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Product File Submission

Massachusetts

Versions: Product File Submission• Product File Submission• Product File SubmissionCompare Versions


Name:Product File Submission
State:Massachusetts
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.
VersionOctober 22, 2010 - v2.0

File Specification for Product File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text HD 2
Multiple versionsHD002 Payer Header Submitter/Carrier ID Text 8
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Text 30
Multiple versionsHD004 Type of File Header Type of File Text PR 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer ####### 10
Multiple versionsHD008 Comments Header Carrier Comments Text Free Text Comments 80
Multiple versionsPR001 Product ID number Product Identification Number Text 20
Multiple versionsPR002 Product Name Carrier defined Product Name Text Free Text Name 70
Multiple versionsPR003 Carrier License Type Carrier License Type Text tlkpCarrierLicenseType 10
Multiple versionsPR004 Product Line of Business Model The Line of Business / Insurance Model the Product relates to. Text tlkpProductLineOfBusiness 2
Multiple versionsPR005 Insurance Plan Market Insurance Plan Market Code Text tlkpInsurancePlanMarket 10
Multiple versionsPR006 Product Benefit Type Indicates combinations of offerings. Integer tlkpProductBenefitType 1
Multiple versionsPR007 Other Product Benefit Description Benefit Description Text Free Text Description 80
Multiple versionsPR008 Risk Type Indicates if the product was an at-risk product or self insured. Text tlkpRiskType 1
Multiple versionsPR009 Product Start Date Product Start Date Date CCYYMMDD 8
Multiple versionsPR010 Product End Date Last date on which members could be enrolled in this product Date CCYYMMDD 8
Multiple versionsPR011 Product Active Flag Indicator to further refine activity status Text tlkpFlagIndicators 1
Multiple versionsPR012 Annual Per Person Deductible Code Per Person Deductible bandwidth reporting Text tlkpAnnualPerPersonDeductible 3
Multiple versionsPR013 AnnualPer Family Deductible Code Per Family Deductible bandwidth reporting Text tlkpAnnualPerFamilyDeductible 3
Multiple versionsPR014 Coordinated Care model Indicates if a patient's care is clinically coordinated or managed. Text tlkpFlagIndicators 1
Multiple versionsPR899 Record Type File Type Identifier Text PR 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text TR 2
Multiple versionsTR002 Payer Carrier Specific Submitter Code as defined by APCD. This must match the Submitter Code reported in HD002 Text 8
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Text 30
Multiple versionsTR004 Type of File This is an indicator that defines the type of file and the data contained within the file. This must match the File Type reported in HD004. Text PR 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Date CCYYMMDD 8

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Data Element ID Data Element Code Value
HD001 Record Type HD
HD004 Type of File PR
PR003 Carrier License Type 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
PR004 Product Line of Business Model 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
PR005 Insurance Plan Market 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
PR006 Product Benefit Type 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
PR008 Risk Type 1 Fully Insured
2 Self Insured
3 Product available to risk and self insured accounts
PR011 Product Active Flag 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PR012 Annual Per Person Deductible Code 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
PR013 AnnualPer Family Deductible Code 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
PR014 Coordinated Care model 1 Yes
2 No
3 Unknown
4 Other
5 Not Applicable
PR899 Record Type PR
TR001 Record Type TR
TR004 Type of File PR
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