CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

The Plan Benefit Package (PBP) and Formulary Submission for Advantage (MA) Plans and Prescription Drug Plans (PDPs) (CMS-R-262)

Appendix_C_CY2020_Formulary_IndicationBasedCoverage_Record_Layout

CY2019 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

OMB: 0938-0763

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CY 2020 Indication-Based Coverage File Record Layout
Required File Format = ASCII File – Tab Delimited
Do not include a header record
Filename extension should be “.TXT”
Field Name

RxCUI

Field Type

Number

Maximum
Field
Length

Alphanumeric

Sample Field
Value(s)

8

RxCUI – must exist on the
related formulary file

210597

8

Condition Indication Code

M0010859

Always Required
Indication Code

Field Description

Always Required
Please Note: Certain characters are restricted from HPMS. The submitted file will be rejected if any of the
following characters are included in any field: 1) greater than sign (>), 2) less than sign (<), and 3) semicolon (;).

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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File Typeapplication/pdf
File TitleCY 2019 Value Based Insurance Design Record Layout
SubjectCY 2019 Value Based Insurance Design Record Layout
AuthorLucas, Corey A
File Modified2018-09-12
File Created2018-09-12

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