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pdfMedicare Modernization Act (MMA)
State File Specifications and Data
Dictionary
Version 2.3
Last Modified: November 16, 2010
Document No: MMA.SPD.2701.02.3.1110
Contract No.: 500-2007-00141
Centers for Medicare & Medicaid Services
7500 Security Blvd
Baltimore, MD 21244-1850
MMA State File Specification Data Dictionary
Version 2.3
REVISION HISTORY
Date
04/18/2008
06/11/2008
Version
1.0
1.1
08/30/2010
09/17/2010
2.0
2.1
11/03/2010
2.2
11/16/2010
2.3
MMA.SPD.2701.02.3.1110
Reason for Change
Initial Draft
Revisions to the output detail record
for valid values.
Incorporate CMCS Changes
Incorporate additional CMCS
Changes
Updated document to 508 Compliant
version.
Updated document to address 508
Compliance identified by CMS.
i
Author
Marie Pusloskie
Marie Pusloskie
Nancy Porter
Nancy Porter
NGC
NGC
November 2010
MMA State File Specification Data Dictionary
Version 2.3
CONTENTS
Technical Instructions for Submitting State Data for Medicare Modernization Act
1.
(MMA) Provisions ......................................................................................................................... 1
1.1
1.2
1.3
1.4
2.
State Enrollment File(s) Timing and Content ................................................................ 2
2.1
2.2
2.3
2.4
2.5
2.6
2.7
3.
State Monthly MMA File Submission Requirements ........................................ 1
Dual Eligible Enrollment...................................................................................... 1
Phased Down State Calculation ........................................................................... 1
State LIS Applications .......................................................................................... 1
Enrollment File Timing ........................................................................................ 2
Enrollment File Content ....................................................................................... 2
PROspective Full Dual Eligibles .......................................................................... 3
PRO Enrollment Process...................................................................................... 4
Submission of PRO Records ................................................................................ 4
Processing of Returned PRO Records ................................................................ 5
Enrollment File and Record Specifications ........................................................ 6
2.7.1 Data Types: ....................................................................................................... 6
2.7.2 File Format: ....................................................................................................... 6
Special Key Fields/User Tips............................................................................................ 7
3.1
Fields submitted by the State on monthly MMA File ........................................ 7
3.1.1 Beneficiary date of birth.................................................................................... 7
3.2.2 Institutional Status Indicator ............................................................................. 7
3.2
Fields Received by the State on monthly MMA Response File: ....................... 8
3.2.1 Medicare Part D Eligibility Indicator ................................................................ 8
3.2.2 Group Health Organization: GHO (10 Occurrences)........................................ 8
3.2.3 Plan Benefit Package Election (10 Occurrences).............................................. 9
3.2.4 Part D Plan Benefit Package (10 Occurrences)................................................. 9
4.
Enrollment File to CMS ................................................................................................. 10
5.
Enrollment Return File Specifications .......................................................................... 17
6.
File Summary Record ..................................................................................................... 65
7.
Month Summary Record ................................................................................................ 69
8.
Trailer Record:................................................................................................................ 71
9.
APPENDIX A CMS Central Office Contacts .............................................................. 71
10.
APPENDIX B State Codes ............................................................................................. 73
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List of Tables
Table 1: Enrollment File to CMS Header Record ................................................................ 10
Table 2: Enrollment File to CMS Detail Record .................................................................. 11
Table 3: Enrollment File to CMS Trailer Record ................................................................. 16
Table 4: Enrollment Return File Specifications Header Record ............................................. 17
Table 5: Enrollment Return File Specifications Detail Record .............................................. 19
Table 6: File Summary Record .......................................................................................... 65
Table 7: Month Summary Record ...................................................................................... 69
Table 8: Trailer Record .................................................................................................... 71
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1. Technical Instructions for Submitting State Data for Medicare Modernization Act
(MMA) Provisions
1.1
State Monthly MMA File Submission Requirements
CMS data collection for MMA implementation will be met by States submitting at least one
monthly file. States have the option to submit a single monthly file including all known dual
eligibles, or multiple files throughout the month (up to one per day). Multiple files are intended
to give the States the opportunity to provide current information on updated dual eligibility
status. Multiple submittals should represent only those individual person-months with changes
in status. We expect that many States will opt to submit a large initial file including the bulk of
enrollments for the reporting month, and smaller incremental files providing updates for changes
in dual eligibility status (additions, deletions, or changes). States should not submit multiple full
replacement files as CMS will not be able to process the files.
The monthly files will address the following program needs:
1.2
Dual Eligible Enrollment
The monthly file submittals will include all Medicare/Medicaid dual eligibles in the State (full
benefit) as well as QMB, SLMB, and QI (partial benefits), PROspective (PRO) records, and
State Low Income Subsidy (LIS) applications for Part D subsidy processed through the file
creation date. This will allow CMS to establish the low-income-subsidy (LIS) status of dual
eligibles, and to perform auto-assignment of individuals to Medicare Part D plans.
1.3
Phased Down State Calculation
One of the purposes for which the State‟s monthly MMA file submission will be used is to
calculate the State‟s phasedown contribution payment. The phasedown process requires a
monthly count of all full benefit dual eligibles with an active Part D plan enrollment in the
month. CMS will make this selection of records using dual eligibility status codes contained in
the person-month record to identify all full-benefit dual eligibles (codes 02, 04 and 08). In the
case where in a given month, multiple records were submitted for the same client in multiple file
submittals, the last record submitted for that client shall be used to determine the final effect on
the Phasedown count.
1.4
State LIS Applications
The file may also include records for those individuals for whom the State has made a low
income subsidy determination. A record for each Medicare Part D low income subsidy
application processed by the State must be included in the file.
States are strongly encouraged to use the SSA‟s subsidy application (SSA-1020) for subsidy
applicants unless an individual specifically requests the State make the subsidy determination
using a State application form. States should ask applicants if they have already applied for the
subsidy with SSA and, if so, urge them to wait for a decision from SSA. However, if the
applicant insists on filing with the State prior to an SSA decision, the State must comply. If an
individual requests a State determination or refuses to use the SSA application, the State must
use its own application and process the case using Federal Low-Income Subsidy income, family
size, and resource rules. The State follows its process for taking applications. The State is then
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responsible for notices, appeals, and redeterminations for subsidy cases it has determined using a
State application form.
2. State Enrollment File(s) Timing and Content
2.1
Enrollment File Timing
Each month‟s enrollment file(s) is sent to CMS between the 1st and the end (i.e. 30th or 31st) of
the enrollment month. If a State submits only one file, this submittal must be a complete monthly
dual eligible enrollment file. If a State chooses to submit multiple files, a State may either submit
one complete enrollment file and submit subsequent files including only file accretions and
deletions, or a State may conceivably also submit multiple files throughout the month each
consisting only of partial enrollments, as long as the accrual of all those file submission would
deliver, by month‟s end, a complete representation of all dual eligible enrollment in the State for
that month.
If the State submits multiple enrollment files per any given month, once a file has been accepted,
any subsequent submissions in the same month will be treated as a unique submission and
processed like the first file. For each State file accepted and processed successfully, CMS will
send a response file within 24 to 48 hours. CMS will process all files nightly for the deeming and
auto-assignment process. Resulting enrollment transactions shall be sent weekly on Sundays to
the Part D plans.
Files that are rejected based on data quality validation must be received in CMS by the last day
of the month if this is to be the sole submission of the month. If a State submits an additional file
on the last day of the month, and it is received on or after our cutoff processing time of 6 p.m.
Eastern Standard Time (EST), the file will be processed the first day of the subsequent month.
Thus if a file of end of month updates is submitted to CMS on January 31st, 2010, at 11pm EST,
it would not be processed until February 1 and all DETail records submitted as “current” for
January 2010 would now be treated as retroactive records, any (one month into the future)
DETail records would be processed as current records. If no file is successfully submitted for the
month, CMS will project enrollment from the prior month‟s file and apply retroactive updates
based on the subsequent months‟ submittals for the purpose of the phasedown calculation.
2.2
Enrollment File Content
The Record Identifier field will identify if the record is an enrollment detail record (“DET”) for a
known dual eligible or future Medicaid eligible (not to exceed one month into the future), a
prospective full dual (“PRO”) or a low-income subsidy determination (“LIS”) record.
Medically-needy and other spend-down individuals who have not met their incurred liability for
the month and are in inactive enrollment status for the reporting month should not be included.
Below are the types of records States should include in their file:
Current DET records – States must include a person-month record for each individual
eligible for the current reporting month. If a State submits only one file per month, the
Medicaid Eligibility Status Field must be populated with “Y”. If a State submits multiple
files per month, the Medicaid Eligibility Status Field can be populated with a “Y” or
“N”. For example, if a client was submitted as a Current DET record in a previous
submission during the current reporting month as a “Y”, but the State discovered the
client was not Medicaid eligible, the State may correct the eligibility status by
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resubmitting the client‟s record with an “N” in the Medicaid Eligibility Status Field for
the current reporting month within the same month.
Retro DET records – Additionally, all files will include a full person-month record to
report information on changes in the circumstances for individuals that were effective in
a prior month. These records are referred to as “retroactive” records and will be
identified in the monthly file by the effective month and year to which the retroactive
record data are to be applied. Illustrative examples of possible situations that would lead
to retroactive changes include:
1. an individual not previously reported who was determined by the State to be
retroactively eligible three months prior to the reporting month,
2. an individual having a change in dual status code two months prior to the
reporting month, but for whom the State was not aware of the change until the
reporting month.
3. an individual who was previously reported eligible but is deceased or ineligible
for another reason.
In each of these cases, the state file will include a complete person-month record for that
individual for the current month, and a second (or more, as needed) record providing a
replacement record for the effective month and year of the change.
For example, in the January 2010 reporting month file due by January 31, a dual eligible that
became retroactively eligible in October 2009, the State would submit a full, complete record for
each month of eligibility through the reporting month i.e., 4 records (October 2009 – January
2010). Since this is a replacement record, the record will include data in all required fields; not
just those fields that have changed. A person who was reported eligible for November but was
discovered in December to be deceased during the full month of November would have a
change record for November showing an eligibility status of ineligible (coded value of “N”) for
the November enrollment month.
NOTE: CMS is only able to process records up to 36 months of retroactivity from the
current reporting month. Any records older than 36 months will be rejected.
Future DET records – The file(s) may also include Medicare beneficiaries who will be
identified as Medicaid beneficiaries one month into the future.
LIS records – The monthly file submittal may also include all State LIS applications for
Part D subsidy processed through the file creation date.
PRO records – States should include individuals in state Medicaid programs who are not
known to be full dual eligibles, but are Medicaid eligibles approaching an age (64 and 7
months or older in the reporting month) or disability status that is likely to lead to a future
determination of full dual eligibility. (See Section 2.3 – 2.6 for detailed information on
PRO Records).
2.3
PROspective Full Dual Eligibles
One of the concerns related to the monthly MMA reporting cycle is the effect on Medicaid-only
individuals who transition to dual eligible status and the difficulty in ensuring a seamless
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transition in drug coverage. This section will clarify a few key elements that are part of the
submission, as well as processing, of these PROspective records.
Only submit PROspective records for individuals with full Medicaid benefits; i.e., individuals
who, if they have Medicare coverage, would be full dual eligibles. Do not include individuals
who would only represent partial dual eligibles; i.e., QMB-only, SLMB-only, or QI s. In the
Dual Status Code field in the PRO record, include a full dual eligible status code (i.e., 02-QMB
plus, 04-SLMB plus, or 08-Other) which best describes the dual status assuming that individual
is Medicare eligible.
2.4
PRO Enrollment Process
By including these PROspective individuals on the monthly files, CMS will be able to return
information to the States on the response files for individuals already in Medicare and those
projected to get Medicare coverage in the near future. We will also be able to set up subsidy
status and auto-enroll individuals into a Part D plan so their coverage will be in place when they
become Part D eligible.
This is a process that has been advocated by many States to help minimize the transitional drug
coverage issues for individuals becoming eligible for Part D. This process also provides an
opportunity to better synchronize State information on Medicare enrollment.
2.5
Submission of PRO Records
In order for CMS to successfully process a PRO record the following conditions must be
met/elements must be in place:
RECORD IDENTIFIER CODE field (position 1-3) must contain „PRO‟.
