ID Load and Response Files

introduction pbm/payers use the id load file to provide surescripts with their member roster to populate the surescripts master patient index (mpi) surescripts uses these files from the pbm/payers to establish uniqueness for individuals across pbm/payers surescripts’ search process uses demographics to identify a patient and then uses the pbm/payer's unique member id to communicate with the pbm/payers surescripts responds to pbm/payer id loads with a member directory response file indicating the status of each load, including details at both the file and detail level information provided by surescripts indicates if a file loaded successfully, loaded with errors or was not loaded at all affected records are detailed in the response file which indicates the specific reason each line had an error or warning surescripts will also provide statistical data about the processing for a given delimited file received from a pbm/payer the member directory response summary file will allow pbm/payers new insight into the processing of mpi files, and will allow them to better determine whether all of the records sent to surescripts were loaded as expected id load process flow the following steps depict the flow of the id load the pbm/payer creates a directory of patients, assigning each occurrence a unique member id note it is recommended to update the mpi daily the pbm/payer submits the initial load to surescripts surescripts populates the mpi internal directory with the initial file load surescripts creates a response file for the pbm/payer indicating the process success and failure details note all date/times within response files are in utc the pbm/payer creates an update file to keep the surescripts mpi internal directory up to date note updates should only be sent if there is a change in the members’ demographic data that surescripts has defined in the file layout if other member information not contained in the file layout changes, no update should be sent surescripts processes the updates surescripts sends a response to the pbm/payer indicating the process success and failure details format to be used surescripts has implemented a custom specification that contains demographic and pbm/payer specific information in a delimited field file format use the same character set as referenced in character set docid 1fe8uhpdbqjezhwe2txr8 except for the “^” character – decimal 94 which cannot be used in the id load process notes delimited files designated in the header record as a full file that contain more than 8m records must be scheduled with surescripts support, and will be manually processed file name cannot contain a hyphen member processing examples purpose file type method terminate a member update send the cancellation or termination date (past/present/future) along with the 024 – cancel code terminate a member full refresh either send the cancellation/termination date (past/present/future) along with the 024 – cancel code or do not include the member in the full refresh file add new member full refresh or update send the new member data in the full refresh or update file along with the 021 – addition code update member demographics full refresh or update send the updated member demographics along with the 001 – change code reinstate a previously terminated member where the record has not been removed via the full refresh process update send either a future termination date or leave the termination field blank along with the 025 – reinstatement code future effective date examples purpose method update future coverage for existing member 1 add expiration date for current coverage to the existing member 2 add new demographic details of existing member to a new pbm unique member id with future effective date note the master patient index will not accept multiple instances of a pbm unique member id to reflect a future coverage change the master patient index accepts the latest record with a pbm unique member id as an update, nullifying any previous record(s) with that id future changes to a member utilizing the future effective date need to include a new pbm unique member id update effective date for future member update the member’s future effective date along with the 001 change code note the master patient index uses the latest update as the member’s current demographics extend an existing member send new future effective date for member and use the same pbm unique member id along with the 001 change code example if original coverage is 1/1/2024 – 12/31/2024 and coverage remains the same through 2025 in the new record, keep the same effective date as 1/1/2024 and the new term date would be 12/31/2025 add a future member send future effective date for new member and use a new pbm unique member id along with the 021 – addition code example if the coverage begins 1/1/2025, send record with an effective date of 1/1/2025 and new pbm unique member id error scenarios note error scenarios do not vary based on file type (full refresh or update) code sent in mpi full refresh or update file mpi database record status response file action error code and message change (001) record does not exist add the mpi database record w04 change record not found, record added addition (021) record already exists change the mpi database record w05 record to add exists, record updated cancellation or termination (024) record does not exist add the mpi database record with the termination date