United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Product File Submission October 22, 2010 - v2.0 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
Product File Submission June 7, 2013 - v3.1 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
Product File Submission October 1, 2014 - v4.0 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
File Specification: Product File Submission - October 22, 2010 - v2.0 (Massachusetts) Product File Submission - June 7, 2013 - v3.1 (Massachusetts) Product File Submission - October 1, 2014 - v4.0 (Massachusetts)
[Shared] Responsible Organization:
Massachusetts Center for Health Information and Analysis Massachusetts Center for Health Information and Analysis Massachusetts Center for Health Information and Analysis
[Shared] Definition:
A MA APCD file that reports all products that a carrier maintains as a saleable service. Typically these products are listed with the Division of Insurance. A MA APCD file that reports all products that a carrier maintains as a saleable service. Typically these products are listed with the Division of Insurance. A MA APCD file that reports all products that a carrier maintains as a saleable service. Typically these products are listed with the Division of Insurance.
File Specification: Product File Submission - October 22, 2010 - v2.0 (Massachusetts) Product File Submission - June 7, 2013 - v3.1 (Massachusetts) Product File Submission - October 1, 2014 - v4.0 (Massachusetts)
HD001
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
 
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
Header Elements
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
Header Elements
HD002
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
HD003
[Shared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
HD004
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
 
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
PRODUCT
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
PRODUCT
HD005
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
HD006
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
HD007
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
HD008
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
HD009
Data Element: HD009
not present in this file submission.
[Unshared] Name: APCD Version Number
[Unshared] Type: Decimal - Numeric
[Unshared] Length: 3
Codes:
2.0
Prior Version; valid only for reporting periods prior to October 2013
3.0
Current Version; required for reporting periods as of October 2013
 
 
[Unshared] Name: APCD Version Number
[Unshared] Type: Decimal - Numeric
[Unshared] Length: 3
Codes:
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
PR001
[Shared] Name: Product ID number
[Shared] Type: Text
[Unshared] Length: 20
[Shared] Name: Product ID number
[Shared] Type: Text
[Unshared] Length: 30
[Shared] Name: Product ID number
[Shared] Type: Text
[Unshared] Length: 30
PR002
[Shared] Name: Product Name
[Shared] Type: Text
[Shared] Length: 70
[Shared] Name: Product Name
[Shared] Type: Text
[Shared] Length: 70
[Shared] Name: Product Name
[Shared] Type: Text
[Shared] Length: 70
PR003
[Shared] Name: Carrier License Type
[Unshared] Type: Text
[Unshared] Length: 10
Codes:
176
Chapter 176
BLU
Blue Cross and Blue Shield Licensee
COM
Commercial Carrier
HMO
Health Maintenance Organization
MAO
Medicare Advantage Organization
 
 
 
 
SCO
Senior Care Option
TPA
Third Party Administrator
[Shared] Name: Carrier License Type
[Unshared] Type: Lookup Table - Text
[Unshared] Length: 3
Codes:
176
Chapter 176
BLU
Blue Cross and Blue Shield Licensee
COM
Commercial Carrier
HMO
Health Maintenance Organization
MAO
Medicare Advantage Organization
OTH
Other License Type
PBM
Pharmacy Benefit Manager
SCO
Senior Care Option
TPA
Third Party Administrator
[Shared] Name: Carrier License Type
[Unshared] Type: Lookup Table - Text
[Unshared] Length: 3
Codes:
176
Chapter 176
BLU
Blue Cross and Blue Shield Licensee
COM
Commercial Carrier
HMO
Health Maintenance Organization
MAO
Medicare Advantage Organization
OTH
Other License Type
PBM
Pharmacy Benefit Manager
SCO
Senior Care Option
TPA
Third Party Administrator
PR004
[Shared] Name: Product Line of Business Model
[Unshared] Type: Text
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
 
 
 
