Medimpact Media & File Layout Specifications Type 42 — External
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MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Type 42 — External Accumulator Load File Layout The Type 42 is submitted and loaded to update a member’s accumulator benefit amount with external values. The Type 42 file contains a fixed length format. Examples of group and member updates and file load logic are shown in Section 3 of the MedImpact Media & File Layout System Specifications document. Table 1. Field Number Notes
Type 42 External Accumulator Load File Layout
Field Name
Position Field Length From Thru
Description
1.
(1)
Record Type
X(2)
1
2
Constant “42”
2.
(1)
Headquarters Code
X(5)
3
7
Assigned by MedImpact
3.
(1)
Carrier Number
9(5)
8
12
Assigned by MedImpact
4.
(1)
Group Number
X(10)
13
22
5.
(1)
Division
X(10)
23
6.
(1)
Member Number
X(30)
33
7.
(1)
Person Code
9(2)
63
8.
(1)
Month Day and Year 9(8) of External Value
65
Reserved
X(48)
73
External Deductible Used Amount External Deductible Used Type
9(10)v99 121
132 External Deductible Used Amount
X(2)
133
External Deductible Used Qualifier
X(1)
135
134 CR = Reduce Deductible Used by External Deductible Amount DB = Increase Deductible Used by External Deductible Used Amount 135 U = Update the Existing External Deductible Used Amount (Not a replace; do not use U if member is Part D) R = Replace the Existing External Deductible Used Amount
9. 10.
(7)
11.
(7)
12.
(7)
Type_42_v7.0.pdf Effective Date: 8/20/2009
Group to which member is associated 32 Division to which member is associated 62 ID Number for members on card (no special characters) 64 Example: Insured = 01; Spouse = 02; and Dependents 03 to 99 72 YYYYMMDD – Cannot be 2009 if Part D member, due to FIR rollout 120 Reserved
MedImpact Information Technologies Page 1
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
Description
13.
External Benefit Used Amount
9(10)v99 136
147 External Benefit Used Amount
14.
External Benefit Used Type
X(2)
148
15.
External Benefit Used Qualifier
X(1)
150
16.
External Brand Benefit Used Amount External Brand Benefit Used Type
9(10)v99 151
149 CR = Reduce Benefit Used by External Benefit Used Amount DB = Increase Benefit Used by External Benefit Used Amount 150 U = Update the Existing External Benefit Used Amount (not a replace) R = Replace the Existing External Benefit Used Amount 162 External Brand Benefit Used Amount
X(2)
163
18.
External Brand Benefit Used Qualifier
X(1)
165
19.
External Generic Benefit Used Amount External Generic Benefit Used Type
9(10)v99 166
17.
20.
Type_42_v7.0.pdf Effective Date: 8/20/2009
X(2)
178
164 CR = Reduce Brand Benefit Used by External Brand Benefit Used Amount DB = Increase Brand Benefit Used by External Brand Benefit Used Amount 165 U = Update the Existing External Brand Benefit Used Amount (not a replace) R = Replace the Existing External Brand Benefit Used Amount 177 External Generic Benefit Used Amount 179 CR = Reduce Generic Benefit Used by External Generic Benefit Used Amount DB = Increase Generic Benefit Used by External Generic Benefit Used Amount
MedImpact Information Technologies Page 2
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
21.
External Generic Benefit Used Qualifier
X(1)
22.
External Out Of Pocket (OOP) Used Amount External OOP Used Type
9(10)v99 181
X(2)
193
External OOP Used Qualifier
X(1)
195
External Medical Deductible Used Amount External Medical Deductible Used Type
9(10)v99 196
X(2)
208
210
23.
24.
180
25.
(3)
26.
(3)
27.
(3)
External Medical Deductible Used Qualifier
X(1)
28.
(2)
External Medical OOP Used Amount
9(10)v99 211
Type_42_v7.0.pdf Effective Date: 8/20/2009
Description
180 U = Update the Existing External Generic Benefit Used Amount (not a replace) R = Replace the Existing External Generic Benefit Used Amount 192 External OOP Used Amount
194 CR = Reduce OOP Used by External OOP Used Amount DB = Increase OOP Used by External OOP Used Amount 195 U = Update the Existing External OOP Used Amount (not a replace) R = Replace the Existing External OOP Used Amount 207 External Medical Deductible Used Amount (To be used Rx + Med Deductible Benefits only) 209 CR = Reduce External Medical Deductible Used by External Medical Deductible Used Amount DB = Increase External Medical Deductible Used by External Medical Deductible Used Amount (To be used Rx + Med Deductible Benefits only) 210 U = Update the Existing External Medical Deductible Used Amount (not a replace) R = Replace the Existing External Medical Deductible Used Amount 222 External Medical OOP Used Amount
MedImpact Information Technologies Page 3
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
29.
