121 0122
CREATE YEAR 9(04) 0123 0126
FILLER X(169) 0127 0295
*********REMAINDER OF RECORD**************************************************
FILLER X(2666) 0296 2961
Person-Level Detail Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
******ORIGINAL RECORD SUBMITTED BY STATE****************************
RECORD IDENT CODE X(03) 0001 0003
ELIGIBILITY MONTH/YEAR 9(06) 0004 0009
ELIGIBILITY STATUS X(01) 0010 0010
HIC/RRB X(15) 0011 0025
HIC-RRB IND X(01) 0026 0026
SOCIAL SECURITY NUM 9(09) 0027 0035
SMA IDENTIFIER X(20) 0036 0055
FIRST NAME X(12) 0056 0067
LAST NAME X(20) 0068 0087
MIDDLE NAME X(15) 0088 0102
SUFFIX NAME X(04) 0103 0106
SEX X(01) 0107 0107
DATE OF BIRTH 9(08) 0108 0115
DUAL STATUS CODE 9(02) 0116 0117
FPL % IND 9(01) 0118 0118
DRUG COVERAGE IND 9(01) 0119 0119
INSTITUTIONAL STATUS IND X(01) 0120 0120
PART D SUBSIDY APPLICATION
APPROVAL CODE X(01) 0121 0121
PART D SUBSIDY APPRVD/DISAPPRVD
DATE 9(08) 0122 0129
PART D SUBSIDY START
DATE 9(08) 0130 0137
PART D SUBSIDY END
DATE 9(08) 0138 0145
PART D % OF FPL 9(03) 0146 0148
PART D SUBSIDY LEVEL 9(03) 0149 0151
INCOME USED FOR
DETERMINATION X(01) 0152 0152
RESOURCE LEVEL X(01) 0153 0153
BASIS OF PART D
SUBSIDY DENIAL X(01) 0154 0154
RESULT OF AN APPEAL X(01) 0155 0155
CHANGE TO PREVIOUS
DETERMINATION X(01) 0156 0156
DETERMINATION CANCLD X(01) 0157 0157
FILLER X(23) 0158 0180
Person-Level Detail Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
*********** ERROR RETURN CODES (ERC) ***************************************
RECORD IDENT CODE ERC X(02) 0181 0182
ELIGIBILITY MONTH/YEAR
ERC X(02) 0183 0184
ELIGIBILITY STATUS ERC X(02) 0185 0186
HIC/RRB ERC X(02) 0187 0188
HIC-RRB IND ERC X(02) 0189 0190
SOCIAL SECURITY NUM ERC X(02) 0191 0192
SEX ERC X(02) 0193 0194
DATE OF BIRTH ERC X(02) 0195 0196
DUAL STATUS CODE ERC X(02) 0197 0198
FPL % IND ERC X(02) 0199 0200
DRUG COVERAGE IND ERC X(02) 0201 0202
INSTITUTIONAL STATUS IND
ERC X(02) 0203 0204
PART D SUBSIDY APPLICATION
APPROVAL CODE ERC X(02) 0205 0206
PART D SUBSIDY APPRVD/DISAPPRVD
DATE ERC X(02) 0207 0208
PART D SUBSIDY START
DATE ERC X(02) 0209 0210
PART D SUBSIDY END
DATE ERC X(02) 0211 0212
PART D % OF FPL ERC X(02) 0213 0214
PART D SUBSIDY LEVEL ERC X(02) 0215 0216
INCOME USED FOR
DETERMINATION ERC X(02) 0217 0218
RESOURCE LEVEL ERC X(02) 0219 0220
BASIS OF PART D
SUBSIDY DENIAL ERC X(02) 0221 0222
RESULT OF AN APPEAL ERC X(02) 0223 0224
CHANGE TO PREVIOUS
DETERMINATION ERC X(02) 0225 0226
DETERMINATION CANCLD
ERC X(02) 0227 0228
*************************** CMS MBD FILE **************************************
RECORD RETURN CODE X(06) 0229 0234