the record must contain a termination date or it will be rejected w06 record to term does not exist, record added reinstatement (025) record does not exist add the mpi database record the record must contain a future termination date or no termination date w07 record to reinstate not found, record added requirement designation code description mandatory the element must be used per the specification (e g , xml schema validation) note the term mandatory applies to mandatory and required fields in the different standards business rule if sent, the element must be used per the surescripts business rule note not all business rules reside in this table conditional the element is to be used per the conditions specified note the term conditional applies to conditional and situational fields in the different standards for example, x12 uses the term situational recommended surescripts recommends sending the element as a best practice optional some fields do not have specific conditions data should be sent if available not used not used by surescripts member directory maintenance delimited file from pbm/payer each field is delimited by the pipe character (|) each line is separated by a new line (hex 0a) character the tilde character ( ) is used as a repetition character – currently only supported in the postal code field header info field # field name type required comments examples 1 record type an 3/5 mandatory identifies record type value hdr 2 version/release number an 3/5 mandatory version number of this specification value 3 0 3 sender id an 3/30 mandatory id as assigned by surescripts identifying customer sending the file p11111111111111 4 sender participant password an 10/10 mandatory password for this customer identified in field 3 (sender id) abcde12345 5 receiver id an 1/30 mandatory id identifying the receiver of the file value rxhub 6 source name an 1/35 not used future use 7 transmission control number an 1/10 mandatory unique identifier defined by the sender 0000001000 8 transmission date dt 8/8 mandatory date message was created ( ccyymmdd) 20170701 9 transmission time tm 8/8 mandatory time message was created (hhmmssdd) 12200101 10 transmission file type an 1/3 mandatory identifier telling the type of message value mpi 11 transmission action an 1/1 optional values u=update f=full file if blank, default to u=update u 12 extract date dt 8/8 mandatory date file was created (ccyymmdd) 20170630 13 file type an 1/1 mandatory test or production values t=test p=production p detail info field # field name type required comments examples 1 record type an 3/3 mandatory identifies record type value mem 2 record sequence number an 1/10 mandatory number for this detail row in the message 3 pbm unique member id an 1/60 mandatory unique id as identified by the pbm/payer for the member 4 pbm unique id for subscriber an 1/60 optional unique id as identified by the pbm/payer for the subscriber of the member 5 health plan member number an 1/30 optional health plan unique member identification number on the health plan card identifying the patient (either a subscriber or a dependent) 6 health plan subscriber number an 1/30 optional health plan unique subscriber identification number number on the health plan card identifying the subscriber 7 policy number an 1/30 optional health plan policy or group number 8 member expiration date dt 8/8 optional date that the member is no longer eligible (ccyymmdd) if multiple dates are available (i e term date, expired date, end date), use the earliest date of the three 9 last name an 1/35 mandatory last name of the member 10 first name an 1/25 mandatory first name of the member 11 middle name an 1/25 recommended middle name of the member recommended to send to aid in patient matching 12 prefix an 1/10 optional member prefix 13 suffix an 1/10 recommended member suffix recommended to send to aid in patient matching 14 social security number n 9/9 optional member ssn no dashes 15 address line 1 an 1/55 recommended first line of the address (no c/o type info) recommended to send to aid in patient matching 16 address line 2 an 1/55 recommended second line of the address (no c/o type info) recommended to send to aid in patient matching 17 city name an 2/30 recommended member city name recommended to send to aid in patient matching 18 state or province code an 2/2 recommended member state code recommended to send to aid in patient matching 19 postal code an 3/15 recommended member zip code 5 or 9 numeric no punctuation 55123 20 country code an 2/3 optional member country code 21 comm number 1 type an 2/2 recommended 1st comm number type values em = email ex = telephone extension fx = facsimile hp = home phone te = telephone wp = work phone recommended to send to aid in patient matching 22 communication number 1 an 1/80 recommended 1st communication number recommended to send to aid in patient matching 23 communication number 2 type an 2/2 recommended 2nd communication number type values em = email ex = telephone extension fx = facsimile hp = home phone te = telephone wp = work phone recommended to send to aid in patient matching 24 communication number 2 an 1/80 recommended 2nd communication number recommended to send to aid in patient matching 25 communication number 3 type an 2/2 optional 3rd communication number type values em = email ex = telephone extension fx = facsimile hp = home phone te = telephone wp = work phone 26 communication number 3 an 1/80 optional 3rd