XEROX 03D-Provider 4intf
3.4 Provider Subsystem Interface Functionality
The interfaces supported by this subsystem are:
• CLIA Input Interface
• PDCS Physician Output Interface
• PDCS Pharmacy Output Interface
• Provider Network Affiliation Input Interface
• BCBS Provider File Interface
• CRM Provider Interface
• OCR/RRI Provider Interface
• Provider DRAMS Interface
• BCBS Provider NPI Cross-Match Interface
• HMS Provider Interface
• Wells Fargo EFT Prenote Interface
• LEIE Database Match
• State Level Registry Interface
• Digital Harbor Provider Credentialing
• Spectrum Informatics – Provider Interface
• Provider Master Interface
• Provider Notification Interface
• Provider Notification Error Interface
• Provider Confirmation Interface
Each of these is described in detail on the following pages.
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
CLIA INTERFACE
|Description: |
|The CLIA interface assists in the verification of the provider’s CLIA ID and provides an automated update to the provider’s CLIA certification data. CMS makes available all CLIA certificate |
|data in the form of the OSCAR (Online Survey, Certification and Reporting) file. Updates are made by CMS to this file daily. When we receive this file (approximately once a month), it is |
|downloaded and applied to the Provider database in the MMIS. |
|Source Files: |
|OSCAR File |
|Target Tables: |
|(P_CLIA_CERT_TB) |
|Reports: |
|A CLIA Update Report and a CLIA Update Error report is produced each time the interface is run. |
|Remarks: |
|N/A |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
CLIA INTERFACE
OSCAR PROVIDER INTERFACE FILE
01. OSCAR-INT-REC.
05 OSCAR-REC-TYPE PIC X(1).
05 OSCAR-CLIA-ID PIC X(10).
05 OSCAR-CLIA-CERT-TYPE PIC X(1).
05 OSCAR-CLIA-CERT-NUM PIC X(3).
05 OSCAR-CLIA-CERT-BEG-DT PIC 9(8).
05 OSCAR-CLIA-CERT-END-DT PIC 9(8).
05 OSCAR-CLIA-UPDATE-CD PIC X(1).
05 OSCAR-CLIA-UPDATE-DT PIC 9(8).
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
CLIA INTERFACE
OSCAR INTERFACE RECORD
|Source |Target |Target |Std | | | |Note |
|Field |Table |Column |Edit |Req |Def |Specifications |Ref |
|OSCAR-CLIA-ID |P_CLIA_CERT_TB |P_CLIA_NUM |N/A |A |N/A | |2 |
|OSCAR-CLIA-CERT-TYPE |P_CLIA_CERT_TB |P_CLIA_CERT_TY_CD |N/A |A |N/A | | |
|OSCAR-CLIA-CERT-NUM |N/A |N/A |N/A |N/A |N/A | | |
|OSCAR-CLIA-CERT-BEG-DT |P_CLIA_CERT_TB |P_CLIA_CERT_EFF_DT |N/A |A |N/A |Format is MMDDYYYY. | |
|OSCAR-CLIA-CERT-END-DT |P_CLIA_CERT_TB |P_ CERT_EXPIR_DT |N/A |A |N/A |Format is MMDDYYYY. | |
|OSCAR-CLIA-UPDATE-CD |N/A |N/A |N/A |A |N/A |(A)dd, (U)pdate, (D)elete If none | |
| | | | | | |of these codes are listed, an error | |
| | | | | | |is written to the error report. | |
|OSCAR-CLIA-UPDATE-DT |N/A |N/A |N/A |N/A |N/A | | |
Notes:
1. This is a MSA Certificate Record.
2. If a provider for this CLIA number is not on the OmniCaid database, an error is written to the CLIA error report.
3. If a certificate type of 5 is sent in, it will be changed to certificate type 3 before the record is saved to the database.
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit C = Conditionally N = Numeric Edits S = System Generated
N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PDCS PHYSICIAN INTERFACE
|Description: |
|An interface file containing physician information will be generated daily for PDCS. All providers on the MMIS Provider Database meeting the following criteria are included on the interface |
|file: |
|Provider Types: |
|201 Hospital, General Acute |
|202 Hospital, PPS Exempt , Rehab |
|203 Hospital, Rehabilitation |
|204 Hospital, PPS Exempt, Psychiatric205 Hospital, Psychiatric |
|221 Indian Health SVCS Hospital |
|301 Physician |
|302 Osteopath |
|303 Physician Component for Hospital |
|304 Physician Component for Residential Program |
|305 Physician Assistants |
|313 Clinic Federally QLFD Health Center |
|314 Clin,Rural Health MED, Free Stand |
|315 Clin,Rural Health MED, Hosp BSD316 Nurse Practitioners |
|322 Nurse Midwife |
|325 Podiatrist |
|335 Optometrist |
|421 Dentist |
|431 Psychologist |
|443 Nurse Psych Nurse Specialist |
|Provider has been active in the last 18 months or the provider’s enrollment status has been changed in the last 3 days (current day – 3 days). |
|Restrict the FFS individual practitioners (enrollment status code =’60’ and provider type in (“301”,”302”,”303”,”304”,”305”,”316”,”322”,”325”, “335”,”421”,”431”,”443”) to only include those where|
|Group Indicator = I and Billing Code B |
|Include the FFS individual practitioners (Provider status = 60 and Provider type in(“201”,”202”,”203”,”204”,”205”,”221”,”313”, “314”, ”315” ) without regard to group indicator or Billing code. |
|Source Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_SPECL_TB) |
|(P_ENROL_STAT_TB) |
|(P_NPI_XMTCH_TB) |
|(P_MC_AFFL_X_TB) |
|(P_MCARE_TB) |
|Target Files: |
|PDCS Physician Interface File |
|Reports: |
|N/A |
|Remarks: |
|Every physician record would go through series of SORT steps as below: |
|1. Sort step that eliminates duplicate open ended physicians under the same NPI. |
|2. Sort step that eliminates the physicians having NPI ( NCPDP-PROV-NPI-ID) as SPACES. |
|3. Final physician file would have begin date ( NCPDP-BEGIN-DATE ),NPI and single open ended physician under the same NPI. |
| |
|Exclusion logic: |
|The following conditions will cause a record(s) NOT to be written to the above extract file: |
|If p-stat-eff-dt greater than current processing date |
|If the contract status is XX, program will not write the prescriber record to physician file. This check is performed only for encounters. |
|In the job, there is SORT step to eliminate duplicates with status 70. This step will pick the first duplicate open-ended Medicaid provider id’s under the same NPI as well as non-duplicate NPI’. |
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PDCS PHYSICIAN OUTPUT INTERFACE
Record Layout:
01 NCPDP-PHYSICIAN-REC.
05 NCPDP-CLIENT-ID PIC X(06).
05 NCPDP-DEA-NO PIC X(10).
05 NCPDP-PROVIDER-NO PIC X(09).
05 NCPDP-PROVIDER-NAME PIC X(35).
05 NCPDP-PROVIDER-ADDR-1 PIC X(28).
05 NCPDP-PROVIDER-ADDR-2 PIC X(28).
05 NCPDP-CITY PIC X(18).
05 NCPDP-STATE PIC X(02).
05 NCPDP-COUNTY PIC X(03).
05 NCPDP-ZIP.
10 NCPDP-ZIP5 PIC X(05).
10 NCPDP-ZIP4 PIC X(04).
05 NCPDP-PHONE-NO PIC X(10).
05 NCPDP-PROVIDER-SPEC PIC S9(3) COMP-3.
05 NCPDP-BEGIN-DATE PIC X(08).
05 NCPDP-END-DT PIC X(08).
05 NCPDP-GROUP-ID PIC X(08).
05 NCPDP-SUB-SPEC-CD PIC X(02). 25024
05 NCPDP-P-TY-CD PIC X(03). 25024
05 NCPDP-PROV-NPI-ID PIC X(10). NPI
*****05 FILLER PIC X(08). NPI
** 05 FILLER PIC X(21). NPI
05 NCPDP-PROV-MCARE-ID PIC X(12). P271104
05 FILLER PIC X(09). P271104
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PDCS PHYSICIAN OUTPUT INTERFACE
|Source |Source |Target | | | |Note |
|Table |Column |Field |Req |Def |Specifications |Ref |
|P_PROV_TB |P_DEA_NUM |NCPDP-DEA-NUM |A |N/A |Contains the DEA number. |1 |
|P_PROV_TB |P_ID |NCPDP-PROVIDER-NO |A |N/A |Provider ID - left justify. | |
|P_PROV_TB |P_NAM |NCPDP-PROVIDER-NAME |A |N/A |Provider Name. | |
|P_ADDR_TB |P_LINE1_AD |NCPDP-PROVIDER-ADDR-1 |C |Spaces |Address type L- location. |2 |
|P_ADDR_TB |P_LINE2_AD |NCPDP-PROVIDER-ADDR-2 |C |Spaces |Address type L-location. |2 |
|P_ADDR_TB |P_CITY_NAM |NCPDP-CITY |A |N/A |Address type L-location. | |
|P_ADDR_TB |P_ST_CD |NCPDP-STATE |A |N/A |Address type L-location. | |
|P_ADDR_TB |P_CNTY_CD |NCPDP-COUNTY |A |N/A |Address type L-location. | |
|P_ADDR_TB |P_ZIP4_CD |NCPDP-ZIP |A |N/A |Generated from Address type L-location. | |
| |P_ZIP5_CD | | | | | |
|P_ADDR_TB |P_PHON_NUM |NCPDP-PHONE-NO |N |N/A |Address type -location. | |
|P_SPECL_TB |P_SPECL_CD |NCPDP-PROVIDER-SPEC |N |N/A |Obtain latest currently active specialty. If there are | |
| | | | | |multiples, the most recent occurrence will be used. | |
|P_ENROL_STAT_TB |P_ STAT_EFF_DT |NCPDP-BEGIN-DATE |C |N/A |If the provider is currently active, put the effective date| |
| | | | | |here and spaces in end date. This is populated when the | |
| | | | | |provider is being added or updated. Format MMDDCCYY. | |
|P_ENROL_STAT_TB |P_ STAT_EFF_DT |NCPDP-END-DATE |C |N/A |If the provider is not currently active, put the effective | |
| | | | | |date here and spaces in begin date. This is populated when | |
| | | | | |the provider is being terminated. Format MMDDCCYY. | |
|N/A |N/A |NCPDP-GROUP-ID |A |N/A |Value will be “MED”. | |
|N/A |N/A |NCPDP-SUB-SPEC-CD |N |Spaces | | |
|P_PROV_TB |P_TY_CD |NCPDP-P-TY-CD |A |N/A |Provider Type Code | |
|P_NPI_XMTCH_TB |P_NPI_ID |NCPDP-PROV-NPI-ID |A |N/A | NPI –ID would be populated for all the physician records. | |
| | | | | |. Select the NPI in effect at the time of the extract for | |
| | | | | |the provider id (P_ID). | |
|P_MCARE_TB |P_MCARE_NUM |NCPDP-PROV-MCARE-ID |A |N/A | | |
Notes:
1. If there is no DEA number on the provider table, the provider id will be moved to this field.
2. Address line 1 or address line 2 must be filled in.
LEGEND: For Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit C = Conditionally N = Numeric Edits S = System Generated
N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PDCS PHARMACY INTERFACE
|Description: |
|An interface file containing pharmacy information will be generated daily for PDCS. All providers on the MMIS Provider Database meeting the following criteria are included on the interface file:|
| |
|Provider types of 416 (Pharmacy) and 417 (Rural Health Pharmacy). |
|Provider has been active in the last 18 months or the provider’s enrollment status has been changed in the past 3 days (current day – 3 days) |
|Source Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_DISP_FEE_TB) |
|(P_RVW_CLM_ TB) |
|(P_ENROL_STAT_TB) |
|(P_NPI_XMTCH_TB) |
| |
|Target Files: |
|PDCS Pharmacy Interface File |
|Reports: |
|N/A |
|Remarks: |
|Every Pharmacy record would go through a SORT step as below : |
|Sort step that eliminates the pharmacies having NPI ( NCPDP-PROV-NPI-ID) as SPACES |
| |
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PDCS OUTPUT PHARMACY INTERFACE
Record Layout:
01 NCPDP-PHARMACY-REC.
05 NCPDP-NABP-NO PIC X(11).
05 NCPDP-CLASS-CODE PIC X(03).
05 NCPDP-DISP-FEE-AMT REDEFINES
NCPDP-CLASS-CODE PIC S9(3)V99 COMP-3.
05 NCPDP-PHARMACY-NAME PIC X(32).
05 NCPDP-PHARMACY-ADDRESS PIC X(32).
05 NCPDP-CITY PIC X(17).
05 NCPDP-STATE PIC X(04).
05 NCPDP-ZIP.
10 NCPDP-ZIP5 PIC X(05).
10 NCPDP-ZIPD PIC X(01).
10 NCPDP-ZIP4 PIC X(04).
05 NCPDP-NETWORK-CODE PIC X(06).
05 NCPDP-COUNTY PIC X(02).
05 NCPDP-BEGIN-DATE PIC X(08).
05 NCPDP-END-DATE PIC X(08).
05 NCPDP-ON-REVIEW-IND PIC X(01).
05 NCPDP-SSN-FEIN PIC X(09).
05 NCPDP-PROV-NPI-ID PIC X(10).
*** 05 FILLER PIC X(17). NPI
05 NCPDP-PROV-MCARE-ID PIC X(12). P27110
05 FILLER PIC X(05). P27110
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PDCS OUTPUT PHARMACY INTERFACE
|Source |Source |Target | | | |Note |
|Table |Column |Field |Req |Def |Specifications |Ref |
|P_DISP_FEE_TB |P_DISP_FEE_AMT |NCPDP- DISP-FEE-AMT |N |Zeros |The cost of dispensing a drug. | |
|P_PROV_TB |P_NAM |NCPDP-PHARMACY-NAME |A |N/A |Name of provider | |
|P_ADDR_TB |P_LINE2_AD |NCPDP-PHARMACY-ADDRESS |A |N/A |Address type L-location. | |
|P_ADDR_TB |P_CITY_NAM |NCPDP-CITY |A |N/A |Address type L-location. | |
|P_ADDR_TB |P_ST_CD |NCPDP-STATE |A |N/A |Address type L-location. | |
|P_ADDR_TB |P_ZIP5_CD |NCPDP-ZIP5 |A |N/A |Address type L-location. | |
| |“–“ |NCPDP-ZIPD | | | | |
| |P_ZIP4_CD |NCPDP-ZIP4 | | | | |
|N/A |N/A |NCPDP-NETWORK-CODE |A |N/A |For FFS pharmacies that are not affiliated with a |1 |
| | | | | |Centennial Care MCO, this value will be “NEWMEX”. | |
| | | | | | | |
| | | | | |Legacy MCO Networks (applies to Encounter Only | |
| | | | | |Pharmacies): | |
| | | | | |For Lovelace (Prov ID 000M1796), the value will be | |
| | | | | |“796”. | |
| | | | | |For Cimarron (Prov ID 000M1808), the value will be | |
| | | | | |“808”. | |
| | | | | |For Presbyterian (Prov ID 000M1814), the value will be| |
| | | | | |“814”. | |
| | | | | |For UNM (Prov ID 60052082), the value will be “850”. | |
| | | | | |For Value Options (Prov ID 71006010), the value will | |
| | | | | |be “855”. | |
| | | | | |For Optum Health (Prov ID 38900882), the value will be| |
| | | | | |“879”. | |
| | | | | |For Molina UNM (Prov ID 87602741), the value will be | |
| | | | | |“850”. | |
| | | | | |For AmeriGroup (Prov ID 21535353), the value will be | |
| | | | | |“869”. | |
| | | | | |For Evercare (Prov ID 16785851), the value will be | |
| | | | | |“871”. | |
| | | | | |For BCBS (Prov ID 42101522), the value will be “873”. | |
| | | | | | | |
| | | | | |Centennial Care MCO Networks (applies to both FFS and | |
| | | | | |Encounter Only Pharmacies): | |
| | | | | |For BCBS (Prov ID 42101522), the value will be “820”. | |
| | | | | |For Molina (Prov ID 000M1808), the value will be | |
| | | | | |“822”. | |
| | | | | |For Presbyterian (Prov ID 000M1814), the value will be| |
| | | | | |“824”. | |
| | | | | |For United Healthcare (Prov ID 16785851), the value | |
| | | | | |will be “826”. | |
|P_ADDR_TB |P_CNTY_CD |NCPDP-COUNTY |A |N/A |Address type L. | |
|P_ENROL_STAT_TB |P_ STAT_EFF_DT |NCPDP-BEGIN-DATE |C |N/A |Format CCYYMMDD. Use the status effective date, or the| |
|P_DISP_FEE_TB |P_ DISP_EFF_DT | | | |dispensing fee effective date, whichever is the most | |
| | | | | |recent. | |
|P_ENROL_STAT_TB |P_ STAT_ EFF_DT |NCPDP-END-DATE |C |N/A |If the provider is not currently active, determine the| |
| | | | | |end date of the active span by subtracting one day | |
| | | | | |from the effective date of the span immediately | |
| | | | | |following the active span. Format CCYYMMDD. | |
|P_RVW_CLM_ TB |P_REVW_BEG_DT |NCPDP-ON-REVIEW-IND |A |N/A |Provider on review indicator (Y or N). This field | |
| |P_REVW_END-DT | | | |defaults to N unless the following is true for the | |
| |C_HDR_TY_CD | | | |pharmacy provider, in which case it is set to Y: The | |
| | | | | |current date is between P_REVW_BEG_DT and | |
| | | | | |P_REVW_END-DT, and C_TY_CD is Pharmacy. | |
|P_PROV_TB |P_SSN_NUM |NCPDP-SSN-FEIN |A |N/A |Contains FEIN. If FEIN is spaces, this field will | |
| |P_FED_TAX_ID | | | |contain the SSN. | |
|P_NPI_XMTCH_TB |P_NPI_ID |NCPDP-PROV-NPI-ID |A |N/A | NPI –ID would be populated for all the physician | |
| | | | | |records. . Select the NPI in effect at the time of | |
| | | | | |the extract for the provider id (P_ID). | |
|P_MCARE_TB |P_MCARE_NUM |NCPDP-PROV-MCARE-ID |A |N/A | | |
Notes:
1. A network code identifies the corporate level client that the pharmacy belongs to.
LEGEND: For Req: A = Always C = Conditionally N = Never
NEW MEXICO OMNICAID MMIS
PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NETWORK AFFILIATION INTERFACE
|Description: |
|This interface adds, changes and deletes providers affiliated with the Managed Care Organizations. Each month the MCO organizations provide the State with a new file of providers providing |
|services for their organization. The affiliated providers will be displayed on the Provider Database. They are not required to submit the same information as an MMIS provider and may be |
|affiliated with more than one MCO. Any fields that are required for FFS providers, but not MC network providers are populated with a default value in the provider database. Some of these |
|defaults are as follows: |
|Individual group code = I for individual |
|Status effective date = contract begin date |
|program code = MAD |
|program begin date = contract begin date |
| |
|MCOs will send a separate provider record for each provider type on file for every provider. However, there should be no duplicate combinations of NPI, provider type and location zip code. |
|Source Files: |
|Provider Network Affiliation File |
|Target Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_ENROL_STAT_TB) |
|(P_SPECL_TB) |
|(P_MC_AFFL_X_TB) |
|Reports: |
|MCO Provider Affiliation Error Report |
|Remarks: |
|N/A |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NETWORK AFFILIATION INTERFACE
01 MCO-PROV-HEADER-RECORD.
05 MCO-RECORD-TYPE PIC X(1).
88 MCO-HEADER VALUE 'H'.
88 MCO-PROVIDER VALUE 'P'.
88 MCO-TRAILER VALUE 'T'.
05 MCO-PLAN-ID PIC X(9).
05 MCO-PROV-CREATE-DATE.
10 MCO-PROV-CREATE-CC PIC X(2).
10 MCO-PROV-CREATE-YY PIC X(2).
10 MCO-PROV-CREATE-MM PIC X(2).
10 MCO-PROV-CREATE-DD PIC X(2).
05 FILLER PIC X(338).
*
01 MCO-PROVIDER-RECORD.
05 FILLER PIC X(1).
05 MCO-PROVIDER-ID-QLFR PIC X(2).
05 MCO-PROVIDER-EIN-SSN PIC X(9).
05 FILLER PIC X(4).
05 MCO-SORT-NAME PIC X(35).
05 MCO-PROV-NAME PIC X(35).
05 MCO-SERVICING-ADDRESS-AREA.
10 MCO-SVC-ADDR-LINE1 PIC X(30).
10 MCO-SVC-ADDR-LINE2 PIC X(20).
10 MCO-SVC-CITY PIC X(20).
10 MCO-SVC-STATE PIC X(2).
10 MCO-SVC-ZIP PIC 9(5)V9(4).
10 MCO-SVC-GEO-COUNTY PIC 9(2).
05 MCO-SERVICING-PROV-TELEPHONE PIC X(10).
05 MCO-MAILING-ADDRESS-AREA.
10 MCO-MAIL-ADDR-LINE1 PIC X(30).
10 MCO-MAIL-ADDR-LINE2 PIC X(20).
10 MCO-MAIL-CITY PIC X(20).
10 MCO-MAIL-STATE PIC X(2).
10 MCO-MAIL-ZIP PIC 9(5)V9(4).
05 MCO-PCP-INDICATOR PIC X(1).
05 MCO-CONTRACT-TYPE PIC X(2).
88 MCO-CONTRACTED VALUE 'CT'.
88 MCO-NON-CONTRACTED VALUE 'NC'.
88 PENDING VALUE 'PD'.
88 TERMINATED VALUE 'TD'.
88 DENIED VALUE 'DN'.
05 MCO-AFF-PROV-TYPE PIC 9(03).
05 MCO-AFF-SPECIALTY-DATA.
10 MCO-AFF-SPECIALTY OCCURS 12 TIMES
PIC 9(03).