ELIGIBILITY MONTH/YEAR (position 4-9) of submission must be the CURRENT
PROCESSING MONTH/YEAR. CMS will reject past or future dates.
Record must contain a “Y” in the ELIGIBILITY STATUS field (position 10)
Record must contain a valid SSN (position 27-35). This field cannot be 9-filled or blank.
Record must contain a valid DATE OF BIRTH (position 108-115). If date of birth is
unknown, enter best available data. This policy applies to DET records as well. Records
containing no date of birth will be ignored.
Record must contain a valid, two byte DUAL STATUS CODE (position 116-117) of a
„02‟, „04‟ or „08‟. CMS will reject any other dual status codes.
Based on this coding, these records will be subjected to special processing. This processing will
bypass counting for the phased-down State contribution but will allow us to prospectively autoenroll these individuals and to establish an appropriate Part D low-income subsidy level. These
records will also be excluded from the file acceptance threshold for a 90-percent Medicare match
rate.
PRO records may be submitted in any order within the monthly MMA File(s). They may be
intermingled with the monthly DET records or separated. CMS will sort the file upon receipt and
process each record per the record descriptor located in the first 3 bytes of the record (i.e. DET,
PRO, etc).
The information on Medicare status (for Medicare Parts A, B, C and D) will be returned to the
State in the normal response file format (see Section 2.7, Enrollment Return File Specifications
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for details). For records which do not match Medicare records, the Medicare enrollment
information will be blank. For records having current Medicare enrollment, all available
enrollment information will be returned on the response file, including any prospective
enrollment dates derived from the SSA prospective enrollment information. NOTE: Medicare
enrollment systems can only return auto-enrollment information for prospective periods two
months prior to the enrollment effective date.
Once an individual is identified as a prospective full dual, the person should be submitted with a
Record Identifier of “DET” in the first month Medicare eligibility is effective. If an individual is
identified on the response file as having current or retroactive Medicare coverage, submit
retroactive “DET” records covering the missed months of dual eligibility status. Full duals
submitted as “DET” records should not be submitted as “PRO” records for the same eligibility
month.
2.6
Processing of Returned PRO Records
Once the State has submitted their PRO records to CMS for processing, CMS will respond by
returning a PRO record for each PRO record submitted, regardless if found on CMS MBD
Database. A State will receive PRO statistics in the FILE SUMMARY RECORD. The layout has
been changed to accommodate PRO processing.
According to match result, VALID MATCHED records are marked with a „000000‟ or „000001‟
in the RECORD RETURN CODE FIELD (positions 229-234). VALID records for which no
match was found are marked with a „000003‟. INVALID DUPLICATE PRO RECORDS are
marked with „000010‟. INVALID and thus NON-MATCHED records are marked with a
„000009‟. INVALID PRO RECORD is a DUPLICATE DET RECORD in current file are
marked with a „000011‟. INVALID PRO RECORD is a DUPLICATE OF DET RECORD from
a previous file are marked with a „000012‟.
Valid PRO records that have been matched to the database will contain the same information as
matched DETail records: PART A/B/C Entitlement dates, HICN, SSNs, and ESRD, PART C,
Part D, etc.
For matched PRO records, a State should submit a DET record once the period of current dual
eligibility has been reached and the beneficiary is assigned to a PDP. This information is
contained in the Eligibility Information for Parts A/B and D in the MMA Response File. If, for
example, a PRO record is returned in the December Response File as matched (Record Return
Code Field = „000001‟ or „000000‟) and the Part A/ B/D Entitlement Start Date is 01/01/2010, it
is anticipated that a DETail record will be submitted for this beneficiary in the January 2010 file.
Valid PRO records which were matched and are found to be PART A/B entitled within two
months of submission, will be auto-assigned to a PDP. Auto-assignment may only occur up to
two months into the future. For example, if a beneficiary PRO record was submitted in a
December 2009 State File and was found to be PART A/B/D entitled 03/01/2010, the member
would be submitted to the deeming process the evening of file submission, and be returned in the
RESPONSE FILE within 24 – 48 hours with a deeming onset date of 03/01/2010. The
enrollment information would be available in any January created response file, given the
beneficiary is submitted by the State at some point in January. This auto-assignment would occur
even if the member is not resubmitted after December‟s submission.
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If the eligibility date is more than two months into the future, CMS will not auto-assign them
until the appropriate time frame has been reached (for this example, any record with a future
entitlement date beyond March 2010). Deeming, however, will occur at the same time for the
appropriate time span, regardless if onset is more than two months into the future.
Already existing eligibility / enrollment may be returned for individuals submitted by a State on
a PRO record that a State was otherwise not aware of. When that occurs, the State should submit
retroactive monthly DET records covering the newly-identified period of dual eligibility in the
following month‟s MMA file submission.
2.7
Enrollment File and Record Specifications
This specification document defines the process for this file submittal process in the following
sections:
1. State Enrollment File Specifications
2. Enrollment Return File Specifications
The State Enrollment File(s) will be transferred using Gentran, Cyberfusion (via SSA) or
Connect:Direct (C:D) electronic file transfer. The Enrollment Return File from CMS will be
transferred to the State using the same electronic file transfer the State used to submit their file to
CMS.
For technical support questions or file transmission issues, refer to “Appendix A” for a list of
CMS Central Office MMA contacts.
2.7.1 Data Types:
9(x) = Numeric characters; where “9” indicates a numeric data type and “x” is the field length
X(x) = Alphanumeric characters with field length (x)
DATES = ALL DATES WILL BE IN MMDDCCYY FORMAT (month, day, century, year)
NOTE: Entries of numeric data fields will be right-justified within the field and entries alphanumeric data
fields will be left-justified within the field.
2.7.2
File Format:
File naming standard for Cyberfusion and Connect:Direct (C:D) electronic file
transfers – P#EFT.IN.ELIGIBLE.CMSxx.Dyymmdd.Thhmmsst
File naming standard for GENTRAN electronic file transfers –
Guid.NONE.MBD.M.CMSxx.ELIGIBLE.P
Where “xx” = State abbreviation
Where “GUID” = IACS ID
Mainframe with EBCDIC data format. File format is “FB” (fixed block) and record length is
180 (LRECL=180)
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3. Special Key Fields/User Tips
3.1
Fields submitted by the State on monthly MMA File
3.1.1
Beneficiary date of birth
Key field used to corroborate match between State incoming beneficiary record to
CMS‟ MBD (Medicare Beneficiary Database), which receives this date from the
Social Security Administration‟s MBR (Master Beneficiary Record)
PRIMARY MATCHING Criteria is based on the following algorithm:
EITHER
(SSN
5.0 points
OR
BENE CAN Number (1st 9 positions of HIC)
3.5 points
BENE BIC CODE
1.2 points
AND
BENE DOB CCYY
BENE DOB MM
BENE DOB DD
GENDER
3.25 points
3.0 points
2.25 points
2.5 points
A score of 12.25 must be attained for a record to be successfully matched. If the
primary matching is unsuccessful, a secondary matching is entered:
SECONDARY MATCHING Criteria is based on:
○ 1st 6 positions of the last name
○ 1st position of the first name
○ CAN or SSN
○ Exact Gender
3.2.2
Institutional Status Indicator
(Indicator of nursing facility, ICFMR or inpatient psychiatric hospital) or starting
January 1, 2012, home and community based services)
Values are „Y‟ or „N‟ – A value of „Y‟ indicates that the individual was enrolled in a
Medicaid paid institution for the full reporting month, or is projected by the State to
remain in the institution for the remainder of the month.
Starting January 1, 2012, there will be a new valid value of „H.‟ This value should
be submitted by States for DET and PRO records submitted for an eligibility
month/year no earlier than January 2012, in which a full-benefit dual eligible
individual received home and community based services. This includes home and
community based services delivered under a section 1115 demonstration, under a
1915(c) or (d) waiver, under a State plan amendment under 1915(i), or through
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enrollment in a Medicaid managed care organization with a contract under section
1903(m) or under section 1932 of the Social Security Act.
This is a key field in establishing correct beneficiary copays. States need to submit
not only accurate current-month institutional status, but retroactive records
reflecting institutional status changes in prior months. This is necessary to ensure that
there is closure on the Part D plan‟s responsibility for copay amounts during the span
of coverage. We ask that States submit retroactive records in their files to cover any
unreported past changes in institutional status. For example, if a State has reported an
individual for the first time as having institutional status in February, even though the
first full month in the institution was January, we need a retroactive enrollment record
showing this update.
3.2
Fields Received by the State on monthly MMA Response File:
3.2.1
Medicare Part D Eligibility Indicator
(Part D Payment Switch or MARx Payment Switch)
Value will be „0‟ for dual eligibles who are enrolled in a Part D plan during eligibility
month/year
Value will be „1‟ for dual eligibles who are not enrolled in a Part D Plan during
eligibility month/year
3.2.2 Group Health Organization: GHO (10 Occurrences)
(Prior to the onset of Part D benefits, this part of the record only contained Part C MA
Organizations)
(This area of the response file contains both Medicare Advantage Plans, PACE and Demo
Enrollments offering and not offering Part D drug benefits. The information represents the
overall contract/organization within which a beneficiary may have a choice of plans (PBPs). If a
rollover from a non drug covering plan into one that did occurs, the enrollment effective date of
the GHO/GHP would not change but the enrollment periods of the affected PBPs would be
updated)
The first occurrence is the active (current or future) or most recent Medicare Group
Health Organization coverage (i.e. plan enrollment). Presently, this section is
populated with Medicare Part C and Medicare Part D Organizations enrollments. The
organizations can be distinguished by the first position of „BENE GHO CNTRCT
NUM‟:
H# is for local MA and MA-PDs; PACE, Cost Plans, and Demos
S# is for STAND ALONE PDP'S
R# is for Regional MA and MA-PDs
[9 in the first position may denote a Demo Plan; or a Chronic Care Improvement
Pilot]
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E# -- an employer sponsored prescription drug plan (began with contract year
2007).
Contract number “X0001” is for the new Limited Income Newly Eligible
Transition (NET) program
3.2.3
Plan Benefit Package Election (10 Occurrences)
(This area of the response file describes the various PBP (plan) enrollments within the
given GHO periods mentioned above)
The most active plan enrollment will reside in occurrence 1, followed by historical
enrollments.
Presently, this section is populated with Medicare Part C offering no drug coverage as
well as offering drug coverage and Part D standalone plans
It is possible for a beneficiary to have two open enrollment periods, one signifying a
managed care plan offering no drug coverage and a PDP standalone. In that case, the
GHP contract numbers will be different.
Updated list of values for the
PBP ORG CVRG TYPE CD:
NF = invalid coverage type code
3 = CCP
COORDINATED CARE PLAN
4 = MSA
MEDICARE MEDICAL SAVINGS ACCOUNT
5 = PFFS
PRIVATE FEE FOR SERVICE
6 = PACE
PACE PGM OF ALL INCLUSIVE CARE FOR THE
ELDERLY
7 = Regional MA (MEDICARE ADVANTAGE) or Regional MAPD
(MEDICARE ADVANTAGE & PART D)
8 =DEMO
DEMONSTRATION
9 = FFS
FEE FOR SERVICE
10 = Cost/HCPP
COST/HEALTH CARE PREPAYMENT PLAN
11=PDP
Part D Drug Plan ELECTION
12= Chronic Care Demo
13 = MSA Demo
MEDICARE MEDICAL SAVINGS ACCOUNT DEMO
3.2.4
Part D Plan Benefit Package (10 Occurrences)
This portion of the record will list the Part D Plans which also trigger the MEDICARE PART D
ELIGIBILITY INDICATOR to reflect a „0‟, denoting “Part D Enrollment found”
(This area of the response file describes the various PBP (plan) enrollments within the
given PDP only periods)
The most active plan enrollment will reside in occurrence 1, followed by historical
enrollments.
Presently, this section is populated with Medicare Part C offering drug coverage as
well as Part D standalone plans
It is possible for a beneficiary to have two open enrollment periods, one signifying a
managed care plan offering no drug coverage and a PDP standalone. In that case, the
GHP contract numbers will be different.