communication number 27 date of birth dt 8/8 recommended member dob (ccyymmdd) recommended to send to aid in patient matching 28 gender an 1/1 recommended member gender (m,f,u) recommended to send to aid in patient matching 29 employer name an 1/35 optional employer name 30 transaction type an 3/3 mandatory type of action needed values 001 – change 021 – addition 024 cancellation or termination 025 – reinstatement 31 member active date dt 8/8 recommended date member becomes active (ccyymmdd) if field is left blank, member will be active on date of load recommended to send to aid in patient matching trailer info field # field name type required comments examples 1 record type an 3/3 mandatory identifies record type value trl 2 total records n 1/10 mandatory total records processed member directory response delimited file to pbm/payer the file name reflects the file name from the pbm/payer with a rsp file extension example newpatient testingpbmc mpi 1450188243095 rsp note if the source file had an extension, the extension remains and the rsp is added after it for example newpatient testingpbmc mpi 1450188243095 txt rsp header field description type required comments examples record type identifies record type an 3/3 mandatory value shd version/release number version number of this specification an 1/2 mandatory value 3 0 recipient id id assigned by surescripts for the recipient of the response file (original sender of the id load file) an 3/30 mandatory if the inbound mpi file included an invalid sender id, sender participant password, transmission date, or transmission time, this field in the response file will be populated with “inv header” p11111111111111 sender id id as assigned by surescripts identifying surescripts an 3/30 mandatory value rxhub recipient participant password password assigned by surescripts for accessing the pbm/payer system an 10/10 mandatory if the inbound mpi file included an invalid sender id, sender participant password, transmission date, or transmission time, this field in the response file will be populated with “inv header” transaction control number unique identifier defined by the sender an 1/10 mandatory transaction date date message was created dt 8/8 mandatory ccyymmdd transaction time time message was created tm 8/8 mandatory hhmmssdd transaction file type identifier telling receiver the type of file an 1/3 mandatory value mpr transaction number originating number of the original report message an 1/10 mandatory transaction date originating date original incoming file was created dt 8/8 mandatory ccyymmdd if the inbound mpi file included an invalid sender id, sender participant password, transmission date, and/or transmission time, this field in the response file will be populated with “20000101” transaction time originating time original incoming file was created tm 8/8 mandatory hhmmssdd if the inbound mpi file included an invalid sender id, sender participant password, transmission date, and/or transmission time, this field in the response file will be populated with “00000000” file type test or production (t/p) an 1/1 mandatory values t=test p=production load status code explaining the status of the load an 2/2 mandatory see member directory codes docid\ tvyo6ubs4cltfe6kasg1k detail info field description type required comments examples record type identifies record type n 1/1 mandatory value sdt record sequence number number that identified the row in the incoming message an 1/10 mandatory pbm unique id for the member unique id as identified by the pbm/payer for the member an 1/60 optional error code describes error for this row w signifies a warning e signifies a error an 3/3 mandatory see member directory codes docid\ tvyo6ubs4cltfe6kasg1k trailer info field description type required notes examples record type identifies record type an 3/3 mandatory value str total rows in error n 1/10 mandatory member directory response summary delimited file to pbm/payer file naming convention a human readable file (on workbench) will have a smt file extension example erx rxhub member directory 02082015 201919 1423456259313 smt a pipe delimited file (on ftp) will have a smd file extension note the pbm/payer needs to request an opt in from surescripts in order to receive this smd file \<font color="#000000">example erx rxhub member directory 02082015 201919 1423456259313 smd\</font> field # field description type comments example 1 file load date date the mpi file was processed by surescripts utc date in mm/dd/ccyy format dt 10/10 12/05/2014 2 transmission control number unique identifier defined by the sender from inbound mpi file an 1/10 0000001000 3 participant id surescripts id assigned to the pbm/payer an 3/30 p111111111111111 4 sender id the sender id is surescripts an 3/30 value surescripts 5 incoming file received date time that surescripts received the inbound file 24 hour time used utc datetime in mm/dd/yyyy hh\ mm\ ss format an 19/19 12/05/2014 04 34 02 6 total number of active lives in mpi before processing number of active lives in the mpi before processing this does not include future lives if future lives were included in the file, they will be excluded from the active lives count note number of active lives reflects the customer's requested lag days for example, if the customer's lag day value is 7, all members in their mpi file are considered active for 7 days beyond the member expiration date provided by the customer in the mpi file n 1/12 