05 MCO-CONTRACT-STATUS-DATES.
10 MCO-CONTRACT-STATUS-BEGIN-DATE.
15 MCO-CONTRACT-STATUS-BEG-CC PIC X(02).
15 MCO-CONTRACT-STATUS-BEG-YY PIC X(02).
15 MCO-CONTRACT-STATUS-BEG-MM PIC X(02).
15 MCO-CONTRACT-STATUS-BEG-DD PIC X(02).
10 MCO-CONTRACT-STATUS-END-DATE.
15 MCO-CONTRACT-STATUS-END-CC PIC X(02).
15 MCO-CONTRACT-STATUS-END-YY PIC X(02).
15 MCO-CONTRACT-STATUS-END-MM PIC X(02).
15 MCO-CONTRACT-STATUS-END-DD PIC X(02).
05 FILLER PIC X(11).
05 MCO-PROV-NPI-NO PIC X(10).
05 MCO-SUBCONTRACTOR-AFFILIATION.
10 SUBCONTRACTOR-AFFILIATION-TYPE PIC X(02).
88 PRIMARY-AFFILIATION VALUE 'PR'.
88 SECONDARY-AFFILIATION VALUE 'SD'.
10 SUBCONTRACTOR-AFFIL-ID-QLFR PIC X(02).
10 SUBCONTRACTOR-AFFIL-PROV-NUM PIC X(10).
10 FILLER PIC X(03).
01 MCO-PROV-TRAILER-RECORD.
05 FILLER PIC X(1).
05 MCO-RECORD-COUNT PIC 9(9).
05 FILLER PIC X(346).
MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NETWORK AFFILIATION INTERFACE
MCO AFFILIATE HEADER RECORD
|Source |Target |Target |Std | | | |Note Ref|
|Field |Table |Column |Edit |Req |Def |Specifications | |
|MCO-RECORD-TYPE |N/A |N/A |N/A |N |N/A |H = HEADER | |
| | | | | | |P = PROVIDER | |
| | | | | | |T = TRAILER | |
|MCO-PLAN-ID |P_MC_AFFL_X_TB |P_MCO_P_ID |N/A |A |N/A | |5 |
|MCO-PROV-CREATE-DATE |N/A |N/A |N/A |N/A |N/A | | |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NETWORK AFFILIATION INTERFACE
MCO AFFILIATE RECORD
|Source |Target |Target |Std | | | |Note Ref|
|Field |Table |Column |Edit |Req |Def |Specifications | |
|MCO-PROVIDER-ID-QLFR |N/A |N/A |V |A |N/A |Qualifier that specifies whether the ID in | |
| | | | | | |MCO-PROVIDER-EIN-SSN is an EIN or SSN. | |
| | | | | | |‘EI’ = EIN | |
| | | | | | |‘SY’ = SSN | |
|MCO-PROVIDER-EIN-SSN |P_PROV_TB |P_FED_TAX_ID |N |A |N/A |The provider’s EIN or SSN as indicated by | |
| | |P_SSN_NUM | | | |the qualifier in MCO-PROVIDER-ID-QLFR. | |
| | | | | | |Target column for EIN is P_FED_TAX_ID. | |
| | | | | | |Target column for SSN is P_SSN_NUM. | |
|MCO-PROVIDER-NO |P_MC_AFFL_X_TB |P_MCO_ASGN_ID |N/A |A |N/A |The number that the MCO assigns the | |
| | | | | | |provider | |
|MCO-SORT-NAME |P_PROV_TB |P_SORT_NAM |N/A |A |N/A |N/A | |
|MCO-PROV-NAME |P_PROV_TB |P_NAM |N/A |A |N/A |This data is free form. | |
|MCO-SERVICING-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|MCO-SVC-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |A |N/A |Location address line 1 | |
|MCO-SVC-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Location address line 2 | |
|MCO-SVC-CITY |P_ADDR_TB |P_CITY_NAM |N/A |A |N/A |Location city | |
|MCO-SVC-STATE |P_ADDR_TB |P_ST_CD |V |A |N/A |Location state | |
|MCO-SVC-ZIP |P_ADDR_TB |P_ZIP5_CD |N/A |A |N/A |Generate from zip codes for the Location | |
| | |“– “ | | | |address | |
| | |P_ZIP4_CD | | | | | |
|MCO-SVC-GEO-COUNTY |P_ADDR_TB |P_CNTY_CD |V |A |N/A |Location county | |
|MCO-SERVICING-PROV- TELEPHONE |P_ADDR_TB |P_PHON_NUM |N/A |A |N/A |Phone number | |
|MCO-MAILING-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|MCO-MAIL-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |A |N/A |Mailing address line 1 | |
|MCO-MAIL-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Mailing address line 2 | |
|MCO-MAIL-CITY |P_ADDR_TB |P_CITY_NAM |N/A |A |N/A |Mailing city | |
|MCO-MAIL-STATE |P_ADDR_TB |P_ST_CD |V |A |N/A |Mailing state | |
|MCO-MAIL-ZIP |P_ADDR_TB |P_ZIP5_CD |N/A |A |N/A |Mailing zip | |
| | |“– “ | | | | | |
| | |P_ZIP4_CD | | | | | |
|MCO-PCP-INDICATOR |P_MC_AFFL_X_TB |P_PCP_IND |N/A |C |N/A |“Y”, “N” or space. | |
| | | | | | |Required if contract status is not “PD” or | |
| | | | | | |“DN”. | |
|MCO-CONTRACT-STATUS |P_MC_AFFL_X_TB |P_CNTRCT_STAT_CD |N/A |A |N/A |CONTRACTED= “CT” |1 |
| | | | | | |NON-CONTRACTED= “NC” | |
| | | | | | |PENDING= “PD” | |
| | | | | | |TERMINATED= “TD” | |
| | | | | | |DENIED= “DN” | |
|MCO-AFF-PROV-TYPE |P_PROV_TB |P_TY_CD |V |C |N/A |Required if contract status is not “PD” or | |
| | | | | | |“DN”. Must be “721” if subcontractor | |
| | | | | | |affiliation provider number is populated. | |
| | | | | | | | |
| | | | | | |MCO’s should send a separate record for | |
| | | | | | |each provider type on file for every | |
| | | | | | |provider. There should be no duplicate | |
| | | | | | |combinations of NPI, provider type and | |
| | | | | | |location zip code, or EIN/SSN | |
|MCO-AFF-SPECIALTY-DATA |N/A |N/A |N/A |N/A |N/A | | |
|MCO-AFF-SPECIALTY |P_SPECL_TB |P_SPECL_CD |V |C |N/A |Occurs 12 times | |
| | | | | | |Required if contract status is not “PD” or | |
| | | | | | |“DN” and if the provider type requires a | |
| | | | | | |specialty. | |
|MCO-CONTRACT-STATUS-DATES |N/A |N/A |N/A |N/A |N/A | | |
|MCO- CONTRACT-STATUS –BEGIN-DATE |P_MC_AFFL_X_TB |P_CNTRCT_STAT_B_DT |D |A |N/A |CCYYMMDD |2 |
|MCO- CONTRACT-STATUS –BEGIN-DATE |P_SPECL_TB |P_SPECL_BEG_DT |D |C |N/A |Required if there is a specialty code. |2 |
|MCO- CONTRACT-STATUS –BEGIN-DATE |P_PROV_TB |P_APPL_DT |D |A |N/A | |2 |
|MCO- CONTRACT-STATUS –BEGIN-DATE |P_ENROL_STAT_TB |P_STAT_EFF_DT |D |A |N/A | |2 |
|MCO- CONTRACT-STATUS –BEGIN-DATE |P_PROG_TB |P_PROG_BEG_DT |D |A |N/A | |2 |
|MCO- CONTRACT-STATUS – END-DATE |P_MC_AFFL_X_TB |P_CNTRCT_STAT_E_DT |D |N |N/A |CCYYMMDD |2 |
| | | | | | |Default is “9999-12-31” | |
|MCO- CONTRACT-STATUS – END-DATE |P_SPECL_TB |P_SPECL_END_DT |D |C |N/A |Required if there is a specialty code. |2 |
|MCO- CONTRACT-STATUS – END-DATE |P_PROG_TB |P_PROG_END_DT |D |A |N/A | |2 |
|MCO-DEA-NO |P_PROV_TB |P_DEA_NUM |N/A |C |N/A | |3 |
|MCO-PROV-NPI-NO |P_NPI_XMTCH_TB |P_NPI_ID |N |C |N/A |Required for all health care providers. |4 |
| | | | | | |Must pass check digit validation. | |
|SUBCONTRACTOR-AFFILIATION-TYPE |P_MC_AFFL_X_TB |P_SUB_CNTRCT_TY_CD |N/A |N |N/A |If this is filled in it must be “PR” or | |
| | | | | | |“SD”. | |
| | | | | | |Default is spaces. | |
|SUBCONTRACTOR-AFFIL-ID-QLFR |N/A |N/A |V |A |N/A |Qualifier that specifies whether the ID in | |
| | | | | | |SUBCONTRACTOR-AFFIL-PROV-NUM is an NPI, EIN| |
| | | | | | |or SSN. | |
| | | | | | |‘NP’ = NPI | |
| | | | | | |‘EI’ = EIN | |
| | | | | | |‘SY’ = SSN | |
|SUBCONTRACTOR-AFFIL-PROV-NUM |P_NPI_XMTCH_TB |P_NPI_ID |N |C |N/A |If subcontractor affiliation type is filled| |
| | | | | | |in, this number is required. | |
| |P_PROV_TB |P_FED_TAX_ID | | | |Default is spaces. When | |
| | |P_SSN_NUM | | | |SUBCONTRACTOR-AFFIL-ID-QLFR = “NP”,| |
| | | | | | |must pass check digit validation. | |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NETWORK AFFILIATION INTERFACE
MCO AFFILIATE TRAILER RECORD
|Source |Target |Target |Std | | | |Note Ref|
|Field |Table |Column |Edit |Req |Def |Specifications | |
|MCO-RECORD-COUNT |N/A |N/A |N/A |N/A |N/A | | |
Notes:
1. The enrollment status inserted into the enrollment table will be 70- None-MCO Provider.
2. The MCO Contract Status Begin Date and the MCO Contract Status End Date are used to populate multiple columns in multiple tables in the provider database. When the MCO sends a record with a contract status end date, the interface will find the provider with the matching NPI, provider type and location zip code and perform the following updates:
a. update the contract status end date on the matching provider’s affiliation record for the MCO with the contract status end date
b. check to see if the provider’s affiliations with all other MCOs have also been ended, and if so, add an enrollment status 11 (Term MCO) termination span for the provider on the provider enrollment table an effective date equal to latest of the affiliated MCO contract status end dates + 1 day
3. Plan ID from the header is used to look up the provider in the Provider table. The provider type code found on the Provider table is then checked to make sure it is an MCO, otherwise processing stops.
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit
C = Conditionally V = Valid Value Edit
N = Never N = Numeric Edits S = System Generated
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
BCBS PROVIDER FILE INTERFACE
|Description: |
|An interface file containing provider information will be generated weekly for BCBS. All providers on the MMIS Provider Database meeting the following criteria are included on the interface |
|file: |
| |
|Billing Code not equal to “E”(Encounter Only). |
|Source Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_ENROL_STAT_TB) |
|(P_SPECL_TB) |
|Target Files: |
|BCBS File |
|Reports: |
|N/A |
|Remarks: |
|N/A |
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
BCBS PROVIDER FILE INTERFACE
Record Layout:
01 WFP36051-PROV-OUTFILE-REC.
05 WFP36051-P-ID PIC X(08).
05 WFP36051-P-NPI-ID PIC X(10).
05 WFP36051-P-TY-CD PIC X(03).
05 WFP36051-P-SPECIALTY-DATA OCCURS 6 TIMES
10 WFP36051-P-SPECL-CD PIC X(3).
10 WFP36051-P-SPECL-BEG-DT PIC X(10).
10 WFP36051-P-SPECL-END-DT PIC X(10).
05 WFP36051-P-ENROL-STAT-TY-CD PIC X(04).
05 WFP36051-P-STAT-EFF-DT PIC X(10).
05 WFP36051-P-STAT-END-DT PIC X(10).
05 WFP36051-P-PRACT-TY-CD PIC X(1).
05 WFP36051-P-FED-TAX-ID PIC X(9).
05 WFP36051-P-SSN-NUM PIC X(9).
05 WFP36051-P-CAT-OF-SERV OCCURS 2 TIMES
10 WFP36051-P-COS-CD PIC X(2).
05 WFP36051-P-LAST-NAM PIC X(35).
05 WFP36051-P-FST-NAM PIC X(15).
05 WFP36051-P-MI-NAM PIC X(1).
05 WFP36051-P-SFX-NAM PIC X(5).
05 WFP36051-P-DBA-LAST-NAM PIC X(35).
05 WFP36051-P-DBA-FST-NAM PIC X(15).
05 WFP36051-P-DBA-MI-NAM PIC X(1).
05 WFP36051-P-DBA-SFX-NAM PIC X(5).
05 WFP36051-PHONE PIC X(10).
05 WFP36051-PHONE-EXT PIC X(05).
05 WFP36051-ADDR-LINE-1 PIC X(30).
05 WFP36051-ADDR-LINE-2 PIC X(30).
05 WFP36051-CITY PIC X(20).
05 WFP36051-STATE PIC X(02).
05 WFP36051-ZIP PIC X(05).
05 WFP36051-ZIP-4 PIC X(04).
05 WFP36051-CURRENT-DATE PIC X(10).
05 FILLER PIC X(26).
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
BCBS PROVIDER FILE INTERFACE
|Source |Source |Target | | | |Note |
|Table |Column |Field |Req |Def |Specifications |Ref |
|P_NPI_XMTCH_TB |P_NPI_ID |WFP36051-P-NPI-ID | | | | |
|P_PROV_TB |P_TY_CD |WFP36051-P-TY-CD | | |Provider Type | |
|Provider Specialty data occurs | | | | | | |
|6 times | | | | | | |
|P_SPECL_TB |P_SPECL_CD |WFP36051-P-SPECL-CD | | |Provider Specialty |1 |
|P_SPECL_TB |P_SPECL_BEG_DT |WFP36051-P-SPECL-BEG-DT | | |Format ‘CCYY-MM-DD’ |1 |
|P_SPECL_TB |P_SPECL_END_DT |WFP36051-P-SPECL-END-DT | | |Format ‘CCYY-MM-DD’ |1 |
|P_ENROL_STAT_TB |P_ENROL_STAT_TY_CD |WFP36051-P-ENROL-STAT-TY-CD | | | |2 |
|P_ENROL_STAT_TB |P_STAT_EFF_DT |WFP36051-P-STAT-EFF-DT | | |Format ‘CCYY-MM-DD’ |2 |
|n/a |n/a |WFP36051-P-STAT-END-DT | | |Format ‘CCYY-MM-DD’. Program Generated. |2 |
|P_PROV_TB |P_PRACT_TY_CD |WFP36051-P-PRACT-TY-CD | | | | |
|P_PROV_TB |P_FED_TAX_ID |WFP36051-P-FED-TAX-ID | | | | |
|Category of Service occurs 2 | | | | | | |
|times | | | | | | |
|n/a |n/a |WFP36051-P-COS-CD | | |Set to spaces. |5 |
|P_PROV_TB |P_SSN_NUM |WFP36051-P-SSN-NUM | | | | |
|P_PROV_TB |P_LAST_NAM |WFP36051-P-LAST-NAM | | | |3, 4 |
|P_PROV_TB |P_FST_NAM |WFP36051-P-FST-NAM | | | |3 |
|P_PROV_TB |P_MI_NAM |WFP36051-P-MI-NAM | | | |3 |
|P_PROV_TB |P_SFX_NAM |WFP36051-P-SFX-NAM | | | |3 |
|P_PROV_TB |P_DBA_LAST_NAM |WFP36051-P-DBA-LAST-NAM | | | |3, 4 |
|P_PROV_TB |P_DBA_FST_NAM |WFP36051-P-DBA-FST-NAM | | | |3 |
|P_PROV_TB |P_DBA_MI_NAM |WFP36051-P-DBA-MI-NAM | | | |3 |
|P_PROV_TB |P_DBA_SFX_NAM |WFP36051-P-DBA-SFX-NAM | | | |3 |
|P_ADDR_TB |P_PHON_NUM |WFP36051-PHONE | | |Location Phone Number | |
|P_ADDR_TB |P_PHON_EXT_NUM |WFP36051-PHONE-EXT | | |Location Phone Number | |
|P_ADDR_TB |P_LINE1_AD |WFP36051-ADDR-LINE-1 | | |Location address line 1 | |
|P_ADDR_TB |P_LINE2_AD |WFP36051-ADDR-LINE-2 | | |Location address line 2 | |
|P_ADDR_TB |P_CITY_NAM |WFP36051-CITY | | |Location City Name | |
|P_ADDR_TB |P_ST_CD |WFP36051-STATE | | |Location State | |
|P_ADDR_TB |P_ZIP4_CD |WFP36051-ZIP | | |Location Zip5 Code | |
|P_ADDR_TB |P_ZIP5_CD |WFP36051-ZIP-4 | | |Location Zip 4 Code | |
|n/a |n/a |WFP36051-CURRENT-DATE | | |Format ‘CCYY-MM-DD’. Program Generated, Date the | |
| | | | | |interface record was created. | |
Notes:
1. Up to six provider specialty codes and associated effective and termination dates will be populated.
2. The most recent active span for the provider is shown here. If the provider is currently active, ‘9999-12-31- is moved to the status end date. If the provider is not currently active, but was in the past, then the effective date of the termination status, less one day, is moved here. If the provider was never active, then the begin date of the termination status span is moved to the end date.
3. These fields are populated for individual providers (P_NAM_ORG_IND = “N”).
4. These fields are only populated for organization providers (P_NAM_ORG_IND = “Y”).
5. It was determined that BCBS doesn’t use this field other than to initialize it, so we are not populating it.
The following table shows the new Post-NPI interface layout, cross-walked to the Pre-NPI layout.
|Post NPI |Pre-NPI Field |Notes |
|Field |Req | |
|WFP36051-P-ID |P-PROVIDER-NO | |
|WFP36051-P-NPI-ID |N/A | |
|WFP36051-P-TY-CD |P-TYPE |1 |
|WFP36051-P-SPECL-CD |P-SPECIALITY |1 |
|WFP36051-P-SPECL-BEG-DT |P-SPEC-BEGIN-DATE | |
|WFP36051-P-SPECL-END-DT |P-SPEC-END-DATE | |
|WFP36051-P-ENROL-STAT-TY-CD |P-ENROLL-STATUS |1 |
|WFP36051-P-STAT-EFF-DT |P-19-BEGIN-DATE | |
|WFP36051-P-STAT-END-DT |P-19-END-DATE | |
|WFP36051-P-PRACT-TY-CD |P-PRACTICE-TYPE |1 |
|WFP36051-P-FED-TAX-ID |P-IRS-NUMBER | |
|WFP36051-P-COS-CD |P-CAT-OF-SERV | |
|WFP36051-P-SSN-NUM |P-SOC-SEC-NUMBER | |
|WFP36051-P-LAST-NAM |P-PROV-LAST-N1, P-NAME1-FIL | |
|WFP36051-P-FST-NAM |P-PROV-FIRST-NI | |
|WFP36051-P-MI-NAM |P-PROV-INITIAL-N1 | |
|WFP36051-P-SFX-NAM |P-PROV-TITLE-N1 | |
|WFP36051-P-DBA-LAST-NAM |P-PROV-LAST-N2, P-NAME2-FIL | |
|WFP36051-P-DBA-FST-NAM |P-PROV-FIRST-N2 | |
|WFP36051-P-DBA-MI-NAM |P-PROV-INITIAL-N2 | |
|WFP36051-P-DBA-SFX-NAM |P-PROV-TITLE-N2 | |
|WFP36051-PHONE |P-PHONE | |
|WFP36051-PHONE-EXT |N/A | |
|WFP36051-ADDR-LINE-1 |P-ADDR-LN1-SV | |
|WFP36051-ADDR-LINE-2 |P-ADDR-LN2-SV | |
|WFP36051-CITY |P-ADDR-LN3-CITY-PT | |
|WFP36051-STATE |P-ADDR-ST-SV | |
|WFP36051-ZIP |P-ZIP-SV | |
|WFP36051-ZIP-4 |P-ZIP-SV | |
|WFP36051-CURRENT-DATE |P-LAST-ACTIVITY-DATE | |
Notes:
