Data models
Jessica Summers
ReportA.xlsxrecord identifiers
| Record Indicator | Record Definition | Notes |
| CHD | Contract of Record level file header | Occurs once per Contract of Record for each one on file |
| SHD | Submitting Contract level file header | Occurs once per Submitting Contract for each one on file |
| DET | Detail records for the report | Occurs 1 to many times per SHD record |
| STR | Submitting Contract level file trailer | Occurs once per each SHD on the file |
| CTR | Contract of Record level file trailer | Occurs once per each CHD on the file |
| REPORT 43: COV only |
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DET Sort Order
| FIELD NO. | FIELD NAME |
| 4 | Current CMS Medicare beneficiary identifier |
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CHD (contract of record hdr)
| FIELD NO. | FIELD NAME | POSITION | PICTURE | LENGTH | FIELD DESCRIPTION / VALUES |
| 1 | RECORD-ID | 1 - 3 | X(3) | 3 | "CHD" |
| 2 | SEQUENCE-NO | 4 - 10 | 9(7) | 7 | Starts with 0000001 |
| 3 | CONTRACT-NO | 11 - 15 | X(5) | 5 | Contract number of the Plan of Record |
| 4 | FILE-ID | 16 - 31 | X(16) | 16 | 43COVCCYY### (Where 43 = Due To Submitting Contracts - Current Month report COV indicates the drug coverage status being reported on (covered drugs only) CCYY indicates the benefit year ### indicates sequential versions of this file. The 4 right-most positions are populated with spaces.) |
| 5 | PROD-TEST-IND | 32 - 35 | X(4) | 4 | TEST or PROD |
| 6 | AS-OF-YEAR | 36 - 39 | X(4) | 4 | Identifies "data reported through" year. Format is CCYY. |
| 7 | AS-OF-MONTH | 40 - 41 | X(2) | 2 | Identifies "data reported through" month. Valid values are 01 through 12. |
| 8 | DDPS-SYSTEM-DATE | 42 - 49 | X(8) | 8 | ‘CCYYMMDD’ = DDPS File creation date. |
| 9 | DDPS-SYSTEM-TIME | 50 - 55 | X(6) | 6 | ‘HHMMSS’ = DDPS File creation time. |
| 10 | DDPS-REPORT-ID | 56 - 60 | X(5) | 5 | DDPS Report identifier ('43COV') |
| 11 | FILLER | 61 - 512 | X(452) | 452 | SPACES |
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SHD (submitting contract hdr)
| FIELD NO. | FIELD NAME | POSITION | PICTURE | LENGTH | FIELD DESCRIPTION / VALUES |
| 1 | RECORD-ID | 1 - 3 | X(3) | 3 | "SHD" |
| 2 | SEQUENCE-NO | 4 - 10 | 9(7) | 7 | Starts with 0000001 |
| 3 | CONTRACT-NO | 11 - 15 | X(5) | 5 | Submitting Contract number |
| 4 | FILLER | 16 - 18 | X(3) | 3 | SPACES |
| 5 | FILE-ID | 19 - 34 | X(16) | 16 | 43COVCCYY### (Where 43 = Due To Submitting Contracts - Current Month report COV indicates the drug coverage status being reported on (covered drugs only) CCYY indicates the benefit year ### indicates sequential versions of this file. The 4 right-most positions are populated with spaces.) |
| 6 | PROD-TEST-IND | 35 - 38 | X(4) | 4 | TEST or PROD |
| 7 | AS-OF-YEAR | 39 - 42 | X(4) | 4 | Identifies "data reported through" year. Format is CCYY. |