(2)
External Medical OOP Used Type
X(2)
223
30.
(2)
External Medical OOP Used Qualifier
X(1)
225
External Medical Benefit Used Amount External Medical Benefit Used Type
9(10)v99 226
X(2)
238
33.
External Medical Benefit Used Qualifier
X(1)
240
34.
Member First Name
X(30)
35.
Member Date of X(8) Birth Member Relationship 9(2) Code
31.
32.
36. 37.
(7)
38.
39.
Description
241
224 CR = Reduce Medical OOP Used by External Medical OOP Used Amount DB = Increase Brand Benefit Used by External Brand Benefit Used Amount 225 U = Update the Existing External Medical OOP Used Amount (not a replace) R = Replace the Existing External Medical OOP Used Amount 237 External Medical Benefit Used Amount (To be used Rx + Med Deductible Benefits only) 239 CR = Reduce External Medical Benefit Used by External Medical Deductible Used Amount DB = Increase External Medical Benefit Used by External Medical Deductible Used Amount (To be used Rx + Med Benefit only) 240 U = Update the Existing External Medical Benefit Used Amount (not a replace) R = Replace the Existing External Benefit Used Amount 270 First Name of Member
271
278 YYYYMMDD
279
280 Client-specific relationship numbers
9(10)v99 281
292 External Part D TrOOP Amount
(4) (7)
External Part D TrOOP Amount External Part D TrOOP Type
X(2)
293
(4) (7)
External Part D TrOOP Qualifier
X(1)
295
294 CR = Reduce TrOOP Used by External TrOOP Amount DB = Increase TrOOP Used by External TrOOP Amount 295 R = Replace the Existing External TrOOP Amount
Type_42_v7.0.pdf Effective Date: 8/20/2009
MedImpact Information Technologies Page 4
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
40.
(7)
External TDS Amount
9(10)v99 296
41.
(5) (7)
External TDS Type
X(2)
308
42.
(5) (7) (7)
External TDS Qualifier
X(1)
310
9(10)v99 311 X(2)
323
43. 44.
(6) (7)
External Part D Std Deductible Amount External Part D Std Deductible Type
45.
(6) (7)
External Part D Std Deductible Qualifier
X(1)
325
Obsolete Flag
X(1)
326
46.
Description
307 External TDS (Total Drug Spend) Amount. TDS is the total amount spent on Part D eligible drugs. 309 CR = Reduce TDS Used by External TDS Amount DB = Increase TDS Used by External TDS Amount 310 R = Replace the Existing External TDS Amount 322 External Part D Std Deductible Amount 324 CR = Reduce Deductible by External Std Deductible Amount DB = Increase Deductible by External Std Deductible Amount 325 R = Replace the Existing Std Deductible Amount 326 Y = Obsolete
N = Active Blank = Active 47.
48.
(8)
49.
(8)
50.
51.
(8)
Submitter ID
X(30)
Maximum Benefit Credit Amount Maximum Benefit Credit Amount Type
9(10)v99 357 X(2)
327
369
Maximum Benefit Credit Amount Qualifier
X(1)
371
Filler2
X(129)
372
Type_42_v7.0.pdf Effective Date: 8/20/2009
356 Used to submit the name of MedAccess user making the update 368 Maximum Benefit Credit Amount 370 CR = Increase Maximum Benefit Credit Amount DB = Reduce Maximum Benefit Credit Amount Only validated when the qualifier is U. 371 U = Update the Existing Maximum Benefit Credit Amount R = Replace the Existing Maximum Benefit Credit Amount 500 Filler
MedImpact Information Technologies Page 5
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
Description
Notes (1) Mandatory Fields (2) This is to be used only when the benefit has an Rx + Med OOP value. (3) This is to be used only when the benefit has an Rx + Med Deductible value. (4) This field is required if External Part D TrOOP Amount is populated. (5) This field is required if External TDS Amount is populated. (6) This field is required if External Part D Std Deductible Amount is populated. (7) Entire record will reject if this field is populated for a Part D member with a date > 20081231 in field 8.
(8) This field is to be used only when the benefit has a Maximum Benefit accumulation value.
Type_42_v7.0.pdf Effective Date: 8/20/2009
MedImpact Information Technologies Page 6
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
Type 42 — External Accumulator Load File Layout The Type 42 is submitted and loaded to update a member’s accumulator benefit amount with external values. The Type 42 file contains a fixed length format. Examples of group and member updates and file load logic are shown in Section 3 of the MedImpact Media & File Layout System Specifications document. Table 1. Field Number Notes
Type 42 External Accumulator Load File Layout
Field Name
Position Field Length From Thru
Description
1.
