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Product File Submission

Massachusetts

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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 1, 2014 - v4.0

File Specification for Product File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsHD001 Record Type Header Record Identifier Text char[2] 2
Multiple versionsHD002 Submitter Header Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsHD003 National Plan ID Header CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsHD004 Type of File Defines the file type and data expected. Text char[2] 2
Multiple versionsHD005 Period Beginning Date Header Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD006 Period Ending Date Header Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsHD007 Record Count Header Record Count Integer varchar[10] 10
Multiple versionsHD008 Comments Header Carrier Comments Text varchar[80] 80
Multiple versionsHD009 APCD Version Number Submission Guide Version Decimal - Numeric char[3] 3
Multiple versionsPR001 Product ID number Product Identification Text varchar[30] 30
Multiple versionsPR002 Product Name Submitter defined Product name Text varchar[70] 70
Multiple versionsPR003 Carrier License Type Carrier License Type Lookup Table - Text char[3] 3
Multiple versionsPR004 Product Line of Business Model Line of Business / Insurance Model the Product relates to. Lookup Table - Text char[2] 2
Multiple versionsPR005 Insurance Plan Market Insurance Plan Market Code Lookup Table - Text char[4] 4
Multiple versionsPR006 Product Benefit Type Benefit Options Lookup Table - Integer int[1] 1
Multiple versionsPR007 Other Product Benefit Description Benefit Description Text varchar[80] 80
Multiple versionsPR008 Risk Type Risk Options Lookup Table - Integer int[1] 1
Multiple versionsPR009 Product Start Date Product Start Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPR010 Product End Date Product End Date Full Date - Integer int[8] CCYYMMDD 8
Multiple versionsPR011 Product Active Flag Indicator - Active Product Lookup Table - Integer int[1] 1
Multiple versionsPR012 Annual Per Person Deductible Code Per Person Deductible bandwidth reporting Lookup Table - Text char[3] 3
Multiple versionsPR013 Annual Per Family Deductible Code Per Family Deductible bandwidth reporting Lookup Table - Text char[3] 3
Multiple versionsPR014 Coordinated Care model Indicator - Clinical Coordination Lookup Table - Integer int[1] 1
Multiple versionsPR015 Other Product Line of Business Model Defines Product Line of Business when Other is selected Text varchar[30] 30
Multiple versionsPR016 Other Risk Type Defines Risk Type Other is selected Text varchar[30] 30
Multiple versionsPR017 NAIC Code National Association of Insurance Commissioners' Code Integer int[5] 5
PR018 Situs State / Province of the situs of the Product External Code Source 2 - Text char[2] 2
Multiple versionsPR899 Record Type File Type Identifier Text char[2] 2
Multiple versionsTR001 Record Type Trailer Record Identifier Text char[2] 2
Multiple versionsTR002 Submitter Trailer Submitter / Carrier ID defined by CHIA Integer varchar[6] 6
Multiple versionsTR003 National Plan ID CMS National Plan Identification Number (PlanID) Integer int[10] 10
Multiple versionsTR004 Type of File Validates the file type defined in HD004. Text char[2] 2
Multiple versionsTR005 Period Beginning Date Trailer Period Start Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR006 Period Ending Date Trailer Period Ending Date Date Period - Integer int[6] CCYYMM 6
Multiple versionsTR007 Date Processed Trailer Processed Date Full Date - Integer int[8] CCYYMMDD 8

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Data Element ID Data Element Code Value
HD001 Record Type HD Header Elements
HD004 Type of File PR PRODUCT
HD009 APCD Version Number 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
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
OTH Other License Type
PBM Pharmacy Benefit Manager
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
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 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
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 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 0 Other
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 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 Annual Per Family Deductible Code 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 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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