Connect: Direct Applications for RAPS, Encounter, PDE, and MMP

Palmetto GBA

OMB No. 0938-1152

(Expires: TBD)

Connect:Direct Parameters for the
Submission of Medicare-Medicaid Plan (MMP) Data

Connect:Direct Network Mapping Values

The submitters will require the following parameters in order to setup Connect:Direct tables to allow connectivity to Palmetto GBA. Palmetto GBA uses RACF security to enforce data security. The MMP technical team will provide a User ID and Password to the submitter during the connectivity testing phase.

NAT’d IP Address:	158.73.33.160
Listener Port:	1369
Node ID:	SCA.A70NDM.MC
System Platform:	OS390 - z/OS
AGNS ID:	PGBA

Submitter’s Connect:Direct Parameters

Please provide the parameters Palmetto GBA will need in order to establish connectivity to the submitter.

NAT’d IP Address:
Listener Port:
Node ID:
System Platform:	OS390, z/OS AS/400 Windows, Unix, or Server
AGNS ID:

If the submitter requires a User ID and Password to access their system please provide these parameters in the table below.

User ID:		Password:

Please provide the contact information CSSC will require in order to coordinate the setup and testing.

Technical Contact Name:
Phone Number:
E-mail Address:

Palmetto GBA Contact Information

Please contact the CSSC Help Desk with any questions using the following contact information:

Phone Number - 1-877-534-2772

E-mail Address – [email protected]

(Please include “Encounter Question” in the subject line)

Line of Business Submissions Intended for This Setup

Check as many of the following that apply.

☐ Medicare Prescription Drug data

☐ Medicare Risk Adjustment data

☐ Medicare Encounter Data

☐ Medicaid Data

☐ Medicaid NCPDP Data

Submission Datasets

Listed below are the file parameter values that you, as the submitter, need to code in your Connect:Direct SCL scripts. The CSSC Help Desk will provide the submitter with the Submitter Id value that will be used in the dataset name.

Medicare Prescription Drug Data Submission Dataset

DSN: MAB.PROD.NDM.MMFS.PDE. <Submitter Id>(+1)

DISP: (NEW,CATLG,DELETE) UNIT: SYSDG

SPACE: (CYL,(1200,500),RLSE)

DCB: (RECFM=FB,LRECL=512,BLKSIZE=27648)

Medicare Risk Adjustment Data Submission Dataset

DSN: MAB.PROD.NDM.MMFS.RAS. <Submitter Id>(+1)

DISP: (NEW,CATLG,DELETE) UNIT: SYSDG

SPACE: (CYL,(75,10),RLSE)

DCB: (RECFM=FB,LRECL=512,BLKSIZE=27648)

Medicare Encounter Data Submission Dataset

DSN: MAB.PROD.NDM.MMFS.ENC.<Submitter Id>(+1)

DISP: (NEW,CATLG,DELETE) UNIT: SYSDG

SPACE: (CYL,(100,100),RLSE)

DCB: (RECFM=FB,LRECL=80,BLKSIZE=27920)

Medicaid Data Submission Dataset

DSN: MAB.PROD.NDM.MMFS.MCD.<Submitter Id>(+1)

DISP: (NEW,CATLG,DELETE) UNIT: SYSDG

SPACE: (CYL,(100,100),RLSE)

DCB: (RECFM=FB,LRECL=80,BLKSIZE=27920)

Medicaid NCPDP Data Submission Dataset

DSN: MAB.PROD.NDM.MMFS.NCP.<Submitter Id>(+1)

DISP: (NEW,CATLG,DELETE) UNIT: SYSDG

SPACE: (CYL,(100,100),RLSE)

DCB: (RECFM=FB,LRECL=3700,BLKSIZE=25900)

Medicare Prescription Drug Data Responses/Reports

Please provide the dataset names for each report being returned to you by Palmetto GBA.

Daily Reports

PDFS Response
Record Format is 80 bytes per record.
Dataset Name:

DDPS Return File Report #1
Record Format is 512 bytes per record.
Dataset Name:

DDPS Transaction Error Summary Report #3
Record Format is 512 bytes per record.
Dataset Name:

Monthly Reports

These reports are returned based on the date of service. Please provide a dataset name which will contain a variable for the year.

For example : <file name>CCYY or <filename>YY

Palmetto GBA will return: <file name>2013 or <filename>13

Note: The variable can be anywhere in the filename. The example above was for illustration purposes only.