(1)
Record Type
X(2)
1
2
Constant “42”
2.
(1)
Headquarters Code
X(5)
3
7
Assigned by MedImpact
3.
(1)
Carrier Number
9(5)
8
12
Assigned by MedImpact
4.
(1)
Group Number
X(10)
13
22
5.
(1)
Division
X(10)
23
6.
(1)
Member Number
X(30)
33
7.
(1)
Person Code
9(2)
63
8.
(1)
Month Day and Year 9(8) of External Value
65
Reserved
X(48)
73
External Deductible Used Amount External Deductible Used Type
9(10)v99 121
132 External Deductible Used Amount
X(2)
133
External Deductible Used Qualifier
X(1)
135
134 CR = Reduce Deductible Used by External Deductible Amount DB = Increase Deductible Used by External Deductible Used Amount 135 U = Update the Existing External Deductible Used Amount (Not a replace; do not use U if member is Part D) R = Replace the Existing External Deductible Used Amount
9. 10.
(7)
11.
(7)
12.
(7)
Type_42_v7.0.pdf Effective Date: 8/20/2009
Group to which member is associated 32 Division to which member is associated 62 ID Number for members on card (no special characters) 64 Example: Insured = 01; Spouse = 02; and Dependents 03 to 99 72 YYYYMMDD – Cannot be 2009 if Part D member, due to FIR rollout 120 Reserved
MedImpact Information Technologies Page 1
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
Description
13.
External Benefit Used Amount
9(10)v99 136
147 External Benefit Used Amount
14.
External Benefit Used Type
X(2)
148
15.
External Benefit Used Qualifier
X(1)
150
16.
External Brand Benefit Used Amount External Brand Benefit Used Type
9(10)v99 151
149 CR = Reduce Benefit Used by External Benefit Used Amount DB = Increase Benefit Used by External Benefit Used Amount 150 U = Update the Existing External Benefit Used Amount (not a replace) R = Replace the Existing External Benefit Used Amount 162 External Brand Benefit Used Amount
X(2)
163
18.
External Brand Benefit Used Qualifier
X(1)
165
19.
External Generic Benefit Used Amount External Generic Benefit Used Type
9(10)v99 166
17.
20.
Type_42_v7.0.pdf Effective Date: 8/20/2009
X(2)
178
164 CR = Reduce Brand Benefit Used by External Brand Benefit Used Amount DB = Increase Brand Benefit Used by External Brand Benefit Used Amount 165 U = Update the Existing External Brand Benefit Used Amount (not a replace) R = Replace the Existing External Brand Benefit Used Amount 177 External Generic Benefit Used Amount 179 CR = Reduce Generic Benefit Used by External Generic Benefit Used Amount DB = Increase Generic Benefit Used by External Generic Benefit Used Amount
MedImpact Information Technologies Page 2
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
21.
External Generic Benefit Used Qualifier
X(1)
22.
External Out Of Pocket (OOP) Used Amount External OOP Used Type
9(10)v99 181
X(2)
193
External OOP Used Qualifier
X(1)
195
External Medical Deductible Used Amount External Medical Deductible Used Type
9(10)v99 196
X(2)
208
210
23.
24.
180
25.
(3)
26.
(3)
27.
(3)
External Medical Deductible Used Qualifier
X(1)
28.
(2)
External Medical OOP Used Amount
9(10)v99 211
Type_42_v7.0.pdf Effective Date: 8/20/2009
Description
180 U = Update the Existing External Generic Benefit Used Amount (not a replace) R = Replace the Existing External Generic Benefit Used Amount 192 External OOP Used Amount
194 CR = Reduce OOP Used by External OOP Used Amount DB = Increase OOP Used by External OOP Used Amount 195 U = Update the Existing External OOP Used Amount (not a replace) R = Replace the Existing External OOP Used Amount 207 External Medical Deductible Used Amount (To be used Rx + Med Deductible Benefits only) 209 CR = Reduce External Medical Deductible Used by External Medical Deductible Used Amount DB = Increase External Medical Deductible Used by External Medical Deductible Used Amount (To be used Rx + Med Deductible Benefits only) 210 U = Update the Existing External Medical Deductible Used Amount (not a replace) R = Replace the Existing External Medical Deductible Used Amount 222 External Medical OOP Used Amount
MedImpact Information Technologies Page 3
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
29.
(2)
External Medical OOP Used Type
X(2)
223
30.