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Updated list of values enrollment type code:
-Values for Enrollment Type Code:
A - Beneficiary was auto-enrolled thru CMS (full duals)
B - Beneficiary elected plan (overrides auto enrolled plan)
C - Facilitated enrollment: CMS facilitates enrollment of partial duals into a PDP
D - System (plan‟s) generated enrollment: the beneficiary is in a plan and either
the contract or PBP # is changing and they are rolled over automatically into
the new number. This usually occurs at the end of the calendar year (which
coincides with contract year), when contracts/plans may transition to new
numbers
E - Plan submitted auto-enrollments
F - Plan submitted facilitated enrollments
G - Point of Sale (POS) submitted enrollments
H - CMS or Plan submitted reassignment enrollments
I - Assigned to Plan submitted transactions with enrollment source other than any
of the following: B, E, F, G, H, and blank.
4. Enrollment File to CMS
Table 1: Enrollment File to CMS Header Record
Data Element Name
Record Identification Code
State Code
Position
Format
1-3
4-5
X(03)
X(02)
Create Month
6-7
9(02)
Create Year
8-11
9(04)
12-180
X(169)
Filler
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Instructions
Enter 'MMA'.
Enter US Postal Service State
Abbreviation.
Example = 'MD'.
See Appendix B State Codes.
Enter month that the file is
created. Examples, if month is
May, enter '05'.
Enter year that the file is created.
Example = '2010'.
Enter spaces.
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Table 2: Enrollment File to CMS Detail Record
Data Element Name
Record Identification Code
Position
Format
1-3
X(03)
Instructions
Enter 'DET' if individual is eligible
for Medicare and is currently
eligible for Medicaid or will be
eligible for Medicaid within the
next month.
Enter "PRO' if individual is eligible
for full Medicaid benefits and
although not known to the State as
dually eligible is at least 64 years
and seven months old or has a
disability-related condition.
Eligibility Month/Year
4-9
MMCC
YY
Enter "LIS' if individual has
undergone a low income subsidy
determination within the current
month.
Enter calendar month/year for
applicable Medicaid eligibility.
Enter the effective month/year of
the changes for each retroactive
record.
Retroactive changes must be
submitted to reflect prior month
changes in one or more of the
following fields:
- Eligibility Status
- HICN/RRB
- Social Security Number
- Sex
- Date of Birth
- Dual Status Code
- FPL% Indicator
- Institutional Status Indicator
Retroactive records must include
replacement values for ALL fields
for that record, NOT just for the
fields that have changed.
MMA.SPD.2701.02.3.1110
11
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Eligibility Status
Version 2.3
Position
Format
10
X(01)
Instructions
Enter 'Y' (Yes) if individual is
eligible for Medicaid for that
Eligibility Month/Year.
Enter 'N' (No) if individual is not
eligible for Medicaid for that
Eligibility Month/Year.
HICN/RRB
11-25
X(15)
HICN/RRB Indicator
Social Security Number
26
27-35
X(01)
9(09)
SMA Identifier
36-55
X(20)
Individual's First Name
56-67
X(12)
Individual's Last Name
68-87
X(20)
Individual's Middle Name
88-102
X(15)
Individual's Suffix Name
103-106
X(04)
MMA.SPD.2701.02.3.1110
12
CMS will reject a PRO record with
'N' in this field.
Enter the Medicare Health
Insurance Claim Number (HICN) or
the Railroad Retirement Board
Number (RRB) whichever the State
has active and available for the
individual.
This field is not used by CMS.
Enter the individual's SSN.
CMS will reject a record with no
SSN if there is no HICN reported.
Enter the individual's State
Medicaid Agency Enrollee
Identifier.
This field is optional as CMS does
not use.
Enter the individual's first name
(first 12 letters). This entry is used
only for beneficiary secondary
match.
Enter the individual's last name
(first 20 letters). This entry is used
only for beneficiary secondary
match.
Enter the individual's middle name
(first 15 letters).
Enter the individual's suffix name
(first four letters). Examples - 'JR',
'III'.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Individual's Gender
Individual's Date of Birth
Individual's Dual Status
Code
Version 2.3
Position
Format
107
X(01)
108-115
116-117
MMDD
CCYY
9(02)
Instructions
Enter the individual's gender:
M = Male
F = Female
U = Unknown
This entry is used for beneficiary
secondary match.
Enter the individual's date of birth.
CMS will not match a detail record
without a date of birth to a
beneficiary on the Medicare
database.
Enter one of the following values
for DET records:
01 - Eligible is entitled to Medicare
- QMB only
02 - Eligible is entitled to Medicare
- QMB and full Medicaid coverage
03 - Eligible is entitled to Medicare
- SLMB only
04 - Eligible is entitled to Medicare
- SLMB and full Medicaid coverage
05 - Eligible is entitled to Medicare
- QDWI
06 - Eligible is entitled to Medicare
- Qualifying individuals
08 - Eligible is entitled to Medicare
-Other Full Dual Eligibles with full
Medicaid coverage
09 - Eligible is entitled to Medicare
-Other Dual eligibles but without
Medicaid coverage, includes
Pharmacy Plus and 1115 drug-only
demonstration.
States should submit a PRO record
only for an individual with full
Medicaid benefits, that is, an
individual who if he /she had
Medicare would qualify for a full
dual status code of '02' , '04' or '08'.
CMS will reject PRO records with
any other dual codes.
MMA.SPD.2701.02.3.1110
13
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
Position
Format
Federal Poverty Level
Percentage Indicator
118
9(01)
Drug Coverage Indicator
Institutional Status Indicator
NOTE: States should not
include “H” value on file
until January 2012.
119
120
9(01)
X(01)
Instructions
Enter one of the following values
for DET and PRO record types:
1- Individual 's income at or below
100% FPL.
2 - Individual's income above 100%
FPL.
Do not derive this value from the
Dual Status Code.
This field is not used by CMS.
Enter one of the following values:
'Y' (Yes) - Individual is
institutionalized in a nursing
facility, intermediate care facility or
inpatient psychiatric hospital for
the entire span of eligibility for the
month. Only full-benefit dual
eligibles will receive the $0 copay.
'N' (No) - Individual is not
institutionalized in a nursing
facility, intermediate care facility or
inpatient psychiatric hospital for
the entire span of eligibility for the
month.
Low Income Subsidy
Application Approval Code
Low Income Subsidy
Approved/Disapproved
Date
MMA.SPD.2701.02.3.1110
121
122-129
X(01)
MMDD
CCYY
14
For DET and PRO records for
eligibility month/year starting
January 2012 and later, 'H' (Home
and Community Based) Individual is receiving home and
community based services at any
period during the month.
Enter 'Y' (Yes) if individual's
subsidy application is approved.
Enter 'N' (No) if individual's
subsidy application is not approved.
Enter date that State approved or
disapproved low income subsidy
application.
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
Position
Format
Instructions
Low Income Subsidy
Effective Date
130-137
MMDD
CCYY
Enter the date that the subsidy
begins.
Low Income Subsidy End
Date
138-145
MMDD
CCYY
The day of this entry must be the
first day of the month in which the
State received the application.
Enter the date that the subsidy ends.
The day of this entry must be the
last day of the month in which the
subsidy ends.
Income as % of FPL
146-148
9(03)
Low Income Subsidy Level
149-151
9(03)
Identifies portion of Part D
premium subsidized, based
on sliding scale linked to
income as % of FPL.
Income Used for
Determination
Resource Level
152
153
X(01)
X(01)
This field is not required and should
be left blank or filled with 9's unless
the State has a definite knowledge
of when the subsidy award ends.
Enter percentage of income to
Federal Poverty Level as defined by
Federal LIS income determination
policy.
Enter one of the following values to
describe the portion of Part D
premium subsidized, based on
sliding scale linked to FPL %:
100- under 136 % FPL
075 - 136- 140%
050 - 141- 145
025 - 146-149
If individual's FPL% is 150 or over,
then subsidy award will be rejected
by CMS.
Enter '1' if income used for
determination is based on that of
individual.
Enter '2' if income used for
determination is based on that of
couple.
Enter '1' if individual's resource
limit is over the limit.
Enter '2' if individual's resource
limit is under the limit.
MMA.SPD.2701.02.3.1110
15
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
Position
Format
Basis of Low Income
Subsidy Denial
154
X(01)
Result of an Appeal
155
X(01)
Change to Previous
Determination
156
X(01)
157
X(01)
158-180
X(23)
Determination Cancelled
Filler
Instructions
Enter the reason that the State
denied the subsidy application:
1 = NAB (Not enrolled in Medicare
Part A or Part B)
2 = NUS (Does not reside in the
USA)
3 = FTC (Failure to cooperate)
4 = RES (Resources too high)
5 = INC (Income too high)
Enter 'Y' (Yes) if this record is the
result of an appeal.
Enter 'N' (No) if 'Y' not entered.
This is a future element.
Enter 'Y' (Yes) if this record cancels
previously sent record.
Enter 'N' (No) if 'Y' not entered.
Enter spaces.
Table 3: Enrollment File to CMS Trailer Record
Data Element Name
Record Identification Code
Record Count
State Code
Position
1-3
4-11
Format
X(03)
9(08)
12-13
X(02)
Create Month
14-15
9(02)
Create Year
16-19
9(04)
Filler
20-180
X(161)
MMA.SPD.2701.02.3.1110
16
Instructions
Enter 'TRL'.
Enter total number of DET, PRO
and LIS records in the file.
Enter US Postal Service State
Abbreviation.
Example = 'MD'.
See Appendix B State Codes.
Enter month that the file is created.
Example, if month is May, enter
'05'.
Enter year that the file is created.
Example = '2010'.
Enter spaces.
November 2010
MMA State File Specification Data Dictionary
Version 2.3
5. Enrollment Return File Specifications
This file will be automatically returned to the State upon the successful processing of a State
Enrollment File through the same electronic file transfer used to submit the file to CMS [i.e.
Gentran, Cyberfusion (via SSA) or the Connect:Direct (C:D]. There may be a delay in sending
the response file based upon other scheduling issues.
The content of the enrollment return file will include the following:
1. Header Record with identifying information, record count summaries, and a copy of the
incoming header record
2. Detail Record
a. Copy of the incoming State detail record
b. Series of edit error return codes
c. Data from the Medicare Beneficiary Database
3. File summary including record validation and matching outcomes
4. Summary enrollment count record by month for each month of enrollment information on
the incoming file, and
5. Trailer Record with identifying information and a copy of the incoming trailer record.
Table 4: Enrollment Return File Specifications Header Record
Data Element Name
Record Identification Code
File Process Timestamp
Position
1-3
4-29
Format
X(03)
X(26)
File Accept Indicator
30
X(01)
Filler
31
X(01)
MMA.SPD.2701.02.3.1110
17
Description
SRF'
The exact time that the State
file is processed.
Format: CCYY-MM-DDhh.mm.ss.nnnnnn
CCYY - Year
MM - Month
DD - Day
hh - Hour
mm - Minute
ss - Second
nnnnnn - Microsecond
Y - The State file to CMS is
accepted.
N - The State file to CMS is
not accepted.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Total Records in State File
Version 2.3
Position
32-39
Format
9(08)
Description
The total number of DET
and LIS records in the file.
Note: This count excludes
PRO records.
Total Records = Valid
Records + Invalid Records.
Duplicate Records in State File
Non-Duplicate Records in State File
Valid Records in State File
Invalid Records in State File
Matched Records in State File
40-47
48-55
56-63
64-71
72-79
9(08)
9(08)
Total Records = Matched
Records + Not Matched
Records
The total number of
duplicate DET and LIS
records in the State file.
This count excludes PRO
records.
The total number of nonduplicate DET and LIS
detail records in the State
file.
9(08)
This count excludes PRO
records.
The total number of valid
DET and LIS records in the
State file.
9(08)
This count excludes PRO
records.
The total number of invalid
DET and LIS records in the
State file.
9(08)
This count excludes PRO
records.
The total number of DET
and LIS records in the files
that are successfully
matched to an individual on
the Medicare Beneficiary
Database.
This count excludes PRO
records.