1. Post-NPI populated with Omnicaid valid values. Pre-NPI was populated with FHS values.
2. BC/BS provided XEROX with information about which fields in the Pre-NPI provider interface layout that they use. That information was used to develop the new interface layout. Certain fields that were indicated as being used by BC/BS were not included in the new Post-NPI layout, for various reasons. These fields are:
|BCBS Field Name |Comments |
|PN-CAT-SRVC-20 occurrences 1 thru 2 |These were populated by XEROX in the Pre-NPI layout, and initially BCBS indicated that the fields were used. However, it appears after |
| |further research that BCBS is not using these fields. |
|PN-CAT-SRVC-20 occurrences 3 thru 10 |Only the first two occurrences of the P-CAT-OF-SERV-20 array were populated in the Pre-NPI layout. |
|PN-CLMS-TYPES |The P-CLAIM-TYPES field was always set to spaces in the Pre-NPI layout. |
|PN-NAM1-SV-FIL, PN-NAM1-SV-IND |These fields were just redefines of the P-NAME1 field and were not populated separately in the Pre-NPI layout. |
|PN-NUM-IN-GRP |P-NUMBER-IN-GRP was always set to ‘1’ in the Pre-NPI layout. |
|PN-BELONGS-TO-IND |P-BELONGS-TO-IND was always set to ‘1’ in the Pre-NPI layout. |
|PN-PERCENT-DATE-OP1, PN-PERCENT-OP |The P-PERCENT fields were always set to zero in the Pre-NPI layout. |
LEGEND: For Req: A = Always C = Conditionally N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
CRM PROVIDER INTERFACE
|Description: |
|The CRM Provider interface transmits Provider information from the New Mexico mainframe, which is downloaded to the CRM servers for use by the CRM system. This file is created on a daily |
|basis upon an extract from the joined P_PROV_TB, P_ADDR_TB and P_ENROL_STAT_TB using Platinum’s FastUnload. The data is then formatted, zipped and transmitted to New Mexico via FTP. |
|Only providers which meet the following criteria will be selected for this file: |
| |
|Skip all Providers with P-ENROLL-STAT-TY-CD = ‘70’ |
|Skip all Providers terminated over a year previously (P-ENROLL-STAT-TY-CD < ‘40’) |
|Select only Address Types = ‘L’ (location) |
|Source Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_ENROL_STAT_TB) |
|(P_NPI_XMTCH_TB) |
|Target Files: |
|CRM Provider Extract |
|Remarks: |
|CRM has two servers that the file is transmitted to. The normal production server and their Failover server. The same file is sent to both servers. |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
CRM PROVIDER INTERFACE
CRM PROVIDER EXTRACT
01 PROV-OUTFILE-REC.
10 O-PAYER-CODE PIC X(05).
10 O-ENTITY-ID PIC X(16).
10 O-ENTITY-EIN PIC X(09).
10 O-ENTITY-NPI PIC X(10).
10 O-ENTITY-TAX-ID-SSN PIC X(09).
10 O-FULL-LAST-NAME PIC X(35).
10 O-MIDDLE-INIT PIC X(01).
10 O-FIRST-NAME PIC X(16).
10 O-ENR-STAT-DESC PIC X(30).
10 O-TYPE-DESC PIC X(30).
10 O-EMAIL PIC X(64).
10 O-RETURNED-MAIL PIC X(01).
10 O-ADDR-LINE-1 PIC X(30).
10 O-ADDR-LINE-2 PIC X(30).
10 O-ADDR-LINE-3 PIC X(30).
10 O-CITY PIC X(30).
10 O-COUNTY PIC X(30).
10 O-STATE PIC X(02).
10 O-ZIP PIC X(06).
10 O-ZIP-4 PIC X(04).
10 O-PHONE PIC X(10).
10 O-PHONE-EXT PIC X(06).
10 O-FAX PIC X(10).
10 O-FAX-EXT PIC X(06).
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
CRM PROVIDER INTERFACE
|Source |Source |Target | | | |Note |
|Table |Column |Field |Req |Def |Specifications |Ref |
|P_PROV_TB |P_ID |O-ENTITY-ID |A |N/A |Provider Identifier | |
|P_PROV_TB |P_FED_TAX_ID |O-ENTITY-EIN |A |N/A |Provider Federal Tax ID | |
|P_NPI_XMTCH_TB |P_NPI_ID |O-ENTITY-NPI |A |N/A |Provider NPI Number | |
|P_PROV_TB |P_FED_TAX_ID |O-ENTITY-TAX-ID-SSN |A |N/A |Provider Federal Tax ID | |
|P_PROV_TB |P_LAST_NAM / P_NAM |O-FULL-LAST-NAME |A |N/A |Provider Last Name or Full Name |1 |
|P_PROV_TB |P_MI_NAM |O-MIDDLE-INIT |C |N/A |Provider Middle Initial |1 |
|P_PROV_TB |P_FST_NAM |O-FIRST-NAME |C |N/A |Provider First Name |1 |
|P_ENROL_STAT_TB |Lookup from WVP0189D |O-ENR-STAT-DESC |A |N/A |Provider Enrollment Status Description |2 |
|P_PROV_TB |Lookup from WVP0204D |O-TYPE-DESC |A |N/A |Provider Type Code Description |3 |
|n/a |n/a |O-EMAIL |N |N/A |Spaces | |
|n/a |n/a |O-RETURNED-MAIL |N |N/A |Spaces | |
|P_ADDR_TB |P_LINE1_AD |O-ADDR-LINE-1 |A |N/A |Provider (Location) Address, Line 1 | |
|P_ADDR_TB |P_LINE2_AD |O-ADDR-LINE-2 |C |N/A |Provider (Location) Address, Line 2 | |
|n/a |n/a |O-ADDR-LINE-3 |N |N/A |Spaces | |
|P_ADDR_TB |P_CITY_NM |O-CITY |A |N/A |Provider City | |
|P_ADDR_TB |Lookup from WVP2639D |O-COUNTY |A |N/A |Provider County Description |4 |
|P_ADDR_TB |P_ST_CD |O-STATE |A |N/A |Provider State Code | |
|P_ADDR_TB |P_ZIP5_CD |O-ZIP |A |N/A |Provider Zip Code | |
|P_ADDR_TB |P_ZIP4_CD |O-ZIP-4 |C |N/A |Provider Zip Code +4 | |
|P_ADDR_TB |P_PHON_NUM |O-PHONE |A |N/A |Provider Phone Number | |
|n/a |n/a |O-PHONE-EXT |N |N/A |Spaces | |
|P_ADDR_TB |P_FAX_NUM |O-FAX |A |N/A |Provider Fax Number | |
|n/a |n/a |O-FAX-EXT |N |N/A |spaces | |
Notes:
1. If the Provider is an Organization (P_NAM_ORG_IND = ‘Y’), the full name (P_NAM) is moved to O-FULL-LAST-NAM and spaces are moved to the remaining Name fields, otherwise each field is moved individually.
2. Lookup from copybook WVP0189D based on P_ENROL_STAT_TY_CD.
3. Lookup from copybook WVP0204D based on P_TY_CD.
4. Lookup from copybook WVP2639D based on P_CNTY_CD.
LEGEND: For Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit C = Conditionally N = Numeric Edits S = System Generated
N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
OCR/RRI PROVIDER INTERFACE
|Description: |
|The OCR/RRI Provider interface transmits Provider information to the Montana mainframe, which is then downloaded to the RRI server for use by the RRI system to validate Provider numbers |
|scanned from claims. This file is created on a daily basis by extracting each P_ID from the P_PROV_TB using Platinum’s FastUnload. This 8-character, fixed-length format file is then zipped |
|and transmitted to New Mexico via FTP. All providers on the table are selected regardless of whether they are active or not. |
|Source Tables - Data Element(s): |
|(P_PROV_TB) - P_ID |
|Target Files: |
|OCR/RRI Provider Extract |
|Remarks: |
|Provider type “801” is not sent |
NEW MEXICO OMNICAID MMIS CLAIMS SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE
DRAMS PROVIDER INTERFACE
|Description: |
|The MMIS extracts provider data to the DRAMS system for use in drug rebate processing. |
|Source Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_ENROL_STAT_TB) |
|(P_NPI_XMTCH_TB) |
|Target Files: |
|A sequential file of provider records is produced by this interface to be sent to the DRAMS system. |
|Reports: |
|Process Summary |
|Remarks: Select providers that meet the following criteria: |
|Provider Billing Code is Billing, Encounter, Servicing, or Unrestricted (P_BLNG_CD = ‘B’, ‘E’, ‘S’, or ‘U’) |
|Provider Type Code is in the ranges of 001-400, 413-450 or 901-902. (P_TY_CD) |
|The provider has a valid mailing or location address (P_ADR_TY_CD = ‘M’ or ‘L’) |
|Up to three separate extract records are produced for each provider, one with the NM MMIS provider ID, one with NABP, and one with NPI. |
NEW MEXICO OMNICAID MMIS CLAIMS SUBSYSTEM
INTERFACE LAYOUT
OUTPUT FILE
DRAMS PROVIDER INTERFACE
01 WFP40050-PROV-OUTFILE-REC.
05 WFP40050-FIRST-CHAR PIC X(01).
05 WFP40050-P-ID PIC X(20).
05 WFP40050-P-DBA-NAM PIC X(50).
05 WFP40050-P-NABP-NUM PIC X(15).
05 WFP40050-ADDR-LINE-1 PIC X(50).
05 WFP40050-ADDR-LINE-2 PIC X(50).
05 WFP40050-CITY PIC X(50).
05 WFP40050-STATE PIC X(02).
05 WFP40050-ZIP PIC X(05).
05 WFP40050-ZIP-4 PIC X(04).
05 WFP40050-FAX PIC X(10).
05 WFP40050-PHONE PIC X(10).
05 WFP40050-PHONE-EXT PIC X(05).
05 WFP40050-CONTACT-NAME PIC X(50).
05 WFP40050-P-ENROL-STAT-TY-CD PIC X(04).
05 WFP40050-P-STAT-EFF-DT PIC X(10).
05 WFP40050-P-TY-CD PIC X(04).
05 WFP40050-340B-ID PIC X(15).
NEW MEXICO OMNICAID MMIS CLAIMS SUBSYSTEM
INTERFACE EXHIBIT
OUTPUT FILE
DRAMS PROVIDER INTERFACE
|Source |Source |Target | | | |Note |
|Table / File |Column / Field |Field |Req |Def |Specifications |Ref |
|P_PROV_TB |P_ID |WFP40050-P-ID |A |N | |3 |
| |P_NABP_NUM | | | | | |
|P_NPI_XMTCH_TB |P_NPI_ID | | | | | |
|P_PROV_TB |P_DBA_NAM |WFP40050-P-DBA-NAM |A |N | | |
|P_PROV_TB |P_NABP_NUM |WFP40050-P-NABP-NUM |N |N | | |
|P_ADDR_TB |P_LINE1_AD |WFP40050-ADDR-LINE-1 |N |N |Provider Mailing Address |2 |
|P_ADDR_TB |P_LINE2_AD |WFP40050-ADDR-LINE-2 |N |N |Provider Mailing Address |2 |
|P_ADDR_TB |P_CITY_NM |WFP40050-CITY |N |N |Provider Mailing Address |2 |
|P_ADDR_TB |P_ST_CD |WFP40050-STATE |N |N |Provider Mailing Address |2 |
|P_ADDR_TB |P_ZIP5_CD |WFP40050-ZIP |A |N |Provider Mailing Address |2 |
|P_ADDR_TB |P_ZIP4_CD |WFP40050-ZIP-4 |N |N |Provider Mailing Address |2 |
|P_ADDR_TB |P_FAX_NUM |WFP40050-FAX |N |N | |2 |
|P_ADDR_TB |P_PHON_NUM |WFP40050-PHONE |N |N | |2 |
|N/A |N/A |WFP40050-PHONE-EXT |N |Spaces | | |
|N/A |N/A |WFP40050-CONTACT-NAME |A |Spaces | | |
|P_ENROL_STAT_TB |P_ENROL_STAT_TY_CD |WFP40050-P-ENROL-STAT-TY-CD |A |N |Populated with ‘A’ or ‘I’ |1 |
|P_ENROL_STAT_TB |P_STAT_EFF_DT |WFP40050-P-STAT-EFF-DT |N |N |The most recent status effective date for the| |
| | | | | |provider is used. | |
|P_PROV_TB |P_TY_CD |WFP40050-P-TY-CD |N |N | | |
|N/A |N/A |WFP40050-340B-ID |N |Spaces | | |
|N/A |N/A |WFP40050-P-ID-TY-CD |A |N |This program-generated field specifies | |
| | | | | |whether the provider ID sent on the claim | |
| | | | | |is: | |
| | | | | |01 - National Provider Identifier | |
| | | | | |05 - Medicaid Provider ID | |
| | | | | |07 - NCPDP Provider ID (aka NABP | |
| | | | | |Number) | |
| | | | | |99 - Other | |
| | | | | |The type code needs to be used with the | |
| | | | | |implementation of NPI. | |
________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always
C = Conditionally
N = Never
Notes:
1. A or I indicating active or inactive. The most recent provider status is used to determine this status code. If P_ENROL_STAT_TY_CD = ‘60’, then the provider is Active, otherwise the provider is considered Inactive.
2. This information is populated from the data on the provider mailing address record. If the data is spaces on the mailing address record, then the information is populated from the provider location address record.
3. Separate extract records are produced for each of three identifiers for the provider. The first record contains the NM MMIS Provider ID. The second contains the NPI, if the provider has one. The third contains the NABP, if the provider has one. Prior to the implementation of the NPI project, the NPI number was obtained from the Provider Detail table (P_PROV_TB). After the NPI project implementation, the NPI will be obtained from the NPI Cross-Match table, using the NM MMIS provider id and the enrollment status effective date.
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
BCBS PROVIDER NPI CROSS-MATCH FILE INTERFACE
|Description: |
|An interface file containing provider NPI information will be generated weekly for BCBS. All providers on the MMIS Provider NPI Cross-Match Database are included on the interface file: |
|Source Tables: |
|P_NPI_XMTCH_TB |
|Target Files: |
|BCBS File |
|Reports: |
|N/A |
|Remarks: |
|N/A |
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
BCBS PROVIDER NPI CROSS-MATCH FILE INTERFACE
Record Layout:
01 DCLP-NPI-XMTCH-TB.
10 P-ID PIC X(8).
10 P-NPI-BEG-DT PIC X(10).
10 P-NPI-END-DT PIC X(10).
10 P-NPI-ID PIC X(10).
10 P-TY-CD PIC X(3).
10 P-BLNG-CD PIC X(1).
10 P-ZIP5-CD PIC X(5).
10 G-AUD-ADD-USER-ID PIC X(7).
10 G-AUD-ADD-DT PIC X(10).
10 G-AUD-ADD-TM PIC X(8).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
10 P-ZIP4-CD PIC X(4).
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
BCBS PROVIDER NPI CROSS-MATCH FILE INTERFACE
|Source |Source |Target | | | |Note |
|Table |Column |Field |Req |Def |Specifications |Ref |
|P_NPI_XMTCH_TB |P_NPI_BEG_DT |P-NPI-BEG-DT | | |Effective date of the NPI for this provider. | |
| | | | | |Format ‘CCYY-MM-DD’ | |
|P_NPI_XMTCH_TB |P_NPI_END_DT |P-NPI-END-DT | | |End date of the NPI for this provider. Format | |
| | | | | |‘CCYY-MM-DD’ | |
|P_NPI_XMTCH_TB |P_NPI_ID |P-NPI-ID | | |NPI | |
|P_NPI_XMTCH_TB |P_TY_CD |P-TY-CD | | |Provider Type | |
|P_NPI_XMTCH_TB |P_BLNG_CD |P-BLNG-CD | | | | |
|P_NPI_XMTCH_TB |P_ZIP5_CD |P-ZIP5-CD | | | | |
|P_NPI_XMTCH_TB |G_AUD_ADD_USER_ID |G-AUD-ADD-USER-ID | | | | |
|P_NPI_XMTCH_TB |G_AUD_ADD_DT |G-AUD-ADD-DT | | |Format ‘CCYY-MM-DD’ | |
|P_NPI_XMTCH_TB |G_AUD_ADD_TM |G-AUD-ADD-TM | | |Format ‘HH.MM.SS’. Program Generated. | |
|P_NPI_XMTCH_TB |G_AUD_USER_ID |G-AUD-USER-ID | | | | |
|P_NPI_XMTCH_TB |G_AUD_DT |G-AUD-DT | | |Format ‘CCYY-MM-DD’ | |
|P_NPI_XMTCH_TB |G_AUD_TM |G-AUD-TM | | |Format ‘HH.MM.SS’. Program Generated. | |
Notes:
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
HMS PROVIDER INTERFACE
|Description: |
|This interface is a simple unload of various provider tables on Omnicaid. The data is not manipulated in any way, all of the data on the various tables are included. A control totals file is |
|produced for each table unloaded, containing a table identifier, date produced, and a record count. |
|Source Tables: |
|P_ADDR_TB |
|P_AFFL_TB |
|P_BLNG_MEDM_TB |
|P_CLIA_CERT_TB |
|P_DISP_FEE_TB |
|P_DISP_SHARE_TB |
|P_ENROL_STAT_TB |
|P_LANG_TB |
|P_LIC_CERT_TB |
|P_MC_AFFL_X_TB |
|P_MCARE_TB |
|P_MCARE_CARR_TB |
|P_NUM_BED_TB |
|P_PROG_TB |
|P_PROV_TB |
|P_PROV_SORT_TB |
|P_REVW_TB |
|P_REVW_CLM_TB |
|P_REVW_PROG_TB |
|P_REVW_SVC_TB |
|P_SPECL_TB |
|P_TY_SPECL_X_TB |
|P_NPI_XMTCH_TB |
|P_TXNMY_XMTCH_TB |
|Target Files: |
|Sequential flat files for each of the tables shown above. |
|Reports: |
|N/A |
|Remarks: |
|Detailed output file layouts and specifications are not included for this interface since it consists of simple copies of the Omnicaid provider tables. |
|A example follows of the control totals file for the provider address table (PADDRSTB): |
|PADDRSTB 2016-03-09 000789707 |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
HMS PROVIDER INTERFACE
Record Layout:
01 DCLP-ADDR-TB.
10 P-ID PIC X(8).
10 P-ADR-TY-CD PIC X(1).
10 P-ST-CD PIC X(2).
10 P-CNTY-CD PIC X(2).
10 P-LINE1-AD PIC X(45).
10 P-LINE2-AD PIC X(45).
10 P-CITY-NAM PIC X(20).
10 P-ZIP4-CD PIC X(4).
10 P-ZIP5-CD PIC X(5).
10 P-PHON-NUM PIC X(10).
10 P-PHON-EXT-NUM PIC X(5).
10 P-FAX-NUM PIC X(10).
10 P-EMAIL-ADR-TEXT PIC X(50).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-AFFL-TB.
10 P-GROUP-P-ID PIC X(8).
10 P-MEMBER-P-ID PIC X(8).
10 P-AFFL-BEG-DT PIC X(10).
10 P-AFFL-END-DT PIC X(10).
10 P-AFFL-TY-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-BLNG-MEDM-TB.
10 P-ID PIC X(8).
10 P-BLNG-MEDM-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-CLIA-CERT-TB.
10 P-ID PIC X(8).
10 P-CLIA-CERT-EFF-DT PIC X(10).
10 P-CERT-EXPIR-DT PIC X(10).
10 P-CLIA-NUM PIC X(10).
10 P-CLIA-CERT-TY-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-DISP-FEE-TB.
10 P-ID PIC X(8).
10 P-DISP-EFF-DT PIC X(10).
10 P-DISP-FEE-AMT PIC S9(5)V9(2) USAGE COMP-3.
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-DISP-SHARE-TB.
10 P-ID PIC X(8).
10 P-DISP-SHR-BEG-DT PIC X(10).
10 P-DISP-SHR-END-DT PIC X(10).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-ENROL-STAT-TB.
10 P-ID PIC X(8).
10 P-STAT-EFF-DT PIC X(10).
10 G-AUD-TS PIC X(26).
10 P-ENROL-STAT-TY-CD PIC X(2).
10 G-AUD-USER-ID PIC X(7).
01 DCLP-LANG-TB.
10 P-ID PIC X(8).
10 P-LANG-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-LIC-CERT-TB.
10 P-ID PIC X(8).
10 P-LIC-CERT-NUM PIC X(15).
10 P-LIC-CERT-CD PIC X(2).
10 P-ST-CD PIC X(2).
10 P-LIC-RSTRCT-CD PIC X(1).
10 P-LIC-VRFY-IND PIC X(1).
10 P-LIC-BRD-NUM PIC X(8).
10 P-LIC-EXPIR-DT PIC X(10).
10 P-LIC-EFF-DT PIC X(10).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-MC-AFFL-X-TB.
10 P-MEMBER-P-ID PIC X(8).
10 P-MCO-P-ID PIC X(8).
10 P-MCO-ASGN-ID PIC X(15).
10 P-PCP-IND PIC X(1).
10 P-CNTRCT-STAT-CD PIC X(2).
10 P-CNTRCT-STAT-B-DT PIC X(10).
10 P-CNTRCT-STAT-E-DT PIC X(10).
10 P-SUB-CNTRCT-ID PIC X(15).
10 P-SUB-CNTRCT-TY-CD PIC X(2).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-MCARE-TB.
10 P-ID PIC X(8).
10 P-MCARE-BEG-DT PIC X(10).
10 P-MCARE-END-DT PIC X(10).
10 P-MCARE-NUM PIC X(12).
10 P-MCARE-PART-A-IND PIC X(1).
10 P-MCARE-PART-B-IND PIC X(1).
10 P-MC-CARR-ID PIC X(10).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-MCARE-CARR-TB.
10 P-MC-CARR-ID PIC X(10).
10 P-MC-CARR-AD PIC X(50).
10 P-MC-CARR-CITY-NAM PIC X(20).
10 P-MC-CARR-ST-CD PIC X(2).
10 P-MC-CARR-ZIP-CD PIC X(9).
10 P-MC-CARR-PHON-NUM PIC X(10).
10 P-MC-CARR-NAM PIC X(50).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-NUM-BED-TB.
10 P-ID PIC X(8).
10 P-NUM-BED-EFF-DT PIC X(10).
10 P-NUM-BED-END-DT PIC X(10).
10 P-INTR-BED-NUM PIC S9(4) USAGE COMP.
10 P-SKILL-BED-NUM PIC S9(4) USAGE COMP.
10 P-IP-BED-NUM PIC S9(4) USAGE COMP.
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-PROG-TB.