MEDICARE PART A/B FINDER CODE X(01) 0235 0235
MEDICARE PART D FINDER CODE X(01) 0236 0236
*** BENEFICIARY IDENTIFICATION ***
BENE CLM ACNT NUM X(09) 0237 0245
BENE IDENT CD X(02) 0246 0247
BENE BIRTH DT 9(08) 0248 0255
BENE DEATH DT 9(08) 0256 0263
Person-Level Detail Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
BENE SEX IDENT CD X(01) 0264 0264
BENE GIVN NAME X(30) 0265 0294
BENE MDL NAME X(01) 0295 0295
BENE SURN NAME X(40) 0296 0335
*** CROSS REFERENCE NUMBERS (10 TIMES) *** 0336 0445
XREF BENE CLM ACCT NUM X(09)
XREF BENE IDENT CODE X(02)
*** SOCIAL SECURITY NUMBERS (5 TIMES) *** 0446 0490
BENE SSN NUM 9(09)
*** MAILING ADDRESS ***
MLNG ADDR LINE1 X(40) 0491 0530
MLNG ADDR LINE2 X(40) 0531 0570
MLNG ADDR LINE3 X(40) 0571 0610
MLNG ADDR LINE4 X(40) 0611 0650
MLNG ADDR LINE5 X(40) 0651 0690
MLNG ADDR LINE6 X(40) 0691 0730
MLNG ADDR CITY NAME X(40) 0731 0770
MLNG ADDR STATE CODE X(02) 0771 0772
MLNG ADDR ZIP CD X(09) 0773 0781
MLNG ADDR CHG DT 9(08) 0782 0789
*** RESIDENCE ADDRESS ***
RSDNC ADDR LINE1 X(40) 0790 0829
RSDNC ADDR LINE2 X(40) 0830 0869
RSDNC ADDR LINE3 X(40) 0870 0909
RSDNC ADDR LINE4 X(40) 0910 0949
RSDNC ADDR LINE5 X(40) 0950 0989
RSDNC ADDR LINE6 X(40) 0990 1029
RSDNC ADDR CITY NAME X(40) 1030 1069
RSDNC ADDR STATE CODE X(02) 1070 1071
RSDNC ADDR ZIP CD X(09) 1072 1080
RSDNC ADDR CHG DT 9(08) 1081 1088
*** REPRESENTATIVE PAYEE ***
BENE REP PAYEE SW X(01) 1089 1089
*** NON-ENTITLEMENT STATUS ***
PRT A NENTLMT STUS CODE X(01) 1090 1090
PRT B NENTLMT STUS CODE X(01) 1091 1091
*** ENTITLEMENT REASON (5 TIMES) *** 1092 1151
BENE ENTLMT RSN CD
CHG DT 9(08)
BENE ENTLMT RSN CD X(04)
Person-Level Detail Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
*** PART A ENTITLEMENT (5 TIMES) *** 1152 1241
BENE PTA ENTLMT STRT DT 9(08)
BENE PTA ENTLMT END DT 9(08)
BENE PTA ENRLMT RSN CD X(01)
BENE PTA ENTLMT STUS CD X(01)
*** PART B ENTITLEMENT (5 TIMES) *** 1242 1331
BENE PTB ENTLMT STRT DT 9(08)
BENE PTB ENTLMT END DT 9(08)
BENE PTB ENRLMT RSN CD X(01)
BENE PTB ENTLMT STUS CD X(01)
*** HOSPICE COVERAGE (5 TIMES) *** 1332 1411
BENE HSPC CVRG STRT DT 9(08)
BENE HSPC CVRG END DT 9(08)
*** DISABILITY INSURANCE (3 TIMES) *** 1412 1462
BENE DIB ENTLMT STRT DT 9(08)
BENE DIB ENTLMT END DT 9(08)
BENE DIB ENTLMT DT
JSTFCTN CD X(01)
*** GROUP HEALTH ORGANIZATION (10 TIMES) *** 1463 1672
BENE GHO ENRLMT STRT DT 9(08)
BENE GHO ENRLMT END DT 9(08)
BENE GHO CNTRCT NUM X(05)
*** MBD PLAN BENEFITS PACKAGE ELECTION (10 TIMES) ***
1673 1962
MBD GHP ENRL EFCTV DT 9(08)