MMA.SPD.2701.02.3.1110
18
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Not Matched Records in State File
File Create Month
File Create Year
Filler
Record Identification Code
State Code
Create Month
Create Year
Filler
Filler
Version 2.3
Position
80-87
88-89
90-93
94-115
116-118
119-120
121-122
123-126
127-295
296-3400
Format
9(08)
9(02)
9(04)
X(22)
X(03)
X(02)
9(02)
9(04)
X(169)
X(3105)
Description
The total number of DET
and LIS records in the files
that are not matched to an
individual on the Medicare
Beneficiary Database.
This count excludes PRO
records.
Month that file is created
Year that file is created
Table 5: Enrollment Return File Specifications Detail Record
Data Element Name
Record Identification Code
Eligibility Month/Year
Position
1-3
4-9
10
Format
X(03)
MMCCY
Y
X(01)
HICN/RRB
HICN/RRB Indicator
Social Security Number
SMA Identifier
11-25
26
27-35
36-55
X(15)
X(01)
9(09)
X(20)
First Name
56-67
X(12)
Last Name
68-87
X(20)
Middle Name
88-102
X(15)
Suffix Name
103-106
X(04)
Eligibility Status
MMA.SPD.2701.02.3.1110
19
Description
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Gender
Version 2.3
Position
107
Format
X(01)
Date of Birth
108-115
MMDDC
CYY
Dual Status Code
Federal Poverty Level Percentage
Indicator
Drug Coverage Indicator
Institutional Status Indicator
Low Income Subsidy Application
Approval Code
116-117
118
9(02)
9(01)
119
120
121
9(01)
X(01)
X(01)
Low Income Subsidy
Approved/Disapproved Date
Low Income Subsidy Effective Date
122-129
Low Income Subsidy End Date
138-145
Income as % of FPL
Low Income Subsidy Level
146-148
149-151
MMDDC
CYY
MMDDC
CYY
MMDDC
CYY
9(03)
9(03)
152
153
154
X(01)
X(01)
X(01)
155
156
X(01)
X(01)
157
158-180
181-182
X(01)
X(23)
X(02)
130-137
Description
Identifies portion of Part D premium
subsidized, based on sliding scale
linked to income as % of FPL.
Income used for Determination
Resource Level
Basis of Low Income Subsidy
Denial
Result of an Appeal
Change to Previous Determination
Determination Cancelled
Filler
Record Identification Code Error
Code
00 - Value is valid.
01 - Value is not in Valid
Value Set.
Note: Detail record is valid
if ERC = 00.
MMA.SPD.2701.02.3.1110
20
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Eligibility Month/Year Error Code
Eligibility Status Error Code
HICN/RRB Error Code
HICN/RRB Indicator Error Code
Version 2.3
Position
183-184
185-186
187-188
189-190
Format
X(02)
X(02)
X(02)
X(02)
Description
00 - Value is valid.
02 - Value is not numeric.
04 - Date is unknown.
05 - Eligibility Month/Year
combination for PRO record
not current month/year.
10 - Value is future.
11 - Month value is not
within range of 01-12.
20 - Year < 2004.
37 - Month/year
combination > 36 months.
99 - LIS record not scanned.
Note: Detail record is valid
if ERC = 00 or 99.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
06 - PRO record Eligibility
Status ≠ 'Y'
99 - LIS record not scanned
Note: Detail record is valid
if ERC = 00 or 99.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
03 - Field is empty.
Note: Detail record is valid
if ERC = 00.
Detail record is also valid if
ERC = 01 or 03
and Social Security ERC =
00.
00 - Value is valid.01 Value is not in Valid Value
Set.
Note: Detail record is valid
if ERC = 00.
MMA.SPD.2701.02.3.1110
21
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Social Security Number Error Code
Gender Error Code
Date of Birth Error Code
Dual Status Code Error Code
Version 2.3
Position
191-192
193-194
195-196
197-198
Format
X(02)
X(02)
X(02)
X(02)
Description
00 - Value is valid.
01 - Value is not in Valid
Value Set.
02 - Value is not numeric.
03 - Value is missing.
Note: Detail record is valid
if ERC = 00. Detail record
is also valid if ERC = 01, 02
or 03 and
HICN/RRB ERC = 00.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
Note: Detail record is valid
if ERC = 00.
00 - Value is valid.
02 - Value is not numeric.
04 - Date is unknown.
10 - Value is future.
11 - Month value is not
within range of 01-12.
12 - Day value is out of
range.
21 - Year < 1899.
Note: Detail record is valid
if ERC = 00 or 21.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
07 - PRO record with Dual
Status Code ≠ 02, 04 or 08
40 - DET record has dual
status code of 99
99 - LIS record not scanned.
Note: Detail record is valid
if ERC = 00, 40 or 99.
MMA.SPD.2701.02.3.1110
22
November 2010
MMA State File Specification Data Dictionary
Data Element Name
FPL % Indicator Error Code
Drug Coverage Indicator Error Code
Version 2.3
Position
199-200
201-202
Format
X(02)
X(02)
Institutional Status Indicator Error
Code
203-204
X(02)
Low Income Subsidy Application
Approval Code Error Code
205-206
X(02)
Low Income Subsidy
Approved/Disapproved Date Error
Code
207-208
X(02)
Description
00 - Value is valid.
01 - Value is not in Valid
Value Set.
99 - LIS record not scanned.
Note: Detail record is valid
if ERC = 00 or 99
.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
99 - LIS record not scanned.
Note: Detail record is valid
if ERC = 00 or 99.
00 - Value is valid.01 Value is not in Valid Value
Set.99 - LIS record not
scanned.Note: Detail record
is valid if ERC = 00 or 99.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98
.
00 - Value is valid.
02 - Value is not numeric.
04 - Date is unknown.
10 - Value is future.
11 - Month value is not
within range of 01-12.
12 - Day value is out of
range.
31 - Value is later than Low
Income Subsidy End Date.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98.
MMA.SPD.2701.02.3.1110
23
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Low Income Subsidy Effective
Date Error Code
Version 2.3
Position
209-210
Format
X(02)
Description
00 - Value is valid.
02 - Value is not numeric.
04 - Date is unknown.
10 - Value is future.
11 - Month value is not
within range of 01-12.
12 - Day value is out of
range.
31 - Value is later than Low
Income Subsidy End Date.
36 - Value is earlier than
January 1, 2006.
37 - Day value is not first
day of the month.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00, 37 or 98.
MMA.SPD.2701.02.3.1110
24
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Low Income Subsidy End Date
Error Code
Version 2.3
Position
211-212
Format
X(02)
Description
00 - Value is valid.
02 - Value is not numeric.
04 - Date is unknown.
10 - Value is future.
11 - Month value is not
within range of 01-12.
12 - Day value is out of
range.
33 - Value is earlier than
Low Income Subsidy
Approved/Disapproved
Date.
34 - Value is earlier than
Low Income Subsidy
Effective Date.
35 - Value is earlier than
Low Income Subsidy
Approved/Disapproved
Date and Low Income
Subsidy Effective Date
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98.
Income as % of FPL Error Code
213-214
X(02)
Low Income Subsidy Level Error
Code
215-216
X(02)
00 - Value is valid.01 Value is not in Valid Value
Set.98 - DET or PRO record
not scanned.Note: Detail
record is valid if ERC = 00
or 98.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98.
MMA.SPD.2701.02.3.1110
25
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Income Used for Determination
Error Code
Resource Level Error Code
Basis of Low Income Subsidy
Denial Error Code
Result of an Appeal Error Code
Change to Previous Determination
Error Code
Version 2.3
Position
217-218
219-220
221-222
223-224
225-226
Format
X(02)
X(02)
X(02)
X(02)
X(02)
Description
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned.
Note: Detail record is
invalid if ERC ≠ 00 or 98
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98.
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned
Note: Detail record is valid
if ERC = 00 or 98.
MMA.SPD.2701.02.3.1110
26
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Determination Cancelled Error Code
Version 2.3
Position
227-228
Format
X(02)
Description
00 - Value is valid.
01 - Value is not in Valid
Value Set.
98 - DET or PRO record not
scanned.
Note: Detail record is valid
if ERC = 00 or 98.
MMA.SPD.2701.02.3.1110
27
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Record Return Summary Code
MMA.SPD.2701.02.3.1110
Version 2.3
Position
229-234
28
Format
X(06)
Description
This field is an assessment
of the detail record.
000000: Record is valid
with no errors or warnings.
000001: Record is valid
with warnings.
000002: Record is invalid.
Invalid Record
Identification Code.
000003: Record is invalid:
Insufficient valid
identifying information
[May indicate a mismatch
on the submitted date of
birth.]
000004: Record is invalid:
DET record has invalid
required fields.
000005: Record is invalid:
LIS record has invalid
required fields.
000006: Record is invalid:
DET Record is duplicate of
another DET record.
000007: Record is invalid:
LIS Record is duplicate of
another LIS record.
000009: Record is invalid:
PRO Record has invalid
required fields.
000010: Record is invalid:
PRO Record is duplicate of
another PRO record.
000011: Record is invalid:
PRO Record is duplicate of
a DET record in same file.
000012 - Record is invalid:
PRO Record is duplicate of
a DET record in a previous
file.
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
Position
Medicare Part D Eligibility Indicator
235
Medicare Part D Enrollment
Indicator
236
Format
X(01)
X(01)
Beneficiary Claim Account Number
237-245
X(09)
Beneficiary Identification Code
246-247
X(02)
MMA.SPD.2701.02.3.1110
29
Description
Values:
0 - Beneficiary is eligible
for Medicare Part D.
1 - Beneficiary is not
eligible for Medicare Part
D.
For DET and PRO records,
this field indicates the
presence of Medicare Part D
eligibility during the
Eligibility Month/Year.
Values:
0 - Beneficiary is enrolled in
a Medicare Part D plan.
1 - Beneficiary is not
enrolled in a Medicare Part
D plan.
For DET and PRO records,
this field indicates Medicare
Part D enrollment during
the Eligibility Month/Year.
The number identifying the
primary Medicare
beneficiary under the SSA
or RRB programs. This
number along with the
Beneficiary Identification
Code uniquely identifies a
Medicare beneficiary.
A code that is used in
conjunction with the
Beneficiary Claim Account
Number to uniquely identify
a Medicare beneficiary.
The BIC Code establishes
the beneficiary's
relationship to a primary
Social Security
Administration (SSA) or
Railroad Retirement Board
(RRB) wage earner and is
used to justify entitlement
to Medicare benefits.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Birth Date
Beneficiary Death Date
Beneficiary Sex Identification Code
Beneficiary First Name
Beneficiary Middle Name
Version 2.3
Position
248-255
256-263
264
265-294
295
Format
Description
MMDDC
CYY
MMDDC
CYY
X(01)
Values:
0 - Unknown
1 - Male
2 - Female
X(30)
First name of the Medicare
beneficiary
X(01)
Middle initial of the
Medicare beneficiary
X(40)
Last name of the Medicare
beneficiary including any
titles or suffixes.
X(09)
An additional beneficiary
claim account number
associated with the
Medicare beneficiary. The
beneficiary's entitlement
has been cross-referenced
from this number to the
beneficiary's active claim
account number.
X(02)
The beneficiary's
identification code
associated with the
Medicare beneficiary's
cross-referenced claim
account number.
X(09)
Beneficiary Last Name
296-335
Cross-Reference Beneficiary Claim
Account Number (Occurrence 1)
336-344
Cross-Reference Beneficiary
Identification Code (Occurrence 1)
345-346
Cross-Reference Beneficiary Claim
Account Number (Occurrence 2)
347-355
Cross-Reference Beneficiary
Identification Code (Occurrence 2)
356-357
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 3)
358-366
X(09)
Cross-Reference Beneficiary
Identification Code (Occurrence 3)
367-368
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 4)
369-377
X(09)
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
Cross-Reference Beneficiary
Identification Code (Occurrence 4)
Position
378-379
Format
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 5)
380-388
X(09)
Cross-Reference Beneficiary
Identification Code (Occurrence 5)
389-390
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 6)
391-399
X(09)
Cross-Reference Beneficiary
Identification Code (Occurrence 6)
400-401
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 7)
402-410
X(09)
Cross-Reference Beneficiary
Identification Code (Occurrence 7)
411-412
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 8)
413-421
X(09)
Cross-Reference Beneficiary
Identification Code (Occurrence 8)
422-423
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 9)
424-432
X(09)
Cross-Reference Beneficiary
Identification Code (Occurrence 9)
433-434
X(02)
Cross-Reference Beneficiary Claim
Account Number (Occurrence 10)
435-443
X(09)
Cross-Reference Beneficiary
Identification Code (Occurrence 10)
444-445
X(02)
Beneficiary Social Security Number
(Occurrence 1)
446-454
9(09)
Beneficiary Social Security Number
(Occurrence 2)
455-463
9(09)
MMA.SPD.2701.02.3.1110
31
Description
The beneficiary's
identification number that
was assigned by the Social
Security Administration.
