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Florida Health Plan Export File Formats This document contains the format of each file that is exported by AHS and prepared for each Health
Plan.
Contents Health Plan Export File Formats ............................................................................................................... 1
Revision History ................................................................................................................................... 2
Open Enrollment File ........................................................................................................................... 3
File Name..................................................................................................................................... 3
File Format................................................................................................................................... 3
Enrollment File .................................................................................................................................... 4
File Name..................................................................................................................................... 4
File Format................................................................................................................................... 4
Disenrollment File ............................................................................................................................... 5
File Name..................................................................................................................................... 5
File Format................................................................................................................................... 5
Provider Response File......................................................................................................................... 6
File Name..................................................................................................................................... 6
File Format................................................................................................................................... 6
Appendix A .......................................................................................................................................... 8
Appendix B .......................................................................................................................................... 9
Appendix C ........................................................................................................................................ 10
Appendix D ........................................................................................................................................ 11
Appendix E ........................................................................................................................................ 12
Appendix F ........................................................................................................................................ 13
Appendix G ........................................................................................................................................ 14
Appendix H ........................................................................................................................................ 19
2
Revision History
Date Notes Revised By
03/29/2011 Document Created Greg Holtz
08/01/2011 Added allocation of Characters in the Filler to Medipass Greg Holtz
08/02/2011 Switched certain Error Codes from Errors to Warnings Greg Holtz
01/31/2012 Updated descriptions on Error Codes that were incorrect Greg Holtz
07/01/2012 Changed Error Code 051 from Warning to Error Donna Howe
11/08/2012 Updated Appendix G – Specialty Codes Greg Holtz
11/13/2012 Updated Appendix G – Specialty Codes Donna Howe
3
Open Enrollment File The Open Enrollment File contains information on each beneficiary who becomes:
1. Locked-In
2. Enters a 90-day change window
3. Enters the annual 60-day open enrollment period
The file contains 1 record for each beneficiary who is currently enrolled with the Health Plan and who is
subject to Open Enrollment.
File Name
“XXX_OENYYYYMM.dat”
Notes: XXX = 3 character assigned plan ID
File Format
The files are in a Fixed Width ASCII flat file format and are loaded onto the AHS FTP Server for download
on the Tuesday after the monthly processing cycle.
Field Description Length Notes
Plan Code Plan Code of the Health Plan 9
Recipient Number Beneficiary’s unique Identification number 10
Case Number Beneficiary’s Case Number 10
First Name Beneficiary’s First name 15
Middle Initial Beneficiary’s Middle Initial 1
Last Name Beneficiary’s Last Name 25
Address 1 Beneficiary’s Address Line 1 30
Address 2 Beneficiary’s Address Line 2 30
City Beneficiary’s City 30
State Beneficiary’s State 2
Zip Code Beneficiary’s Zip 10
Phone Number Beneficiary’s Phone Number 10
Begin Date The first day of the period outlined by Status Code 8 MMDDYYYY
End Date The last day of the period outlined by Status Code 8 MMDDYYYY
Status Code Code indicating which period the Beneficiary is currently in.
2 See Appendix A
4
Enrollment File The Enrollment File contains the beneficiary’s primary care physician selection and any special medical
needs information for the beneficiary.
The file contains 1 record for each beneficiary who has selected to enroll in the Health Plan starting on
the first day of the following month.
File Name
“XXX_RECIYYYYMM.dat”
Notes: XXX = 3 character assigned plan ID
File Format
The files are in a Fixed Width ASCII flat file format and are loaded onto the AHS FTP Server for download
on the Tuesday after the monthly processing cycle.