10 P-ID PIC X(8).
10 P-PROG-BEG-DT PIC X(10).
10 P-PROG-END-DT PIC X(10).
10 P-PROG-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-PROV-TB.
10 P-ID PIC X(8).
10 P-RA-MEDM-CD PIC X(1).
10 P-LOCN-CD PIC X(1).
10 P-RA-SORT-SEQ-CD PIC X(1).
10 P-RA-PRT-SUSP-CD PIC X(1).
10 P-PRACT-TY-CD PIC X(1).
10 P-INDIV-GRP-CD PIC X(1).
10 P-TY-CD PIC X(3).
10 P-BIN-NUM PIC X(9).
10 P-EFT-ACCT-NUM PIC X(15).
10 P-EFT-BEG-DT PIC X(10).
10 P-EFT-END-DT PIC X(10).
10 P-NF-CLS-CD PIC X(1).
10 P-PHRM-CLS-CD PIC X(1).
10 P-FACI-TY-CD PIC X(1).
10 P-UPIN-NUM PIC X(6).
10 P-FED-TAX-ID PIC X(9).
10 P-SSN-NUM PIC X(9).
10 P-NABP-NUM PIC X(11).
10 P-NTRPRS-ID PIC X(8).
10 P-DEA-NUM PIC X(11).
10 P-DBA-NAM PIC X(45).
10 P-DBA-ORG-IND PIC X(1).
10 P-DBA-LAST-NAM PIC X(35).
10 P-DBA-FST-NAM PIC X(15).
10 P-DBA-MI-NAM PIC X(1).
10 P-DBA-SFX-NAM PIC X(10).
10 P-NAM PIC X(45).
10 P-NAM-ORG-IND PIC X(1).
10 P-LAST-NAM PIC X(35).
10 P-FST-NAM PIC X(15).
10 P-MI-NAM PIC X(1).
10 P-SFX-NAM PIC X(10).
10 P-W9-SIGNED-DT PIC X(10).
10 P-FSCL-END-MO-NUM PIC X(2).
10 P-APPL-DT PIC X(10).
10 P-FACI-BEG-DT PIC X(10).
10 P-FACI-END-DT PIC X(10).
10 P-COST-STTLMT-DT PIC X(10).
10 P-BLLTN-MEDM-CD PIC X(1).
10 P-BLLTN-COPY-NUM PIC S9(4) USAGE COMP.
10 P-EMC-PSWD-DAT PIC X(8).
10 P-MCARE-IND PIC X(1).
10 P-FED-VAC-CHLD-IND PIC X(1).
10 P-BKUP-WHOLD-IND PIC X(1).
10 P-MULTI-LOCN-IND PIC X(1).
10 P-GROSS-TAX-NUM PIC X(9).
10 P-PROFIT-IND PIC X(1).
10 P-REVER-DT PIC X(10).
10 P-BLNG-CD PIC X(1).
10 P-PROF-TECH-IND PIC X(1).
10 P-IHS-IND PIC X(1).
10 P-SOLE-COMM-IND PIC X(1).
10 P-TAX-DISCT-IND PIC X(1).
10 P-EPSDT-ONLY-IND PIC X(1).
10 P-PSY-SOC-IND PIC X(1).
10 P-ADD-DT PIC X(10).
10 P-SORT-NAM PIC X(45).
10 P-HLTHCARE-IND PIC X(1).
10 P-WARR-MEDIA-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
10 P-PUB-PRV-CD PIC X(1).
10 P-DOB-DT PIC X(10).
01 DCLP-PROV-SORT-TB.
10 P-ID PIC X(8).
10 P-SORT-1-DAT PIC X(35).
10 P-SORT-2-DAT PIC X(35).
10 P-SORT-3-DAT PIC X(35).
10 P-SORT-4-DAT PIC X(35).
10 P-SORT-5-DAT PIC X(35).
01 DCLP-REVW-TB.
10 P-ID PIC X(8).
10 P-REVW-BEG-DT PIC X(10).
10 P-REVW-END-DT PIC X(10).
10 P-REVW-ACTN-CD PIC X(1).
10 P-REVW-RSN-CD PIC X(2).
10 P-REVW-LOCN-CD PIC X(1).
10 P-REVW-DT-IND PIC X(1).
10 P-RSTRCT-SANC-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-REVW-CLM-TB.
10 P-ID PIC X(8).
10 P-REVW-BEG-DT PIC X(10).
10 P-REVW-END-DT PIC X(10).
10 C-HDR-TY-CD PIC X(1).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-REVW-PROG-TB.
10 P-ID PIC X(8).
10 P-PROG-CD PIC X(1).
10 P-REVW-BEG-DT PIC X(10).
10 P-REVW-END-DT PIC X(10).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-REVW-SVC-TB.
10 P-ID PIC X(8).
10 P-REVW-BEG-DT PIC X(10).
10 P-REVW-END-DT PIC X(10).
10 P-REVW-SVC-SEQ-NUM PIC S9(3)V USAGE COMP-3.
10 P-SVC-FR-PROC-CD PIC X(7).
10 P-SVC-THRU-PROC-CD PIC X(7).
10 P-SVC-FR-DIAG-CD PIC X(10).
10 P-SVC-THRU-DIAG-CD PIC X(10).
10 P-SVC-FR-DRG-CD PIC X(5).
10 P-SVC-THRU-DRG-CD PIC X(5).
10 P-SVC-FR-REV-CD PIC X(7).
10 P-SVC-THRU-REV-CD PIC X(7).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-SPECL-TB.
10 P-ID PIC X(8).
10 P-SPECL-BEG-DT PIC X(10).
10 P-SPECL-CD PIC X(3).
10 P-SPECL-END-DT PIC X(10).
10 G-AUD-USER-ID PIC X(7).
10 G-AUD-DT PIC X(10).
10 G-AUD-TM PIC X(8).
01 DCLP-TY-SPECL-X-TB.
10 P-TY-CD PIC X(3).
10 P-SPECL-CD PIC X(3).
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
WELLS FARGO EFT PRENOTE INTERFACE
|Description: |
|An interface file containing Provider EFT banking information will be created weekly for submission to Wells Fargo for verification. Those Providers with an EFT Status Code of ‘T’ will be |
|selected. |
|Source Tables: |
|(P_PROV_TB) |
|(P_EFT_ACCT_TB) |
| |
|Target Files: |
|Wells Fargo EFT Prenote File |
|Reports: |
|N/A |
|Remarks: |
|N/A |
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
WELLS FARGO EFT PRENOTE INTERFACE
Record Layout:
*
*** WELLS FARGO SECURITY RECORD
*
01 WK-299-SECURITY-REC.
05 FILLER PIC X(22)
05 FILLER PIC X(16)
05 FILLER PIC X(56)
*
*** FILE HEADER RECORD
*
01 WK-300-FILE-HDR-REC
05 WK-300-RECORD-TYPE PIC X(01)
05 WK-300-PRIORITY-CODE PIC X(02)
05 WK-300-IMM-DESTINATION PIC X(10)
05 WK-300-ORIGIN-NUM PIC X(10)
05 WK-300-CREAT-DT PIC X(06)
05 WK-300-CREAT-TM PIC X(04)
05 WK-300-FILE-ID PIC X(01)
05 WK-300-REC-SIZ PIC X(03)
05 WK-300-BLCK-FACTOR PIC X(02)
05 WK-300-FORMAT-CD PIC X(01)
05 WK-300-DESTINATION PIC X(23)
05 WK-300-COMPANY-NAM PIC X(23)
05 WK-300-REF-COD PIC X(08)
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
WELLS FARGO EFT PRENOTE INTERFACE
*
*** COMPANY HEADER RECORD
*
01 WK-310-COMPANY-HDR-REC
05 WK-310-RECORD-TYPE PIC X(01)
05 WK-310-SRV-CLASS-CD PIC X(03)
05 WK-310-COMPANY-NAME PIC X(16)
05 WK-310-COMPANY-DISC-DATA PIC X(20)
05 WK-310-COMPANY-ID PIC X(10)
05 WK-310-STAND-ENTR-CLASS-CD PIC X(03)
05 WK-310-COMPANY-ENTRY-DESC PIC X(10)
05 WK-310-COMPANY-DESC-DT PIC X(06)
05 WK-310-EFF-ENTRY-DT PIC X(06)
05 WK-310-SETTLEMENT-DT PIC X(03)
05 WK-310-ORIGIN-ST-CD PIC X(01)
05 WK-310-ORIGIN-DFI-ID PIC X(08)
05 WK-310-BAT-NUM PIC 9(07)
*
*** ENTRY DETAIL RECORD
*
01 WK-320-ENTRY-DTL-REC.
05 WK-320-RECORD-TYPE PIC X(01)
05 WK-320-TRANS-CD PIC X(02)
05 WK-320-ROUTING-NUM PIC 9(08)
05 WK-320-ROUTING-CHK-DIGIT PIC 9(01)
05 WK-320-DFI-ACCOUNT-NUM PIC X(17)
05 WK-320-AMOUNT PIC 9(08)V9(02)
05 WK-320-PAYEE-ID PIC X(15)
05 WK-320-PAYEE-NAME PIC X(22)
05 WK-320-BOA-DRAFT-IND PIC X(02)
05 WK-320-ADDENDA-REC-IND PIC X(01)
05 WK-320-TRACE-NUM PIC X(15)
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
WELLS FARGO EFT PRENOTE INTERFACE
*
*** COMPANY TRAILER RECORD
*
01 WK-330-COMPANY-TRAIL-REC.
05 WK-330-RECORD-TYPE PIC X(01)
05 WK-330-SRV-CLASS-CD PIC X(03)
05 WK-330-ENTRY-REC-COUNT PIC 9(06)
05 WK-330-ENTRY-HASH PIC 9(10)
05 WK-330-TOTAL-DEB-BAT-AMT PIC 9(10)V9(02)
05 WK-330-TOTAL-CRE-BAT-AMT PIC 9(10)V9(02)
05 WK-330-COMPANY-ID PIC X(10)
05 WK-330-FILLER PIC X(25)
05 WK-330-ORIGIN-DFI-ID PIC X(08)
05 WK-330-BAT-NUM PIC 9(07)
*
*** FILE CONTROL RECORD
*
01 WK-340-FILE-CTRL-REC.
05 WK-340-RECORD-TYPE PIC X(01)
05 WK-340-BAT-CNT PIC 9(06)
05 WK-340-BLCK-CNT PIC 9(06)
05 WK-340-ENTRY-CNT PIC 9(08)
05 WK-340-ENTRY-HASH PIC 9(10)
05 WK-340-TOT-DEB-BAT-AMT PIC 9(10)V9(02)
05 WK-340-TOT-CRE-BAT-AMT PIC 9(10)V9(02)
05 WK-340-FILLER PIC X(39)
*
*** BLOCK FILLER RECORD
*
01 WK-999-BLOCK-FILLER-REC.
05 FILLER PIC X(94)
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
WELLS FARGO EFT PRENOTE INTERFACE
|Source |Source |Target | | | |Note |
|Table |Column |Field |Req |Def |Specifications |Ref |
| | | | | | | |
|N/A |N/A |WK-300-RECORD-TYPE |A |N/A |Value will be “1” | |
|N/A |N/A |WK-300-PRIORITY-CODE |A |N/A |Value will be “01” | |
|N/A |N/A |WK-300-IMM-DESTINATION |A |N/A |Value will be “ 091000019” | |
|N/A |N/A |WK-300-ORIGIN-NUM |A |N/A |Value will be “8560005601” | |
|N/A |N/A |WK-300-CREAT-DT |A |N/A |Run Date in YYMMDD format | |
|N/A |N/A |WK-300-CREAT-TM |A |N/A |Run Time in HHMM Format | |
|N/A |N/A |WK-300-FILE-ID |A |N/A |Value will be “A” | |
|N/A |N/A |WK-300-REC-SIZ |A |N/A |Value will be “094” | |
|N/A |N/A |WK-300-BLCK-FACTOR |A |N/A |Value will be “10” | |
|N/A |N/A |WK-300-FORMAT-CD |A |N/A |Value will be “1” | |
|N/A |N/A |WK-300-DESTINATION |A |N/A |Value will be “WELLS FARGO” | |
|N/A |N/A |WK-300-COMPANY-NAM |A |N/A |Value will be “NM HSD-MEDICAID ACH PYT” | |
|N/A |N/A |WK-300-REF-COD |A |N/A |Value will be “PRENOTE” | |
|N/A |N/A |WK-310-RECORD-TYPE |A |N/A |Value will be “5” | |
|N/A |N/A |WK-310-SRV-CLASS-CD |A |N/A |Value will be “220” | |
|N/A |N/A |WK-310-COMPANY-NAME |A |N/A |Value will be “NM HSD-MCAID ACH” | |
|N/A |N/A |WK-310-COMPANY-DISC-DATA |N |N/A |Value will be spaces | |
|N/A |N/A |WK-310-COMPANY-ID |A |N/A |Value will be “8560005601” | |
|N/A |N/A |WK-310-STAND-ENTR-CLASS-CD |A |N/A |Value will be “CCD” | |
|N/A |N/A |WK-310-COMPANY-ENTRY-DESC |N |N/A |Value will be spaces | |
|N/A |N/A |WK-310-EFF-ENTRY-DT |A |N/A |Run Date in YYMMDD format | |
|N/A |N/A |WK-310-SETTLEMENT-DT |N |N/A |Value will be spaces | |
|N/A |N/A |WK-310-ORIGIN-ST-CD |A |N/A |Value will be “1” | |
|N/A |N/A |WK-310-ORIGIN-DFI-ID |A |N/A |Value will be “09100001” | |
|N/A |N/A |WK-310-BAT-NUM |A |N/A |Value will be 1 | |
| | | | | | | |
|N/A |N/A |WK-320-RECORD-TYPE |A |N/A |Value will be “6” | |
|P_EFT_ACCT_TB |P_ACCT_TY_CD |WK-320-TRANS-CD |A |N/A |If this is a Checking Account (P_ACCT_TY_CD = “C”), value | |
| | | | | |is “23”. If this is a Savings Account (P_ACCT_TY_CD = | |
| | | | | |“S”), value is “33”. If neither one, program aborts. | |
|P_EFT_ACCT_TB |P_ROUT_TRANS_NUM (1:8) |WK-320-ROUTING-NUM |A |N/A |First eight (8) digits of the Routing Number | |
|P_EFT_ACCT_TB |P_ROUT_TRANS_NUM (9:1) |WK-320-ROUTING-CHK-DIGIT |A |N/A |Last (ninth) digit of the Routing Number | |
|P_EFT_ACCT_TB |P_ACCT_NUM |WK-320-DFI-ACCOUNT-NUM |A |N/A |Provider Account Number | |
|N/A |N/A |WK-320-AMOUNT |A |N/A |Value will be 0 | |
|P_PROV_TB |P_ID |WK-320-PAYEE-ID |A |N/A |Provider ID Number | |
|P_PROV_TB |P_DBA_NAME or P_NAM |WK-320-PAYEE-NAME |A |N/A |If the Provider Business Name is populated, this is that | |
| | | | | |value; otherwise this is Provider Name | |
|N/A |N/A |WK-320-BOA-DRAFT-IND |N |N/A |Value will be spaces | |
|N/A |N/A |WK-320-ADDENDA-REC-IND |A |N/A |Value will be “0” | |
|N/A |N/A |WK-320-TRACE-NUM |A |N/A |Value will be “091000010000000” | |
| | | | | | | |
|N/A |N/A |WK-330-RECORD-TYPE |A |N/A |Value will be “8” | |
|N/A |N/A |WK-330-SRV-CLASS-CD |A |N/A |Value will be “220” | |
|N/A |program generated |WK-330-ENTRY-REC-COUNT |A |N/A |Total number of Detail (Type = “6”) records | |
|N/A |program generated |WK-330-ENTRY-HASH |A |N/A |This is the ten (10) low-order digits of the sum of all the| |
| | | | | |Routing Numbers (excluding the Check Digit) in this file | |
|N/A |N/A |WK-330-TOTAL-DEB-BAT-AMT |A |N/A |Value will be 0 | |
|N/A |N/A |WK-330-TOTAL-CRE-BAT-AMT |A |N/A |Value will be 0 | |
|N/A |N/A |WK-330-COMPANY-ID |A |N/A |Value will be “8560005601” | |
|N/A |N/A |WK-330-FILLER |N |N/A |Value will be spaces | |
|N/A |N/A |WK-330-ORIGIN-DFI-ID |A |N/A |Value will be “09100001” | |
|N/A |N/A |WK-330-BAT-NUM |A |N/A |Value will be 1 | |
| | | | | | | |
|N/A |N/A |WK-340-RECORD-TYPE |A |N/A |Value will be “9” | |
|N/A |N/A |WK-340-BAT-CNT |A |N/A |Value will be 1 | |
|N/A |program generated |WK-340-BLCK-CNT |A |N/A |This is the total number of record blocks in the file. The| |
| | | | | |program calculates this number as the total number of | |
| | | | | |records in the file (including Block Filler records) | |
| | | | | |divided by ten (10). | |
|N/A |program generated |WK-340-ENTRY-CNT |A |N/A |Total number of Detail (Type = “6”) records | |
|N/A |program generated |WK-340-ENTRY-HASH |A |N/A |This is the ten (10) low-order digits of the sum of all the| |
| | | | | |Routing Numbers (excluding the Check Digit) in this file | |
|N/A |N/A |WK-340-TOT-DEB-BAT-AMT |A |N/A |Value will be 0 | |
|N/A |N/A |WK-340-TOT-CRE-BAT-AMT |A |N/A |Value will be 0 | |
|N/A |N/A |WK-340-FILLER |N |N/A |Value will be spaces | |
| | | | | | | |
Notes:
1. Wells Fargo requires that all files be in multiples of ten (10) records. The program adds enough “pad” records to make that happen.
LEGEND: For Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit C = Conditionally N = Numeric Edits S = System Generated
N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
LEIE DATABASE MATCH INTERFACE- disable based on DH handles now
|Description: |
|The LEIE Database is downloaded from the web to compare against the MMIS Provider subsystem. |
|Source Files: |
|LEIE File |
|Target Tables: |
|Reports: |
|A LEIE Database Match report is produce when Name or Address is matched against the input LEIE file against the Provider tables. This is a on request run and then worked manually. |
|Remarks: |
|N/A |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
LEIE Database Match INTERFACE
LEIE DATABASE INTERFACE FILE
01. P4000SA-LEIE-DB-REC.
05 LEIE-LAST-NAM PIC X(20).
05 LEIE-FST-NAM PIC X(15).
05 LEIE-MI-NAM PIC X(15).
05 LEIE-BUS-NAM PIC X(30).
05 LEIE-GENERAL PIC X(20).
05 LEIE-SPECL PIC X(20).
05 LEIE-UPIN PIC X(06).
05 LEIE-DOB PIC X(08).
05 LEIE-ADDR PIC X(30).
05 LEIE-CITY PIC X(20).
05 LEIE-ST PIC X(02).
05 LEIE-ZIP PIC X(05).
05 LEIE-SANC-TY PIC X(09).
05 LEIE-SANC-DT PIC X(08).
05 LEIE-REIN-DT PIC X(08).
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
LEIE DATABASE MATCH INTERFACE
LEIE DATABASE MATCH INTERFACE RECORD
|Source |Target |Target |Std | | | |Note |
|Field |Table |Column |Edit |Req |Def |Specifications |Ref |
|LEIE-FST-NAM |P_PROV_TB |P_FST_NAM |N/A |C |N/A | | |
|LEIE-MI-NAM |N/A |N/A |N/A |N/A |N/A | | |
|LEIE-BUS-NAM |P_PROV_TB |P_NAM |N/A |C |N/A | | |
|LEIE-GENERAL |N/A |N/A |N/A |N/A |N/A | | |
|LEIE-SPECL |N/A |N/A |N/A |N/A |N/A | | |
|LEIE-UPIN |N/A |N/A |N/A |A |N/A | | |
|LEIE-DOB |N/A |N/A |N/A |N/A |N/A | | |
|LEIE-ADDR |P_ADDR_TB |P_LINE1_AD |N/A |C |N/A | | |
|LEIE-CITY |P_ADDR_TB |P_CITY_NAM |N/A |C |N/A | | |
|LEIE-ST |P_ADDR_TB |P_ST_CD |N/A |C |N/A | | |
|LEIE-ZIP |P_ADDR_TB |P_ZIP5_CD |N/A |C |N/A | | |
|LEIE-SANC-TY |N/A |N/A |N/A |N/A |N/A | | |
|LEIE-SANC-DT |N/A |N/A |N/A |N/A |N/A | | |
|LEIE-REIN-DT |N/A |N/A |N/A |N/A |N/A | | |
Notes:
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit C = Conditionally N = Numeric Edits S = System Generated
N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
STATE LEVEL REGISTRY INTERFACE
|Description: |
|An interface file containing Provider information will be created weekly in support of the State Level Registry. The State Level Registry is a State system that tracks and attests provider |
|meaningful use and incentive payments as mandated by the ARRA HITECH Act. This is a full replacement file. |
|Source File: |
|Initial Provider Extract File |
| |
|Source Tables: |
|P_PROV_TB |
|P_NPI_XMTCH_TB |
|P_ADDR_TB |
|P_CLIA_CERT_TB |
|P_LIC_CERT_TB |
|P_ENROL_STAT_TB |
|P_SPECL_TB |
|C_PROV_PMT_HIST_TB |
| |
|Target Files: |
|Provider SLR Interface File |
|Reports: |
|N/A |
|Remarks: |
|This is a full replacement file as opposed to an update file. It will be pipe delimited, fixed length, generated weekly and transmitted via XEROX’ secure FTP via Move-It DMZ. The selection |
|criteria: |
| |
|Medicaid FFS Providers (Status Code “70”, “11”) |
|Provider Billing Code = ‘S’, ‘B’ , “F” or ‘U’ |
|Provider Type = 201, 221, 301, 302, 303, 304,305,316, 322,421, 803, 311, 312, 313, 314, 315, 422 OR provider has an IHS indicator |
