Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.5 Coordination of Benefits (COB); Validated Other Health Insurance Data
File
This file contains members’ primary and secondary coverage, validated through COB
processing. MARx forwards this report whenever a Plan’s enrollees are affected, which may
occur as often as daily. The enrollees included on the report are those newly enrolled who have
known Other Health Insurance (OHI) and those Plan enrollees with changes to their OHI.
The following records are included in this file:
Detail Record
Primary Record
Supplemental Record
F.5.1 General Organization of Records
Detail Record (DTL) Record 1 (Beneficiary A)
Primary (PRM) records associated with ‘DTL’ Record 1 (Beneficiary A)
Supplemental (SUP) records associated with ‘DTL’ Record 1 (Beneficiary A)
‘DTL’ Record 2 (Beneficiary B)
‘PRM’ records associated with ‘DTL’ Record 2 (Beneficiary B)
‘SUP’ records associated with ‘DTL’ Record 2 (Beneficiary B)
‘DTL’ Record 3 (Beneficiary C)
‘PRM’ records associated with ‘DTL’ Record 3 (Beneficiary C)
‘SUP’ records associated with ‘DTL’ Record 3 (Beneficiary C)
‘DTL Record n
‘PRM’ records associated with ‘DTL’ Record n
‘SUP’ records associated with ‘DTL’ Record n
F.5.2 Detail Records: Indicates the Beginning of a Series of Beneficiary Subordinate Detail
Records
Item Field Size Position Format Valid Values/Description
1 Record Type 3 1-3 CHAR "DTL"
2 HICN/RRB Number 12 4-15 CHAR Spaces if unknown
3 SSN 9 16-24 ZD 000000000 if unknown
4 Date of Birth (DOB) 8 25-32 CHAR YYYYMMDD
5 Gender Code 1 33 CHAR
0=unknown, 1 = male, 2 =
female
6 Contract Number 5 34-38 CHAR
7 Plan Benefit Package 3 39-41 CHAR
8 Action Type 1 42 CHAR 2 = Full replacement
9 Filler 958 43-1000 CHAR Spaces
Note: Record Length = 1000
December 28, 2012 F-11 COB; Validated Other Health Insurance
Data