MBD PBP STRT DT 9(08)
MBD PBP END DT 9(08)
MBD PBP NUM X(03)
MBD PBP CVRG TYPE CD X(02)
*** END STAGE RENAL DISEASE COVERAGE ***
BENE ESRD CVRG STRT DT 9(08) 1963 1970
BENE ESRD CVRG END DT 9(08) 1971 1978
BENE ESRD TRMNTN RSN CD X(01) 1979 1979
*** END STAGE RENAL DISEASE DIALYSIS ***
BENE ESRD DLYS STRT DT 9(08) 1980 1987
BENE ESRD DLYS END DT 9(08) 1988 1995
*** END STAGE RENAL DISEASE TRANSPLANT ***
BENE ESRD TRNSPLNT
STRT DT 9(08) 1996 2003
BENE ESRD TRNSPLNT
END DT 9(08) 2004 2011
Person-Level Detail Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
*** THIRD PARTY PART A HISTORY (5 TIMES) *** 2012 2111
BENE PTA TP STRT DT 9(08)
BENE PTA TP PRM PYR CD X(03)
BENE PTA TP END DT 9(08)
BENE PTA TP BUYIN
ELGBLTY CD X(01)
*** THIRD PARTY PART B HISTORY (5 TIMES) *** 2112 2211
BENE PTB TP STRT DT 9(08)
BENE PTB TP PRM PYR CD X(03)
BENE PTB TP TRMNTN DT 9(08)
BENE PTB TP BUYIN
ELGBLTY CD X(01)
*** PART D DATA ELEMENTS ***
BENE FIRST ELIGIBLE PART D DATE 9(08) 2212 2219
BENE AFF DECL IND X(01) 2220 2220
(BENE PTD OPT OUT IND)
****BENE COPAY HISTORY(10 TIMES)**** 2221 2400
BENE COPAY TYPE X(01)
BENE COPAY LEVEL X(01)
BENE COPAY START DATE 9(08)
BENE COPAY END DATE 9(08)
****PART D PLAN BENEFIT PACKAGE(10 TIMES) 2401 2650
BENE CONTRACT NUM X(05)
BENE PTD PBP ENRLMNT STRT DT 9(08)
BENE PTD PBP ENRLMNT END DT 9(08)
BENE PTD PBP PLAN ID X(03)
BENE ENROLL TYPE IND X(01)
FILLER X(250) 2651 2900
SECONDARY MATCH IND X(01) 2901 2901
SPD CALCULATION IND X(01) 2902 2902
*** REMAINDER OF RECORD ***
FILLER X(59) 2903 2961
File Summary Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
REC IDENT CODE X(03) 0001 0003
STATE CODE X(02) 0004 0005
FILE PROCESS TIMESTAMP X(26) 0006 0031
FILE CREATE MONTH 9(02) 0032 0033
FILE CREATE YEAR 9(04) 0034 0037
RECORDS TOTAL 9(08) 0038 0045
RECORDS DUPLICATE 9(08) 0046 0053
RECORDS NONDUP 9(08) 0054 0061
RECORDS VALID 9(08) 0062 0069
RECORDS INVALID 9(08) 0070 0077
RECORDS MATCH 9(08) 0078 0085
RECORDS NOT MATCHED 9(08) 0086 0093
FILLER X(01) 0094 0094
FILLER X(20) 0095 0114
FILLER X(26) 0115 0140
VALID DUAL RECORDS 9(08) 0141 0148
VALID DUAL MATCHES 9(08) 0149 0156
VALID DUAL NONMATCHES 9(08) 0157 0164
VALID LIS RECORDS 9(08) 0165 0172
VALID CURRENT DUALS 9(08) 0173 0180
VALID RETRO DUALS 9(08) 0181 0188
TOTAL ELIG MONTHS 9(02) 0189 0190
TOTAL VALID PRO RECORDS 9(08) 0191 0198
TOTAL INVALID PRO RECORDS 9(08) 0199 0206
TOTAL MATCHED PRO RECORDS 9(08) 0207 0214
FILLER X(2747) 0215 2961
Month Summary Record Physical Layout
(One generated for each Eligibility month found in the file.)