Field Description Length Notes
Recipient Number Beneficiary’s unique Identification number 10
Case Number Beneficiary’s Case Number 10
First Name Beneficiary’s First name 25
Middle Initial Beneficiary’s Middle Initial 1
Last Name Beneficiary’s Last Name 15
Address 1 Beneficiary’s Address Line 1 30
Address 2 Beneficiary’s Address Line 2 30
City Beneficiary’s City 30
State Beneficiary’s State 2
Zip Code Beneficiary’s Zip 10
Phone Number Beneficiary’s Phone Number 10
Language Language spoken by the Beneficiary 2 See Appendix B
Pregnancy Indicator Indicates if the Beneficiary is pregnant 1 0 = NO, 1 = YES
Pregnancy Due Date Expected due date of the Pregnancy 8 MMDDYYYY
Special Need Code 1 Indicates if the Beneficiary has a special need 2 See Appendix C
Special Need Code 2 Indicates if the Beneficiary has a special need 2 See Appendix C
Special Need Code 3 Indicates if the Beneficiary has a special need 2 See Appendix C
Special Need Notes Notes about special needs 200
Plan Provider Number Number assigned to the Provider by the Plan 15
Provider Last Name Last Name of the Provider 30
Provider First Name First Name of the Provider 30
Clinic/Hosp/Group Name Name of the Clinic, Hospital, or Group 60
Plan Enrollment Indicator Indicates the Type of Enrollment 1 0 = Mandatory 1 = Voluntary
Plan Number Plan Code of the Health Plan 9
5
Disenrollment File The Disenrollment File contains the Beneficiaries who will be leaving the Health Plan, effective at the
end of the current month.
The file contains 1 record for each Beneficiary with the reason they are leaving.
File Name
“XXX_RECI_DE_FLCC_YYYYMM.dat”
Notes: XXX = 3 character assigned plan ID
File Format
The files are in a Fixed Width ASCII flat file format and are loaded onto the AHS FTP Server for download
on the Tuesday after the monthly processing cycle.
Field Description Length Notes
Recipient Number Beneficiary’s unique Identification number 10
Case Number Beneficiary’s Case Number 10
First Name Beneficiary’s First name 25
Middle Initial Beneficiary’s Middle Initial 1
Last Name Beneficiary’s Last Name 15
Disenroll Date The Last day the Beneficiary will be enrolled 8 MMDDYYYY
Disenroll Reason The reason the Beneficiary is leaving the Plan 50
6
Provider Response File The Provider Response File is a return of the original Provider Import File with an additional 4 characters
added to the end of the file for the error codes (total of 387 characters).
File Name
“XXX_RESP_PROVYYYYDDMM.dat”
Notes: XXX = 3 character assigned plan ID
File Format
Field Description Length Notes
Plan Code Plan Code of the Health Plan 9
Provider Type Indicates the provider’s area of service 1 See Appendix D
Plan Provider Number Number assigned to the Provider by the Plan 15
Group Affiliation Number assigned to the Group by the Plan 15
SSN/FEIN SSN or Federal ID Number 9
Provider Last Name Last Name of the Provider or Group Name 30
Provider First Name First Name of the Provider 30
Provider Address 1 Address 1 of the Provider’s Location 30
Provider Address 2 Address 2 of the Provider’s Location 30
Provider City City of the Provider’s Location 30
Provider Zip Code Zip Code of the Provider’s Location 9
Provider Area Code Area Code of the Provider Phone Number 3
Provider Phone Number Phone Number of the Provider’s Location 7
Provider Phone Ext Phone Extension of the Provider’s Location 4
Provider Gender Gender of the Provider 1 M = Male F = Female U = Unknown
PCP Indicator Indicates if the Provider is a PCP 1 P = YES, N = NO
Provider Limitation Limitation of the Provider 1 See Appendix E
Plan Type The Type of Plan 1 See Appendix F
Evening Hours Does the Provider have Evening Hours 1 Y = YES, N = NO
Saturday Hours Does the Provider have Saturday Hours 1 Y = YES, N = NO
Age Restrictions Age Restrictions 20
Primary Specialty Code identifying the provider’s specialty 3 See Appendix G
Specialty 2 Code identifying the provider’s specialty 3 See Appendix G
Specialty 3 Code identifying the provider’s specialty 3 See Appendix G
Language 1 Code identifying the provider’s language 2 See Appendix B
Language 2 Code identifying the provider’s language 2 See Appendix B
Language 3 Code identifying the provider’s language 2 See Appendix B
Hospital Affiliation 1 Hospital with which the Provider is affiliated 9
Hospital Affiliation 2 Hospital with which the Provider is affiliated 9
Hospital Affiliation 3 Hospital with which the Provider is affiliated 9
Hospital Affiliation 4 Hospital with which the Provider is affiliated 9
Hospital Affiliation 5 Hospital with which the Provider is affiliated 9
Wheel Chair Access Does the Provider have wheel chair access 1 Y = YES, N = NO
# of Patients The Number of members enrolled with PCP 4
Active Patient Load The Number of allowed member enrollments 4
License Number Professional License Number of the Provider 15
7
AHCA Hospital ID Hospital ID 8
CHD Indicator County Health Department Indicator 1
NPI Type I NPI 1 10
NPI Type II NPI 2 10
Medicaid ID Medicaid ID of the Provider 12
Filler *The 1st Character is being used by MediPass to indicate a CMS Provider. **The 2nd-5th Characters are being used by MediPass to indicate maximum monthly Auto Assignment allowed for a Provider.
