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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

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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

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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

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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

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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

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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

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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.

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Error Code 4 Digit error code indicating if there is an issue with the record.

4 See Appendix H

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Appendix A List of Status Codes contained in the Open Enrollment File

1 = 90-day change

2 = Locked-In

3 = 60-day Open Enrollment

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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

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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

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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

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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

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Appendix F List of Plan Types contained in the Provider Response File

H = HMO

P = PSN

M = MediPass

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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

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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

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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

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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

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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

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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

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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