 
AC
Accident Only
BH
Basic Hospital
CH
CHAMPUS
DM
Dental Maintenance Organization
DS
Disability
HC
HMO - Closed
HO
HMO - Open
IN
Individual
LM
Liability Medical
MC
Medicaid FFS
MO
Medicaid Managed Care Organization
MP
Medicare Primary
MR
Medicare
 
 
OF
Other Federal Program (e.g. Black Lung)
PC
Medicaid Primary Care Clinician Plan
PR
Preferred Provider Organization (PPO)
 
 
QM
Qualified Medicare Beneficiary/SLMB
SA
Self Administered Group
SC
Senior Care Option
SP
Supplemental Policy
 
 
TV
Title V
 
 
VA
Veterans Administration Plan
 
 
WC
Workers' Compensation
ZZ
Mutually Defined Other
[Shared] Name: Product Line of Business Model
[Unshared] Type: Lookup Table - Text
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
20
Medicare Advantage PPO
21
Medicare Advantage Private Fee for Service
AC
Accident Only
BH
Basic Hospital
CH
CHAMPUS
DM
Dental Maintenance Organization
DS
Disability
HC
HMO - Closed
HO
HMO - Open
IN
Individual
LM
Liability Medical
MC
Medicaid FFS
MO
Medicaid Managed Care Organization
MP
Medicare Primary
MR
Medicare
MS
Medicare Secondary Plan
OF
Other Federal Program (e.g. Black Lung)
PC
Medicaid Primary Care Clinician Plan
PR
Preferred Provider Organization (PPO)
 
 
QM
Qualified Medicare Beneficiary/SLMB
SA
Self-Administered Group
SC
Senior Care Option
SP
Supplemental Policy
TF
HSN Trust Fund
TV
Title V
UN
Unemployment
VA
Veterans Administration Plan
VS
Vision
WC
Workers' Compensation
ZZ
Other
[Shared] Name: Product Line of Business Model
[Unshared] Type: Lookup Table - Text
[Shared] Length: 2
Codes:
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Advantage
20
Medicare Advantage PPO
21
Medicare Advantage Private Fee for Service
AC
Accident Only
BH
Basic Hospital
CH
CHAMPUS
DM
Dental Maintenance Organization
DS
Disability
HC
HMO - Closed
HO
HMO - Open
IN
Individual
LM
Liability Medical
MC
Medicaid FFS
MO
Medicaid Managed Care Organization
MP
Medicare Primary
MR
Medicare
MS
Medicare Secondary Plan
OF
Other Federal Program (e.g. Black Lung)
PC
Medicaid Primary Care Clinician Plan
PR
Preferred Provider Organization (PPO)
QH
Qualified Health Plan
QM
Qualified Medicare Beneficiary/SLMB
SA
Self-Administered Group
SC
Senior Care Option
SP
Supplemental Policy
TF
HSN Trust Fund
TV
Title V
UN
Unemployment
VA
Veterans Administration Plan
VS
Vision
WC
Workers' Compensation
ZZ
Other
PR005
[Shared] Name: Insurance Plan Market
[Unshared] Type: Text
[Unshared] Length: 10
Codes:
COBR
COBRA
GCCH
Group-Commonwealth Choice
GCOB
Group COBRA
GEMP
Group-Employer
GFED
Group-Federal
GGIC
Group-GIC
GMMK
Group-Merged Market
GMUN
Group-Municipality
GPOS
Group - POS
GPRT
Group-Retiree
GRUP
Group
GSC0
Group-Senior Care Option
GUNN
Group-Union
HEXC
Health Exchange
ICCA
Individual - Commonwealth Care
ICCH
Individual - Commonwealth Choice
ICLO
Individual Closed
ICOB
Individual COBRA
 