FIELD NAME FORMAT <------POSITION------>
START END
REC IDENT CODE X(03) 0001 0003
STATE CODE X(02) 0004 0005
FILE PROCESS TIMESTAMP X(26) 0006 0031
FILE CREATE MONTH 9(02) 0032 0033
FILE CREATE YEAR 9(04) 0034 0037
ELIGIBILITY MONTH 9(02) 0038 0039
ELIGIBILITY YEAR 9(04) 0040 0043
CALCULATION SWITCH X(01) 0044 0044
TOTAL VALID RECORDS 9(08) 0045 0052
TOTAL VALID FULL DUAL
RECORDS 9(08) 0053 0060
TOTAL VALID NON-FULL
DUAL RECORDS 9(08) 0061 0068
NET TOTAL VALID FULL
DUAL ENROLLMENTS 9(08) 0069 0076
NET TOTAL VALID FULL
DUAL DISENROLLMENTS 9(08) 0077 0084
FILLER X(2877) 0085 2961
Trailer Record Physical Layout
FIELD NAME FORMAT <------POSITION------>
START END
RECORD IDENT CODE X(03) 0001 0003
FILE PROCESS TIMESTAMP 9(26) 0004 0029
FILE CREATE MONTH 9(02) 0030 0031
FILE CREATE YEAR 9(04) 0032 0035
FILE ACCEPT IND X(01) 0036 0036
FILLER X(07) 0037 0043
*********ORIG STATE TRAILER REC 180 characters ****************************
RECORD IDENT CODE X(03) 0044 0046
BENE RECORD COUNT 9(08) 0047 0054
STATE CODE X(02) 0055 0056
CREATE MONTH 9(02) 0057 0058
CREATE YEAR 9(04) 0059 0062
FILLER X(161) 0063 0223
*********REMAINDER OF RECORD**************************************************
FILLER X(2738) 0224 2961
Header Record Data Element Specifications
RECORD IDENT CODE |
"SRF"
|
FILE PROCESS TIMESTAMP |
Format: YYYY.MM.DD.hh.mm.ss.nnnn YYYY = Year; MM = Month; DD = Day; hh = hour; mm = minute; ss = second; nnnnnn = microsecond
The exact time that the state file had been processed.
|
FILE ACCEPT IND |
Y = The state file had been accepted; N = the state file had not been accepted.
|
FILLER |
Filler.
|
RECORDS TOTAL |
The total number of detail records in the state file. RECORDS VALID + RECORDS INVALID = RECORDS TOTAL. RECORDS MATCHED + RECORDS NOT MATCHED = RECORDS TOTAL.
This total does not include PRO records.
|
RECORDS DUPLICATE |
The total number of duplicate detail records found in the state file.
This count does not include PRO records.
|
RECORDS NONDUP |
The total number of non-duplicate valid detail records found in the state file.
This count does not include PRO records.
|
RECORDS VALID |
The total number of valid detail records found in the file. Valid records are non-duplicate and provide valid essential information. See also Person-Level Record Data Element Specifications: Error Return Codes (ERC)
Additionally, a detail record will be considered Invalid if it does not have one of the following combinations of identifying information: - HICN or RRB, Social Security Number, Date of Birth - HICN or RRB, Date of Birth - Social Security Number, Date of Birth
This count does not include PRO records.
|
RECORDS INVALID |
The total number of invalid detail records found in the file See also Person-Level Record Data Element Specifications: Error Return Codes (ERC)
This count does not include PRO records.
|
RECORDS MATCHED |
The total number of detail records that could be matched successfully to an individual on the Medicare Beneficiary Database.
This count does not include PRO records.
|
RECORDS NOT MATCHED |
The total number of detail records that could not be matched successfully to an individual on the Medicare Beneficiary Database. This count includes Invalid detail records because no match is attempted on an invalid detail record.