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
Beneficiary Social Security Number
(Occurrence 3)
Position
464-472
Format
9(09)
Beneficiary Social Security Number
(Occurrence 4)
473-481
9(09)
Beneficiary Social Security Number
(Occurrence 5)
482-490
9(09)
Mailing Address Line 1
Mailing Address Line 2
Mailing Address Line 3
Mailing Address Line 4
Mailing Address Line 5
Mailing Address Line 6
Mailing Address City Name
Mailing Address State Code
Mailing Address Zip Code
Mailing Address Change Date
491-530
531-570
571-610
611-650
651-690
691-730
731-770
771-772
773-781
782-789
X(40)
X(40)
X(40)
X(40)
X(40)
X(40)
X(40)
X(02)
X(09)
MMDDC
CYY
790-829
830-869
870-909
910-949
950-989
990-1029
1030-1069
1070-1071
1072-1080
1081-1088
X(40)
X(40)
X(40)
X(40)
X(40)
X(40)
X(40)
X(02)
X(09)
X(08)
Residence Address Line 1
Residence Address Line 2
Residence Address Line 3
Residence Address Line 4
Residence Address Line 5
Residence Address Line 6
Residence Address City Name
Residence Address State Code
Residence Address Zip code
Residence Address Change Date
MMA.SPD.2701.02.3.1110
32
Description
1st line of address
2nd line of address
3rd line of address
4th line of address
5th line of address
6th line of address
City name
Postal state code
ZIP
The date a new or corrected
address becomes effective
for a Medicare beneficiary.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Representative Payee
Switch
Version 2.3
Position
1089
Format
X(01)
Description
A switch indicating whether
the beneficiary has a
representative payee
according to SSA.
Values are:
Y - beneficiary has a
designated representative
payee
Part A Non-Entitlement Status Code
1090
X(01)
N or space - beneficiary has
no designated
representative payee
Indicator/reason for the
beneficiary's current nonentitlement status to Part A
Medicare benefits.
Values are:
D - Coverage was denied
F - Terminated due to
invalid enrollment or
enrollment voided
H - Not eligible for free
Part A, or did not enroll for
premium Part A
N - Not valid SSA HIC, but
used by CMS Third Party
system to indicate potential
Part A entitlement date
R - Refused benefits
Space - No non-entitlement
reason applies
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Data Element Name
Part B Non-Entitlement Status Code
Version 2.3
Position
1091
Format
X(01)
Description
Indicator/reason for a
beneficiary's current nonentitlement status to Part B
Medicare benefits.
Values are:
D - Coverage was denied
N - Not entitled
R- Refused benefits
Space - No non-entitlement
reason applies to the
beneficiary.
Beneficiary Entitlement Reason
Code Change Date (Occurrence 1)
1092-1099
9(08)
Beneficiary' Entitlement Reason
Code (1)
Beneficiary Entitlement Reason
Code 2)
Beneficiary Entitlement Reason
Code (3)
Beneficiary's Entitlement Reason
Code (4)
Beneficiary Entitlement Reason
Code (5)
Beneficiary Part A Entitlement Start
Date (Occurrence 1)
1100-1103
X(04)
1104-1115
1116-1127
1128-1139
1140-1151
1152-1159
9(08) +
X(04)
9(08) +
X(04)
9(08) +
X(04)
9(08) +
X(04)
MMDDC The date beneficiary
CYY
became entitled to Medicare
benefits.
This field is filled with
zeroes if no Part A
Entitlement Start Date is
found.
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part A Entitlement End
Date (Occurrence 1)
Version 2.3
Position
1160-1167
Format
Description
MMDDC The last day that
CYY
beneficiary is entitled to
Medicare benefits.
If both the Part A
Entitlement Start and End
Dates are filled with zeroes,
then no entitlement period
was found.
If the Part A Entitlement
Start Date is a valid date
and the Part A Entitlement
End Date is filled with 9s,
then the entitlement has not
ended.
MMA.SPD.2701.02.3.1110
35
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part A Entitlement
Reason Code (Occurrence 1)
MMA.SPD.2701.02.3.1110
Version 2.3
Position
1168
36
Format
X(01)
Description
Values:
A - Attainment of age 65
B - Equitable relief
D - Disability
G - General enrollment
period
I - Initial enrollment period
J - MQGE entitlement
K - Renal disease is or was
a reason for entitlement
prior to age 65 or 25th
month of disability
L - Late filing
M - Termination based on
renal entitlement but
entitlement based on
disability continues.
N - Age 65 and uninsured
P - Potentially insured
beneficiary is enrolled for
Medicare coverage only.
Q - Quarters of coverage
requirements are involved.
R - Residency requirements
are involved.
S - State buy-in
T - Disabled working
individual
U – unknown. This field is
filled with a space if no
entitlement is found.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part A Entitlement
Status Code (Occurrence 1)
Version 2.3
Position
1169
Format
X(01)
Description
Values:
E - Free Part A Entitlement
G - Entitled due to good
cause
Y - Currently entitled,
premium is payable
Values when there is a
termination date:
C - No longer entitled due
to disability cessation
S - Terminated, no longer
entitled under ESRD
provision
T - Terminated for nonpayment of premiums
W - Voluntary withdrawal
from premium coverage
X - Free Part A terminated
or refused HI.
Part A Entitlement (Occurrence 2)
1170 - 1187
X(18)
This field is filled with a
space if no entitlement
period is found.
Same as Occurrence 1
Part A Entitlement (Occurrence 3)
1188 - 1205
X(18)
Same as Occurrence 1
Part A Entitlement (Occurrence 4)
1206 - 1223
X (18)
Same as Occurrence 1
Part A Entitlement (Occurrence 5)
1224 - 1241
X (18)
Same as Occurrence 1
Beneficiary Part B Enrollment Start
Date (Occurrence 1)
1242 - 1249
MMA.SPD.2701.02.3.1110
37
MMDDC This field is filled with
CYY
zeroes if no Part B
enrollment period is found.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part B Enrollment End
Date (Occurrence 1)
Beneficiary Part B Enrollment
Reason Code (Occurrence 1)
Version 2.3
Position
1250 - 1257
1258
Format
Description
MMDDC When no Part B enrollment
CYY
period is found, this field
and the Part B Enrollment
Start Date are filled with
zeroes.
X(01)
If there is a valid Part B
Enrollment Start Date and
the period is still active,,
then this field is filled with
9s.
Values:
B - Equitable relief
C - Good cause
D - Deemed date of birth
F - Working aged
G - General enrollment
period
I - Initial enrollment period
K - Renal disease is or was
a reason for enrollment
prior to age 65 or 25th
month of disability.
M -Termination based on
renal enrollment but
enrollment based on
disability continues.
R - Residency requirements
are involved.
S - State buy-in
T - Disabled working
beneficiary
U -Unknown
This field is filled with a
space if no enrollment is
found.
MMA.SPD.2701.02.3.1110
38
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part B Enrollment
Status Code (Occurrence 1)
Version 2.3
Position
1259
Format
X(01)
Description
Values when there is a Part
B Enrollment Start Date
and no Part D Enrollment
End Date:
G - Enrolled due to good
cause
Y - Currently enrolled,
premium is payable.
Values when Part B
Enrollment End Date is
present:
C -No longer entitled due to
disability cessation.
F - Terminated due to
invalid enrollment or
enrollment voided.
S - Terminated, no longer
entitled under ESRD
provision.
T - Terminated for nonpayment of premiums.
W - Voluntary withdrawal
from premium coverage.
Part B Entitlement
(Occurrence 2)
Part B Entitlement
(Occurrence 3)
Part B Entitlement(Occurrence 4)
1260 - 1277
X(18)
This field is filled with a
space if no enrollment is
found.
Same as Occurrence 1
1278 - 1295
X(18)
Same as Occurrence 1
1296 - 1313
X(18)
Same as Occurrence 1
Part B Entitlement
(Occurrence 5)
Beneficiary Hospice Coverage Start
Date (Occurrence 1)
1314 - 1331
X(18)
Same as Occurrence 1
MMA.SPD.2701.02.3.1110
1332 - 1339
39
MMDDC This field is filled with
CYY
zeroes if beneficiary has no
hospice benefit or coverage.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Hospice Coverage End
Date (Occurrence 1)
Beneficiary Hospice Coverage
(Occurrence 2)
Beneficiary Hospice Coverage
(Occurrence 3)
Beneficiary Hospice Coverage
(Occurrence 4)
Beneficiary Hospice Coverage
(Occurrence 5)
Beneficiary DIB Entitlement Start
Date (Occurrence 1)
Version 2.3
Position
1340 - 1347
Format
Description
MMDDC If hospice coverage has a
CYY
valid Hospice Start Date
and no Hospice End Date,
then this field is filled with
9s.
1348 - 1363
9(16)
If there is no Hospice Start
Date, then this field is filled
with zeroes.
Same as Occurrence 1
1364 - 1379
9(16)
Same as Occurrence 1
1380 - 1395
9(16)
Same as Occurrence 1
1396 - 1411
9(16)
Same as Occurrence 1
1412-1419
MMDDC The date that a beneficiary
CYY
covered by the SSA
disability program becomes
entitled to Medicare
benefits
If no DIB Entitlement Start
Date is found, then this
field is filled with zeroes.
Beneficiary DIB Entitlement End
Date (Occurrence 1)
1420 - 1427
MMDDC The date that a beneficiary
CYY
covered by the SSA
disability program is no
longer entitled to Medicare
benefits
If there is a valid DIB
Entitlement Start Date and
no DIB Entitlement End
Date, then this field is filled
with 9s.
If there is no DIB
Entitlement Start Date and
no DIB Entitlement End
Date, then this field is filled
with zeroes.
MMA.SPD.2701.02.3.1110
40
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary DIB Entitlement Date
Justification Code (Occurrence 1)
Version 2.3
Position
1428
Beneficiary DIB Entitlement
(Occurrence 2)
1429 - 1445
Description
The justification code for a
beneficiary's Part A and /or
Part B Medicare benefit
dates based upon
beneficiary's disability
insurance benefits (DIB)
status. Values:1 Beneficiary is entitled to
Medicare coverage due to
prior periods of SSA
disability entitlement.A Beneficiary is entitled to
Medicare based upon SSA
disability and the 24 month
waiting period has been
waived. This field will have
a space if no DIB is found.
Same as Occurrence 1
Beneficiary DIB Entitlement
(Occurrence 3)
Beneficiary GHO Contract Effective
Date (Occurrence 1)
1446 - 1462
Same as Occurrence 1
Beneficiary GHO Contract End Date
(Occurrence 1)
1471 - 1478
1463 - 1470
Format
X(01)
MMDDC This field is filled with
CYY
zeroes if no health
organization enrollment is
found.
MMDDC This field is filled with
CYY
zeroes if there is no health
organization enrollment
found.
This field is filled with 9s if
there is a GHO Contract
Effective Date and no GHO
Contract End Date.
MMA.SPD.2701.02.3.1110
41
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary GHO Contract Number
(Occurrence 1)
Version 2.3
Position
1479 - 1483
Format
X(05)
Description
Unique identification for an
agreement between CMS
and a Managed Care
Organization. Generally the
following assumptions can
be made about contract
numbers, but there may be
exceptions:
A contract number starting
with 'H' indicates local MA
(Medicare Advantage)
plans, MA-PD (Medicare
Advantage with
Prescription Drug) plans,
PACE organizations, cost
plans and some
demonstrations.
A contract number starting
with 'R' indicates regional
MA and MA-PD plans.
A contract number starting
with '9' indicates a
Medicare Demonstration.
A contract number starting
with 'E' indicates an
employer-sponsored
prescription drug plan.