| 8 | AS-OF-MONTH | 43 - 44 | X(2) | 2 | Identifies "data reported through" month. Valid values are 01 through 12. |
| 9 | DDPS-SYSTEM-DATE | 45 - 52 | X(8) | 8 | ‘CCYYMMDD’ = DDPS File creation date. |
| 10 | DDPS-SYSTEM-TIME | 53 - 58 | X(6) | 6 | ‘HHMMSS’ = DDPS File creation time. |
| 11 | DDPS-REPORT-ID | 59 - 63 | X(5) | 5 | DDPS Report identifier ('43COV') |
| 12 | FILLER | 64 - 512 | X(449) | 449 | SPACES |
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DET
| FIELD NO. | FIELD NAME | POSITION | PICTURE | LENGTH | FIELD DESCRIPTION / VALUES |
| 1 | RECORD-ID | 1 - 3 | X(3) | 3 | DET |
| 2 | SEQUENCE-NO | 4 - 10 | 9(7) | 7 | Must start with 0000001 |
| 3 | DRUG-COVERAGE-STATUS-CODE | 11 - 11 | X(1) | 1 | Note: only PDEs with a value of 'C' (Covered Drug) will be included on this report. |
| 4 | Current CMS Medicare beneficiary identifier | 12 - 31 | X(20) | 20 | The most current CMS Medicare Beneficiary Identifier (MBI). |
| 5 | Last Submitted Medicare beneficiary identifier | 32 - 51 | X(20) | 20 | Beneficiary identifier (HICN or MBI) from the most recent accepted PDE in the DDPS database. |
| 6 | CURRENT-MONTH-GDCB-AMOUNT | 52 - 65 | S9(12)V99 | 14 | Monthly change in Gross Drug Cost Below the Catastrophic Coverage Threshold |
| 7 | CURRENT-MONTH-GDCA-AMOUNT | 66 - 79 | S9(12)V99 | 14 | Monthly change in Gross Drug Cost Above the Catastrophic Coverage Threshold |
| 8 | CURRENT-MONTH-TOTAL-GROSS-DRUG-COST | 80 - 93 | S9(12)V99 | 14 | Sum of Net Ingredient Cost, Net Dispensing Fee,Net Sales Tax and Net Vaccine Administration Fee. |
| 9 | CURRENT-MONTH-LICS-AMOUNT | 94 - 107 | S9(12)V99 | 14 | Monthly change in Low Income Cost Sharing Amount |
| 10 | CURRENT-MONTH-CPP-AMOUNT | 108 - 121 | S9(12)V99 | 14 | Monthly change in Covered Plan Paid Amount |
| 11 | P2P-CONTRACT | 122 - 126 | X(5) | 5 | The contract number of the Submitting Contract associated with the P2P reconciliation condition. |
| 12 | CURRENT-MONTH-P2P-AMOUNT | 127 - 140 | S9(12)V99 | 14 | The amount related to the Plan-to-Plan reconciliation condition. This amount represents the amount "due-to" this Submitting Contract from this Contract of Record for this beneficiary. This field is the sum of the LICS Amount and CPP Amount. |
| 13 | FILLER | 141 - 512 | X(372) | 372 | SPACES |
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STR (submitting contract trlr)
| FIELD NO. | FIELD NAME | POSITION | PICTURE | LENGTH | FIELD DESCRIPTION / VALUES |
| 1 | RECORD-ID | 1 - 3 | X(3) | 3 | "STR" |
| 2 | SEQUENCE-NO | 4 - 10 | 9(7) | 7 | Starts with 0000001 |
| 3 | CONTRACT-NO | 11 - 15 | X(5) | 5 | Same as SHD |
| 4 | FILLER | 16 - 18 | X(3) | 3 | SPACES |
| 5 | DRUG-COVERAGE-STATUS-CODE | 19 - 19 | X(1) | 1 | Note: only PDEs with a value of 'C' (Covered Drug) will be included on this report. |
| 6 | BENEFICIARY-COUNT | 20 - 30 | 9(11) | 11 | Count of beneficiaries with utilization in the reporting period. |