Cumulative Beneficiary Activity (Covered Drugs) 04COV
Record Format is 512 bytes per record.
Dataset Name:

Cumulative Beneficiary Activity (Enhanced Alternative Drugs) 04ENH
Record Format is 512 bytes per record.
Dataset Name:

Cumulative Beneficiary Activity (Over-the-Counter Drugs) 04OTC
Record Format is 512 bytes per record.
Dataset Name:

PDE Accounting Report (Covered Drugs) 40COV
Record Format is 512 bytes per record.
Dataset Name:

PDE Accounting Report (Enhanced Drugs) 40ENH
Record Format is 512 bytes per record.
Dataset Name:

PDE Accounting Report (Over-the-Counter Drugs) 04OTC
Record Format is 512 bytes per record.
Dataset Name:

PDE Receivable Report Report #41
Record Format is 512 bytes per record.
Dataset Name:

PDE Part-D Payment Reconciliation Report Report #42
Record Format is 512 bytes per record.
Dataset Name:

PDE Payable Report Report #43
Record Format is 512 bytes per record.
Dataset Name:

Quarterly Reports

DDPS Potential Exclusion Warning Report
Record Format is 500 bytes per record.
Dataset Name:

Annual Reports

Phase III Report
Record Format is 512 bytes per record.
Dataset Name:

Monthly Risk Adjustment Data Responses/Reports

Please provide the dataset names for each report being returned to you by Palmetto GBA.

Daily Reports

FERAS Response
Record Format is 80 bytes per record.
Dataset Name:

RAPS Return File
Record Format is 512 bytes per record.
Dataset Name:

RAPS Error Report
Record Format is 133 bytes per record.
Dataset Name:

RAPS Summary Report
Record Format is 133 bytes per record.
Dataset Name:

RAPS Duplicate Diagnosis Cluster Report 502 Error Report
Record Format is 133 bytes per record.
Dataset Name:

Monthly Reports

RAPS Monthly Summary Report
Record Format is 133 bytes per record.
Dataset Name:

RAPS Monthly Cumulative Report
Record Format is 512 bytes per record.
Dataset Name:

RAPS Monthly Error Frequency Report
Record Format is 133 bytes per record.
Dataset Name:

Quarterly Reports

RAPS Quarterly Error Frequency Report
Record Format is 133 bytes per record.
Dataset Name:

Medicare Encounter Data Responses/Reports

Please provide the dataset names for each report being returned to you by Palmetto GBA.

Daily Reports

Invalid Response
Record Format is 80 bytes per record.
Dataset Name:

TA1 Response
Record Format is 80 bytes per record.
Dataset Name:

999R and 999E Responses
Record Format is 80 bytes per record.
Dataset Name:

277CA Response
Record Format is 80 bytes per record.
Dataset Name:

Data Duplicates Report
Record Format is 287 bytes per record.
Dataset Name:

Data Duplicates File
Record Format is 287 bytes per record.
Dataset Name:

Data Processing Status Report
Record Format is 154 bytes per record.
Dataset Name:

Data Processing Status File
Record Format is 154 bytes per record.
Dataset Name:

Data Pricing Status Report
Record Format is 174 bytes per record.
Dataset Name:

Data Pricing Status File
Record Format is 174 bytes per record.
Dataset Name:

Data Risk Adjustment Filter Report
Record Format is 194 bytes per record.
Dataset Name:

Data Risk Adjustment Filter File
Record Format is 194 bytes per record.
Dataset Name:

Data Summary Report
Record Format is 76 bytes per record.
Dataset Name:

Data Summary File
Record Format is 76 bytes per record.
Dataset Name:

Edit Disposition Summary Report
Record Format is 112 bytes per record.
Dataset Name:

Edit Disposition Summary File
Record Format is 112 bytes per record.
Dataset Name:

Detail Report
Record Format is 331 bytes per record.
Dataset Name:

Detail File
Record Format is 331 bytes per record.
Dataset Name:

Medicaid Data Responses/Reports

Please provide the dataset names for each report being returned to you by Palmetto GBA.

Daily Reports

Invalid Response
Record Format is 80 bytes per record.
Dataset Name:

TA1 Report
Record Format is 80 bytes per record.
Dataset Name:

999 Report
Record Format is 80 bytes per record.
Dataset Name:

277CA Report
Record Format is 80 bytes per record.
Dataset Name:

Dental Validation Report
Record Format is 133 bytes per record.
Dataset Name:

Medicaid NCPDP Data Responses/Reports

Please provide the dataset names for each report being returned to you by Palmetto GBA.

Daily Reports

NCPDP Response
Record Format is 80 bytes per record.
Dataset Name:

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 0938-1152. The time required to complete this information collection is estimated to average 7 minutes 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 any 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-10340( / )

Enrollment Package/2016 13