Beneficiary GHO
(Occurrence 2)
Beneficiary GHO
(Occurrence 3)
MMA.SPD.2701.02.3.1110
1484 - 1504
A contract number starting
with 'S' indicates a standalone PDP (Prescription
Drug Plan).Note: Standalone plans are not included
in this section. This field is
filled with spaces if no
enrollment is found.
Same as Occurrence 1
1505 - 1525
Same as Occurrence 1
42
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary GHO
(Occurrence 4)
Beneficiary GHO
(Occurrence 5)
Beneficiary GHO
(Occurrence 6)
Beneficiary GHO
(Occurrence 7)
Beneficiary GHO
(Occurrence 8)
Beneficiary GHO
(Occurrence 9)
Beneficiary GHO
(Occurrence 10)
Group Health Plan Enrollment
Effective Date (Occurrence 1)
Plan Benefit Package (PBP) Start
Date (Occurrence 1)
Plan Benefit Package End Date
(Occurrence 1)
Version 2.3
Position
1526 - 1546
Format
Description
Same as Occurrence 1
1547 - 1567
Same as Occurrence 1
1568 - 1588
Same as Occurrence 1
1589 - 1609
Same as Occurrence 1
1610 - 1630
Same as Occurrence 1
1631 - 1651
Same as Occurrence 1
1652 - 1672
Same as Occurrence 1
1673 - 1680
1681 - 1688
1689 - 1696
MMDDC The date of the beneficiary's
CYY
enrollment at the contract
level.
This field is filled with
zeroes if there is no
enrollment found.
MMDDC The date the PBP
CYY
enrollment starts.
This field is filled with
zeroes if the beneficiary has
no plan benefit package
(PBP) enrollment.
MMDDC The date the PBP
CYY
enrollment ends.
This field is filled with
zeroes if there is no PBP
Start Date.
Plan Benefit Package Number
(Occurrence 1)
1697 - 1699
X(03)
This field is filled with 9s if
there is a PBP Start Date
and no PBP End Date.
A unique identifier for the
managed care plan benefit
package.
This field is filled with
spaces if beneficiary has no
PBP.
MMA.SPD.2701.02.3.1110
43
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Plan Benefit Package Coverage
Type Code (Occurrence 1)
Version 2.3
Position
1700 - 1701
Format
X(02)
Description
Identifies the type of
managed care plan benefit
package in which the
beneficiary is enrolled
Values:
NF – Invalid coverage type
code 3 - CCP (Coordinated
Care Plan)
4 – MSA (Medicare
Medical Savings Account0
5 - PFFS (Private Fee For
Service)
6 - PACE (Program of All
Inclusive Care for the
Elderly)
7 – Regional MA (Medicare
Advantage) or Regional
MAPD (Medicare
Advantage & Part D)
8 - Demo (Demonstration)
9 - FFS (Fee For Service)
10 - Cost / HCPPCost
(Health Care Prepayment
Plan)
11 - PDP (Part D Drug
Plan) Election
12- Chronic Care Demo
13 – MSA (Medicare
Medical Savings Account)
Demo
This field is filled with
spaces if no PBP enrollment
is found.
PBP Enrollment (Occurrence 2)
PBP Enrollment (Occurrence 3)
PBP Enrollment (Occurrence 4)
PBP Enrollment (Occurrence 5)
PBP Enrollment (Occurrence 6)
PBP Enrollment (Occurrence 7)
PBP Enrollment (Occurrence 8)
PBP Enrollment (Occurrence 9)
MMA.SPD.2701.02.3.1110
1702 - 1730
1731 - 1759
1760 - 1788
1789 - 1817
1818 - 1846
1847 - 1875
1876 - 1904
1905 - 1933
44
Same as Occurrence 1
Same as Occurrence 1
Same as Occurrence 1
Same as Occurrence 1
Same as Occurrence 1
Same as Occurrence 1
Same as Occurrence 1
Same as Occurrence 1
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
PBP Enrollment (Occurrence 10)
Position
1934 - 1962
Beneficiary ESRD Coverage Start
Date
1963 - 1970
Beneficiary ESRD Coverage End
Date
1971 - 1978
Format
Description
Same as Occurrence 1
MMDDC The date on which the
CYY
beneficiary is entitled to
Medicare in some part
because of a diagnosis of
End Stage Renal Disease.
This field is filled with
zeroes if beneficiary has no
ESRD coverage.
MMDDC The date on which the
CYY
beneficiary is no longer
entitled to Medicare under
ESRD provision.
This field is filled with
zeroes if beneficiary has no
ESRD coverage.
Beneficiary ESRD Termination
Reason Code
1979
X(01)
This field is filled with 9s if
there is no ESRD Coverage
End Date.
The reason Medicare ESRD
coverage was terminated.
Values:
A - Month of transplant
plus 36 months.
B - Last month of chronic
dialysis
C - Part A termination
D - Death
E - ESRD ended
This field is filled with
spaces if beneficiary has no
ESRD coverage or if there
is no ESRD Coverage End
Date.
MMA.SPD.2701.02.3.1110
45
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary ESRD Dialysis Start
Date
Beneficiary ESRD Dialysis End
Date
Version 2.3
Position
1980 - 1987
1988 - 1995
Format
Description
MMDDC The date when ESRD
CYY
dialysis starts.
This field is filled with
zeroes if beneficiary has no
ESRD Dialysis Start Date.
MMDDC The date when ESRD
CYY
dialysis ends.
This field is filled with
zeroes if beneficiary has no
ESRD Dialysis Start Date.
Beneficiary ESRD Transplant Start
Date
1996 - 2003
Beneficiary ESRD Transplant End
Date
2004 - 2011
Beneficiary Part A Third Party Start
Date (Occurrence 1)
2012 - 2019
This field is filled with 9s if
there is no ESRD Dialysis
End Date.
MMDDC The date that a kidney
CYY
transplant operation
occurred.
This field is filled with
zeroes when no ESRD
Transplant Start Date is
found,
MMDDC The date that a kidney
CYY
transplant fails or transplant
benefit ends.This field is
filled with zeroes when no
ESRD Transplant Start Date
is found. This field is filled
with 9s when there is a
valid ESRD Transplant
Start Date and there is no
ESRD Transplant End Date.
MMDDC The start date of a private
CYY
third party group's or State's
liability for a beneficiary's
Part A premium.
This field is filled with
zeroes if there is no Part A
Third Party Start Date..
MMA.SPD.2701.02.3.1110
46
November 2010
MMA State File Specification Data Dictionary
Version 2.3
Data Element Name
Position
Beneficiary Part A Third Party
2020 - 2022
Premium Payer Code (Occurrence 1)
Format
X(03)
Description
The identifier for a third
party agency (either a
private group or State buyin agency) responsible for
paying a beneficiary's
Medicare Part A premium.
Values:
S01 thru S99 - State Billing
T01 thru Z98 - Private
Third Part Billing
Z99 - Conditional State
Group Payer Enrollment
Beneficiary Part A Third Party End
Date (Occurrence 1)
2023 - 2030
MMDDC The end date of a private
CYY
third party group's or State's
liability for a beneficiary's
Part A premium.
This field is filled with
zeroes if no Part A Third
Party Start Date was found.
This field is filled with 9s if
there is a Third Party Start
Date and no Third Party
End Date.
MMA.SPD.2701.02.3.1110
47
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part A Third Party Buyin Eligibility Code (Occurrence 1)
Third Party Part A History
(Occurrence 2)
Third Party Part A History
(Occurrence 3)
Third Party Part A History
(Occurrence 4)
Third Party Part A History
(Occurrence 5)
MMA.SPD.2701.02.3.1110
Version 2.3
Position
2031
2032 - 2051
Description
A code that indicates the
reason for Part A State buyin eligibility.Values:
A - Aged recipient of SSI
payments (CMS to State)
B - Blind recipient of SSI
payments (CMS to State)
C - Entitled to Part A of
Title IV (AFDC) (State to
CMS).
D - Disabled recipient of
SSA payments (CMS to
State)
E - Aged recipient of
supplemental payment
administered by SSA (CMS
to State)
F - Blind recipient of
supplemental payment
administered by SSA
(CMS to State)
G - Disabled recipient of
supplemental payment
administered by SSA (CMS
to State)
H - Aged, blind, or disabled
recipient of a one-time
payment (OTP) (CMS to
State)
M - Entitled to medical
assistance only (MAO),
non-cash recipient (State to
CMS)
Z - Deemed categorically
needy (State to CMS)
Same as Occurrence 1
2052 - 2071
Same as Occurrence 1
2072 - 2091
Same as Occurrence 1
2092 - 2111
Same as Occurrence 1
48
Format
X(01)
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part B Third Party Start
Date (Occurrence 1)
Beneficiary Part B Third Party
Premium Payer Code (Occurrence 1)
Beneficiary Part B Third Party
Termination Date (Occurrence 1)
MMA.SPD.2701.02.3.1110
Version 2.3
Position
2112 - 2119
2120 - 2122
2123 - 2130
49
Format
Description
MMDDC The start date of a private
CYY
third party group's or State's
liability for a Part B
premium.
X(03)
This field is filled with
zeroes if no Part B Third
party benefit is found for
the beneficiary.
The identifier for a third
party agency (either a
private group, State buy-in
agency or the Office of
Personnel Management
(OPM)) responsible for
paying a beneficiary's
Medicare Part B premium.
Values:
000 - Beneficiary is having
Part B premium deducted
from Title II check
001 - Uninsured beneficiary
005 - Insured beneficiary
006 - Program Service
Center control, no bill
007 - Special age 72
enrollee
008 - PSC annual billing
010 - 650 - State billing
700 - Office of Personnel
Management (OPM)
A01 - R99 - Group payers
for Part B premiums
MMDDC The end date of a private
CYY
third party group's or State's
liability for a beneficiary's
Part B premium.This field
is filled with zeroes if no
Part B Third Party Start
Date is found.This field is
filled with 9s if there is a
Third Party Start Date and
no Third Party End Date.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Part B Third Party Buyin Eligibility Code (Occurrence 1)
Third Party Part B History
(Occurrence 2)
Third Party Part B History
(Occurrence 3)
Third Party Part B History
(Occurrence 4)
MMA.SPD.2701.02.3.1110
Version 2.3
Position
2131
Format
X(01)
Description
A code that indicates the
reason for Part B State buyin eligibility.
2132 - 2151
Values:
A - Aged recipient of SSI
payments (CMS to State)
B - Blind recipient of SSI
payments (CMS to State)
C - Entitled to Part A of
Title IV (AFDC) (State to
CMS).
D - Disabled recipient of
SSI payments (CMS to
State)
E - Aged recipient of
supplemental payment
administered by SSA (CMS
to State)
F - Blind recipient of
supplemental payment
administered by SSA
(CMS to State)
G - Disabled recipient of
supplemental payment
administered by SSA (CMS
to State)
H - Aged, blind, or disabled
recipient of a one-time
payment (OTP) (CMS to
State)
M - Entitled to medical
assistance only (MAO),
non-cash recipient (State to
CMS)
P - Qualified Medicare
Beneficiary (QMB)
Z - Deemed categorically
needy (State to CMS)
Same as Occurrence 1
2152 - 2171
Same as Occurrence 1
2172 - 2191
Same as Occurrence 1
50
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Third Party Part B History
(Occurrence 5)
Beneficiary Part D Eligibility Start
Date
Beneficiary Part D Opt-Out
Indicator
Beneficiary Co-Payment Type
(Occurrence 1)
Version 2.3
Position
2192 - 2211
Format
2212 - 2219
MMDD
CCYY
2220
X(01)
2221
X(01)
Description
Same as Occurrence 1
The date when the
beneficiary becomes
eligible for Part D
benefits.This field is filled
with zeroes if no Part D
Start Date is found.This
field indicates eligibility
only, not enrollment in a
plan with drug coverage.If
there are multiple Part D
eligibility periods, then this
field will contain the earliest
Part D Eligibility Start Date.
An indicator that
beneficiary chooses not to
be automatically enrolled by
CMS into a Part D plan.
Values:
Y - Yes
N - No
Space - No
A code indicating whether
the beneficiary was
determined eligible for low
income subsidy (LIS) or
deemed eligible.