| |
|Providers without NPI numbers will not be included. |
| |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
STATE LEVEL REGISTRY INTERFACE
01 WK-300-DETAIL-REC.
05 WK-300-RECORD-TYPE PIC X(01)
05 FILLER1 PIC X(01)
05 WK-300-P-NPI-ID PIC X(10)
05 FILLER2 PIC X(01)
05 WK-300-CCN PIC X(12)
05 FILLER3 PIC X(01)
05 WK-300-P-SSN-NUM PIC X(09)
05 FILLER4 PIC X(01)
05 WK-300-P-FED-TAX-ID PIC X(09)
05 FILLER5 PIC X(01)
05 WK-300-P-ID PIC X(10)
05 FILLER6 PIC X(01)
05 WK-300-P-TXNMY-CD PIC X(10)
05 FILLER7 PIC X(01)
05 WK-300-P-CLIA-NUM PIC X(10)
05 FILLER8 PIC X(01)
05 WK-300-P-CLIA-CERT-TY PIC X(01)
05 FILLER9 PIC X(01)
05 WK-300-P-PGM-PROV-NUM PIC X(12)
05 FILLER10 PIC X(01)
05 WK-300-P-LIC-CERT-NUM PIC X(15)
05 FILLER11 PIC X(01)
05 WK-300-P-TY-CD PIC X(03)
05 FILLER12 PIC X(01)
05 WK-300-PAID-CLAIM-IND PIC X(01)
05 FILLER13 PIC X(01)
05 WK-300-P-FST-NAM PIC X(40)
05 FILLER14 PIC X(01)
05 WK-300-P-LAST-NAM PIC X(40)
05 FILLER15 PIC X(01)
05 WK-300-P-MI-NAM PIC X(01)
05 FILLER16 PIC X(01)
05 WK-300-P-DBA-NAM PIC X(60)
05 FILLER17 PIC X(01)
05 WK-300-P-LINE1-AD PIC X(40)
05 FILLER18 PIC X(01)
05 WK-300-P-LINE2-AD PIC X(40)
05 FILLER19 PIC X(01)
05 WK-300-P-CITY-NAM PIC X(20)
05 FILLER20 PIC X(01)
05 WK-300-P-ST-NAM PIC X(02)
05 FILLER21 PIC X(01)
05 WK-300-P-ZIP5-CD PIC X(05)
05 FILLER22 PIC X(01)
05 WK-300-P-ZIP4-CD PIC X(04)
05 FILLER23 PIC X(01)
05 WK-300-P-PHON-NUM PIC X(10)
05 FILLER24 PIC X(01)
05 WK-300-P-FAX-NUM PIC X(10)
05 FILLER25 PIC X(01)
05 WK-300-P-CNTY-CD PIC X(05)
05 FILLER26 PIC X(01)
05 WK-300-P-EMAIL-ADR PIC X(60)
05 FILLER27 PIC X(01)
05 WK-300-P-ENROL-STAT-TY PIC X(02)
05 FILLER28 PIC X(01)
05 WK-300-P-STAT-EFF-DT PIC X(08)
05 FILLER29 PIC X(01)
05 WK-300-ENROLL-END-DT PIC X(08)
05 FILLER30 PIC X(01)
05 WK-300-NUM-BEDS PIC X(05)
05 FILLER31 PIC X(01)
05 WK-300-ADD-DATE PIC X(08)
05 FILLER32 PIC X(01)
05 WK-300-P-INDIV-GRP-CD PIC X(01)
05 FILLER33 PIC X(01)
05 WK-300-DUAL-ELIG-IND PIC X(01)
05 FILLER34 PIC X(01)
05 WK-300-P-SPECL-CD PIC X(03)
05 FILLER35 PIC X(01)
05 WK-300-P-BLNG-CD PIC X(01)
01 WK-330-TRAILER-REC.
05 WK-330-RECORD-TYPE PIC X(01)
05 FILLER36 PIC X(1)
05 WK-330-RECORD-COUNT PIC 9(09)
05 FILLER37 PIC X(33)
05 FILLER38 PIC X(468)
NEW MEXICO MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
STATE LEVEL REGISTRY INTERFACE
|Source |Source |Target | | | |Note |
|Table |Column |Field |Req |Def |Specifications |Ref |
| | |WK-300-RECORD-TYPE |A |S |Literal value “1” | |
|P_NPI_XMTCH_TB |P_NPI_ID |WK-300-P-NPI-ID | | |Select the latest NPI if there are multiple NPI id’s. | |
|P_PROV_TB | |WK-300-CCN |N |N/A |SPACES | |
|P_PROV_TB |P_SSN_NUM |WK-300-P-SSN-NUM |A |N/A | | |
|P_PROV_TB |P_FED_TAX_ID |WK-300-P-FED-TAX-ID |A |N/A | | |
|P_PROV_TB |P_ID |WK-300-P-ID |A |N/A |Left justify fill with spaces. | |
| | |WK-300-P-TXNMY-CD |N |N/A |SPACES | |
|P_CLIA_CERT_TB |P_CLIA_NUM |WK-300-P-CLIA-NUM |A |N/A | | |
|P_CLIA_CERT_TB |P_CLIA_CERT_TY_CD |WK-300-P-CLIA-CERT-TY |A |N/A |The State value for clia cert type is cross walked |3 |
| | | | | |(converted) . | |
| | |WK-300-P-PGM-PROV-NUM |N |N/A |SPACES | |
|P_LIC_CERT_TB |P_LIC_CERT_NUM |WK-300-P-LIC-CERT-NUM |A |N/A |Where there is an active license that shows State as NM, | |
| | | | | |choose it, otherwise, choose the greatest expiration date. | |
| | | | | |If more than one exists with the greatest expiration date, | |
| | | | | |choose the one with the greatest update date | |
|P_PROV_TB |P_TY_CD |WK-300-P-TY-CD |A |N/A | | |
|C_PROV_PMT_HIST_TB | |WK-300-PAID-CLAIM-IND |A |N/A |Value will the “1” if there has been a paid claim or “0” if|2 |
| | | | | |there has not been a paid claim. | |
|P_PROV_TB |P_FST_NAM |WK-300-P-FST-NAM |A |N/A |May be spaces depending on the organization indicators |4 |
|P_PROV_TB |P_LST_NAM |WK-300-P-LAST-NAM |A |N/A |May be spaces depending on the organization indicators |4 |
|P_PROV_TB |P_MI_NAM |WK-300-P-MI-NAM |A |N/A |May be spaces depending on the organization indicators |4 |
|P_PROV_TB |P_NAM / P_DBA_NAM |WK-300-P-DBA-NAM |A |N/A |Depends on organization indicator |4 |
|P_ADDR_TB |P_LINE1_AD |WK-300-P-LINE1-AD |A |N/A | | |
|P_ADDR_TB |P_LINE2_AD |WK-300-P-LINE2-AD |A |N/A | | |
|P_ADDR_TB |P_CITY_NAM |WK-300-P-CITY-NAM |A |N/A | | |
|P_ADDR_TB |P_ST_NAM |WK-300-P-ST-NAM |A |N/A | | |
|P_ADDR_TB |P_ZIP5_CD |WK-300-P-ZIP5-CD |A |N/A | | |
|P_ADDR_TB |P_ZIP4_CD |WK-300-P-ZIP4-CD |A |N/A | | |
|P_ADDR_TB |P_PHON_NUM |WK-300-P-PHON-NUM |A |N/A | | |
|P_ADDR_TB |P_FAX_NUM |WK-300-P-FAX-NUM |A |N/A | | |
|P_ADDR_TB |P_CNTY_CD |WK-300-P-CNTY-CD |A |N/A |The State value should be cross walked to the FIPS values | |
|P_ADDR_TB |P_EMAIL_ADR |WK-300-P-EMAIL-ADR |A |N/A | | |
|P_ENROL_ST_TB |P_ENROL_STAT_TY |WK-300-P-ENROL-STAT-TY |A |N/A |The State value is cross walked to other values for the SLR|5 |
|P_ENROL_ST_TB |P_STAT_EFF_DT |WK-300-P-STAT-EFF-DT |A |N/A |Format of all dates is “CCYYMMDD” | |
| | |WK-300-ENROLL-END-DT |A |N/A |This will always be “99991231” | |
| | |WK-300-NUM-BEDS |N |N/A |SPACES | |
|P_PROV_TB |P_ADD_DT |WK-300-ADD-DATE |A |N/A |Format of all dates is “CCYYMMDD” | |
|P_PROV_TB |P_INDIV_GRP_CD |WK-300-P-INDIV-GRP-CD |A |N/A | | |
| | |WK-300-DUAL-ELIG-IND |N |N/A |SPACES | |
|P_SPECL_TB |P_SPECL_CD |WK-300-P-SPECL-CD |A |N/A |If provider has an ‘037’ speciality, select it otherwise | |
| | | | | |pick the first one found. | |
|P_PROV_TB |P_BLNG_CD |WK-300-P-BLNG-CD |A |N/A | | |
|TRAILER RECORD | | | | | |1 |
| | |WK-330-RECORD-TYPE |A |S |Literal value “2” | |
| | |WK-330-RECORD-COUNT |A |N/A |Numeric – right justified with zero fill to left | |
Notes:
1. Each field is delimited with the “pipe” delimiter (“|”).
2. The paid claim indicator is set if the client has had any paid claims (using the CPVHISTB – Claims Provider Payment History table).
3. Conversion of CLIA Certification Type code:
o WHEN P-CLIA-CERT-TY-CD is 2 = "A"
o WHEN P-CLIA-CERT-TY-CD is 4 = "B"
o WHEN P-CLIA-CERT-TY-CD is 9 = "C"
o WHEN P-CLIA-CERT-TY-CD is 1 = "D"
o WHEN P-CLIA-CERT-TY-CD is3 = "E"
4. The names will be populated based on the following logic. If either P_DBA_ORG_IND or P_NAM_ORG_IND is checked, enter the provider name that is entered for the indicator that is checked in the Provider Business Name as an organization and do not populate the first/middle/last name. If both P_DBA_ORG_IND or P_NAM_ORG_IND are checked, enter the provider associated with the P_NAM_ORG_IND as an organization in the Provider Business Name and do not populate the first/middle/last name. If neither P_DBA_ORG_IND or P_NAM_ORG_IND are checked, enter the first/middle/last and the entry from P_NAM in the Provider Business Name.
5. Conversion of Enrollment Status code:
• WHEN '01' THRU '10' = “02”
• WHEN '13' = “02”
• WHEN '20' THRU '24' = “05”
• WHEN '40' THRU '46' = “03”
• WHEN '60' = “01”
• WHEN OTHER = “ “
LEGEND: For Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit C = Conditionally N = Numeric Edits S = System Generated
N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
Digital Harbor Interface – Provider Credentialing
|Description: |
|Digital Harbor extracts provider information for Provider Credentialing. There is a daily process that extracts providers that meet the following criteria: |
|Provider latest enrollment status of 45 |
|Add date (P_ADD_DT) that falls between PARM 2001(provider begin date) and 2002(provider end date) |
|AND SSN not equal to all 9’s |
|AND Provider billing code not equal to “E”(encounter) |
|AND Provider types not 801, 802, 803, 821, 822, 831, 832, 833, and 899. |
|Provider latest enrollment status of 44 |
|Enrollment effective date (P_STAT_EFF_DT) that falls between PARM 2001(provider begin date) and 2002(provider end date) |
|AND Provider types not 801, 802, 803, 821, 822, 831, 832, 833, and 899. |
| |
|The process runs after midnight using the PARM to process all providers matching the criteria for that cycle day. The process runs before the PARMS are updated so it only extracts provider |
|data who have been added with P_ADD_DT of yesterday. Except on Tuesday where the PARM dates will span the weekend plus Monday. |
| |
|There is a monthly process that extracts all providers that meet the following criteria: |
|Provider latest enrollment status of 60 |
|Provider types not 801, 802, 803, 821, 822, 831, 832, 833, and 899. |
|Provider latest enrollment status of 70 |
|AND Enrollment effective date (P_STAT_EFF_DT) greater than or equal to '2014-01-01' |
|AND SSN not equal to all 9’s |
|AND Provider types not 801, 802, 803, 821, 822, 831, 832, 833, and 899. |
| |
| |
| |
|Source Files: |
|P_PROV_TB |
|P_ENROL_STAT_TB |
|P_LIC_CERT_TB |
|P_ADDR_TB |
|P_MCARE_TB |
|P_NPI_XMTCH_TB |
|P_CLIA_CERT_TB |
|P_SPECL_TB |
|Target Tables: |
|N/A |
|Reports: |
|N/A |
|Remarks: |
| |
|The provider location address is used to populate this interface. |
|Logic was put in place to look at the DBA ORG indicator (P-DBA-ORG-IND). If checked, move “G” to the DH layout field P6100SA-P-INDIV-GRP-CD. If not checked move “I”. |
|Logic was also put in place (on 4/6/15) to check for P6100SA-P-INDIV-GRP-CD = 'G'. If ‘G’, space out last name fields in the output (P6100SA-LAST-N1 and P6100SA-DBA-LAST-N1). This was |
|causing concerns with KYP. |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
Digital Harbor Interface – Provider Credentialing
Digital Harbor Output INTERFACE FILE
01 P6100SA-PROVIDER-DATA.
05 P6100SA-PROV-DATA.
10 P6100SA-APPL-TY-CD PIC X(001).
10 FILLER PIC X(001).
10 P6100SA-PROVIDER-NO PIC X(008).
10 FILLER PIC X(001).
10 P6100SA-DEA-NUMBER PIC X(011).
10 FILLER PIC X(001).
10 P6100SA-PROV-TYPE PIC X(003).
10 FILLER PIC X(001).
10 P6100SA-PRAC-TY-CD PIC X(001).
10 FILLER PIC X(001).
10 P6100SA-DOB-DT PIC X(010).
10 FILLER PIC X(001).
10 P6100SA-TAX-ID PIC X(009).
10 FILLER PIC X(001).
10 P6100SA-SSN-NUM PIC X(009).
05 P6100SA-NAME-DATA.
10 FILLER PIC X(001).
10 P6100SA-P-INDIV-GRP-CD PIC X(001).
10 FILLER PIC X(001).
10 P6100SA-LAST-N1 PIC X(035).
10 FILLER PIC X(001).
10 P6100SA-FIRST-N1 PIC X(015).
10 FILLER PIC X(001).
10 P6100SA-INITIAL-N1 PIC X(001).
10 FILLER PIC X(001).
10 P6100SA-TITLE PIC X(010).
10 FILLER PIC X(001).
10 P6100SA-LEGAL-NAM PIC X(045).
10 FILLER PIC X(001).
10 P6100SA-DBA-LAST-N1 PIC X(035).
10 FILLER PIC X(001).
10 P6100SA-DBA-FIRST-N1 PIC X(015).
10 FILLER PIC X(001).
10 P6100SA-DBA-INITIAL-N1 PIC X(001).
10 FILLER PIC X(001).
10 P6100SA-DBA-TITLE PIC X(010).
10 FILLER PIC X(001).
10 P6100SA-DBA-NAM PIC X(045).
05 P6100SA-ADDRESS-DATA.
10 FILLER PIC X(001).
10 P6100SA-ADDR-SVC-LINE1 PIC X(045).
10 FILLER PIC X(001).
10 P6100SA-ADDR-SVC-LINE2 PIC X(045).
10 FILLER PIC X(001).
10 P6100SA-ADDR-SVC-CITY PIC X(020).
10 FILLER PIC X(001).
10 P6100SA-ADDR-SVC-STATE PIC X(002).
10 FILLER PIC X(001).
10 P6100SA-ADDR-SVC-ZIP-CODE PIC X(005).
10 FILLER PIC X(001).
10 P6100SA-ADDR-SVC-ZIP4-CODE PIC X(004).
05 P6100SA-NABP-DATA.
10 FILLER PIC X(001).
10 P6100SA-NABP-NUMBER PIC X(011).
05 P6100SA-LICENSE-DATA OCCURS 10 TIMES
INDEXED BY P6100SA-LIC-DATA-X.
10 P6100SA-LICENSE-DATA-GRP.
15 FILLER PIC X(001).
15 P6100SA-PROV-LIC-NUM PIC X(015).
15 FILLER PIC X(001).
15 P6100SA-PROV-LIC-ST PIC X(002).
15 FILLER PIC X(001).
15 P6100SA-PROV-ST-BOARD PIC X(008).
15 FILLER PIC X(001).
15 P6100SA-LIC-EXPIR-DT PIC X(010).
05 P6100SA-NPI-DATA OCCURS 2 TIMES
INDEXED BY P6100SA-NPI-ID-DATA-X.
10 P6100SA-NPI-GRP.
15 FILLER PIC X(001).
15 P6100SA-NPI-NUMBER PIC X(010).
05 P6100SA-MCARE-DATA OCCURS 5 TIMES
INDEXED BY P6100SA-MCARE-DATA-X.
10 P6100SA-MCARE-DATA-GRP.
15 FILLER PIC X(001).
15 P6100SA-MEDICARE PIC X(012).
05 P6100SA-CLIA-DATA OCCURS 5 TIMES
INDEXED BY P6100SA-CLIA-DATA-X.
10 P6100SA-CLIA-GRP.
15 FILLER PIC X(001).
15 P6100SA-CLIA-NUM PIC X(010).
05 P6100SA-OWNER-DATA OCCURS 20 TIMES
INDEXED BY P6100SA-OWNER-DATA-X.
10 P6100SA-OWNER-DATA-GRP .
15 FILLER PIC X(001).
15 P6100SA-OWNER-LAST-N1 PIC X(020).
15 FILLER PIC X(001).
15 P6100SA-OWNER-FIRST-N1 PIC X(015).
15 FILLER PIC X(001).
15 P6100SA-OWNER-INITIAL-N1 PIC X(001).
15 FILLER PIC X(001).
15 P6100SA-OWNER-TTL-N1 PIC X(003).
15 FILLER PIC X(001).
15 P6100SA-OWNER-DOB PIC X(010).
15 FILLER PIC X(001).
15 P6100SA-OWNER-SSN PIC X(009).
15 FILLER PIC X(001).
15 P6100SA-ADDR-OWN-LINE1 PIC X(030).
15 FILLER PIC X(001).
15 P6100SA-ADDR-OWN-LINE2 PIC X(030).
15 FILLER PIC X(001).
15 P6100SA-ADDR-OWN-CITY PIC X(020).
15 FILLER PIC X(001).
15 P6100SA-ADDR-OWN-STATE PIC X(002).
15 FILLER PIC X(001).
15 P6100SA-ADDR-OWN-ZIP-CD PIC X(005).
15 FILLER PIC X(001).
15 P6100SA-ADDR-OWN-ZIP4-CD PIC X(004).
15 FILLER PIC X(001).
15 P6100SA-BUSN-NAM PIC X(035).
15 FILLER PIC X(001).
15 P6100SA-BUSN-DBA-NAM PIC X(035).
15 FILLER PIC X(001).
15 P6100SA-BUSN-TAX-ID PIC X(009).
15 FILLER PIC X(001).
15 P6100SA-BUSN-ADDR-LINE1 PIC X(030).
15 FILLER PIC X(001).
15 P6100SA-BUSN-ADDR-LINE2 PIC X(030).
15 FILLER PIC X(001).
15 P6100SA-BUSN-ADDR-CITY PIC X(020).
15 FILLER PIC X(001).
15 P6100SA-BUSN-ADDR-STATE PIC X(002).
15 FILLER PIC X(001).
15 P6100SA-BUSN-ADDR-ZIP-CD PIC X(005).
15 FILLER PIC X(001).
15 P6100SA-BUSN-ADDR-ZIP4-CD PIC X(004).
05 P6100SA-EMP-EMPL-DATA OCCURS 20 TIMES
INDEXED BY P6100SA-EMP-DATA-X.
10 P6100SA-EMP-EMPL-DATA-GRP.
15 FILLER PIC X(001).
15 P6100SA-EMP-LAST-N1 PIC X(020).
15 FILLER PIC X(001).
15 P6100SA-EMP-FIRST-N1 PIC X(015).
15 FILLER PIC X(001).
15 P6100SA-EMP-INITIAL-N1 PIC X(001).
15 FILLER PIC X(001).
15 P6100SA-EMP-TTL PIC X(003).
15 FILLER PIC X(001).
15 P6100SA-EMP-SSN PIC X(009).
15 FILLER PIC X(001).
15 P6100SA-EMP-DOB PIC X(010).
15 FILLER PIC X(001).
15 P6100SA-ADDR-EMP-LINE1 PIC X(030).
15 FILLER PIC X(001).
15 P6100SA-ADDR-EMP-LINE2 PIC X(030).
15 FILLER PIC X(001).
15 P6100SA-ADDR-EMP-CITY PIC X(020).
15 FILLER PIC X(001).
15 P6100SA-ADDR-EMP-STATE PIC X(002).
15 FILLER PIC X(001).
15 P6100SA-ADDR-EMP-ZIP-CODE PIC X(005).
15 FILLER PIC X(001).
15 P6100SA-ADDR-EMP-ZIP4-CODE PIC X(004).
05 P6100SA-SPCL-DATA OCCURS 5 TIMES
INDEXED BY P6100SA-SPCL-DATA-X.