10
Error Code 4 Digit error code indicating if there is an issue with the record.
4 See Appendix H
8
Appendix A List of Status Codes contained in the Open Enrollment File
1 = 90-day change
2 = Locked-In
3 = 60-day Open Enrollment
9
Appendix B List of Languages contained in the Enrollment File
01 = English
02 = Spanish
03 = Haitian Creole
04 = Vietnamese
05 = Cambodian
06 = Russian
07 = Laotian
08 = Polish
09 = French
10 = Other
10
Appendix C List of Special Need Codes contained in the Enrollment File
1 = Asthma
2 = Diabetes
3 = Heart Disease
4 = High Blood Pressure
5 = Kidney Problems
6 = Birth Defects
7 = Recent Surgery
8 = Cancer
9 = Mental Health Condition
10 = Sickle Cell Disease
11 = Visually Impaired
12 = Hearing Impaired
13 = Speech Impaired
14 = Developmental Delay
15 = Physical Disability
16 = Drug/Alcohol Problem
17 = Mentally Retarded
18 = Substitute Care
19 = Wheelchair Access Req.
20 = Other Chronic Illness
21 = HIV/AIDS
11
Appendix D List of Provider Types contained in the Provider Response File
P = Primary Care Provider
I = Non-PCP Practitioner
B = Birthing Center
T = Therapy
G = Group Practice
H = Hospital
C = Crisis Stabilization Unit
D = Dentist
R = Pharmacy
A = Ancillary Provider
12
Appendix E List of Provider Limitations contained in the Provider Response File
X = Accepting New Patients
N = No New Patients
L = Leaving Network
P = Existing Patients Only
C = Accepting Children Only
A = Accepting Adults Only
R = Refer Member To HMO Member Services
F = Female Patients Only
S = Accepting Children Through CMS Only
13
Appendix F List of Plan Types contained in the Provider Response File
H = HMO
P = PSN
M = MediPass
14
Appendix G List of Specialty Codes contained in the Provider Response File
Legend
Highlight Description
Blue The code has a new description.
Yellow The code is new and the description has been moved from one of the codes highlighted in Blue. The old code is listed in parenthesis after the description, ex) (Old code 100) and is not part of the actual description.
Green The code and description are new.