 
ITHR
Other
IYGA
Individual Young Adult
MCRA
Medicare Part A
MCRB
Medicare Part B
MCRC
Medicare Part C
MCRD
Medicare Part D
MEDX
MediGap/Medicare Supplemental/Medex
OTMC
Other Medicare
STUD
Student
[Shared] Name: Insurance Plan Market
[Unshared] Type: Lookup Table - Text
[Unshared] Length: 4
Codes:
COBR
COBRA
GCCH
Group-Commonwealth Choice
GCOB
Group COBRA
GEMP
Group-Employer
GFED
Group-Federal
GGIC
Group-GIC
GMMK
Group-Merged Market
GMUN
Group-Municipality
GPOS
Group - POS
GPRT
Group-Retiree
GRUP
Group
GSC0
Group-Senior Care Option
GUNN
Group-Union
HEXC
Health Exchange
ICCA
Individual - Commonwealth Care
ICCH
Individual - Commonwealth Choice
ICLO
Individual Closed
ICOB
Individual COBRA
ISCO
Individual Senior Care Option
ITHR
Other
IYGA
Individual Young Adult
MCRA
Medicare Part A
MCRB
Medicare Part B
MCRC
Medicare Part C
MCRD
Medicare Part D
MEDX
MediGap/Medicare Supplemental/Medex
OTMC
Other Medicare
STUD
Student
[Shared] Name: Insurance Plan Market
[Unshared] Type: Lookup Table - Text
[Unshared] Length: 4
Codes:
COBR
COBRA
GCCH
Group-Commonwealth Choice
GCOB
Group COBRA
GEMP
Group-Employer
GFED
Group-Federal
GGIC
Group-GIC
GMMK
Group-Merged Market
GMUN
Group-Municipality
GPOS
Group - POS
GPRT
Group-Retiree
GRUP
Group
GSC0
Group-Senior Care Option
GUNN
Group-Union
HEXC
Health Exchange
ICCA
Individual - Commonwealth Care
ICCH
Individual - Commonwealth Choice
ICLO
Individual Closed
ICOB
Individual COBRA
ISCO
Individual Senior Care Option
ITHR
Other
IYGA
Individual Young Adult
MCRA
Medicare Part A
MCRB
Medicare Part B
MCRC
Medicare Part C
MCRD
Medicare Part D
MEDX
MediGap/Medicare Supplemental/Medex
OTMC
Other Medicare
STUD
Student
PR006
[Shared] Name: Product Benefit Type
[Unshared] Type: Integer
[Shared] Length: 1
Codes:
0
Other
1
Medical Only
2
Pharmacy Only
3
Medical and Pharmacy bundled
4
Dental
5
Behavioral Health
6
Vision
7
Accident Only
8
Medical Comprehensive
[Shared] Name: Product Benefit Type
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
0
Other
1
Medical Only
2
Pharmacy Only
3
Medical and Pharmacy bundled
4
Dental
5
Behavioral Health
6
Vision
7
Accident Only
8
Medical Comprehensive
[Shared] Name: Product Benefit Type
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
0
Other
1
Medical Only
2
Pharmacy Only
3
Medical and Pharmacy bundled
4
Dental
5
Behavioral Health
6
Vision
7
Accident Only
8
Medical Comprehensive
PR007
[Shared] Name: Other Product Benefit Description
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Other Product Benefit Description
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Other Product Benefit Description
[Shared] Type: Text
[Shared] Length: 80
PR008
[Shared] Name: Risk Type
[Unshared] Type: Text
[Shared] Length: 1
Codes:
 