This count does not include PRO records.
|
FILE CREATE MONTH |
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12) Create Month of the MMA State File
|
FILE CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created Create Year of the MMA State File
|
FILLER |
|
*********************** |
ORIGINAL STATE HEADER RECORD 180 BYTES |
RECORD IDENT CODE |
Always contains value of “MMA”
|
STATE CODE |
State Code - Valid Code Alabama AL Missouri MO Alaska AK Montana MT Arizona AZ Nebraska NE Arkansas AR Nevada NV California CA New Hampshire NH Colorado CO New Jersey NJ Connecticut CT New Mexico NM Delaware DE New York NY District of North Carolina NC Columbia DC North Dakota ND Florida FL Ohio OH Georgia GA Oklahoma OK Hawaii HI Oregon OR Idaho ID Pennsylvania PA Illinois IL Rhode Island RI Indiana IN South Carolina SC Iowa IA South Dakota SD Kansas KS Tennessee TN Kentucky KY Texas TX Louisiana LA Utah UT Maine ME Vermont VT Maryland MD Virginia VA Massachusetts MA Washington WA Michigan MI West Virginia WV Minnesota MN Wisconsin WI Mississippi MS Wyoming WY
|
CREATE MONTH |
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12)
|
CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created
|
FILLER |
|
*********************** |
REMAINDER OF RECORD |
FILLER |
|
Person-Level Detail Record Data Element Specifications
File Summary Record Data Element Specifications
REC IDENT CODE |
"FSM"
|
STATE CODE |
State Code - Valid Code Alabama AL Missouri MO Alaska AK Montana MT Arizona AZ Nebraska NE Arkansas AR Nevada NV California CA New Hampshire NH Colorado CO New Jersey NJ Connecticut CT New Mexico NM Delaware DE New York NY District of North Carolina NC Columbia DC North Dakota ND Florida FL Ohio OH Georgia GA Oklahoma OK Hawaii HI Oregon OR Idaho ID Pennsylvania PA Illinois IL Rhode Island RI Indiana IN South Carolina SC Iowa IA South Dakota SD Kansas KS Tennessee TN Kentucky KY Texas TX Louisiana LA Utah UT Maine ME Vermont VT Maryland MD Virginia VA Massachusetts MA Washington WA Michigan MI West Virginia WV Minnesota MN Wisconsin WI Mississippi MS Wyoming WY
|
FILE PROCESS TIMESTAMP |
Format: YYYY.MM.DD.hh.mm.ss.nnnn YYYY = Year; MM = Month; DD = Day; hh = hour; mm = minute; ss = second; nnnnnn = microsecond
The exact time that the state file had been processed.
|
FILE CREATE MONTH |
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12) The month in which the MMA state file was created.
|
FILE CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created The year in which the MMA state file was created.
|
RECORDS TOTAL |
The total number of detail records in the state file. RECORDS VALID + RECORDS INVALID = RECORDS TOTAL. RECORDS MATCHED + RECORDS NOT MATCHED = RECORDS TOTAL.
This total does not include PRO detail records.
|
RECORDS DUPLICATE |
The total number of duplicate detail records found in the state file.
This count does not include PRO detail records.
|
RECORDS NONDUP |
The total number of non-duplicate valid detail records found in the state file.
This count does not include PRO detail records.
|
RECORDS VALID |
The total number of valid detail records found in the file. Valid records are non-duplicate and provide valid essential information.
Additionally, a detail record will be considered Invalid if it does not have one of the following combinations of identifying information: - HICN or RRB, Social Security Number, Date of Birth - HICN or RRB, Date of Birth - Social Security Number, Date of Birth
This count does not include PRO detail records.
See also Person-Level Record Data Element Specifications: Error Return Codes.
|
RECORDS INVALID |
The total number of invalid detail records found in the file.See also Person-Level Record Data Element Specifications: Error Return Codes.
This count does not include PRO detail records.
|
RECORDS MATCHED |
The total number of detail records that could be matched successfully to an individual on the Medicare Beneficiary Database.
