File and Record Level Editing Sample Clauses

File and Record Level Editing. ‌ Upon the BCRC’s receipt of the PAP Input File, high-level file edits are performed to verify the format and validity of the Input File. High-level editing verifies Header and Trailer data and record counts. The size of the PAP Input File (the number of records contained in the file) is compared to the size of the previous monthly file submitted. The method for deleting enrollees in full file replacement processing is to not include enrollee files previously submitted. If the current file size is less then 70% of the previous month’s file, the current Input File will be placed on hold and the PAP partner will be notified. The PAP partner will be asked to verify the high number of delete records in the current submission. The Input File is then processed at the record level to determine if an incoming enrollee record is an add, update, delete, or if no action will be taken on it. The system initially attempts to convert an SSN to a Medicare ID (HICN or MBI) if a Medicare ID is not submitted on the input file. If a Medicare beneficiary is identified through an SSN and other data the beneficiary’s Medicare ID will be returned to the PAP, and the PAP is then required to use the Medicare ID in any future data exchanges with the BCRC. The BCRC will only create a response record if a record has been added, or an existing record has been updated or deleted. An input record that has already been applied in a previous full file submission and is contained in the current submission unchanged (i.e., with no updates or errors) will not generate a response record. However, the BCRC and CMS work to ensure that PAPs will receive updated Part D enrollment status in their monthly response files even if no other information about the affected beneficiary has changed.
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