Florida Health Plan Export File Formats Contents · PDF fileFlorida Health Plan Export File...

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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
5/07/2013 Updated file name (date) and schedule for when the files are loaded onto the AHS FTP Server for download by the plans (Changes are Red Text Highlighted Yellow)
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
The date in the file name will be the effective date of the enrollments within the Enrollment file.
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 following schedule: Tuesday after the monthly processing cycle.
1. Monthly Magic: On the penultimate Saturday of the month.
2. Month End: First day of the next month.
3. MediKids Supplemental: Between the 3rd and 8th of the next month.
Field Description Length Notes
Plan Code Plan Code of the Health Plan 9
Recipient Number Beneficiarys unique Identification number 10
Case Number Beneficiarys Case Number 10
First Name Beneficiarys First name 15
Middle Initial Beneficiarys Middle Initial 1
Last Name Beneficiarys Last Name 25
Address 1 Beneficiarys Address Line 1 30
City Beneficiarys City 30
State Beneficiarys State 2
Zip Code Beneficiarys Zip 10
Phone Number Beneficiarys 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 beneficiarys 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
The date in the file name will be the effective date of the enrollments within the file.
File Format
Last Name Beneficiarys Last Name 15
City Beneficiarys City 30
State Beneficiarys State 2
Zip Code Beneficiarys Zip 10
Phone Number Beneficiarys 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 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
The date in the file name will be the effective date of the dis-enrollments within the file.
File Format
Last Name Benefic

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