Common use of File Level Editing Clause in Contracts

File Level Editing. ‌ Upon receipt of the PAP’s Input File, the BCRC first performs high-level file edits to verify the format and validity of the Input File, including Header and Trailer data and record counts. The new Input File is compared with the previously submitted Input File. If it is detected that processing the new Input File will delete at least 30% of the records that were accepted in the previous submission, a “threshold error” will be generated and the file will not be processed without additional confirmation from the PAP. The PAP will be asked to verify the high number of delete records in the current submission. With a full file replacement, the method for deleting enrollee records is to not include previously submitted enrollee records in the current Input File. (Note: PAPs are required to continue to include coverage records for 3 years after the termination date of the coverage.) The Input File is then processed at the record level. The system initially attempts to use an SSN to match to a Medicare ID (HICN or MBI) if a Medicare ID is not submitted on the input file. The system will also determine if an incoming enrollee record is an Add, Update, or Delete, or if no action will be taken.

File Level Editing. ‌ Upon receipt of the PAP’s Input File, the BCRC first performs high-level file edits to verify the format and validity of the Input File, including Header and Trailer data and record counts. The new Input File is compared with the previously submitted Input File. If it is detected that processing the new Input File will delete at least 30% of the records that were accepted in the previous submission, a “threshold error” will be generated and the file will not be processed without additional confirmation from the PAP. The PAP will be asked to verify the high number of delete records in the current submission. With a full file replacement, the method for deleting enrollee records is to not include previously submitted enrollee records in the current Input File. (Note: PAPs are required to continue to include coverage records for 3 years after the termination date of the coverage.) The Input File is then processed at the record level. The system initially attempts to use an SSN to match to a Medicare ID (HICN or MBI) if a Medicare ID is not submitted on the input file. The system will also determine if an incoming enrollee record is an Add, Update, or Delete, or if no action will be taken.