| 7 | CURRENT-MONTH-GDCB-AMOUNT | 31 - 44 | S9(12)V99 | 14 | Monthly change in Gross Drug Cost Below the Catastrophic Coverage Threshold |
| 8 | CURRENT-MONTH-GDCA-AMOUNT | 45 - 58 | S9(12)V99 | 14 | Monthly change in Gross Drug Cost Above the Catastrophic Coverage Threshold |
| 9 | CURRENT-MONTH-TOTAL-GROSS-DRUG-COST | 59 - 72 | S9(12)V99 | 14 | Sum of Net Ingredient Cost, Net Dispensing Fee, Net Sales Tax and Net Vaccine Administration Fee. |
| 10 | CURRENT-MONTH-LICS-AMOUNT | 73 - 86 | S9(12)V99 | 14 | Monthly change in Low Income Cost Sharing Amount |
| 11 | CURRENT-MONTH-CPP-AMOUNT | 87 - 100 | S9(12)V99 | 14 | Monthly change in Covered Plan Paid Amount |
| 12 | DET-RECORD-TOTAL | 101 - 108 | 9(8) | 8 | Total count of DET records |
| 13 | CURRENT-MONTH-P2P-AMOUNT-DUE-TO-ALL-SUBMITTING-CONTRACTS | 109 - 122 | S9(12)V99 | 14 | The amount related to the Plan-to-Plan reconciliation condition. This amount represents the amount "due-to" this Submitting Contract from this Contract of Record. This field is the sum of the LICS Amount and CPP Amount. |
| 14 | FILLER | 123 - 512 | X(390) | 390 | SPACES |
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CTR (contract of record trlr)
| FIELD NO. | FIELD NAME | POSITION | PICTURE | LENGTH | FIELD DESCRIPTION / VALUES |
| 1 | RECORD-ID | 1 - 3 | X(3) | 3 | "CTR" |
| 2 | SEQUENCE-NO | 4 - 10 | 9(7) | 7 | Must start with 0000001 |
| 3 | CONTRACT-NO | 11 - 15 | X(5) | 5 | Must match CHD |
| 4 | DRUG-COVERAGE-STATUS-CODE | 16 - 16 | X(1) | 1 | Note: only PDEs with a value of 'C' (Covered Drug) will be included on this report. |
| 5 | BENEFICIARY-COUNT | 17 - 27 | 9(11) | 11 | Count of beneficiaries with utilization in the reporting period. |
| 6 | FILLER | 28 - 36 | X(9) | 9 | SPACES |
| 7 | CURRENT-MONTH-GDCB-AMOUNT | 37 - 50 | S9(12)V99 | 14 | Monthly change in Gross Drug Cost Below the Catastrophic Coverage Threshold |
| 8 | CURRENT-MONTH-GDCA-AMOUNT | 51 - 64 | S9(12)V99 | 14 | Monthly change in Gross Drug Cost Above the Catastrophic Coverage Threshold |
| 9 | CURRENT-MONTH-TOTAL-GROSS-DRUG-COST | 65 - 78 | S9(12)V99 | 14 | Sum of Net Ingredient Cost, Net Dispensing Fee, Net Sales Tax and Net Vaccine Administration Fee. |
| 10 | CURRENT-MONTH-LICS-AMOUNT | 79 - 92 | S9(12)V99 | 14 | Monthly change in Low Income Cost Sharing Amount |
| 11 | CURRENT-MONTH-CPP-AMOUNT | 93 - 106 | S9(12)V99 | 14 | Monthly change in Covered Plan Paid Amount |
| 12 | DET-RECORD-TOTAL | 107 - 114 | 9(8) | 8 | Total count of DET records |
| 13 | CURRENT-MONTH-P2P-AMOUNT-DUE-TO-ALL-SUBMITTING-CONTRACTS | 115 - 128 | S9(12)V99 | 14 | The amount related to the Plan-to-Plan reconciliation condition. This amount represents the amount "due-to" all Submitting Contracts from this Contract of Record. This field is the sum of the LICS Amount and CPP Amount. |
| 14 | FILLER | 129 - 512 | X(384) | 384 | SPACES |
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