Procella HelpdeskPROCELLA ELIGIBILITY LOAD - STANDARD FORMAT
- This file should be a pipe-delimited text file.
- The keyword “MEMBERENROLLMENT” is mandatory in file name. For example - ACME_MEMBERENROLLMENT_sample.txt.
- The text file must include a header row.
- The sample file is attached to this document
| Column Name | Format | REQ/ OPT | Description |
| ACTION CODE | A/N | R | Indicates the action being performed. Default value is "A". |
| EXTERNAL GROUP ID | A/N | R | Group ID |
| EXTERNAL PLAN ID | A/N | R | Plan ID |
| PLAN CODE | A/N | O | Not in Use |
| CDH FIRST NAME | A/N | O | First name of the cardholder, if applicable. |
| CDH LAST NAME | A/N | O | Last name of the cardholder, if applicable. |
| CDH DOB | A/N | O | Date of birth of the cardholder, if applicable. |
| ENROLLMENT TYPE | A/N | R | Type of enrollment available: FAM - FAMILY SUB - SUBSCRIBER SSP - SUB AND SPOUSE SDP - SUB AND DEPENDENTS E1D - SUB AND ONE DEPENDENT ONLY DEP - DEPENDENTS ONLY |
| PERSON CODE | N | R | Pharmacy person code |
| MEDICAL PERSON CODE | N | O | Medical person code, if applicable. |
| RELATIONSHIP CODE | N | R | Relationship code: 01 for subscriber 02 for spouse 03 for dependents |
| FIRST NAME | A/N | R | First name of the member. |
| LAST NAME | A/N | R | Last name of the member. |
| MIDDLE INITIAL | A/N | O | Middle initial of the member, if available. |
| GENDER | A | R | Gender of the member (F, M, O). |
| DATE OF BIRTH | D | R | Date of birth of the member. |
| DATE OF DEATH | D | O | Date of death of the member, if applicable. |
| MULT BIRTH CODE | A/N | O | Multiple birth code, if applicable. |
| LANGUAGE NAME CODE | A/N | O | Language name code, if applicable. |
| ADDRESS1 | A/N | O | Address line 1. |
| ADDRESS2 | A/N | O | Address line 2. |
| CITY | A/N | O | City name. |
| STATE | A/N | O | State name. |
| ZIP | A/N | O | ZIP code. |
| ZIP4 | A/N | O | ZIP+4 code. |
| COUNTRY CODE | A/N | O | Country code. |
| HOME PHONE | A/N | O | Home phone number. |
| CELL PHONE | A/N | O | Cell phone number. |
| WORK PHONE | A/N | O | Work phone number. |
| OTHER PHONE | A/N | O | Other phone number. |
| EMAIL PERSONAL | A/N | O | Personal email address. |
| EMAIL OTHER | A/N | O | Other email address. |
| REPORTING SUB GROUP | A/N | O | Reporting sub-group. |
| COB COVERAGE LEVEL | A/N | O | COB (Coordination of Benefits) coverage level. |
| COVERAGE START DATE | D | R | Start date of coverage. |
| COVERAGE END DATE | D | R | End date of coverage. |
| EFFECTIVE START DATE | D | R | Effective start date. |
| EFFECTIVE END DATE | D | R | Effective end date. |
| COVERAGE SELECTED | A | R | Indicates whether coverage is selected. Y - Member has coverage N - Member is not covered |
| CARDHOLDER ID | A/N | R | Cardholder ID. |
| ALT CARDHOLDER ID | A/N | R | Alternate cardholder ID. |
| ALT CARDHOLDER ID QUALIFIER | A/N | R | Qualifier for the alternate cardholder ID. |
| CDH OTHER ID | A/N | R | Other ID of the cardholder. |
| CDH EMPLOYEE ID | A/N | O | Employee ID of the cardholder, if applicable. |
| MEDICAL CARDHOLDER ID | A/N | O | Medical cardholder ID, if applicable. |
| OTHER ID | A/N | R | Other ID associated with the member. |
| EXTERNAL MEMBER ID | A/N | O | External member ID, if applicable. |
| FAMILY ATTR1 | A/N | O | This is for client use to store any common attribute applicable to the Family. (For eg., if any specific coverage code value to be stored) |
| FAMILY ATTR2 | A/N | O | This is for client use to store any common attribute applicable to the Family. |
| FAMILY ATTR3 | A/N | O | This is for client use to store any common attribute applicable to the Family. |
| FAMILY ATTR4 | A/N | O | This is for client use to store any common attribute applicable to the Family. |
| FAMILY ATTR5 | A/N | O | This is for client use to store any common attribute applicable to the Family. |
| MEMBER ATTR1 | A/N | O | This is for client use to store any specific attribute applicable to the Member. For eg., This attribute can be used to indicate Diabetic patient or Out of state-dependent etc |
| MEMBER ATTR2 | A/N | O | This is for client use to store any specific attribute applicable to the Member. |
| MEMBER ATTR3 | A/N | O | This is for client use to store any specific attribute applicable to the Member. |
| MEMBER ATTR4 | A/N | O | This is for client use to store any specific attribute applicable to the Member. |
| MEMBER ATTR5 | A/N | O | This is for client use to store any specific attribute applicable to the Member. |
| MEMBER ALIAS ID QUALIFIER | A/N | O | Qualifier for member alias ID. |
| MEMBER ALIAS ID | A/N | O | Member alias ID. |
| MEMBER ALIAS ID STATE | A/N | O | State associated with member alias ID. |