Values:
L - Determined eligible
D - Deemed
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Co-Payment Level
(Occurrence 1)
Version 2.3
Position
2222
Beneficiary Co-Payment Start Date
(Occurrence 1)
2223 - 2230
Beneficiary Co-Payment End Date
(Occurrence 1)
2231 - 2238
Beneficiary Co-Payment History
(Occurrence 2)
Beneficiary Co-Payment History
(Occurrence 3)
Beneficiary Co-Payment History
(Occurrence 4)
Beneficiary's Co-Payment History
(Occurrence 5)
Beneficiary's Co-Payment History
(Occurrence 6)
Beneficiary's Co-Payment History
(Occurrence 7)
Beneficiary's Co-Payment History
(Occurrence 8)
Beneficiary's Co-Payment History
(Occurrence 9)
Beneficiary's Co-Payment History
(Occurrence 10)
2239 - 2256
MMA.SPD.2701.02.3.1110
Format
X(01)
Description
An indicator providing the
level of co-payment granted
to the beneficiary.
Values:
If bene co-pay type is
'L', then
1 - high
4 - 15% subsidy
If bene co-pay type is
'D', then
1 - high
2 - low
3 - 0 (zero)
MMDDC The effective date of the coCYY
payment period.
This field is filled with
zeroes if there is no CoPayment Start Date.
MMDDC The end date of the coCYY
payment period. The field is
filled with zeroes if there is
no Co-Payment Start Date.
This field is filled with 9s if
there is a Co-Payment Start
Date and no Co-Payment
End Date..
Same as Occurrence 1
2257 - 2274
Same as Occurrence 1
2275 -2292
Same as Occurrence 1
2293 - 2310
Same as Occurrence 1
2311 - 2328
Same as Occurrence 1
2329 - 2346
Same as Occurrence 1
2347 - 2364
Same as Occurrence 1
2365 - 2382
Same as Occurrence 1
2383 - 2400
Same as Occurrence 1
52
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Contract Number
(Occurrence 1)
Beneficiary Part D PBP Enrollment
Start Date
(Occurrence 1)
Version 2.3
Position
2401 - 2405
2406 - 2413
Format
X(05)
Description
Unique identification for an
agreement between CMS
and a managed care
organization (MCO) or Part
D Prescription (PDP)
sponsor enabling the plan to
provide Medicare Part D
prescription drug coverage.
MMDDC The date that the
CYY
beneficiary was enrolled in
the plan benefit package.
This field is filled with
zeroes if no MA-PD or Part
D PBP enrollment is found
for the beneficiary
Beneficiary Part D PBP Enrollment
End Date (Occurrence 1)
2414 - 2421
Beneficiary Part D PBP Plan
Number (Occurrence 1)
2422 - 2424
MMA.SPD.2701.02.3.1110
53
MMDDC The end date of the
CYY
beneficiary's enrollment in
the plan benefit
package.This field is filled
with zeroes if there is no
Part D PBP Enrollment
Start Date.This field is
filled with 9s if there is a
Part D PBP Enrollment
Start Date and no Part D
PBP Enrollment End Date.
X(03)
A unique identifier for the
managed care benefit
package.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Enrollment Type Code
(Occurrence 1)
Part D Plan Benefit
Package (Occurrence 2)
Part D Plan Benefit
Package (Occurrence 3)
Part D Plan Benefit
Package (Occurrence 4)
Part D Plan Benefit
Package (Occurrence 5)
Part D Plan Benefit
Package (Occurrence 6)
Part D Plan Benefit
Package (Occurrence 7)
Part D Plan Benefit
Package (Occurrence 8)
Part D Plan Benefit
Package (Occurrence 9)
Part D Plan Benefit
Package (Occurrence 10)
MMA.SPD.2701.02.3.1110
Version 2.3
Position
2425
Format
X(01)
Description
An indicator providing the
type of enrollment
performed.
2426 - 2450
Values:
A - Auto enrolled
B - Beneficiary election
C - Facilitated enrollment
D - System-generated
enrollment (Rollover)
E - Plan submitted autoenrollments
F - Plan submitted
facilitated enrollments
G - Point of sale (POS)
submitted enrollments
H - CMS or plan submitted
re-assignment enrollments
I - Assigned to plan
submitted transactions with
enrollment source other
than any of the following:
B, E, F, G, H, and blank.
Same as Occurrence 1
2451 - 2475
Same as Occurrence 1
2476 -2500
Same as Occurrence 1
2501 - 2525
Same as Occurrence 1
2526 - 2550
Same as Occurrence 1
2551 - 2575
Same as Occurrence 1
2576 - 2600
Same as Occurrence 1
2601 - 2625
Same as Occurrence 1
2626 - 2650
Same as Occurrence 1
54
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Part C Organization Name
Version 2.3
Position
2651 - 2705
Format
X(55)
Part C Plan Name
2706 - 2755
X(50)
Part D Organization Name
2756 - 2810
X(55)
Part D Organization Plan Name
2811 - 2860
X(50)
Part D Organization Plan Benefit
2861
X(01)
MMA.SPD.2701.02.3.1110
55
Description
Relates to the first
occurrence of the
beneficiary's Group Health
Organization contract
number in positions 14791483.
Relates to the first
occurrence of the
beneficiary's plan benefit
package in positions 16971699.
Relates to the first
occurrence of the
beneficiary's contract
number in Part D Plan
Benefit Package in positions
2401-2405.
Relates to the first
occurrence of the
beneficiary's plan benefit
package in positions 24222424.
This field is filled with a
space.
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Language Indicator
Version 2.3
Position
2862
Format
X(01)
Description
A code that identifies the
language that the
beneficiary requested SSA
to use for beneficiary
notices.
Values:
E - English requested
C - Chinese
D - German
F - French
G - Greek
I - Italian
J - Japanese
N - Norwegian
P - Polish
R - Russian
S - Spanish
V - Swedish
W - Serb-Croatian
Blank - English assumed
SNP Indicator (Occurrence 1)
2863
X(01)
Indicates that beneficiary is
enrolled in a special needs
plan
Values:
Y - SNP
N - not SNP
SNP Indicator (Occurrence 2)
2864
X(01)
Corresponds to the first
occurrence of plan benefit
package in positions 16731701
Same as Occurrence 1
Corresponds to the second
occurrence of plan benefit
package in positions 17021730
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Data Element Name
SNP Indicator (Occurrence 3)
SNP Indicator (Occurrence 4)
Version 2.3
Position
2865
2866
Format
X(01)
X(01)
Description
Same as Occurrence 1
Corresponds to the third
occurrence of plan benefit
package in positions 17311759
Same as Occurrence 1
SNP Indicator (Occurrence 5)
2867
X(01)
SNP Indicator (Occurrence 6)
2868
X(01)
Corresponds to the fourth
occurrence of plan benefit
package in positions 17601788
Same as Occurrence
1Corresponds to the fifth
occurrence of plan benefit
package in positions 17891817
Same as Occurrence 1
X(01)
Corresponds to the sixth
occurrence of plan benefit
package in positions 18181846
Same as Occurrence 1
X(01)
Corresponds to the seventh
occurrence of plan benefit
package in positions 18471875
Same as Occurrence 1
X(01)
Corresponds to the eighth
occurrence of plan benefit
package in positions 18761904
Same as Occurrence 1
SNP Indicator (Occurrence 7)
SNP Indicator (Occurrence 8)
SNP Indicator (Occurrence 9)
2869
2870
2871
Corresponds to the ninth
occurrence of plan benefit
package in positions 19051933
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Data Element Name
SNP Indicator (Occurrence 10)
Incarceration Start Date
Incarceration End Date
Version 2.3
Position
2872
2873 - 2880
2881 - 2888
Format
X(01)
Description
Same as Occurrence 1
Corresponds to the tenth
occurrence of plan benefit
package in positions 19341962
MMDDC This date is provided solely
CYY
to show why a dual eligible
is not auto-enrolled.
If there is no Incarceration
Start Date, then this field is
filled with zeroes.
MMDDC This date is provided solely
CYY
to show why a dual eligible
is not auto-enrolled.
If there is no Incarceration
Start Date and no
Incarceration End Date,
then this field is filled with
zeroes.
FILLER
MMA.SPD.2701.02.3.1110
2889 - 2899
58
X(11)
If there is an Incarceration
Start Date and no
Incarceration End Date,
then this field is filled with
9s.
Spaces
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Previous Month SPD Calculation
Code
Version 2.3
Position
2900
Format
X(01)
Description
Code to indicate how the
individual beneficiary was
used for calculations for
State enrollment and
disenrollment in a prior
month's entry
Values:
E - Enrollment count
D - Disenrollment count
C - Carry forward
enrollment count
M -Missing state file
(counted as enrollment)
N - Not counted (this also
indicates future Medicaid
DET records)
P - Prospective Duals, not
considered in Clawback
counts Space - Historical
entries before code was
added
MMA.SPD.2701.02.3.1110
59
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Secondary Match Indicator
Version 2.3
Position
2901
Format
X(01)
Description
This field indicates if a
matched detail record was
matched under the
Secondary Match algorithm
of HICN and/or SSN and
the first 6 characters of the
last name and the 1st letter
of the first name and the
gender code.
** A matched detail record
is indicated by the presence
of alphanumeric values in
the fields 'Beneficiary
Claim Account Number'
and 'Beneficiary
Identification Code'
(columns 237 - 247) and a
Record Return Code (RRC)
of '000000' or '000001'.
Values:
Space - Default for either
primary match located
beneficiary (if RRC =
'000000' or '000001') or
neither primary or
secondary match was
successful (if RRC =
'000003').
S - Match accomplished by
Secondary Match
algorithm.
MMA.SPD.2701.02.3.1110
60
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Daily State Phasedown Calculation
Code
Version 2.3
Position
2902
Format
X(01)
Description
Code to indicate if the
individual beneficiary was
used for calculations for
State enrollment and
disenrollment in a current
file's entry. (This entry will
relate to the latest
beneficiary information
provided by the State.)
Values:
E - Enrollment count
D - Disenrollment count
C - Carry forward
enrollment count
M - Missing state file
(counted as enrollment)
N - Not counted (This also
includes future Medicaid
DET records)
P - Prospective Duals, not
considered in Clawback
counts
Space - Historical entries
before code was added
RDS Start Date (Occurrence 1)
2903 - 2910
MMDDC The start date of the
CYY
beneficiary's enrollment in
employer plan.
If there is no RDS Start
Date, then this field is filled
with zeroes.
MMA.SPD.2701.02.3.1110
61
November 2010
MMA State File Specification Data Dictionary
Data Element Name
RDS Termination Date (Occurrence
1)
Version 2.3
Position
2911 - 2918
Format
Description
MMDDC The end date of the
CYY
beneficiary's enrollment in
employer plan.
If there are multiple RDS
coverage periods,
overlapping dates are
possible.
If there is no RDS Start
Date, then this field is filled
with zeroes.
RDS Coverage Period (Occurrence
2)
RDS Coverage Period (Occurrence
3)
RDS Coverage Period (Occurrence
4)
RDS Coverage Period (Occurrence
5)
FILLER
2919 - 2934
9(16)
If there is a RDS Start Date
and no RDS End Date, then
this field is filled with 9s.
Same as Occurrence 1
2935 - 2950
9(16)
Same as Occurrence 1
2951 - 2966
9(16)
Same as Occurrence 1
2967 - 2982
9(16)
Same as Occurrence 1
2983
X(01)
Spaces
Part D Eligibility Start Date
(Occurrence 1)
2984 - 2991
MMDDC Indicates the date that
CYY
beneficiary became eligible
for Part D benefits.
This field is filled with
zeroes if no Part D
Eligibility Start Date is
found.
MMA.SPD.2701.02.3.1110
62
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Part D Eligibility End Date
(Occurrence 1)
Version 2.3
Position
2992 - 2999
Format
Description
MMDDC Indicates the date that
CYY
beneficiary is no longer
eligible for Part D benefits.
This field is filled with
zeroes if no Part D
Eligibility Start Date is
found.
Part D Eligibility Dates (Occurrence
2)
Part D Eligibility Dates (Occurrence
3)
Part D Eligibility Dates (Occurrence
4)
Part D Eligibility Dates (Occurrence
5)
Subsidy Level (Occurrence 1)
3000 - 3015
9(16)
This field is filled with 9s if
there is a Part D Eligibility
Start Date and no Part D
Eligibility End Date.