 
1
Fully Insured
2
Self Insured
3
Product available to risk and self insured accounts
[Shared] Name: Risk Type
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
0
Other
1
Fully Insured
2
Self-Insured
3
Product available to risk and self-insured accounts
[Shared] Name: Risk Type
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
0
Other
1
Fully Insured
2
Self-Insured
3
Product available to risk and self-insured accounts
PR009
[Shared] Name: Product Start Date
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Product Start Date
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Product Start Date
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
PR010
[Shared] Name: Product End Date
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Product End Date
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Product End Date
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
PR011
[Shared] Name: Product Active Flag
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Product Active Flag
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Product Active Flag
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
PR012
[Shared] Name: Annual Per Person Deductible Code
[Unshared] Type: Text
[Shared] Length: 3
Codes:
000
plans with no per person deductible
001
plans with per person deductibles under $1,000
002
plans with per person deductibles of $1,000 - $1,999
003
plans with per person deductibles $2,000-$2,999
004
plans with per person deductibles >= $3000
999
Not Applicable
[Shared] Name: Annual Per Person Deductible Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
000
No per person deductible
001
Deductible Total under $1,000
002
Deductible Total of $1,000 thru $1,999
003
Deductible Total of $2,000 thru $2,999
004
Deductible Total greater than $3000
999
Not Applicable
[Shared] Name: Annual Per Person Deductible Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
000
No per person deductible
001
Deductible Total under $1,000
002
Deductible Total of $1,000 thru $1,999
003
Deductible Total of $2,000 thru $2,999
004
Deductible Total greater than $3000
999
Not Applicable
PR013
[Unshared] Name: AnnualPer Family Deductible Code
[Unshared] Type: Text
[Shared] Length: 3
Codes:
000
plans with no per family deductible
001
plans with per family deductibles under $1,000
002
plans with per family deductibles of $1,000 - $1,999
003
plans with per family deductibles $2,000 -$2,999
004
plans with per family deductibles $3,000 - $3,999
005
plans with per family deductibles $4,000 - $4,999
006
plans with per family deductibles $5,000 - $5,999
007
plans with per family deductibles >= $6,000
999
Not Applicable
[Unshared] Name: Annual Per Family Deductible Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
000
No per family deductible
001
Deductible Total under $1,000
002
Deductible Total of $1,000 thru $1,999
003
Deductible Total of $2,000 thru $2,999
004
Deductible Total of $3,000 thru $3,999
005
Deductible Total of $4,000 thru $4,999
006
Deductible Total of $5,000 thru $5,999
007
Deductible Total greater than $6,000
999
Not Applicable
[Unshared] Name: Annual Per Family Deductible Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 3
Codes:
000
No per family deductible
001
Deductible Total under $1,000
002
Deductible Total of $1,000 thru $1,999
003
Deductible Total of $2,000 thru $2,999
004
Deductible Total of $3,000 thru $3,999
005
Deductible Total of $4,000 thru $4,999
006
Deductible Total of $5,000 thru $5,999
007
Deductible Total greater than $6,000
999
Not Applicable
PR014
[Shared] Name: Coordinated Care model
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Coordinated Care model
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Coordinated Care model
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
PR015
Data Element: PR015
not present in this file submission.
[Unshared] Name: Other Product Line of Business Model
[Unshared] Type: Text
[Unshared] Length: 30
[Unshared] Name: Other Product Line of Business Model
[Unshared] Type: Text
[Unshared] Length: 30
PR016
Data Element: PR016
not present in this file submission.
[Unshared] Name: Other Risk Type
[Unshared] Type: Text
[Unshared] Length: 30
[Unshared] Name: Other Risk Type
[Unshared] Type: Text
[Unshared] Length: 30
PR017
Data Element: PR017
not present in this file submission.
[Unshared] Name: NAIC Code
[Unshared] Type: Integer
[Unshared] Length: 5
[Unshared] Name: NAIC Code
[Unshared] Type: Integer
[Unshared] Length: 5
PR018
Data Element: PR018
not present in this file submission.
Data Element: PR018
not present in this file submission.
[Unshared] Name: Situs
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 2
PR899
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
 
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
 
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
 
TR001
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
TR
 
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
TR
 
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
TR
 
TR002
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
TR003
[Shared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
TR004
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
 
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
 
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PR
 
TR005
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
TR006
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
TR007
[Shared] Name: Date Processed
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Date Processed
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Date Processed
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
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