001 = ADOLESCENT MEDICINE
002 = ALLERGY
003 = ANESTHESIOLOGY
004 = CARDIOVASCULAR MEDICINE
005 = DERMATOLOGY
006 = DIABETES
007 = EMERGENCY MEDICINE
008 = ENDOCRINOLOGY
009 = FAMILY PRACTICE
010 = GASTROENTEROLOGY
011 = GENERAL PRACTICE (DEFAULT SPEC FOR PHYS)
012 = PREVENTATIVE MEDICINE
013 = GERIATRICS
014 = GYNECOLOGY
015 = HEMATOLOGY
016 = IMMUNOLOGY
017 = INFECTIOUS DISEASE
018 = INTERNAL MEDICINE
019 = NEONATAL / PERINATAL
020 = NEOPLASTIC DISEASES
021 = NEPHROLOGY
022 = NEUROLOGY
023 = NEUROLOGY / CHILDREN
024 = NEUROPATHOLOGY
025 = NUTRITION
026 = OBSTETRICS
027 = OB-GYN
028 = OCCUPATIONAL MEDICINE
029 = ONCOLOGY
030 = OPHTHALMOLOGY
031 = OTOLARYNGOLOGY
032 = PATHOLOGY
033 = PATHOLOGY, CLINICAL
034 = PATHOLOGY, FORENSIC
035 = PEDIATRICS
036 = PEDIATRIC ALLERGY
15
037 = PEDIATRIC CARDIOLOGY
038 = PEDIATRIC ONCOLOGY & HEMATOLOGY
039 = PEDIATRIC NEPHROLOGY
040 = PHARMACOLOGY
041 = PHYSICAL MEDICINE AND REHAB
042 = PSYCHIATRY
043 = PSYCHIATRY, CHILD
044 = PSYCHOANALYSIS
045 = PUBLIC HEALTH
046 = PULMONARY DISEASES
047 = RADIOLOGY
048 = RADIOLOGY, DIAGNOSTIC
049 = RADIOLOGY, PEDIATRIC
050 = RADIOLOGY, THERAPEUTIC
051 = RHEUMATOLOGY
052 = SURGERY, ABDOMINAL
053 = SURGERY, CARDIOVASCULAR
054 = SURGERY, COLON / RECTAL
055 = SURGERY, GENERAL
056 = SURGERY, HAND
057 = SURGERY, NEUROLOGICAL
058 = SURGERY, ORTHOPEDIC
059 = SURGERY, PEDIATRIC
060 = SURGERY, PLASTIC
061 = SURGERY, THORACIC
062 = SURGERY, TRAUMATIC
063 = SURGERY, UROLOGICAL
064=OTHER (NO LONGER EXISTS)
065 = MATERNAL / FETAL
066 = COMPREHENSIVE BEHAVIORAL HEALTH ASSESSMENT
067 = SPECIALIZED THERAPEUTIC FOSTER CARE
068 = CONSUMER DIRECTED CARE
069 = MEDICAL OXYGEN RETAILER
070 = ADULT DENTURES ONLY
071 = GENERAL DENTISTRY
072 = ORAL SURGEON (DENTIST)
073 = PEDODONTIST
074 = OTHER DENTIST
075 = ADULT PRIMARY CARE
076 = CLINICAL NURSE SPECIALIST PSYCH. MENTAL HEALTH
077 = COLLEGE HEALTH NURSE PRACTITIONER
078 = DIABETIC NURSE PRACTITIONER
079 = TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY
080 = FAMILY NURSE
081 = FAMILY PLANNING
16
082 = GERIATRIC
083 = MATERNAL / CHILD HEALTH FAMILY PLANNING
084 = CERTIFIED REGISTERED NURSE ANESTHETIST
085 = CERTIFIED REGISTERED NURSE MIDWIFE
086 = OB/GYN NURSE
087 = PEDIATRIC NURSE
088 = ORTHODONTIST
089 = ASSISTED LIVING FOR THE ELDERLY
090 = OCCUPATIONAL THERAPIST
091 = PHYSICAL THERAPIST
092 = SPEECH THERAPIST
093 = RESPIRATORY THERAPIST
095 = AGED/DISABLED ADULTS
096 = DEVELOPMENTAL DISABILITY
097 = CHANNELING
098 = COMMUNITY SUPPORTED LIVING ARRANGEMENT
099 = PROJECT AIDS CARE
100 = GENETICS
101 = PEDIATRICS, CRITICAL CARE
102 = PEDIATRICS, EMERGENCY CARE
103 = SURGERY, PEDIATRIC - NON-BOARD CERTIFIED
104 = SURGERY, UROLOGIC - NON-BOARD CERTIFIED
110 = FAMILIAL DYSAUTONOMIA
112 = ADULT CYSTIC FIBROSIS
113 = ADULT DAY CARE
114 = PERSONAL CARE
121 = ASSISTED LIVING
122 = EXTENDED CONGREGATE CARE
123 = LIMITED NURSING SPECIALTY LICENSE
124 = LIMITED MENTAL HEALTH SPECIALTY LICENSE
125 = ADULT FAMILY CARE HOME
126 = RESIDENTIAL TREATMENT FACILITY
130 = ANESTHESIOLOGY ASSISTANT
140 = HOSPITALIST (OLD CODE 104)
