CY2023 Plan Benefit Package (PBP) Software and Formulary Submission (CMS-R-262)

CY 2022 UMGD Criteria Response Record Layout
Required File Format = ASCII File - Tab Delimited
Do not include a header record
Filename extension should be “.TXT”
Plan Users upload Utilization Management Group Description (UMGD) Criteria Responses when there
are open requests.
Field Name

Field Type

Maximum
Field
Length

Criteria ID

NUM

NA

Always
Required

Request for
Formulary Gate
Opening
Plan Response
Option

CHAR

Identifier for the UMGD criteria for which
to submit response.

1

Required
1

Always
Required

A ‘Y’ or ‘N’ selection must be made to
indicate whether a new version of the
formulary will be submitted to address the
UMGD response.
Valid values for Plan Response Option
field are:
1=Remove Entire UMGD
2=Remove PA Element
3=Revise UMGD Criteria
4=Submit Clinical Justification

Plan Clinical
Justification/
Resubmission
Comment

CHAR
Sometimes
Required

Sample Field
Value(s)
654321

Note: Criteria ID with open response
requests can be found on the UMGD
Criteria Detail Report under OJS Reports.

Always

NUM

Field Description

4000

Comments or clinical justification (this field
is optional unless option 4 is chosen for
the plan response option)

CMS SENSITIVE INFORMATION - REQUIRES SPECIAL HANDLING
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N = No
Y = Yes

1