Same as Occurrence 1
3016 - 3031
9(16)
Same as Occurrence 1
3032 - 3047
9(16)
Same as Occurrence 1
3048 - 3063
9(16)
Same as Occurrence 1
3064 - 3066
X(03)
Identifies the portion of the
Part D Premium subsidized
Values:
100
075
050
025
Relates to the numbered
occurrences of the
Beneficiary Co-Payment
History, e.g. first
occurrence here relates to
first occurrence of CoPayment in position 2222.
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Data Element Name
LIS/Deem Source code (Occurrence
1)
Version 2.3
Position
3067 - 3068
Format
X(02)
Description
Indicates the source of the
LIS/Deeming action found
in position 2221 (CoPayment history
occurrence) and 3064
(Premium percentage
occurrence).
Values for D (Deemed):
01 - MBD Third Party
02 - EEVS (State data
baseline)
03 - SSA
04 - State
05 - Point of Sale
06 - CMS User
Values for L (LIS):
SS - SSA
- Postal State Code
Abbreviation
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 2)
3069 - 3073
X(05)
Same as Occurrence 1
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 3)
3074 - 3078
X(05)
Same as Occurrence 1
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 4)
3079 - 3083
X(05)
Same as Occurrence 1
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 5)
3084 - 3068
X(05)
Same as Occurrence 1
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 6)
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 7)
3069 - 3093
X(05)
Same as Occurrence 1
3094 - 3098
X(05)
Same as Occurrence 1
MMA.SPD.2701.02.3.1110
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MMA State File Specification Data Dictionary
Data Element Name
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 8)
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 9)
Beneficiary Low Income Subsidy
Premium Percentage and Source
(Occurrence 10)
FILLER
Version 2.3
Position
3099 - 3103
Format
X(05)
Description
Same as Occurrence 1
3104 - 3108
X(05)
Same as Occurrence 1
3109 - 3113
X(05)
Same as Occurrence 1
3114 - 3400
X(287)
6. File Summary Record
Table 6: File Summary Record
Data Element Name
Record Identification Code
State Code
File Process Timestamp
Position
1-3
4-5
Format
X(03)
X(02)
6-31
X(26)
Description
'FSM'
US Postal Service State
Abbreviation.
See Appendix B State
Codes
The exact time that the
State file is processed
Format: CCYY-MM-DDhh.mm.ss.nnnnnn
CCYY - Year
MM - Month
DD - Day
hh - Hour
mm - Minute
ss - Second
nnnnnn - Microsecond
The month that the State
file to CMS is created
File Create Month
32-33
9(02)
File Create Year
34-37
9(04)
The year that the State file
to CMS is created
Records Total
38-45
9(08)
The total number of DET
records in the State file
This count does not include
PRO records.
MMA.SPD.2701.02.3.1110
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MMA State File Specification Data Dictionary
Data Element Name
Records Duplicate
Records Non-Duplicate
Records Valid
Records Invalid
Version 2.3
Position
46-53
54-61
62-69
70-77
Format
9(08)
Description
The total number of
duplicate DET records in
the State file
9(08)
This count does not include
PRO records.
The total number of nonduplicate valid DET records
in State file
9(08)
This count does not include
PRO records.
The total number of valid
DET records in the State
File to CMS
9(08)
This count does not include
PRO records.
The total number of invalid
DET records in the State
File to CMS
Records Matched
78-85
9(08)
Records Not Matched
86-93
9(08)
This count does not include
PRO records.
The total number of DET
records that could be
matched to an individual on
the Medicare Beneficiary
DatabaseThis count does
not include PRO records.
The total number of DET
records that could not be
matched to an individual on
the Medicare Beneficiary
Database
This count includes invalid
records because match is
not attempted on invalid
records.
This count does not include
PRO records.
Filler
MMA.SPD.2701.02.3.1110
94-140
66
X(47)
November 2010
MMA State File Specification Data Dictionary
Data Element Name
Valid Dual Records
Valid Dual Matches
Valid Dual Non-Matches
Version 2.3
Position
141-148
149-156
157-164
Format
9(08)
9(08)
9(08)
Valid LIS Records
165-172
9(08)
Valid Current Duals
173-180
9(08)
Valid Retro Duals
Total Eligibility Months
181-188
189-190
9(08)
9(02)
Description
The total number of valid
DET records in the file
This count does not include
PRO records.
The total number of DET
records that are matched to
an individual on the
Medicare Beneficiary
Database
This count does not include
PRO records.
The total number of valid
DET records that are not
matched to an individual on
the Medicare Beneficiary
Database
This count does not include
PRO records.
The total number of valid
LIS records in the State to
CMS file
The total number of valid
DET records with
Eligibility Month/Year =
File Create Month/Year
This count does not include
PRO records.
The total number of valid
DET records with
Eligibility Month/Year <
File Create Month/Year
This count does not include
PRO records.
The total number of
Eligibility Months in the
State to CMS file
This count does not include
PRO records.
MMA.SPD.2701.02.3.1110
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MMA State File Specification Data Dictionary
Data Element Name
Total Valid PRO Records
Version 2.3
Position
191-198
Format
9(08)
Total Invalid PRO Records
199-206
9(08)
Total Matched PRO Records
207-214
9(08)
Filler
215-3400
X(3186)
MMA.SPD.2701.02.3.1110
68
Description
The total number of valid
PRO records in the State to
CMS File.
The total number of invalid
PRO records in the State to
CMS File
The total number of valid
PRO records that are
matched to an individual on
the Medicare Beneficiary
Database
November 2010
MMA State File Specification Data Dictionary
Version 2.3
7. Month Summary Record
Table 7: Month Summary Record
Data Element Name
Record Identification Code
State Code
File Process Timestamp
Position
1-3
4-5
Format
X(03)
X(02)
6-31
X(26)
File Create Month
32-33
9(02)
File Create Year
34-37
9(04)
38-39
9(02)
40-43
9(04)
Eligibility Year
Calculation Switch
44
X(01)
Total Valid Records
45-52
9(08)
Eligibility Month
Description
'MSM'
US Postal Service State
Abbreviation.
See Appendix B (State
Codes)
The exact time that the
State file is processed.
Format: CCYY-MM-DDhh.mm.ss.nnnnnn
CCYY - Year
MM - Month
DD - Day
hh - Hour
mm - Minute
ss - Second
nnnnnn - Microsecond
The month that the State
MMA file to CMS is
created
The year that the State
MMA file to CMS is
created
Month for applicable
Medicaid eligibility
Year for applicable
Medicaid eligibility
'Y' - This Eligibility
Month/Year was used in
the State phase-down
calculation.
'N' - This Eligibility
Month/Year was not used
in the State phase-down
calculation.
The total number of valid
DET records found in the
MMA State File to CMS
for this Eligibility
Month/Year.
This count does not
MMA.SPD.2701.02.3.1110
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November 2010
MMA State File Specification Data Dictionary
Data Element Name
Total Valid Full Dual Records
Total Valid Non-Full Dual Records
Net Total Valid Full Dual
Enrollments
Net Total Valid Full Dual
Disenrollments
Version 2.3
Position
53-60
61-68
69-76
77-84
Format
9(08)
9(08)
9(08)
9(08)
Description
include PRO records.
The total number of valid
full dual beneficiary
records.
This count does not
include PRO records.
The total number of valid
non-full dual beneficiary
records.
This count does not
include PRO records.
The net total number of
valid Full Dual Eligible
enrollments counted for
this Eligibility
Month/Year.
This count does not
include PRO records.
The net total number of
valid Full Dual Eligible
disenrollments counted for
this Eligibility
Month/Year.
This count does not
include PRO records.
Filler
MMA.SPD.2701.02.3.1110
85-3400
70
X(3316)
November 2010
MMA State File Specification Data Dictionary
Version 2.3
8. Trailer Record:
Table 8: Trailer Record
Data Element Name
Record Identification Code
File Process Timestamp
Position
1-3
4-29
Format
X(03)
X(26)
File Create Month
30-31
9(02)
File Create Year
32-35
9(04)
36
X(01)
37-43
44-46
47-54
55-56
57-58
59-62
63-223
224-3400
X(07)
X(03)
9(08)
X(02)
9(02)
9(04)
X(161)
X(3177)
File Accept Indicator
Filler
Record Identification Code
Beneficiary Record Count
State Code
File Create Month
File Create Year
Filler
Filler
Description
'TRL'
The exact time that the
State file is processed.
Format: CCYY-MM-DDhh.mm.ss.nnnnnn
CCYY - Year
MM - Month
DD - Day
hh - Hour
mm - Minute
ss - Second
nnnnnn - Microsecond
Month that MMA State
file to CMS is created
Year that MMA State file
to CMS is created
'Y' - The MMA State file
to CMS is accepted.
'N' - The MMA State file
to CMS is not accepted.
9. APPENDIX A CMS Central Office Contacts
CMS CENTRAL OFFICE MMA CONTACTS
TBQ Query Process: Main: mailto:Carolyn.Lawson@cms.hhs.gov; (410) 786.0704;
Secondary: mailto:Goldy.Austen@cms.hhs.gov; (410) 786.6450
MMA EFT Test Files: Main: mailto:Carolyn.Lawson@cms.hhs.gov; (410) 786.0704;
Secondary: mailto:Goldy.Austen@cms.hhs.gov; (410) 786.6450
All Other MMA File Issues: Contact your CMS Central Office (CO) MMA Contact: Carolyn
Lawson or mailto:Vasanthi.Kandasamy@cms.hhs.gov; (410) 786.0433
MMA.SPD.2701.02.3.1110
71
November 2010
MMA State File Specification Data Dictionary
Version 2.3
STATE
CMS CO CONTACT
STATE
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Carolyn Lawson
Vasanthi Kandasamy
Vasanthi Kandasamy
Vasanthi Kandasamy
Vasanthi Kandasamy
Vasanthi Kandasamy
Vasanthi Kandasamy
Vasanthi Kandasamy
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
District Of
Columbia
Florida
Vasanthi Kandasamy
North Dakota
Carolyn Lawson
Ohio
Georgia
Hawaii
Carolyn Lawson
Vasanthi Kandasamy
Oklahoma
Oregon
Idaho
Illinois
Indiana
Iowa
Vasanthi Kandasamy
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Pennsylvania
Rhode Island
South Carolina
South Dakota
Kansas
Carolyn Lawson
Tennessee
Kentucky
Louisiana
Vasanthi Kandasamy
Carolyn Lawson
Texas
Utah
Maine
Vasanthi Kandasamy
Vermont
Maryland
Vasanthi Kandasamy
Virginia
Massachusetts
Michigan
Minnesota
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Washington
West Virginia
Wisconsin
Mississippi
Carolyn Lawson
Wyoming
Missouri
Vasanthi Kandasamy
MMA.SPD.2701.02.3.1110
72
CMS CO
CONTACT
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Vasanthi
Kandasamy
Vasanthi
Kandasamy
Vasanthi
Kandasamy
Carolyn Lawson
Vasanthi
Kandasamy
Carolyn Lawson
Carolyn Lawson
Carolyn Lawson
Vasanthi
Kandasamy
Vasanthi
Kandasamy
Carolyn Lawson
Vasanthi
Kandasamy
Vasanthi
Kandasamy
Vasanthi
Kandasamy
Carolyn Lawson
Carolyn Lawson
Vasanthi
Kandasamy
Vasanthi
Kandasamy
November 2010
MMA State File Specification Data Dictionary
Version 2.3
10. APPENDIX B State Codes
Data Element Name
STATE CODE
MMA.SPD.2701.02.3.1110
Specifications
State Code - Valid Code
Alabama
AL
Alaska
AK
Arizona
AZ
Arkansas
AR
California
CA
Colorado
CO
Connecticut
CT
Delaware
DE
District of
Columbia
DC
Florida
FL
Georgia
GA
Hawaii
HI
Idaho
ID
Illinois
IL
Indiana
IN
Iowa
IA
Kansas
KS
Kentucky
KY
Louisiana
LA
Maine
ME
Maryland
MD
Massachusetts
MA
Michigan
MI
Minnesota
MN
Mississippi
MS
73
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
November 2010
| File Type | application/pdf |
| File Modified | 2012-12-07 |
| File Created | 2010-12-08 |