Department of Health Care Services Health Care Options
Weekly Plan File Record Layout
June 03, 2014
Version 3.0
Department of Health Care Services Health Care Options
Weekly Plan File Record Layout V 3.0
Preface The Weekly Plan File (WPF) is made available on the Secure Data Exchange Services (SDES) web site by MAXIMUS on behalf of the Department of Health Care Services (DHCS) to participating Health and Dental plans. The file contains a data extract of enrollment and/or disenrollment activity on a weekly basis. The extract also provides an update to previously transmitted records in the event a beneficiary provides updated provider information. NOTE: the WPF file is not to be utilized to provide or deny services to beneficiaries. It should only be used for forecasting purposes.
Revision History
Date 8/1/98 4/20/11 6/3/14
Version 1.0 2.0 3.0
Confidential
Description Initial Release Included additional fields for LA and Sacramento plans. Added fields HICN (Field 32): added as per C-Letter #0414-2573 and Enrollment Record ID (Field 33): added as a MAXIMUS recommendation. DHCS verbally approved the addition.
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Author MAXIMUS MAXIMUS MAXIMUS (Shrenik Dedhia)
June 03, 2014
Department of Health Care Services Health Care Options
Weekly Plan File Record Layout V 3.0
Table of Contents 1
Weekly Plan File ................................................................................................................................ 1 1.1
Weekly Plan File Record Layout ............................................................................................ 1
1.2
Field Reference Codes........................................................................................................... 3
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June 03, 2014
Department of Health Care Services Health Care Options
Weekly Plan File Record Layouts V 3.0
1
Weekly Plan File
1.1
Weekly Plan File Record Layout
File Format: ASCII file. Fields are TAB delimited. No header row. No trailer row. File Naming Convention: Transaction Detail: T_yymmdd.### example: T_110401.999 Transaction Summary: S_yymmdd.### example: S_110401.999 Where: yy: Year Field #
mm: Month
dd: Day
###: Plan Number
Field Name
Field Description
Attributes
1
Plan Code
Plan Number
char (03)
2
Last Name
Beneficiary Last Name
char (20)
3
First Name
Beneficiary First Name
char (15)
4
Middle Initial
Beneficiary Middle Initial Name
char (01)
5
SSN
Social Security Number
char (09)
6
County
County Code
char (02)
7
Aid Code
Medi-Cal Aid Code
char (02)
8
Case ID
MEDS Case Number
char (07)
9
FBU
Family Budget Unit
char (01)
10
Person Number
Person Number
char (02)
11
Date of Birth
Date of Birth
char (10) Format: MM/DD/YYYY
12
Transaction Code
Transaction Code (1) See Code Descriptions below.
char (01)
13
Plan Name
Health Plan Name
char (49)
14
Address 1
Mailing Address 1 from MEDS
char (38)
15
Address 2
Mailing Address 2 from MEDS
char (50)
16
City
City
char (20)
17
ZIP
Mailing ZIP Code
char (05)
18
State
State
char (02)
19
Telephone
Beneficiary’s Telephone Number “N/A” if blank
char (10)
20
Sex
Beneficiary’s Gender
char (01)
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June 03, 2014
Department of Health Care Services Health Care Options
Weekly Plan File Record Layouts V 3.0 (2) See Code Descriptions below.
21
Language
Beneficiary’s Language Code (3) See Code Descriptions below.
char (01)
22
Medical Doctor ID / NPI *
Medical Provider ID or National Provider Identifier as provided by beneficiary. Not validated by MAXIMUS. “N/A” if not available * NPI Source:
char (10)
For Enrollment Transactions (see Field #12/“Transaction Code”), NPI is beneficiary supplied. For Default /Auto Assignment Transactions created for SPD beneficiaries, NPI is provided if the Auto Assignment was based upon Provider Linkage. Note: if there is no clear provider linkage, an auto assignment is made at random. The randomly assigned plan is cross-referenced against the beneficiaries linked provider. If a match is found, the corresponding NPI is provided. 23
Medical Affiliate and Medical Provider Information
Medical Affiliate abbreviation (up to 4 characters) or “N/A” + “-” + Other Doctor/Clinic Information as provided by Beneficiary or “N/A” (e.g. “ABCD-N/A”). Not validated by MAXIMUS.
char (40)
24
Effective Date
Date the Transaction is Effective Format: MM/DD/YYYY
char (10)
25
Period End Date
Period End Date for File Extract Format: MM/DD/YYYY
char (10)
26
Transaction Description
“Enrollment” for enrollment transactions, Disenrollment Reason for disenrollments, “%” for demographic updates.
char (50)
27
PCP/Demo Type
Indicates type of demographic update.
char (22)
28
Pregnancy Due Date
Pregnancy Due Date Format: MM/DD/YYYY “N/A” if not available
char (10)
29
CIN
Client Identification Number
char (09)
30
Dental Provider ID/NPI
Dental Provider ID or National Provider Identifier as provided by beneficiary. Not validated by MAXIMUS. “N/A” if not available
char (10)
31
Dental Affiliate and Dental Provider Information
Dental Affiliate abbreviation (up to 4 characters) or “N/A” + “-” + Other Dental/Clinic Information as provided by Beneficiary or “N/A” (e.g. “ABCD-N/A”). Not validated by MAXIMUS.
char(40)
32
HICN
Health Insurance Claim Number “N/A” if Null/Blank
char(12)
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Department of Health Care Services Health Care Options 33
Enrollment Record ID
Weekly Plan File Record Layouts V 3.0
CRM Enrollment ID - For DHCS Use Only
char(10)
The following four additional fields are present on files for Los Angles and Sacramento County plans only: Note: These additional fields are NOT included in the PACE plan files irrespective of county. The fields are populated only for Enrollment Transactions where the beneficiary has provided a valid Medical Provider ID (Refer to field 22) that can be cross referenced to the Plan supplied Provider Master File. 1
PCPID
Primary Car Provider Identifier from the Plan supplied Provider Master File
char (40)
2
PCP Location ID
Primary Care Provider Location Identifier from the Plan supplied Provider Master File
char (15)
3
NPI
National Provider Identifier from the Plan supplied Provider Master File
char (10)
4
Medical Group
Medical Group Name from the Plan supplied Provider Master File