This count does not include PRO detail records.
|
RECORDS NOT MATCHED |
The total number of detail records that could not be matched successfully to an individual on the Medicare Beneficiary Database. This count includes Invalid detail records because no match is attempted on an invalid detail record.
This count does not include PRO detail records.
|
|
|
|
|
FILLER |
|
VALID DUAL RECORDS |
The total number of valid Dual Eligible detail records found in the file. Valid records are non-duplicate and provide valid essential information. See also Person-Level Record Data Element Specifications: Error Return Codes.
This count does not include PRO detail records.
|
VALID DUAL MATCHES |
The total number of valid Dual Eligible detail records that could be matched successfully to an individual on the Medicare Beneficiary Database.
This count does not include PRO detail records.
|
VALID DUAL NONMATCHES |
The total number of valid Dual Eligible detail records that could not be matched successfully to an individual on the Medicare Beneficiary Database. This count does not include detail records that were not tried in the match process i.e. invalid records.
This count does not include PRO detail records.
|
VALID LIS RECORDS |
The total number of valid Low-Income Subsidy detail records found in the file. Valid records are non-duplicate and provide valid essential information. See also Person-Level Record Data Element Specifications: Error Return Codes.
This count does not include PRO detail records.
|
VALID CURRENT DUALS |
The total number of valid Dual Eligible detail records with Eligibility Month/Year = File Create Month/Year. Valid records are non-duplicate and provide valid essential information. See also Person-Level Record Data Element Specifications: Error Return Codes.
This count does not include PRO detail records.
|
VALID RETRO DUALS |
The total number of valid Dual Eligible detail records with Eligibility Month/Year < File Create Month/Year. Valid records are non-duplicate and provide valid essential information. See also Person-Level Record Data Element Specifications: Error Return Codes.
This count does not include PRO detail records.
|
TOTAL ELIG MONTHS |
The total number of Eligibility months found in the file.
This count does not include PRO detail records.
|
TOTAL VALID PRO RECORDS |
The total number of valid Prospective Full Dual (PRO) detail records found in the file. Valid records are non-duplicate and provide valid essential information. See also Person-Level Record Data Element Specifications: Error Return Codes.
|
TOTAL INVALID PRO RECORDS |
The total number of invalid Prospective Full Dual (PRO) detail records found in the file See also Person-Level Record Data Element Specifications: Error Return Codes (ERC)
|
TOTAL MATCHED PRO RECORDS |
The total number of valid Prospective Full Dual (PRO) detail records that could be matched successfully to an individual on the Medicare Beneficiary Database.
|
FILLER |
|
Month Summary Record Data Element Specifications
*********************** |
ONE OF THESE RECORDS WILL BE GENERATED FOR EACH ELIGIBILITY MONTH FOUND IN THE FILE. |
REC IDENT CODE |
"MSM"
|
STATE CODE |
State Code - Valid Code Alabama AL Missouri MO Alaska AK Montana MT Arizona AZ Nebraska NE Arkansas AR Nevada NV California CA New Hampshire NH Colorado CO New Jersey NJ Connecticut CT New Mexico NM Delaware DE New York NY District of North Carolina NC Columbia DC North Dakota ND Florida FL Ohio OH Georgia GA Oklahoma OK Hawaii HI Oregon OR Idaho ID Pennsylvania PA Illinois IL Rhode Island RI Indiana IN South Carolina SC Iowa IA South Dakota SD Kansas KS Tennessee TN Kentucky KY Texas TX Louisiana LA Utah UT Maine ME Vermont VT Maryland MD Virginia VA Massachusetts MA Washington WA Michigan MI West Virginia WV Minnesota MN Wisconsin WI Mississippi MS Wyoming WY
|
FILE PROCESS TIMESTAMP |
Format: The exact time that the state file had been processed.
|
FILE CREATE MONTH |
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12) Create Month of the MMA State File
|
FILE CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created Create Year of the MMA State File
|
ELIGIBILITY MONTH |
Calendar Month Code for applicable Medicaid eligibility (e.g.012006) found in the MMA state file. Valid Month Values: 01 – 12 (e.g. January=01, December=12.)