(2)
External Medical OOP Used Qualifier
X(1)
225
External Medical Benefit Used Amount External Medical Benefit Used Type
9(10)v99 226
X(2)
238
33.
External Medical Benefit Used Qualifier
X(1)
240
34.
Member First Name
X(30)
35.
Member Date of X(8) Birth Member Relationship 9(2) Code
31.
32.
36. 37.
(7)
38.
39.
Description
241
224 CR = Reduce Medical OOP Used by External Medical OOP Used Amount DB = Increase Brand Benefit Used by External Brand Benefit Used Amount 225 U = Update the Existing External Medical OOP Used Amount (not a replace) R = Replace the Existing External Medical OOP Used Amount 237 External Medical Benefit Used Amount (To be used Rx + Med Deductible Benefits only) 239 CR = Reduce External Medical Benefit Used by External Medical Deductible Used Amount DB = Increase External Medical Benefit Used by External Medical Deductible Used Amount (To be used Rx + Med Benefit only) 240 U = Update the Existing External Medical Benefit Used Amount (not a replace) R = Replace the Existing External Benefit Used Amount 270 First Name of Member
271
278 YYYYMMDD
279
280 Client-specific relationship numbers
9(10)v99 281
292 External Part D TrOOP Amount
(4) (7)
External Part D TrOOP Amount External Part D TrOOP Type
X(2)
293
(4) (7)
External Part D TrOOP Qualifier
X(1)
295
294 CR = Reduce TrOOP Used by External TrOOP Amount DB = Increase TrOOP Used by External TrOOP Amount 295 R = Replace the Existing External TrOOP Amount
Type_42_v7.0.pdf Effective Date: 8/20/2009
MedImpact Information Technologies Page 4
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
40.
(7)
External TDS Amount
9(10)v99 296
41.
(5) (7)
External TDS Type
X(2)
308
42.
(5) (7) (7)
External TDS Qualifier
X(1)
310
9(10)v99 311 X(2)
323
43. 44.
(6) (7)
External Part D Std Deductible Amount External Part D Std Deductible Type
45.
(6) (7)
External Part D Std Deductible Qualifier
X(1)
325
Obsolete Flag
X(1)
326
46.
Description
307 External TDS (Total Drug Spend) Amount. TDS is the total amount spent on Part D eligible drugs. 309 CR = Reduce TDS Used by External TDS Amount DB = Increase TDS Used by External TDS Amount 310 R = Replace the Existing External TDS Amount 322 External Part D Std Deductible Amount 324 CR = Reduce Deductible by External Std Deductible Amount DB = Increase Deductible by External Std Deductible Amount 325 R = Replace the Existing Std Deductible Amount 326 Y = Obsolete
N = Active Blank = Active 47.
48.
(8)
49.
(8)
50.
51.
(8)
Submitter ID
X(30)
Maximum Benefit Credit Amount Maximum Benefit Credit Amount Type
9(10)v99 357 X(2)
327
369
Maximum Benefit Credit Amount Qualifier
X(1)
371
Filler2
X(129)
372
Type_42_v7.0.pdf Effective Date: 8/20/2009
356 Used to submit the name of MedAccess user making the update 368 Maximum Benefit Credit Amount 370 CR = Increase Maximum Benefit Credit Amount DB = Reduce Maximum Benefit Credit Amount Only validated when the qualifier is U. 371 U = Update the Existing Maximum Benefit Credit Amount R = Replace the Existing Maximum Benefit Credit Amount 500 Filler
MedImpact Information Technologies Page 5
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
MedImpact Media & File Layout Specifications Type 42 — External Accumulator Load File Layout
Field Number Notes
Field Name
Position Field Length From Thru
Description
Notes (1) Mandatory Fields (2) This is to be used only when the benefit has an Rx + Med OOP value. (3) This is to be used only when the benefit has an Rx + Med Deductible value. (4) This field is required if External Part D TrOOP Amount is populated. (5) This field is required if External TDS Amount is populated. (6) This field is required if External Part D Std Deductible Amount is populated. (7) Entire record will reject if this field is populated for a Part D member with a date > 20081231 in field 8.
(8) This field is to be used only when the benefit has a Maximum Benefit accumulation value.
Type_42_v7.0.pdf Effective Date: 8/20/2009
MedImpact Information Technologies Page 6
Proprietary and Confidential The contents of this document are confidential and proprietary to MedImpact and may not be reproduced, transmitted, published, or disclosed to others without MedImpact's expressed prior written authorization. It may only be used for the purpose for which it was provided and for no other purpose. MedImpact maintains the sole and exclusive ownership, right, title, and interest in and to this document.
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