10000 incoming file record count 7 total records in file number of patient records in the mpi file n 1/12 1000 8 number of adds number of records in the inbound mpi file where transaction type == 021 n 1/12 200 9 number of terms number of records in the inbound mpi file where transaction type == 024 n 1/12 300 10 number of changes number of records in the inbound mpi file where transaction type == 001 n 1/12 500 11 number of reinstatements number of records in the inbound mpi file where transaction type == 025 n 1/12 5 12 number of records with a member active date number of records in the inbound mpi file with a member active date n 1/12 500 13 number of records with a future member active date number of records in the inbound mpi file with a future member active date n 1/12 500 results of processing the file 14 requested number of records added number of records with transaction type == 021 that were added n 1/12 300 15 requested number of records changed number of records with transaction type == 001 that were changed n 1/12 600 16 requested number of records termed number of records with transaction type == 024 that were terminated n 1/12 50 17 requested number of reinstatements number of records with transaction type == 025 that were reinstated n 1/12 4 18 number of errors number of errors generated n 1/12 50 19 number of adds that already existed number of cases on update file loads where a record in the inbound file had transaction type == 021, but the patient already existed in the surescripts system n 1/12 75 20 number of changed that did not exist number of cases on update file loads where a record in the inbound file had transaction type == 001, but the patient record did not exist in the surescripts system n 1/12 100 21 number of terms that did not exist number of cases on update file loads where a record in the inbound file had transaction type == 024, but the patient record did not exist in the surescripts system n 1/12 50 22 number of reinstatements that did not exist number of cases on update file loads where a record in the inbound file had transaction type == 025, but the patient record did not exist in the surescripts system (patient was not found in either an active or inactive state) n 1/12 1 23 total number of active lives in mpi after processing number of active lives in the mpi after processing this does not include future lives if future lives were included in the file, they will be excluded from the active lives count after processing the new file, the number of records where the member expiration date is >= to today's date in the surescripts system n 1/12 10300 24 processing start time date time the new mpi file began processing in 24 hour clock utc datetime in mm/dd/yyyy hh\ mm\ ss format an 19/19 12/05/2014 05 04 00 25 processing end time date time the new mpi file began processing in 24 hour clock utc datetime in mm/dd/yyyy hh\ mm\ ss format an 19/19 12/05/2014 07 16 02 26 processing time for file time it took to process the file in hhh\ mm\ ss format dt 9/9 002🕛02 27 member directory response summary version id version id of the member directory response summary an 3/3 3 0 member directory codes header response codes code description 01 file loaded correctly 02 file loaded with errors 03 invalid file format file not loaded 04 system error please resend 05 invalid header section id file not loaded (not used) 06 invalid header participant id or password file not loaded 07 invalid header transaction number format file not loaded 08 invalid header transaction datetime format file not loaded 09 invalid header usage indicator file not loaded 10 invalid header filler file not loaded 11 invalid header new line character file not loaded 12 invalid trailer section id – trailer not validated file not loaded 13 invalid trailer filler trailer not validated file not loaded 14 invalid reported number of records file not loaded 15 contract does not exist file not loaded 17 invalid header version number file not loaded (not used) 18 invalid receiver id – file not loaded 19 invalid source name – file not loaded 20 invalid file type – if the file type is not mpi, alt, or rle file not loaded 21 invalid transmission action – if the transmission action is not “u” or “f” – file not loaded 22 invalid number of fields – file not loaded note applies if the header does not have all of the fields only applies to versions 2 0 and 3 0 detail error/warning codes code description e01 missing pbm unique member id, record not loaded e02 missing required fields, record not loaded e03 invalid characters in row, record not loaded e04 invalid record length, record not loaded e05 invalid record type, record not loaded e07 invalid transaction type, record not loaded e09 missing term date, record not loaded e10 maximum repetitions exceeded e13 term date must be a future date or not populated when 25 reinstatement transaction type is used e14 invalid member active date (wrong format or invalid date) e15 member active date is greater than member expiration date w04 change record not found, record added w05 record to add exists, record updated w06 record to term does not exist, record added w07 record to reinstate not found, record added w08 duplicate pbm unique member id found in update file, record not loaded this warning will only occur for the membership update process if a duplicate pbm unique member id is found in the initial membership load, no records are loaded and the entire file is rejected