|
ELIGIBILITY YEAR |
Calendar Year Code for applicable Medicaid eligibility (e.g.012006) found in the MMA state file. Valid Month Values: 01 – 12 (e.g. January=01, December=12.)
|
CALCULATION SWITCH |
Y = This Eligibility Month/Year was used in the state phase-down calculation. N = This Eligibility Month/Year was not used in the state phase-down calculation. Please note: Months previous to 012006 are not used in State Phase-Down Calculation.
|
TOTAL VALID RECORDS |
The total number of valid Dual Eligible detail records found in the MMA state file for this Eligibility Month/Year. TOTAL VALID FULL DUAL RECORDS + TOTAL VALID NON-FULL DUAL RECORDS = TOTAL VALID RECORDS
This count does not include PRO detail records.
|
TOTAL VALID FULL DUAL RECORDS |
The total number of valid full dual beneficiary records.
This count does not include PRO detail records.
|
TOTAL VALID NON-FULL DUAL RECORDS |
The total number of valid non-full dual beneficiary records.
This count does not include PRO detail records.
|
NET TOTAL VALID FULL DUAL ENROLLMENTS |
The net total number of valid Full Dual Eligible enrollments counted for this Eligibility Month/Year.
This count does not include PRO detail records.
|
NET TOTAL VALID FULL DUAL DISENROLLMENTS |
The net total number of valid Full Dual Eligible disenrollments counted for this Eligibility Month/Year.
This count does not include PRO detail records.
|
FILLER |
|
Trailer Record Data Element Specifications
RECORD IDENT CODE |
"TRL"
|
FILE PROCESS TIMESTAMP |
Format: YYYY.MM.DD.hh.mm.ss.nnnn YYYY = Year; MM = Month; DD = Day; hh = hour; mm = minute; ss = second; nnnnnn = microsecond
The exact time that the state file had been processed.
|
FILE CREATE MONTH |
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12) The month in which the MMA state file was created.
|
FILE CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created The year in which the MMA state file was created.
|
FILE ACCEPT IND |
Y = The state file had been accepted; N = the state file had not been accepted.
|
FILLER |
|
*********************** |
ORIGINAL STATE TRAILER RECORD (180 BYTES) |
RECORD IDENT CODE |
Identifies Record as Trailer always = “TRL”
|
BENE RECORD COUNT |
Total number of records on the file
|
STATE CODE |
State Code - Valid Code Alabama AL Missouri MO Alaska AK Montana MT Arizona AZ Nebraska NE Arkansas AR Nevada NV California CA New Hampshire NH Colorado CO New Jersey NJ Connecticut CT New Mexico NM Delaware DE New York NY District of North Carolina NC Columbia DC North Dakota ND Florida FL Ohio OH Georgia GA Oklahoma OK Hawaii HI Oregon OR Idaho ID Pennsylvania PA Illinois IL Rhode Island RI Indiana IN South Carolina SC Iowa IA South Dakota SD Kansas KS Tennessee TN Kentucky KY Texas TX Louisiana LA Utah UT Maine ME Vermont VT Maryland MD Virginia VA Massachusetts MA Washington WA Michigan MI West Virginia WV Minnesota MN Wisconsin WI Mississippi MS Wyoming WY
|
CREATE MONTH |
Month Code for Current Month – Valid Values (01 – 12)Calendar Month equals Month the file is created (e.g. January=01, December=12
|
CREATE YEAR |
Year Code for Current Year – i.e. 2006 Current Year equals Calendar Year the file is created
|
FILLER |
|
*********************** |
REMAINDER OF RECORD |
FILLER |
|
CMS
STATEmma20061228.doc
12/28/2006
| File Type | application/msword |
| File Title | Questions Received Prior to December 25, 2003--Answers |
| Author | CMS |
| Last Modified By | CMS_DU |
| File Modified | 2008-03-19 |
| File Created | 2008-03-19 |