150 = COMMUNITY PHARMACY
151 = INFUSION PHARMACY
152 = LTC - NON COMMUNITY
153 = INSTITUTIONAL CLASS I PHARMACY (HOSPITAL/NH)
154 = TAX SUPPORTED
155 = 340B PHARMACY
156 = DISPENSING PRACTITIONER
157 = NUCLEAR PHARMACY
158 = SPECIAL PHARMACY (PARENTERAL, ALF, CLSD SYS, ESRD)
160 = RETAIL HEALTH CLINIC
172 = RNFA
17
173 = COUNTY HEALTH DEPARTMENT CERTIFIED MATCH RN/LPN
174 = MENTAL HEALTH TCM
800 = MANAGED CARE TREATING PROVIDER - ACUPUNCTURIST
801 = MANAGED CARE TREATING PROVIDER - NUTRITIONIST
802 = MANAGED CARE TREATING PROVIDER - INDPDT DIAGNOST
803 = MANAGED CARE TREATING PROVIDER - OTHER
901 = GENERAL HOSPITAL
905 = COMMUNITY MENTAL HEALTH SERVICES
906 = AMBULATORY SURGERY CENTER
907 = SPECIALIZED MENTAL HEALTH PRACTITIONER
908 = SCHOOL DISTRICT
909 = SKILLED NURSING UNIT HOSPITAL BASED
910 = SKILLED NURSING FACILITY
913 = SWING BED FACILITY
915 = HOSPICE
923 = MEDICAL FOSTER CARE/ PERSONAL CARE PROVIDER
924 = PRESCRIBED PEDIATRIC EXTENDED CARE
927 = PODIATRIST (OLD CODE 102)
928 = CHIROPRACTOR (OLD CODE 100)
929 = PHYSICIAN ASSISTANT
930 = NURSE PRACTITIONER (ARNP) - GROUP
934 = LICENSED MIDWIFE
940 = AMBULANCE
941 = NON-EMERGENCY TRANSPORT
942 = AIR AMBULANCE
943 = TAXICAB COMPANY
944 = GOVERNMENT/MUNICIPAL TRANSPORT
945 = PRIVATE TRANSPORTATION
946 = NON-PROFIT TRANSPORTATION
947 = MULTI-LOAD PRIVATE TRANSPORT
950 = INDEPENDENT LABORATORY
951 = PORTABLE X-RAY COMPANY
960 = AUDIOLOGIST
961 = HEARING AID SPECIALIST
962 = OPTOMETRIST (OLD CODE 101)
963 = OPTICIAN
965 = HOME HEALTH AGENCY
966 = RURAL HEALTH CLINIC
968 = FEDERALLY QUALIFIED HEALTH CENTER
969 = BIRTH CENTER
981 = PROFESSIONAL EARLY INTERVENTION SERVICES
983 = THERAPIST (PT, OT, ST, RT) - GROUP
989 = DIALYSIS CENTER
990 = DURABLE MED EQUIPT/ MEDICAL SUPPLIES
991 = CASE MANAGEMENT AGENCY
18
992 = UROLOGIST (OLD CODE 103)
BH1 = PSYCHOLOGY, ADULT
BH2 = PSYCHOLOGY, CHILD
BH3 = MENTAL HEALTH COUNSELOR
BH4 = COMMUNITY MENTAL HEALTH CENTER
BH5 = CASE MANAGER
BH6 = INDIVIDUAL LICENSED PRACTITIONER OF HEALTH ARTS
BH7 = PSYCHIATRY (CHILD & ADULT)
BH8 = PSYCHOTHERAPY (CHILD & ADULT)
D01 = ENDODONTIC
D02 = PROSTHODONTISTRY
D03 = PERIODONTIST
19
Appendix H List of Error Codes contained in the Provider Response File
Code Field Description IsWarning
0001 Plan Code Plan Code is a required field Error
0002 Provider Type Provider Type is a required field Error
0003 Plan Provider Number Plan Provider Number is a required field Error
0004 Group Affiliation Group Affiliation is required when Provider Type = 'G' Error
0005 Group Affiliation Group Affiliation must match Plan Provider Number when Provider Type = 'G' Error
0006 Group Affiliation Group Affiliation must match a previously submitted group or a group on this file Error
0007 SSN or FEIN SSN or FEIN is a required field Error
0008 Provider Last Name Provider Last Name is a required field Error
0009 Address Line 1 Address Line 1 is a required field Error
0010 City City is a required field Error
0011 Zip Code Zip Code is a required field Error
0012 Zip Code Zip Code must be 5 or 9 digits Error
0013 Phone Area Code Area Code must be 3 digits Error