10 P6100SA-SPCL-DATA-GRP.
15 FILLER PIC X(001).
15 P6100SA-SPECL-CD PIC X(020).
05 P6100SA-AUDIT-DATA.
10 FILLER PIC X(001).
10 P6100SA-ENRL-G-AUD-USER-ID PIC X(007).
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
Digital Harbor Interface – Provider Credentialing INTERFACE
Digital Harbor Interface – Provider Credentialing INTERFACE RECORD
|Source |Source |Target |Std | | | |Note |
|Table |Table |Field |Edit |Req |Def |Specifications |Ref |
|P_PROV_TB |P_ID |P6100SA-PROVIDER-NO | |A | | | |
|P_PROV_TB |P_DEA_NUM |P6100SA-DEA-NUMBER | |C | | | |
|P_PROV_TB |P_TY_CD |P6100SA-PROV-TYPE | |A | | | |
|P_PROV_TB |P_PRACT_TY_CD |P6100SA-PRAC-TY-CD | |C | | | |
|P_PROV_TB |P_DOB_DT |P6100SA-DOB-DT | |A | | | |
|P_PROV_TB |P_FED_TAX_ID |P6100SA-TAX-ID | |C | | | |
|P_PROV_TB |P_SSN_NUM |P6100SA-SSN-NUM | |C | | | |
|P_PROV_TB |P_IND_ORG_INDI |P6100SA-P-INDIV-GRP-CD | |C | | | |
|P_PROV_TB |P_DBA_LAST_NAM |P6100SA-LAST-N1 | |A | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_DBA_FST_NAM |P6100SA-FIRST-N1 | |C | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_DBA_MI_NAM |P6100SA-INITIAL-N1 | |C | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_DBA_SFX_NAM |P6100SA-TITLE | |C | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_DBA_NAM |P6100SA-LEGAL-NAM | |A | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_LAST_NAM |P6100SA-DBA-LAST-N1 | |A | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_FST_NAM |P6100SA-DBA-FIRST-N1 | |C | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_MI_NAM |P6100SA-DBA-INITIAL-N1 | |C | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_ SFX_NAM |P6100SA-DBA-TITLE | |C | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_PROV_TB |P_NAM |P6100SA-DBA-NAM | |A | | |Requested |
| | | | | | | |by DH/KYP |
| | | | | | | |due to |
| | | | | | | |their |
| | | | | | | |inflexible|
| | | | | | | |system. |
|P_ADDR_TB |P_LINE1_AD |P6100SA-ADDR-SVC-LINE1 | |A | | | |
|P_ADDR_TB |P_LINE2_AD |P6100SA-ADDR-SVC-LINE2 | |C | | | |
|P_ADDR_TB |P_CITY_NAM |P6100SA-ADDR-SVC-CITY | |A | | | |
|P_ADDR_TB |P_ST_CD |P6100SA-ADDR-SVC-STATE | |A | | | |
|P_ADDR_TB |P_ZIP5_CD |P6100SA-ADDR-SVC-ZIP-CODE | |A | | | |
|P_ADDR_TB |P_ZIP4_CD |P6100SA-ADDR-SVC-ZIP4-CODE | |C | | | |
|P_PROV_TB |P_NABP_NUM |P6100SA-NABP-NUMBER | |C | | | |
|P6100SA-LICENSE-DATA-GRP | | | |Occurs 10 times | |
|P_LIC_CERT_TB |P_LIC_CERT_NUM |P6100SA-PROV-LIC-NUM | |C | | | |
|P_LIC_CERT_TB |P_ST_CD |P6100SA-PROV-LIC-ST | |C | | | |
|P_LIC_CERT_TB |P_LIC_BRD_NUM |P6100SA-PROV-ST-BOARD | |C | | | |
|P_LIC_CERT_TB |P_LIC_EXPIR_DT |P6100SA-LIC-EXPIR-DT | |C | | | |
|P6100SA-NPI-GRP | | | |Occurs 2 times | |
|P_NPI_XMTCH_TB |P_NPI_ID |P6100SA-NPI-NUMBER | |C | | | |
|P6100SA-MCARE-DATA-GRP | | | |Occurs 5 times | |
|P_MCARE_TB |P_MCARE_NUM |P6100SA-MEDICARE | |C | | | |
|P6100SA-CLIA-GRP | | | |Occurs 5 times | |
|P_CLIA_PROV_TB |P_CLIA_NUM |P6100SA-CLIA-NUM | |C | | | |
|P6100SA-OWNER-DATA-GRP | | | |Occurs 20 times | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LAST-NAM |P6100SA-OWNER-LAST-N1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-FST-NAM |P6100SA-OWNER-FIRST-N1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-MI-NAM |P6100SA-OWNER-INITIAL-N1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-TITL-NAM |P6100SA-OWNER-TTL-N1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-DOB-DT |P6100SA-OWNER-DOB | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-EINSSN-ID |P6100SA-OWNER-SSN | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LINE1-AD |P6100SA-ADDR-OWN-LINE1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LINE2-AD |P6100SA-ADDR-OWN-LINE2 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-CITY-NAM |P6100SA-ADDR-OWN-CITY | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ST-CD |P6100SA-ADDR-OWN-STATE | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ZIP5-CD |P6100SA-ADDR-OWN-ZIP-CD | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ZIP4-CD |P6100SA-ADDR-OWN-ZIP4-CD | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 2. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-DBA-NAM |P6100SA-BUSN-NAM | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-DBA-NAM |P6100SA-BUSN-DBA-NAM | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-EINSSN-ID |P6100SA-BUSN-TAX-ID | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LINE1-AD |P6100SA-BUSN-ADDR-LINE1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LINE2-AD |P6100SA-BUSN-ADDR-LINE2 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-CITY-NAM |P6100SA-BUSN-ADDR-CITY | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ST-CD |P6100SA-BUSN-ADDR-STATE | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ZIP5-CD |P6100SA-BUSN-ADDR-ZIP-CD | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ZIP4-CD |P6100SA-BUSN-ADDR-ZIP4-CD | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 1. | |
|P6100SA-MGMT-EMPL-DATA-GRP | | | |Occurs 20 times | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LAST-NAM |P6100SA-EMP-LAST-N1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-FST-NAM |P6100SA-EMP-FIRST-N1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-MI-NAM |P6100SA-EMP-INITIAL-N1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-TITL-NAM |P6100SA-EMP-TTL | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-DOB-DT |P6100SA-EMP-SSN | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-EINSSN-ID |P6100SA-EMP-DOB | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LINE1-AD |P6100SA-ADDR-EMP-LINE1 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-LINE2-AD |P6100SA-ADDR-EMP-LINE2 | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-CITY-NAM |P6100SA-ADDR-EMP-CITY | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ST-CD |P6100SA-ADDR-EMP-STATE | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ZIP5-CD |P6100SA-ADDR-EMP-ZIP-CODE | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P_OWNEMP_INFO_TB |P-OWNEMP-ZIP4-CD |P6100SA-ADDR-EMP-ZIP4-CODE | |N/A | |If P-OWNEMP-TAX-IND OF | |
| | | | | | |DCLP-OWNEMP-INFO-TB = 3. | |
|P6100SA-SPCL-DATA-GRP | | | |Occurs 5 times | |
|P_SPECL_TB |P_SPECL_CD |P6100SA-SPECL-CD | |C | | | |
|P6100SA-AUDIT-DATA | | | | | |
|P-ENROL-STAT-TB |G-AUD-USER-ID |P6100SA-ENRL-G-AUD-USER-ID | |A | | | |
Notes:
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit V = Valid Value Edit C = Conditionally N = Numeric Edits S = System Generated
N = Never
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
SPECTRUM INFORMATICS PROVIDER INTERFACE
|Description: |
|This interface involves sending the Provider files created for the Data Warehouse to Spectrum Informatics via MOVEIT Central tasks. The Provider files are sent on a weekly basis. |
| |
|Source Table |
|Source Mainframe File |
|MOVEIT Task Nbr(TTDC) |
| |
|provaddr |
|NEWM.PDSS.JWPR01SZ.PROVADDR.ZIPFILE |
|p00178r |
| |
|provaffl |
|NEWM.PDSS.JWPR02SZ.PROVAFFL.ZIPFILE |
|p00178s |
| |
|provdisp |
|NEWM.PDSS.JWPR03SZ.PROVDISP.ZIPFILE |
|p00178t |
| |
|provenrl |
|NEWM.PDSS.JWPR04SZ.PROVENRL.ZIPFILE |
|p00178u |
| |
|provlicn |
|NEWM.PDSS.JWPR05SZ.PROVLICN.ZIPFILE |
|p00178v |
| |
|provmcaf |
|NEWM.PDSS.JWPR06SZ.PROVMCAF.ZIPFILE |
|p00178w |
| |
|provmcre |
|NEWM.PDSS.JWPR07SZ.PROVMCRE.ZIPFILE |
|p00178x |
| |
|provprog |
|NEWM.PDSS.JWPR08SZ.PROVPROG.ZIPFILE |
|p00178y |
| |
|provbase |
|NEWM.PDSS.JWPR09SZ.PROVBASE.ZIPFILE |
|p00178z |
| |
|provspec |
|NEWM.PDSS.JWPR10SZ.PROVSPEC.ZIPFILE |
|p00179a |
| |
|provrevw |
|NEWM.PDSS.JWPR11SZ.PROVREVW.ZIPFILE |
|p00179b |
| |
|provphst |
|NEWM.PDSS.JWPR12SZ.PROVPHST.ZIPFILE |
|p00179c |
| |
|provnbed |
|NEWM.PDSS.JWPR13SZ.PROVNBED.ZIPFILE |
|p00179d |
| |
|provnpix |
|NEWM.PDSS.JWPR14SZ.PROVNPIX.ZIPFILE |
|p00179e |
| |
| |
| |
| |
| |
|Target Files: |
|A zipped file with the above source table name is catalogued on the Spectrum Informatics server for each file. |
|Reports: |
|N/A |
|Remarks: |
|Detailed output file layouts and specifications are not included for this interface and can be found in the Data Warehouse file layouts. |
|16.4.3 Data Warehouse Interface Functionality |
NEW MEXICO OMNICAID MMIS
PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER MASTER INTERFACE
|Description: |
|The Provider Master interface file is generated monthly for the Centennial Care MCOs. The interface file contains all Medicaid FFS and Medicaid Managed Care Only enrolled providers who meet the|
|criteria below: |
| |
|Provider has a status “60” (Active) or “70” (None(MCO)) as an unterminated status |
|OR |
|Provider has a termination status with an effective date within the past 60 days |
|OR |
|Provider has a denied status with an effective date within the past 60 days |
|OR |
|Provider has a pending status with an effective date within the past 90 days |
| |
| |
|Providers who meet the criteria below are excluded from the Provider Master file: |
| |
|Provider Types '701','702','703','704', 801, 802, 803, 833, 899 and 344 |
|Source Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_ENROL_STAT_TB) |
|(P_SPECL_TB) |
|(P_MC_AFFL_X_TB) |
|(P_NPI_XMTCH_TB) |
|Reports: |
|N/A |
|Remarks: Providers may have both status ‘60’ and status ‘70’ unterminated. In that case, the termination date for the earlier effective status will be calculated as one day prior to the start of|
|the later effective status, and the termination date for the later effective status will be 9999-12-31. |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER MASTER INTERFACE
01 WFP20050-HEADER-RECORD.
05 WFP20050-RECORD-TYPE PIC X(1).
88 WFP20050-REC-TYPE-HEADER VALUE 'H'.
05 WFP20050-FILE-TYPE PIC X(1).
88 WFP20050-FILE-TYPE-CONFIRM VALUE 'C'.
88 WFP20050-FILE-TYPE-ERROR VALUE 'E'.
88 WFP20050-FILE-TYPE-MASTER VALUE 'M'.
88 WFP20050-FILE-TYPE-NOTIF VALUE 'N'.
05 WFP20050-MCO-ID PIC X(8).
05 WFP20050-FILE-CREATE-DATE.
10 WFP20050-FILE-CREATE-CC PIC X(2).
10 WFP20050-FILE-CREATE-YY PIC X(2).
10 WFP20050-FILE-CREATE-MM PIC X(2).
10 WFP20050-FILE-CREATE-DD PIC X(2).
05 FILLER PIC X(477).
******
******
01 WFP20100-PROVIDER-RECORD.
05 WFP20100-RECORD-TYPE PIC X(01).
05 WFP20100-PROV-STATUS PIC X(01).
88 MC-ONLY-ENROLLED VALUE '1'.
88 FFS-ENROLLED VALUE '2'.
88 PROV-DENIED VALUE '3'.
88 PROV-TERM-OMNICAID VALUE '4'.
88 PROV-PENDING VALUE '5'.
05 WFP20100-PROV-NPI-ID PIC X(10).
05 WFP20100-PROV-EIN-SSN PIC X(09).
05 WFP20100-SORT-NAME PIC X(45).
05 WFP20100-PROV-MEDICAID-ID PIC X(08).
05 WFP20100-SVC-ADDRESS-AREA.
10 WFP20100-SVC-ADDR-LINE1 PIC X(45).
10 WFP20100-SVC-ADDR-LINE2 PIC X(45).
10 WFP20100-SVC-CITY PIC X(20).
10 WFP20100-SVC-ST PIC X(02).
10 WFP20100-SVC-ZIP5 PIC X(05).
10 WFP20100-SVC-ZIP4 PIC X(04).
10 WFP20100-SVC-GEO-CNTY PIC X(02).
05 WFP20100-SVC-PROV-PHONE PIC X(10).
05 WFP20100-MAIL-ADDRESS-AREA.
10 WFP20100-MAIL-ADDR-LINE1 PIC X(45).
10 WFP20100-MAIL-ADDR-LINE2 PIC X(45).
10 WFP20100-MAIL-CITY PIC X(20).
10 WFP20100-MAIL-ST PIC X(02).
10 WFP20100-MAIL-ZIP5 PIC X(05).
10 WFP20100-MAIL-ZIP4 PIC X(04).
05 WFP20100-HEALTH-HOME-SPECL-CD
PIC X(03).
05 WFP20100-MCO-AFFILIATION-DATA
OCCURS 4 TIMES.
10 WFP20100-MCO-P-ID PIC X(02).
10 WFP20100-PCP-IND PIC X(01).
10 WFP20100-MCO-CTRCT-STAT-CD
PIC X(02).
88 CONTRACTED VALUE 'CT'.
88 NON-CONTRACTED VALUE 'NC'.
88 TERMINATED VALUE 'TD'.
88 DELETED VALUE 'XX'.
10 WFP20100-MCO-CTRCT-STAT-DATES.
15 WFP20100-MCO-CTRCT-STAT-BEG-DT.
20 WFP20100-MCO-CTRCT-STAT-BEG-CC
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-YY
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-MM
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-DD
PIC X(02).
15 WFP20100-MCO-CTRCT-STAT-END-DT.
20 WFP20100-MCO-CTRCT-STAT-END-CC
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-YY
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-MM
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-DD
PIC X(02).
05 WFP20100-PROV-TY-CD PIC X(03).
05 WFP20100-SPECIALTY-DATA
OCCURS 9 TIMES.
10 WFP20100-PROV-SPECIALTY PIC X(03).
05 WFP20100-OMNICAID-PROV-BEG-DT.
10 WFP20100-OMNI-PROV-BEG-CC
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-YY
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-MM
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-DD
PIC X(02).
05 WFP20100-OMNICAID-PROV-END-DT.
10 WFP20100-OMNI-PROV-END-CC
PIC X(02).
10 WFP20100-OMNI-PROV-END-YY
PIC X(02).
10 WFP20100-OMNI-PROV-END-MM
PIC X(02).
10 WFP20100-OMNI-PROV-END-DD
PIC X(02).
05 WFP20100-PROFIT-IND PIC X(01). RAT1869
05 FILLER PIC X(09). RAT1869
******
******
01 WFP20200-TRAILER-RECORD.
05 WFP20200-RECORD-TYPE PIC X(01).
88 WFP20200-REC-TYPE-TLR
VALUE 'T'.
05 WFP20200-RECORD-COUNT PIC 9(09).
05 FILLER PIC X(485).
MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER MASTER INTERFACE
PROVIDER MASTER HEADER RECORD
|Target Field |Source Table |Source Field |Std | |Def | |Note Ref |
| | | |Edit |Req | |Specifications | |
|WFP20050-RECORD-TYPE |N/A |RECORD-TYPE |N/A |A |N/A |H = Header | |
|WFP20050-FILE-TYPE |N/A |FILE-TYPE |N/A |A |N/A |M = Provider Master file | |
|WFP20050-MCO-ID |N/A |MCO-ID |N/A |C |N/A |Populate with spaces | |
|WFP20050-FILE-CREATE-DATE |N/A |FILE-CREATE-DATE |N/A |A |N/A |Format = CCYYMMDD | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER MASTER INTERFACE
PROVIDER MASTER DETAIL RECORD
|Target |Source |Source | | |Def | |Note Ref |
|Field |Table |Column / Field |Std Edit |Req | |Specifications | |
|WFP20100-RECORD-TYPE |N/A |RECORD-TYPE |N/A |A |N/A |P = Provider | |
|WFP20100-PROV-NPI-ID |P_NPI_XMTCH_TB |P_NPI_ID |N/A |C |N/A |Required for health care providers | |
|WFP20100-PROV-EIN-SSN |P_PROV_TB |P_FED_TAX_ID |N/A |C |N/A |Required for atypical providers | |
| | |P_SSN_NUM | | | | | |
|WFP20100-PROV-SORT-NAME |P_PROV_TB |P_SORT_NAM |N/A |A |N/A | | |
|WFP20100-SVC-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-SVC-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |A |N/A |Location address line 1 | |
|WFP20100-SVC-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Location address line 2 | |
|WFP20100-SVC-CITY |P_ADDR_TB |P_CITY_NAM |N/A |A |N/A |Location city | |
|WFP20100-SVC-ST |P_ADDR_TB |P_ST_CD |N/A |A |N/A |Location state | |
|WFP20100-SVC-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |A |N/A |Location zip | |
|WFP20100-SVC-PROV- PHONE |P_ADDR_TB |P_PHON_NUM |N/A |A |N/A |Phone number | |
|WFP20100-MAIL-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-MAIL-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |A |N/A |Mailing address line 1 | |
|WFP20100-MAIL-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Mailing address line 2 | |
|WFP20100-MAIL-CITY |P_ADDR_TB |P_CITY_NAM |N/A |A |N/A |Mailing city | |
|WFP20100-MAIL-ST |P_ADDR_TB |P_ST_CD |N/A |A |N/A |Mailing state | |
|WFP20100-MAIL-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |A |N/A |Mailing zip | |
|WFP20100-MCO-P-ID |P_MC_AFFL_X_TB |P_MCO_P_ID |N/A |C |N/A |MCO affiliated with this provider. | |
|WFP20100-PCP-IND |P_MC_AFFL_X_TB |P_PCP_IND |N/A |N |N/A |“Y”, “N” or space. | |
|WFP20100-MCO-CNTRCT-STAT-CD |P_MC_AFFL_X_TB |P_CNTRCT_STAT_CD |N/A |C |N/A |Valid Values are: | |
| | | | | | |Contracted= “CT” | |
| | | | | | |Non-contracted= “NC” | |
| | | | | | |Terminated= “TD” | |
|WFP20100-MCO-CNTRCT-STAT-DATES |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-MCO-CNTRCT-STAT-BEG-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_B_DT |N/A |C |N/A |This is the date on which the MCO | |
| | | | | | |contracted with the provider. Format: | |
| | | | | | |CCYYMMDD | |
|WFP20100-MCO-CNTRCT-STAT- END-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_E_DT |N/A |N |N/A |This is the date on which the MCO ceased | |
| | | | | | |contracting with the provider Format: | |
| | | | | | |CCYYMMDD | |
|WFP20100-PROV-TY-CD |P_PROV_TB |P_TY_CD |N/A |C |N/A | | |
|WFP20100-SPECIALTY-DATA |N/A |N/A |N/A |N/A |N/A |A provider may have more than one | |
| | | | | | |specialty assigned. There will be 9 | |
| | | | | | |occurrences. | |
|WFP20100-PROV-SPECIALTY |P_SPECL_TB |P_SPECL_CD |N/A | |N/A |The provider specialty | |
|WFP20100-OMNICAID PROV- BEG-DT |P_ENROL_STAT_TB |P_STAT_EFF_DT |N/A |A |N/A |The date on which the provider is | |
| | | | | | |enrolled with Omnicaid as a provider | |
| | | | | | |Format: CCYYMMDD | |
|RECORD-TYPE |N/A |System Generated |N/A |A |N/A |T = Trailer | |
|RECORD-COUNT |N/A |System Generated |N/A |A |N/A |Total number of Provider Master detail | |
| | | | | | |records | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
Notes:
1. The Provider Master Interface program translates the provider’s current enrollment status, P_ENROL_STAT_TY_CD, into one of the values valid for WFP20100-PROV-STATUS:
|P_ENROL_STAT_TY_CD |WFP20100-PROV-STATUS |
|70 - MCO Only |1 – MC-ONLY ENROLLED |
|60 - Active |2 – FFS ENROLLED |
|20 - Denied-Invalid License |3 – PROVIDER DENIED |
|21 - Denied Two Prov Numbers | |
|22 - Denied-Prov Already Has Num | |
|23 - Denied Not Eligible | |
|24 - Denied for Other Reasons | |
|01 - Term-Medicaid Authority |4 – PROVIDER TERMINATED WITH OMNICAID |
|02 - Medicare Termination | |
|03 - Term-License Revoked | |
|04 - Term-License Expired | |
|06 - Term-Change Of Ownership | |
|07 - No Claims Activity | |
|08 - Term-Provider Deceased | |
|09 - Term-Pending | |
|10 - Term-Voluntary Termination | |
|11 - Terminated- Mco Authority | |
|13 - Term-No Reverification | |
|99 - NPI ID Missing For Provider | |
|40 - Pending No Lic/Temp Lic |5 – PROVIDER PENDING |
|41 - Pending Signed Agreement | |
|42 - Pending Missing Documentation | |
|43 - Pending Rate Determination | |
|44 - Pending Status Approval | |
|45 - Pending W9 Application | |
|46 - Pend-License/Cert Verif | |
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit
C = Conditionally V = Valid Value Edit
N = Never N = Numeric Edits S = System Generated
NEW MEXICO OMNICAID MMIS
PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NOTIFICATION INTERFACE
|Description: |
|The Provider Notification interface file is a daily file submitted by the Centennial Care MCOs. The purpose of the file is to update Omnicaid provider records for a provider who is |
|participating in the network of one or more Centennial Care MCOs. The interface program validates required fields submitted in the Notification file. A Notification Error file is generated to |
|report back to the submitting MCO any record that contains missing or invalid data. Each MCO submits a Notification file and receives a Notification Error file. |
| |
|If all of the required fields are valid, then the interface will update the incoming Managed Care affiliation data for the target Medicaid Provider ID. The interface will also terminate the |
|provider’s enrollment, if the provider’s current enrollment status is “70” (None(MCO)) and all of the provider’s MCO affiliations are either terminated or expired. The interface adds a status |
|“11” (Term MCO) enrollment termination with an effective date equal to the latest MC affiliation contract date plus one day. If the provider has a NPI span on file, then the interface will |
|terminate the NPI span by setting the NPI end date equal to one day prior to the effective date of the status “11” enrollment termination. |
| |
|Source Files: |
|Provider Notification File |
|Target Tables: |
|(P_ENROL_STAT_TB) |
|(P_MC_AFFL_X_TB) |
|Target Files: |
|Provider Notification Error File |
|Reports: |
|N/A |
|Remarks: |
|N/A |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NOTIFICATION INTERFACE
