The Commonwealth of Massachusetts Center for Health Information and Analysis The Massachusetts All-Payer Claims Database Product File Submission Guide October 2014 L. Patrick, Governor Aron Boros, Executive Director Commonwealth of Massachusetts Center for Health Information and Analysis Marilyn Kramer, Deputy Executive Director Center for Health Information and Analysis Version 4.0
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 Month - 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 total 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 Decimal - Numeric ID Version char[3] Submission 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only for reporting periods prior to October 2013 3.0 Version 3.0; required for reporting periods as of October 2013 – No longer valid as of May 2015 4.0 Version 4.0; required for reporting periods October 2013 onward as of May 2015 PR 1 Product ID number 11/8/12 Text ID Link to ME040, MC079,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 PR PR 006 007
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 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 License Type PR 4 Product Line of Business Model Lookup - Text char[2] Line of Business / Insurance the Product relates to. Report the code that defines the Line of Business that this product follows. EXAMPLE: 12 = PPO All 100% A0 Code Description 12 Preferred Provider Organization (PPO) 13 of Service (POS) 14 Exclusive Provider Organization (EPO) 15 Indemnity Insurance
MCRA Medicare Part A MCRB Medicare Part B MCRC Medicare Part C MCRD Medicare Part D MEDX MediGap/Medicare Supplemental/Medex ITHR Other OTMC Medicare STUD Student COBR GRUP Group PR 6 Product Benefit Type 6/24/10 Lookup Table - Integer int[1] Benefit Options Report the value that defines the types of benefits covered under this product. EXAMPLE: 1 = Medical Only All 100% A0 Code Description 1 Medical Only 2 Pharmacy Only 3 Medical and Pharmacy bundled 4 Dental 5 Behavioral Health 6 Vision 7 Accident Only 8 Medical Comprehensive 0 Other PR 7 Other Product Benefit Description 11/8/12 Text Free Text varchar[80] Benefit Description Report the 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 Month 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 PR011=2 100% 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
5 Period Beginning Date 6/24/10 Date Period - Integer Century Year Month - CCYYMM int[6] Trailer Period Date Report the Year and 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 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 and Other Areas of the US U.S. Postal Service