0014 Phone Number Phone Number must be 7 digits Error
0015 PCP Indicator PCP Indicator is a required field when Provider Type = "P" Error
0016 PCP Indicator PCP Indicator cannot be 'P' when HMO/Medipass Indicator = 'H' and Provider Type = 'G' Error
0017 Provider Limitation Provider Limitation is required when PCP Indicator = 'P' Error
0018 HMO/Medipass Indicator HMO/Medipass Indicator is a required field Error
0019 HMO/Medipass Indicator HMO/Medipass Indicator value is not valid Error
0020 Gender Gender value is not valid Warning
0021 Provider Type Provider Type value is not valid Error
0022 PCP Indicator PCP Indicator value is not valid Error
0023 Provider Limitation Provider Limitation value is not valid Error
0024 Evening Hours Evening Hours value is not valid Warning
0025 Saturday Hours Saturday Hours value is not valid Warning
0026 Primary Specialty
Primary Specialty is required when Provider Type is ('P','I','D','T') or Provider Type = 'G' when recipients are enrolled to the group Error
0027 Primary Specialty Primary Specialty value is not valid Error
0028 Specialty 2 Specialty 2 value is not valid Warning
0029 Specialty 3 Specialty 3 value is not valid Warning
0030 Language 1 Language 1 value is not valid Warning
0031 Language 2 Language 2 value is not valid Warning
0032 Language 3 Language 3 value is not valid Warning
0033 Hospital Affiliation 1 Hospital Affiliation 1 value is not valid Warning
0034 Hospital Affiliation 2 Hospital Affiliation 2 value is not valid Warning
20
0035 Hospital Affiliation 3 Hospital Affiliation 3 value is not valid Warning
0036 # of Member Patients
# of Member Patients is required when PCP Indicator = 'P' and (HMO/Medipass Indicator = 'H' or Provider Type = 'G') Warning
0037 # of Member Patients # of Member Patients value is not valid Warning
0038 Hospital Affiliation 4 Hospital Affiliation 4 value is not valid Warning
0039 Hospital Affiliation 5 Hospital Affiliation 5 value is not valid Warning
0040 Active Patient Load Active Patient Load is required when HMO/Medipass Indicator <> 'M' Error
0041 Active Patient Load Active Patient Load value is not valid Error
0042 Wheel Chair Access Wheel Chair Access value is not valid Warning
0043 Professional License Number Professional License Number is required when Provider Type is not ('A','B','C','G','H','R') Error
0044 AHCA Hospital ID AHCA Hospital ID is required when HMO/Medipass Indicator is ('H','P') AND Provider Type = 'H' Warning
0045 AHCA Hospital ID AHCA Hospital ID value is not valid Warning
0046 County Health Department Indicator County Health Department is required when HMO/Medipass Indicator <> 'M' Warning
0047 County Health Department Indicator County Health Department value is not valid Warning
0048 NPI Type I NPI Type I value is a required field Warning
0049 Medicaid Provider ID Medicaid Provider ID is a required field Warning
0050 Plan Code Plan Code is invalid Error
0051 Age Restrictions Age Restrictions is invalid Error
0052 Not Field Specific Duplicate Record Error
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