01 WFP20050-HEADER-RECORD.
05 WFP20050-RECORD-TYPE PIC X(1).
88 WFP20050-REC-TYPE-HEADER VALUE 'H'.
05 WFP20050-FILE-TYPE PIC X(1).
88 WFP20050-FILE-TYPE-CONFIRM VALUE 'C'.
88 WFP20050-FILE-TYPE-ERROR VALUE 'E'.
88 WFP20050-FILE-TYPE-MASTER VALUE 'M'.
88 WFP20050-FILE-TYPE-NOTIF VALUE 'N'.
05 WFP20050-MCO-ID PIC X(8).
05 WFP20050-FILE-CREATE-DATE.
10 WFP20050-FILE-CREATE-CC PIC X(2).
10 WFP20050-FILE-CREATE-YY PIC X(2).
10 WFP20050-FILE-CREATE-MM PIC X(2).
10 WFP20050-FILE-CREATE-DD PIC X(2).
05 FILLER PIC X(477).
******
******
01 WFP20100-PROVIDER-RECORD.
05 WFP20100-RECORD-TYPE PIC X(01).
05 WFP20100-PROV-STATUS PIC X(01).
88 MC-ONLY-ENROLLED VALUE '1'.
88 FFS-ENROLLED VALUE '2'.
88 PROV-DENIED VALUE '3'.
88 PROV-TERM-OMNICAID VALUE '4'.
88 PROV-PENDING VALUE '5'.
05 WFP20100-PROV-NPI-ID PIC X(10).
05 WFP20100-PROV-EIN-SSN PIC X(09).
05 WFP20100-SORT-NAME PIC X(45).
05 WFP20100-PROV-MEDICAID-ID PIC X(08).
05 WFP20100-SVC-ADDRESS-AREA.
10 WFP20100-SVC-ADDR-LINE1 PIC X(45).
10 WFP20100-SVC-ADDR-LINE2 PIC X(45).
10 WFP20100-SVC-CITY PIC X(20).
10 WFP20100-SVC-ST PIC X(02).
10 WFP20100-SVC-ZIP5 PIC X(05).
10 WFP20100-SVC-ZIP4 PIC X(04).
10 WFP20100-SVC-GEO-CNTY PIC X(02).
05 WFP20100-SVC-PROV-PHONE PIC X(10).
05 WFP20100-MAIL-ADDRESS-AREA.
10 WFP20100-MAIL-ADDR-LINE1 PIC X(45).
10 WFP20100-MAIL-ADDR-LINE2 PIC X(45).
10 WFP20100-MAIL-CITY PIC X(20).
10 WFP20100-MAIL-ST PIC X(02).
10 WFP20100-MAIL-ZIP5 PIC X(05).
10 WFP20100-MAIL-ZIP4 PIC X(04).
05 WFP20100-HEALTH-HOME-SPECL-CD
PIC X(03).
05 WFP20100-MCO-AFFILIATION-DATA
OCCURS 4 TIMES.
10 WFP20100-MCO-P-ID PIC X(02).
10 WFP20100-PCP-IND PIC X(01).
10 WFP20100-MCO-CTRCT-STAT-CD
PIC X(02).
88 CONTRACTED VALUE 'CT'.
88 NON-CONTRACTED VALUE 'NC'.
88 TERMINATED VALUE 'TD'.
88 DELETED VALUE 'XX'.
10 WFP20100-MCO-CTRCT-STAT-DATES.
15 WFP20100-MCO-CTRCT-STAT-BEG-DT.
20 WFP20100-MCO-CTRCT-STAT-BEG-CC
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-YY
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-MM
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-DD
PIC X(02).
15 WFP20100-MCO-CTRCT-STAT-END-DT.
20 WFP20100-MCO-CTRCT-STAT-END-CC
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-YY
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-MM
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-DD
PIC X(02).
05 WFP20100-PROV-TY-CD PIC X(03).
05 WFP20100-SPECIALTY-DATA
OCCURS 9 TIMES.
10 WFP20100-PROV-SPECIALTY PIC X(03).
05 WFP20100-OMNICAID-PROV-BEG-DT.
10 WFP20100-OMNI-PROV-BEG-CC
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-YY
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-MM
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-DD
PIC X(02).
05 WFP20100-OMNICAID-PROV-END-DT.
10 WFP20100-OMNI-PROV-END-CC
PIC X(02).
10 WFP20100-OMNI-PROV-END-YY
PIC X(02).
10 WFP20100-OMNI-PROV-END-MM
PIC X(02).
10 WFP20100-OMNI-PROV-END-DD
PIC X(02).
05 WFP20100-PROFIT-IND PIC X(01). RAT1869
05 FILLER PIC X(09). RAT1869
******
******
01 WFP20200-TRAILER-RECORD.
05 WFP20200-RECORD-TYPE PIC X(01).
88 WFP20200-REC-TYPE-TLR
VALUE 'T'.
05 WFP20200-RECORD-COUNT PIC 9(09).
05 FILLER PIC X(485).
MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NOTIFICATION INTERFACE
PROVIDER NOTIFICATION HEADER RECORD
|Target Field |Source Table |Source Field |Std | |Def | |Note Ref |
| | | |Edit |Req | |Specifications | |
|WFP20050-RECORD-TYPE |N/A |RECORD-TYPE |N/A |A |N/A |H = Header | |
|WFP20050-FILE-TYPE |N/A |FILE-TYPE |N/A |A |N/A |N = Provider Notification file | |
|WFP20050-MCO-ID |N/A |MCO-ID |N/A |A |N/A |Provider ID assigned to the submitting | |
| | | | | | |MCO | |
|WFP20050-FILE-CREATE-DATE |N/A |FILE-CREATE-DATE |N/A |A |N/A |Format = CCYYMMDD | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
INPUT FILE LAYOUT
PROVIDER NOTIFICATION INTERFACE
PROVIDER NOTIFICATION DETAIL RECORD
|Target |Source |Source | | |Def | |Note Ref |
|Field |Table |Column / Field |Std Edit |Req | |Specifications | |
|WFP20100-RECORD-TYPE |N/A |RECORD-TYPE |N/A |A |N/A |P = Provider | |
|WFP20100-PROV-NPI-ID |P_NPI_XMTCH_TB |P_NPI_ID |N/A |C |N/A |Required for health care providers | |
|WFP20100-PROV-EIN-SSN |P_PROV_TB |P_FED_TAX_ID |N/A |C |N/A |Required for atypical providers | |
| | |P_SSN_NUM | | | | | |
|WFP20100-PROV-SORT-NAME |P_PROV_TB |P_SORT_NAM |N/A |A |N/A | | |
|WFP20100-SVC-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-SVC-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Location address line 1 | |
|WFP20100-SVC-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Location address line 2 | |
|WFP20100-SVC-CITY |P_ADDR_TB |P_CITY_NAM |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Location city | |
|WFP20100-SVC-ST |P_ADDR_TB |P_ST_CD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Location state | |
|WFP20100-SVC-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Location zip | |
|WFP20100-SVC-PROV- PHONE |P_ADDR_TB |P_PHON_NUM |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Phone number | |
|WFP20100-MAIL-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-MAIL-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Mailing address line 1 | |
|WFP20100-MAIL-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Mailing address line 2 | |
|WFP20100-MAIL-CITY |P_ADDR_TB |P_CITY_NAM |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Mailing city | |
|WFP20100-MAIL-ST |P_ADDR_TB |P_ST_CD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Mailing state | |
|WFP20100-MAIL-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains Mailing zip | |
|WFP20100-MCO-P-ID |P_MC_AFFL_X_TB |P_MCO_P_ID |N/A |A |N/A |MCO affiliated with this provider. | |
|WFP20100-PCP-IND |P_MC_AFFL_X_TB |P_PCP_IND |N/A |N |N/A |“Y”, “N” or space. | |
|WFP20100-MCO-CNTRCT-STAT-CD |P_MC_AFFL_X_TB |P_CNTRCT_STAT_CD |N/A |A |N/A |Valid Values are: | |
| | | | | | |Contracted= “CT” | |
| | | | | | |Non-contracted= “NC” | |
| | | | | | |Terminated= “TD” | |
|WFP20100-MCO-CNTRCT-STAT-DATES |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-MCO-CNTRCT-STAT-BEG-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_B_DT |N/A |A |N/A |This is the date on which the MCO | |
| | | | | | |contracted with the provider. Format: | |
| | | | | | |CCYYMMDD | |
|WFP20100-MCO-CNTRCT-STAT- END-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_E_DT |N/A |A |N/A |This is the date on which the MCO ceased | |
| | | | | | |contracting with the provider Format: | |
| | | | | | |CCYYMMDD | |
|WFP20100-PROV-TY-CD |P_PROV_TB |P_TY_CD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains provider type | |
|WFP20100-SPECIALTY-DATA |N/A |N/A |N/A |N/A |N/A |A provider may have more than one | |
| | | | | | |specialty assigned. There will be 9 | |
| | | | | | |occurrences. | |
|WFP20100-PROV-SPECIALTY |P_SPECL_TB |P_SPECL_CD |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains provider specialty | |
|WFP20100-OMNICAID PROV- BEG-DT |P_ENROL_STAT_TB |P_STAT_EFF_DT |N/A |N |N/A |Not required. If submitted, field | |
| | | | | | |contains the date on which the provider | |
| | | | | | |is enrolled with Omnicaid as a provider. | |
| | | | | | |Format: CCYYMMDD | |
|RECORD-TYPE |N/A |System Generated |N/A |A |N/A |T = Trailer | |
|RECORD-COUNT |N/A |System Generated |N/A |A |N/A |Total number of Provider Notification | |
| | | | | | |detail records | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
Notes:
1. The WFP20100-PROV-STATUS field is not required for the Provider Notification Interface. If a value is submitted, the field contains the provider’s Medicaid enrollment status. The provider’s enrollment status is communicated to the MCO in the either the Provider Master interface or the Provider Confirmation interface. The MCO can return the same value in the Provider Notification interface file.
The Provider Master and the Provider Confirmation interfaces translate the provider’s current enrollment status, P_ENROL_STAT_TY_CD, into one of the values valid for WFP20100-PROV-STATUS:
|P_ENROL_STAT_TY_CD |WFP20100-PROV-STATUS |
|70 - MCO Only |1 – MC-ONLY ENROLLED |
|60 - Active |2 – FFS ENROLLED |
|20 - Denied-Invalid License |3 – PROVIDER DENIED |
|21 - Denied Two Prov Numbers | |
|22 - Denied-Prov Already Has Num | |
|23 - Denied Not Eligible | |
|24 - Denied for Other Reasons | |
|01 - Term-Medicaid Authority |4 – PROVIDER TERMINATED WITH OMNICAID |
|02 - Medicare Termination | |
|03 - Term-License Revoked | |
|04 - Term-License Expired | |
|06 - Term-Change Of Ownership | |
|07 - No Claims Activity | |
|08 - Term-Provider Deceased | |
|09 - Term-Pending | |
|10 - Term-Voluntary Termination | |
|11 - Terminated- Mco Authority | |
|13 - Term-No Reverification | |
|99 - NPI ID Missing For Provider | |
|40 - Pending No Lic/Temp Lic |5 – PROVIDER PENDING |
|41 - Pending Signed Agreement | |
|42 - Pending Missing Documentation | |
|43 - Pending Rate Determination | |
|44 - Pending Status Approval | |
|45 - Pending W9 Application | |
|46 - Pend-License/Cert Verif | |
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit
C = Conditionally V = Valid Value Edit
N = Never N = Numeric Edits S = System Generated
NEW MEXICO OMNICAID MMIS
PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER NOTIFICATION ERROR INTERFACE
|Description: |
|The Provider Notification Error file is a daily file generated by the Provider Notification interface program for the Centennial Care MCOs. The purpose of the file is to report back to the |
|submitting MCO all Provider Notification file records that contain missing or invalid data. If all of the records in the Provider Notification file are valid, then a Provider Notification Error|
|file is generated with only a header and a trailer record. |
|Source Files: |
|Provider Notification File |
|Target Files: |
|Provider Notification Error File |
|Reports: |
|N/A |
|Remarks: |
|N/A |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER NOTIFICATION ERROR INTERFACE
01 P2900SB-HEADER-RECORD.
05 P2900SB-RECORD-TYPE PIC X(01).
88 P2900SB-HEADER
VALUE 'H'.
05 P2900SB-FILE-TYPE PIC X(01) .
88 P2900SB-FILE-TYPE-ERROR
VALUE 'E'.
05 P2900SB-MCO-ID PIC X(8)
VALUE SPACES.
05 P2900SB-FILE-CREATE-DATE.
10 P2900SB-FILE-CREATE-CC PIC X(2).
10 P2900SB-FILE-CREATE-YY PIC X(2).
10 P2900SB-FILE-CREATE-MM PIC X(2).
10 P2900SB-FILE-CREATE-DD PIC X(2).
05 FILLER PIC X(519)
VALUE SPACES.
******
******
01 WFP20150-NOTIF-ERROR-RECORD.
03 WFP20150-NOTIF-ERROR.
05 WFP20150-RECORD-TYPE PIC X(01).
05 WFP20150-ERROR-NO PIC X(02).
05 WFP20150-ERROR-TXT PIC X(40).
03 WFP20150-NOTIF-DETAIL.
05 WFP20150-PROV-STATUS PIC X(01).
05 WFP20150-PROV-NPI-ID PIC X(10).
05 WFP20150-PROV-EIN-SSN PIC X(09).
05 WFP20150-SORT-NAME PIC X(45).
05 WFP20150-PROV-MEDICAID-ID PIC X(08).
05 WFP20150-SVC-ADDRESS-AREA.
10 WFP20150-SVC-ADDR-LINE1 PIC X(45).
10 WFP20150-SVC-ADDR-LINE2 PIC X(45).
10 WFP20150-SVC-CITY PIC X(20).
10 WFP20150-SVC-ST PIC X(02).
10 WFP20150-SVC-ZIP5 PIC X(05).
10 WFP20150-SVC-ZIP4 PIC X(04).
10 WFP20150-SVC-GEO-CNTY PIC X(02).
05 WFP20150-SVC-PROV-PHONE PIC X(10).
05 WFP20150-MAIL-ADDRESS-AREA.
10 WFP20150-MAIL-ADDR-LINE1 PIC X(45).
10 WFP20150-MAIL-ADDR-LINE2 PIC X(45).
10 WFP20150-MAIL-CITY PIC X(20).
10 WFP20150-MAIL-ST PIC X(02).
10 WFP20150-MAIL-ZIP5 PIC X(05).
10 WFP20150-MAIL-ZIP4 PIC X(04).
05 WFP20150-HEALTH-HOME-SPECL-CD
PIC X(03).
05 WFP20150-MCO-AFFILIATION-DATA
OCCURS 4 TIMES.
10 WFP20150-MCO-P-ID PIC X(08).
10 WFP20150-PCP-IND PIC X(01).
10 WFP20150-MCO-CTRCT-STAT-CD
PIC X(02).
88 CONTRACTED VALUE 'CT'.
88 NON-CONTRACTED VALUE 'NC'.
88 TERMINATED VALUE 'TD'.
88 DELETED VALUE 'XX'.
10 WFP20150-MCO-CTRCT-STAT-DATES.
15 WFP20150-MCO-CTRCT-STAT-BEG-DT.
20 WFP20150-MCO-CTRCT-STAT-BEG-CC
PIC X(02).
20 WFP20150-MCO-CTRCT-STAT-BEG-YY
PIC X(02).
20 WFP20150-MCO-CTRCT-STAT-BEG-MM
PIC X(02).
20 WFP20150-MCO-CTRCT-STAT-BEG-DD
PIC X(02).
15 WFP20150-MCO-CTRCT-STAT-END-DT.
20 WFP20150-MCO-CTRCT-STAT-END-CC
PIC X(02).
20 WFP20150-MCO-CTRCT-STAT-END-YY
PIC X(02).
20 WFP20150-MCO-CTRCT-STAT-END-MM
PIC X(02).
20 WFP20150-MCO-CTRCT-STAT-END-DD
PIC X(02).
05 WFP20150-PROV-TY-CD PIC X(03).
05 WFP20150-SPECIALTY-DATA
OCCURS 9 TIMES.
10 WFP20150-PROV-SPECIALTY PIC X(03).
05 WFP20150-OMNICAID-PROV-BEG-DT.
10 WFP20150-OMNI-PROV-BEG-CC
PIC X(02).
10 WFP20150-OMNI-PROV-BEG-YY
PIC X(02).
10 WFP20150-OMNI-PROV-BEG-MM
PIC X(02).
10 WFP20150-OMNI-PROV-BEG-DD
PIC X(02).
05 WFP20150-OMNICAID-PROV-END-DT.
10 WFP20150-OMNI-PROV-BEG-CC
PIC X(02).
10 WFP20150-OMNI-PROV-BEG-YY
PIC X(02).
10 WFP20150-OMNI-PROV-BEG-MM
PIC X(02).
10 WFP20150-OMNI-PROV-BEG-DD
PIC X(02).
05 WFP20150-PROFIT-IND PIC X(01). RAT1869
05 FILLER PIC X(09). RAT1869
******
******
01 P2900SB-TRAILER-RECORD.
05 P2900SB-RECORD-TYPE PIC X(01).
88 P2900SB-TRAILER
VALUE 'T'.
05 P2900SB-RECORD-COUNT PIC 9(09).
05 FILLER PIC X(527)
VALUE SPACES.
MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER NOTIFICATION ERROR INTERFACE
PROVIDER NOTIFICATION ERROR HEADER RECORD
|Target Field |Source Table |Source Field |Std | |Def | |Note Ref |
| | | |Edit |Req | |Specifications | |
|2900-ERROR-RECORD-TYPE |N/A |System Generated |N/A |A |N/A |H - Header | |
|2900-ERROR-FILE-TYPE |N/A |System Generated |N/A |A |N/A |E = Provider Notification Error file | |
|2900-ERROR-MCO-ID |N/A |WFP20050-MCO-ID |N/A |A |N/A |The MCO ID submitted in the Provider | |
| | | | | | |Notification file header record. | |
|2900-ERROR-FILE-CREATE-DATE |N/A |System Generated |N/A |A |N/A |Format = CCYYMMDD | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER NOTIFICATION ERROR INTERFACE
PROVIDER NOTIFICATION ERROR DETAIL RECORD
|Target |Source |Source | | |Def | |Note Ref |
|Field |Table |Column / Field |Std Edit |Req | |Specifications | |
|WFP20150-NOTIF-ERROR |N/A |N/A |N/A |N/A |N/A |Populate this portion of the Notification | |
| | | | | | |Error detail record with information | |
| | | | | | |describing the Notification record’s | |
| | | | | | |invalid data | |
|WFP20150-RECORD-TYPE |N/A |System Generated |N/A |A |N/A |E = Error | |
|WFP20150-ERROR-NO |N/A |System Generated |N/A |A |N/A |Populate with 2-digit error code number: |1 |
| | | | | | |01 - PROVIDER NOT ACTIVE | |
| | | | | | |03 - PROVIDER NPI INVALID | |
| | | | | | |05 - MEDCAID ID INVALID | |
| | | | | | |06 - NPI/MEDICAID ID MISMATCH | |
| | | | | | |07 - INVALID EIN/SSN | |
| | | | | | |08 - PCP INDICATOR INVALID | |
| | | | | | |10 - MCO ID INVALID | |
| | | | | | |11 - CONTRACT STATUS INVALID | |
| | | | | | |12 - CONTRACT STATUS BEGIN DT INVALID | |
| | | | | | |13 - CONTRACT STATUS END DATE INVALID | |
| | | | | | |14 - HEADER REC MISSING | |
| | | | | | |15 - TRAILER REC INVALID | |
| | | | | | |16 - INVALID CONTRACT STAT CD TD OR XX | |
| | | | | | |17 - CONTRACT STAT BEG DT PRIOR TO ENROL | |
|WFP20150-ERROR-TXT |N/A |System Generated |N/A |A |N/A |Populate with error code description (max |1 |
| | | | | | |40 characters): | |
| | | | | | |01 - PROVIDER NOT ACTIVE | |
| | | | | | |03 - PROVIDER NPI INVALID | |
| | | | | | |05 - MEDCAID ID INVALID | |
| | | | | | |06 - NPI/MEDICAID ID MISMATCH | |
| | | | | | |07 - INVALID EIN/SSN | |
| | | | | | |08 - PCP INDICATOR INVALID | |
| | | | | | |10 - MCO ID INVALID | |
| | | | | | |11 - CONTRACT STATUS INVALID | |
| | | | | | |12 - CONTRACT STATUS BEGIN DT INVALID | |
| | | | | | |13 - CONTRACT STATUS END DATE INVALID | |
| | | | | | |14 - HEADER REC MISSING | |
| | | | | | |15 - TRAILER REC INVALID | |
| | | | | | |16 - INVALID CONTRACT STAT CD TD OR XX | |
| | | | | | |17 - CONTRACT STAT BEG DT PRIOR TO ENROL | |
|WFP20150-NOTIF-DETAIL-REC |N/A |N/A |N/A |N/A |N/A |Populate this portion of the Notification | |
| | | | | | |Error detail record with the Notification | |
| | | | | | |record submitted by the MCO | |
|WFP20150-PROV- STATUS |P_ENROL_STAT_TB |P_ENROL_STAT_TY_CD |N/A |N |N/A |Populate with Provider Status submitted in| |
| | | | | | |Notification Detail record | |
|WFP20150-PROV-NPI-ID |P_NPI_XMTCH_TB |P_NPI_ID |N/A |N |N/A |Populate with NPI submitted in | |
| | | | | | |Notification Detail record | |
|WFP20150-PROV-EIN-SSN |P_PROV_TB |P_FED_TAX_ID |N/A |N |N/A |Populate with EIN or SSN submitted in | |
| | |P_SSN_NUM | | | |Notification Detail record | |
|WFP20150-PROV-SORT-NAME |P_PROV_TB |P_SORT_NAM |N/A |N |N/A |Populate with Provider Sort Name submitted| |
| | | | | | |in Notification Detail record | |
|WFP20150-SVC-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20150-SVC-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |N |N/A |Populate with Service Address Line 1 | |
| | | | | | |submitted in Notification Detail record | |
|WFP20150-SVC-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Populate with Service Address Line 2 | |
| | | | | | |submitted in Notification Detail record | |
|WFP20150-SVC-CITY |P_ADDR_TB |P_CITY_NAM |N/A |N |N/A |Populate with Service City submitted in | |
| | | | | | |Notification Detail record | |
|WFP20150-SVC-ST |P_ADDR_TB |P_ST_CD |N/A |N |N/A |Populate with Service City submitted in | |
| | | | | | |Notification Detail record | |
|WFP20150-SVC-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |N |N/A |Populate with Service Zip5 submitted in | |
| | | | | | |Notification Detail record | |
|WFP20150-SVC-PROV- PHONE |P_ADDR_TB |P_PHON_NUM |N/A |N |N/A |Populate with Service Phone Number | |
| | | | | | |submitted in Notification Detail record | |
|WFP20150-MAIL-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20150-MAIL-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |N |N/A |Populate with Mailing Address Line 1 | |
| | | | | | |submitted in Notification Detail record | |
|WFP20150-MAIL-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Populate with Mailing Address Line 2 | |
| | | | | | |submitted in Notification Detail record | |
|WFP20150-MAIL-CITY |P_ADDR_TB |P_CITY_NAM |N/A |N |N/A |Populate with Mailing City submitted in | |
| | | | | | |Notification Detail record | |
|WFP20150-MAIL-ST |P_ADDR_TB |P_ST_CD |N/A |N |N/A |Populate with Mailing State submitted in | |
| | | | | | |Notification Detail record | |
|WFP20150-MAIL-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |N |N/A |Populate with Mailing Zip5 submitted in | |
| | | | | | |Notification Detail record | |
|WFP20150-MCO-P-ID |P_MC_AFFL_X_TB |P_MCO_P_ID |N/A |N |N/A |Populate with MCO ID submitted in | |
| | | | | | |Notification Detail record. | |
|WFP20150-PCP-IND |P_MC_AFFL_X_TB |P_PCP_IND |N/A |N |N/A |Populate with PCP Indicator submitted in | |
| | | | | | |Notification Detail record. | |
|WFP20150-MCO-CNTRCT-STAT-CD |P_MC_AFFL_X_TB |P_CNTRCT_STAT_CD |N/A |N |N/A |Populate with Contract Status Code | |
| | | | | | |submitted in Notification Detail record. | |
|WFP20150-MCO-CNTRCT-STAT-DATES |N/A |N/A |N/A |N/A |N/A | | |
|WFP20150-MCO-CNTRCT-STAT-BEG-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_B_DT |N/A |N |N/A |Populate with Contract Status Begin Date | |
| | | | | | |submitted in Notification Detail record. | |
| | | | | | |Format: CCYYMMDD | |
|WFP20150-MCO-CNTRCT-STAT- END-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_E_DT |N/A |N |N/A |Populate with Contract Status Begin Date | |
| | | | | | |submitted in Notification Detail record. | |
| | | | | | |Format: CCYYMMDD | |
|WFP20150-PROV-TY-CD |P_PROV_TB |P_TY_CD |N/A |N |N/A |Populate with Provider Type Code submitted| |
| | | | | | |in Notification Detail record | |
|WFP20150-SPECIALTY-DATA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20150-PROV-SPECIALTY |P_SPECL_TB |P_SPECL_CD |N/A |N |N/A |Occurs 9 times, Populate with Provider | |
| | | | | | |Specialty data submitted in Notification | |
| | | | | | |Detail record | |
|WFP20150-OMNICAID PROV- BEG-DT |P_ENROL_STAT_TB |P_STAT_EFF_DT |N/A |N |N/A |Populate with Omnicaid Provider Begin | |
| | | | | | |Date submitted in Notification Detail | |
| | | | | | |record | |
|RECORD-TYPE |N/A |System Generated |N/A |A |N/A |T = Trailer | |
|RECORD-COUNT |N/A |System Generated |N/A |A |N/A |Total number of Provider Notification | |
| | | | | | |Error detail records | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
Notes:
1. Provider Notification Error Descriptions:
|Error Num |Error Text |Critical or Non |Description |
| | |Critical Error | |
|01 |PROVIDER NOT ACTIVE |Critical |PROVIDER NOT ENROLLED WITH NM MEDICAID |
|03 |PROVIDER NPI INVALID |Critical |NPI MISSING OR NOT FOUND ON OMNICAID |
|05 |MEDICAID ID INVALID |Critical |MEDICAID PROVIDER ID MISSING OR NOT FOUND ON OMNICAID |
|06 |NPI/MEDICAID ID MISMATCH |Critical |NPI MATCHES TO A DIFFERENT MEDICAID ID |
|07 |INVALID EIN/SSN |Critical |EIN/SSN INVALID OR MATCHES A DIFFERENT NPI/MEDICAID ID |
|08 |PCP INDICATOR INVALID |Critical |PCP VALUE MUST BE Y OR N; INDICATOR VALUE IS EITHER MISSING OR A DIFFERENT VALUE |
|10 |MCO ID INVALID |Critical |MCO ID DOESN’T MATCH EXISTING CC MCO OR IS MISSING |
|11 |CONTRACT STATUS INVALID |Critical |CONTRACT STATUS CODE MUST BE A VALID CODE. STATUS CODE ‘XX’ IS AN INVALID CODE. |
|12 |CONTRACT STATUS BEGIN DT INVALID |Critical |CONTRACT STATUS BEGIN DATE IS GREATER THAN CONTRACT STATUS END DATE OR IS AN |
| | | |INVALID CCYYMMDD VALUE |
|13 |CONTRACT STATUS END DATE INVALID |Critical |CONTRACT STATUS END DATE IS LESS THAN CONTRACT STATUS BEGIN DATE OR IS AN INVALID|
| | | |CCYYMMDD VALUE |
|14 |HEADER REC MISSING |Critical |NOTIFICATION FILE HEADER RECORD IS MISSING |
|15 |TRAILER REC INVALID |Critical |NOTIFICATION FILE TRAILER RECORD IS MISSING OR TRAILER RECORD COUNT DOES NOT |
| | | |MATCH THE TOTAL NUMBER OF DETAIL ‘P’ RECORDS. |
|16 |INVALID CONTRACT STAT CD TD OR XX |Critical |CONTRACT STATUS CODE IS ‘TD’ OR ‘XX’ FOR PROVIDER WHO HAS NO PRIOR AFFILIATION |
| | | |WITH MCO |
|17 |CONTRACT STAT BEG DT PRIOR TO ENROL |Critical |CONTRACT STATUS BEGIN DATE PRIOR TO MEDICAID ENROLLMENT DATE |
|18 |CONTRACT STAT END DT INVAL FOR STAT TD |Critical |CONTRACT STATUS CODE IS ‘TD’ AND CONTRACT STATUS END DT IS OPEN-ENDED OR A DATE |
| | | |GREATER THAN 1 YEAR IN THE FUTURE |
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit
C = Conditionally V = Valid Value Edit
N = Never N = Numeric Edits S = System Generated
NEW MEXICO OMNICAID MMIS
PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER CONFIRMATION INTERFACE
|Description: |
|The Provider Confirmation interface file is generated daily for the Centennial Care MCOs. The interface file contains all Medicaid FFS and Medicaid Managed Care Only enrolled providers who have|
|had a change in enrollment status, managed care affiliation or specialty since the last run of the daily Confirmation file or the last run of the monthly Provider Master file. Providers who |
|meet the criteria below will be included in the Confirmation File |
| |
|Providers who meet the criteria below are excluded from the Provider Confirmation file: |
| |
|Provider Types '701','702','703','704', 801, 802, 803, 833, 899 and 344 |
|Source Tables: |
|(P_PROV_TB) |
|(P_ADDR_TB) |
|(P_ENROL_STAT_TB) |
|(P_SPECL_TB) |
|(P_MC_AFFL_X_TB) |
|(P_NPI_XMTCH_TB) |
|Reports: |
|N/A |
|Remarks: |
|N/A |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER CONFIRMATION INTERFACE
01 WFP20050-HEADER-RECORD.
05 WFP20050-RECORD-TYPE PIC X(1).
88 WFP20050-REC-TYPE-HEADER VALUE 'H'.
05 WFP20050-FILE-TYPE PIC X(1).
88 WFP20050-FILE-TYPE-CONFIRM VALUE 'C'.
88 WFP20050-FILE-TYPE-ERROR VALUE 'E'.
88 WFP20050-FILE-TYPE-MASTER VALUE 'M'.
88 WFP20050-FILE-TYPE-NOTIF VALUE 'N'.
05 WFP20050-MCO-ID PIC X(8).
05 WFP20050-FILE-CREATE-DATE.
10 WFP20050-FILE-CREATE-CC PIC X(2).
10 WFP20050-FILE-CREATE-YY PIC X(2).
10 WFP20050-FILE-CREATE-MM PIC X(2).
10 WFP20050-FILE-CREATE-DD PIC X(2).
05 FILLER PIC X(477).
******
******
01 WFP20100-PROVIDER-RECORD.
05 WFP20100-RECORD-TYPE PIC X(01).
05 WFP20100-PROV-STATUS PIC X(01).
88 MC-ONLY-ENROLLED VALUE '1'.
88 FFS-ENROLLED VALUE '2'.
88 PROV-DENIED VALUE '3'.
88 PROV-TERM-OMNICAID VALUE '4'.
88 PROV-PENDING VALUE '5'.
05 WFP20100-PROV-NPI-ID PIC X(10).
05 WFP20100-PROV-EIN-SSN PIC X(09).
05 WFP20100-SORT-NAME PIC X(45).
05 WFP20100-PROV-MEDICAID-ID PIC X(08).
05 WFP20100-SVC-ADDRESS-AREA.
10 WFP20100-SVC-ADDR-LINE1 PIC X(45).
10 WFP20100-SVC-ADDR-LINE2 PIC X(45).
10 WFP20100-SVC-CITY PIC X(20).
10 WFP20100-SVC-ST PIC X(02).
10 WFP20100-SVC-ZIP5 PIC X(05).
10 WFP20100-SVC-ZIP4 PIC X(04).
10 WFP20100-SVC-GEO-CNTY PIC X(02).
05 WFP20100-SVC-PROV-PHONE PIC X(10).
05 WFP20100-MAIL-ADDRESS-AREA.
10 WFP20100-MAIL-ADDR-LINE1 PIC X(45).
10 WFP20100-MAIL-ADDR-LINE2 PIC X(45).
10 WFP20100-MAIL-CITY PIC X(20).
10 WFP20100-MAIL-ST PIC X(02).
10 WFP20100-MAIL-ZIP5 PIC X(05).
10 WFP20100-MAIL-ZIP4 PIC X(04).
05 WFP20100-HEALTH-HOME-SPECL-CD
PIC X(03).
05 WFP20100-MCO-AFFILIATION-DATA
OCCURS 4 TIMES.
10 WFP20100-MCO-P-ID PIC X(02).
10 WFP20100-PCP-IND PIC X(01).
10 WFP20100-MCO-CTRCT-STAT-CD
PIC X(02).
88 CONTRACTED VALUE 'CT'.
88 NON-CONTRACTED VALUE 'NC'.
88 TERMINATED VALUE 'TD'.
88 DELETED VALUE 'XX'.
10 WFP20100-MCO-CTRCT-STAT-DATES.
15 WFP20100-MCO-CTRCT-STAT-BEG-DT.
20 WFP20100-MCO-CTRCT-STAT-BEG-CC
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-YY
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-MM
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-BEG-DD
PIC X(02).
15 WFP20100-MCO-CTRCT-STAT-END-DT.
20 WFP20100-MCO-CTRCT-STAT-END-CC
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-YY
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-MM
PIC X(02).
20 WFP20100-MCO-CTRCT-STAT-END-DD
PIC X(02).
05 WFP20100-PROV-TY-CD PIC X(03).
05 WFP20100-SPECIALTY-DATA
OCCURS 9 TIMES.
10 WFP20100-PROV-SPECIALTY PIC X(03).
05 WFP20100-OMNICAID-PROV-BEG-DT.
10 WFP20100-OMNI-PROV-BEG-CC
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-YY
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-MM
PIC X(02).
10 WFP20100-OMNI-PROV-BEG-DD
PIC X(02).
05 WFP20100-OMNICAID-PROV-END-DT.
10 WFP20100-OMNI-PROV-END-CC
PIC X(02).
10 WFP20100-OMNI-PROV-END-YY
PIC X(02).
10 WFP20100-OMNI-PROV-END-MM
PIC X(02).
10 WFP20100-OMNI-PROV-END-DD
PIC X(02).
05 WFP20100-PROFIT-IND PIC X(01). RAT1869
05 FILLER PIC X(09). RAT1869
******
******
01 WFP20200-TRAILER-RECORD.
05 WFP20200-RECORD-TYPE PIC X(01).
88 WFP20200-REC-TYPE-TLR
VALUE 'T'.
05 WFP20200-RECORD-COUNT PIC 9(09).
05 FILLER PIC X(485).
MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER CONFIRMATION INTERFACE
PROVIDER CONFIRMATION HEADER RECORD
|Target Field |Source Table |Source Field |Std | |Def | |Note Ref |
| | | |Edit |Req | |Specifications | |
|WFP20050-RECORD-TYPE |N/A |RECORD-TYPE |N/A |A |N/A |H = Header | |
|WFP20050-FILE-TYPE |N/A |FILE-TYPE |N/A |A |N/A |C = Provider Confirmation file | |
|WFP20050-MCO-ID |N/A |MCO-ID |N/A |N |N/A |Populate with spaces | |
|WFP20050-FILE-CREATE-DATE |N/A |FILE-CREATE-DATE |N/A |A |N/A |Format = CCYYMMDD | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
NEW MEXICO OMNICAID MMIS PROVIDER SUBSYSTEM
INTERFACE SPECIFICATION
OUTPUT FILE LAYOUT
PROVIDER CONFIRMATION INTERFACE
PROVIDER CONFIRMATION DETAIL RECORD
|Target |Source |Source | | |Def | |Note Ref |
|Field |Table |Column / Field |Std Edit |Req | |Specifications | |
|WFP20100-RECORD-TYPE |N/A |RECORD-TYPE |N/A |A |N/A |P = Provider | |
|WFP20100-PROV-NPI-ID |P_NPI_XMTCH_TB |P_NPI_ID |N/A |C |N/A |Required for health care providers | |
|WFP20100-PROV-EIN-SSN |P_PROV_TB |P_FED_TAX_ID |N/A |C |N/A |Required for atypical providers | |
| | |P_SSN_NUM | | | | | |
|WFP20100-PROV-SORT-NAME |P_PROV_TB |P_SORT_NAM |N/A |A |N/A | | |
|WFP20100-SVC-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-SVC-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |A |N/A |Location address line 1 | |
|WFP20100-SVC-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Location address line 2 | |
|WFP20100-SVC-CITY |P_ADDR_TB |P_CITY_NAM |N/A |A |N/A |Location city | |
|WFP20100-SVC-ST |P_ADDR_TB |P_ST_CD |N/A |A |N/A |Location state | |
|WFP20100-SVC-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |A |N/A |Location zip | |
|WFP20100-SVC-PROV- PHONE |P_ADDR_TB |P_PHON_NUM |N/A |A |N/A |Phone number | |
|WFP20100-MAIL-ADDRESS-AREA |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-MAIL-ADDR-LINE1 |P_ADDR_TB |P_LINE1_AD |N/A |A |N/A |Mailing address line 1 | |
|WFP20100-MAIL-ADDR-LINE2 |P_ADDR_TB |P_LINE2_AD |N/A |N |N/A |Mailing address line 2 | |
|WFP20100-MAIL-CITY |P_ADDR_TB |P_CITY_NAM |N/A |A |N/A |Mailing city | |
|WFP20100-MAIL-ST |P_ADDR_TB |P_ST_CD |N/A |A |N/A |Mailing state | |
|WFP20100-MAIL-ZIP5 |P_ADDR_TB |P_ZIP5_CD |N/A |A |N/A |Mailing zip | |
|WFP20100-MCO-P-ID |P_MC_AFFL_X_TB |P_MCO_P_ID |N/A |C |N/A |MCO affiliated with this provider. | |
|WFP20100-PCP-IND |P_MC_AFFL_X_TB |P_PCP_IND |N/A |N |N/A |“Y”, “N” or space. | |
|WFP20100-MCO-CNTRCT-STAT-CD |P_MC_AFFL_X_TB |P_CNTRCT_STAT_CD |N/A |C |N/A |Valid Values are: | |
| | | | | | |Contracted= “CT” | |
| | | | | | |Non-contracted= “NC” | |
| | | | | | |Terminated= “TD” | |
|WFP20100-MCO-CNTRCT-STAT-DATES |N/A |N/A |N/A |N/A |N/A | | |
|WFP20100-MCO-CNTRCT-STAT-BEG-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_B_DT |N/A |C |N/A |This is the date on which the MCO | |
| | | | | | |contracted with the provider. Format: | |
| | | | | | |CCYYMMDD | |
|WFP20100-MCO-CNTRCT-STAT- END-DT |P_MC_AFFL_X_TB |P_CNTRCT_STAT_E_DT |N/A |N |N/A |This is the date on which the MCO ceased | |
| | | | | | |contracting with the provider Format: | |
| | | | | | |CCYYMMDD | |
|WFP20100-PROV-TY-CD |P_PROV_TB |P_TY_CD |N/A |C |N/A | | |
|WFP20100-SPECIALTY-DATA |N/A |N/A |N/A |N/A |N/A |A provider may have more than one | |
| | | | | | |specialty assigned. There will be 9 | |
| | | | | | |occurrences. | |
|WFP20100-PROV-SPECIALTY |P_SPECL_TB |P_SPECL_CD |N/A | |N/A |The provider specialty | |
|WFP20100-OMNICAID PROV- BEG-DT |P_ENROL_STAT_TB |P_STAT_EFF_DT |N/A |A |N/A |The date on which the provider is | |
| | | | | | |enrolled with Omnicaid as a provider | |
| | | | | | |Format: CCYYMMDD | |
|RECORD-TYPE |N/A |System Generated |N/A |A |N/A |T = Trailer | |
|RECORD-COUNT |N/A |System Generated |N/A |A |N/A |Total number of Provider Confirmation | |
| | | | | | |detail records | |
|FILLER |N/A |N/A |N/A |N/A |N/A |Filler field. Populate with spaces | |
Notes:
1. The Provider Confirmation Interface program translates the provider’s current enrollment status, P_ENROL_STAT_TY_CD, into one of the values valid for WFP20100-PROV-STATUS:
|P_ENROL_STAT_TY_CD |WFP20100-PROV-STATUS |
|70 - MCO Only |1 – MC-ONLY ENROLLED |
|60 - Active |2 – FFS ENROLLED |
|20 - Denied-Invalid License |3 – PROVIDER DENIED |
|21 - Denied Two Prov Numbers | |
|22 - Denied-Prov Already Has Num | |
|23 - Denied Not Eligible | |
|24 - Denied for Other Reasons | |
|01 - Term-Medicaid Authority |4 – PROVIDER TERMINATED WITH OMNICAID |
|02 - Medicare Termination | |
|03 - Term-License Revoked | |
|04 - Term-License Expired | |
|06 - Term-Change Of Ownership | |
|07 - No Claims Activity | |
|08 - Term-Provider Deceased | |
|09 - Term-Pending | |
|10 - Term-Voluntary Termination | |
|11 - Terminated- Mco Authority | |
|13 - Term-No Reverification | |
|99 - NPI ID Missing For Provider | |
|40 - Pending No Lic/Temp Lic |5 – PROVIDER PENDING |
|41 - Pending Signed Agreement | |
|42 - Pending Missing Documentation | |
|43 - Pending Rate Determination | |
|44 - Pending Status Approval | |
|45 - Pending W9 Application | |
|46 - Pend-License/Cert Verif | |
_________________________________________________________________________________________________________________________________
LEGEND: For Req: A = Always For Std Edits: D = Date Edit
C = Conditionally V = Valid Value Edit
N = Never N = Numeric Edits S = System Generated
................
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