5 Period Beginning Date 11/8/12 Date Period - Integer Century Year - CCYYMM int[6] Header Period Start Date Report the Year and Month of the reported submission period in CCYYMM format. This date period must be repeated in HD006, TR005 and TR006. This same date must be selected in the upload application for successful transfer. Mandatory 100% HM 6 Period Ending Date 11/8/12 Date Period - Integer Century Year - CCYYMM int[6] Header Period Ending Date Report the Year and Month of the reporting submission period in CCYYMM format. This date period must match the date period reported in HD005 and be repeated in TR005 and TR006. Mandatory 100% HM 7 Record Count 11/8/12 Integer Counter varchar[10] Header Record Count Report the number of records submitted within this file. Do not report leading zeros, space fill, decimals, or any special characters. Mandatory 100% HM 8 Comments 11/8/12 Text Free Text Field varchar[80] Header Carrier Comments May be used to document the submission by assigning a filename, system source, compile identifier, etc. Optional 0% HO 9 APCD Version Number 2/2016 Decimal - Numeric ID Version char[3] Submission Guide Version Report the version number as presented on the APCD Product File Submission Guide in 0.0 Format. Sets the intake control for editing elements. Version must be accurate else file will drop. EXAMPLE: 3.0 = Version 3.0 Mandatory 100% HM Code Description 2.0 Prior Version; valid only for reporting periods prior to October 2013 3.0 Version 3.0; required for reporting periods as of October 2013 – No longer valid as of May 2015 4.0 Version 4.0; required for reporting periods October 2013 onward; No longer valid as of August 2016 5.0 Version 5.0; required for reporting periods October 2013 onward as of August 2016; No longer valid as of August 2017 PR PR 005 006 007
6.0 Version 6.0; required for reporting periods October 2013 onward as of August 2017 1 Product ID number 11/8/12 Text ID Link to ME040, MC079, PC056, DC042 varchar[30] Product Identification Report the submitter-assigned identifier that uniquely defines this product. This identifier is used to link this Product line with its attributes to eligibility and claim lines. All 100% A0 2 Product Name 6/24/10 Text Name Product varchar[70] Submitter defined Product name Report a unique name for every Product in a Carrier's system. For Products with identical names, it is required that the Submitter add a refining 'element' to create unique Product Names that align to unique Product ID Numbers. This refining element can be numeric, alpha or alpha-numeric. All 100% C PR 3 Carrier License Type 11/8/12 Lookup Table - Text char[3] Carrier License Type Report the code that defines the License Type of this Product. EXAMPLE: COM = Commercial All 100% A0 Code Description BLU Blue Cross and Blue Shield Licensee COM Commercial Carrier HMO Health Maintenance Organization MAO Medicare Advantage Organization PBM Pharmacy Benefit Manager SCO Senior Care Option TPA Third Party Administrator 176 Chapter 176 OTH Other License Type PR 4 Product Line of Business Model Lookup - Text char[2] Line of Business / Insurance Model the Product relates to. Report the code that defines the Line of Business that this product follows. EXAMPLE: 12 = PPO All 100% A0 004
0 Other PR 7 Product Benefit Description 11/8/12 Text Free Text Field varchar[80] Benefit Description Report the Other Product description when the product's Product Benefit does not fall within the standard listing for PR006 Product Benefit Type. EXAMPLE: Chiropractic Services Required when PR006 = 0 <zero> 100% A2 PR 8 Risk Type 5/14/13 Lookup Table - Integer tlkpRiskType int[1] Risk Options Report the value that best describes the risk model that defines how eligibilities are insured under this product line. EXAMPLE: 1 = Fully Insured All 100% A0 Value Description 1 Fully Insured 2 Self-Insured 3 Product available to risk and accounts 0 Other PR 9 Product Date 6/24/10 Full Date - Integer Century Year Month Date - CCYYMMDD int[8] Product Start Date Report the first date that this product is active in CCYYMMDD Format. All 100% A0 PR 10 Product End Date Full Date - Integer Century Year Date - CCYYMMDD int[8] Product End Date Report the last date that this product is active in CCYYMMDD Format. If product is still active do not report any value here. Required when 100% B PR 11 Product Active Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Active Product Report the value that defines the element. EXAMPLE: 1 = Yes, the Product is active All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable
PR 12 Annual Per Person Deductible Code 11/8/12 Lookup Table - Text char[3] Per Person Deductible bandwidth reporting Report the value that defines the Total Per Person Deductible for all benefits under this product. EXAMPLE: 000 = Plans with no Per Person Deductible All 100% A2 Value Description 000 No per person deductible Deductible Total under $1,000 Deductible Total of $1,000 thru $1,999 Deductible of $2,000 thru $2,999 Deductible Total greater than $3000 999 Not Applicable PR 13 Annual Per Family Deductible Code 11/8/12 Lookup Table - Text char[3] Per Family Deductible bandwidth reporting Report the value that defines the Total Per Family Deductible for all benefits under this product.. EXAMPLE: 000 = Plans with no Per Family Deductible All 100% A2 Value Description 000 No per family deductible 001 Deductible Total under $1,000 002 Deductible Total of $1,000 thru $1,999 003 Deductible of $2,000 thru $2,999 Deductible Total of $3,000 thru $3,999 Deductible Total of $4,000 thru $4,999 Deductible Total of $5,000 thru $5,999 Deductible Total greater than $6,000 999 Not Applicable PR 14 Care model 11/8/12 Lookup Table - Integer int[1] Indicator - Clinical Coordination Report the value that defines the element. EXAMPLE: 1 = Yes, Member's care is clinically coordinated/managed. All 100% A2 Value Description 1 Yes
2 No 3 Unknown 4 Other 5 Not Applicable PR 15 Other Product Line of Business Model 11/8/12 Text Name Other Line of Business varchar[30] Defines Product Line of Business when Other is selected Report the Other Product Line of Business Model here when PR004 reports ZZ. Required when PR004 = ZZ 98% A2 PR 16 Other Risk Type 11/8/12 Text Name Other Risk varchar[30] Defines Risk Type is selected Report the Risk Type here when PR008 reports 0 <zero>. Required when PR008 = 0 <zero> 98% A2 PR 17 NAIC Code 11/8/12 Integer ID NAIC int[5] National Association of Insurance Commissioners' Code Report the NAIC Code associated with the entity that maintains this product. Entities that are not assigned a NAIC must not report any value here. Required when Submitter is identified as a NAIC entity 100% A2 PR 18 External Code Source 2 - Text Situs State External Code Source 2 - States char[2] State / Province of the situs of the Product Report the in which the product was issued. Report Province when Country Code does not = USA All 98% A0 PR 19 Record Type 6/24/10 Text ID File char[2] File Type Identifier Report PR here. This validates the type of file and the data contained within the file. This must HD004. All 100% A0 1 Record Type 6/24/10 Text ID Record char[2] Trailer Record Identifier Report TR here. Indicates the end of the data file. Mandatory 100% TM 2 Submitter 11/8/12 Integer ID Submitter varchar[6] Trailer Submitter / Carrier ID defined by CHIA Report the Unique Submitter ID as defined by CHIA here. This must match the Submitter ID reported in HD002. Mandatory 100% TM 3 National Plan ID 11/8/12 Integer ID Nat'l PlanID int[10] CMS National Plan Identification Number (PlanID) Do not report any value here until National PlanID is fully implemented. This is a unique identifier as outlined by Centers for Medicare and Medicaid Services (CMS) for Plans or Sub plans. Situational 0% TS
4 Type of File 6/24/10 Text ID File char[2] Validates the file type defined in HD004. Report PR here. This must match the File Type reported in HD004. Mandatory 100% TM 5 Period Beginning Date 6/24/10 Date Period - Integer Century Year Month - CCYYMM int[6] Trailer Period Start Date Report the Year and Month of the reported submission period in CCYYMM format. This date period must match the date period reported in HD005 and HD006. Mandatory 100% TM 6 Period Ending Date 6/24/10 Date Period - Integer Century Year Month - CCYYMM int[6] Trailer Period Ending Date Report the Year and Month of the reporting submission period in CCYYMM format. This date period must match the date period reported in TR005 and HD005 and HD006. Mandatory 100% TM 7 Date Processed 6/24/10 Full Date - Integer Century Year Month Date - CCYYMMDD int[8] Trailer Processed Date Report the full date that the submission was compiled by the submitter in CCYYMMDD Format. Mandatory 100% TM Appendix – External Code Sources 2. States, Zip Codes and Other Areas of the US U.S. Postal Service PR018