Provider Batch Registration Guide

Transcription

1 Provider Batch Registration Guide Version 1.5 August 2015 Beacon Health Options Page 1 of 70

2 Table of Contents Introduction... 4 Purpose... 4 Telecommunications Specifications... 4 Input File Layout and ation Errors... 5 Trailer Record Response Files Naming Convention Summary File Accepted Records File Error Records File Pended Records File Pended Records Output File Appendix A Error Processing Appendix B County Codes Appendix C Default Funds Appendix D Selected Funds Additional Selected Funds Information Appendix E Medicaid and Medicare Funds Appendix F Assigning a CID and Best Match Individual Information Known Field Appendix G Beacon Health Options Page 2 of 70

3 Pended Record Resolution Codes Appendix H Acceptable Georgia City, State, and Zip Code Combinations Version Change Log Version Version Updated Accepted File BATDAT shows Length of 7, example added to Field Description. Updated Appendix A: Error Processing Field Level Error 223 moved to Registration Comments Version Updated Input File Layout and ation Errors, Key for usage Updated Input File Layout and ation Errors Fields 4, 19, 20, 21, 22, 23, 24, 25, 26, 29, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70 updated Short Reg. Usage, Regular Reg. Usage and/or Demo Change Updated Input File Layout and ation Errors Fields 1, 7, 8, 32, 39, 40, 41, 43, 44, 45, 56, 57, 58, 67, 94, 95, 96 updated Field Notes and Errors Added note and removed GACF in appendix C Added Medicaid and Medicare Funds as appendix E Changed Assigning a CID and Best Match to appendix F Version Added in additional note under Key for usage to advise of File Naming Convention Added Return file name for all Response Files Added Pended Records Output File under Response Files Version Updated Input File Layout and ation errors Fields 23, 59, 69, 79, 80, 81, 82, 83 updated Field Notes and Errors Updated Appendix A Error Processing Added error codes 229, 230 Updated Appendix A Error Processing Updated error codes 225, 298 Added Naming Convention to Response Files Update Return file name for all Response Files Updated Appendix D Additional Selected Funds- Updated Information Added Appendix G Pended Record Resolution Codes Added Appendix H Acceptable Georgia City, State, and Zip Code Combinations Version Updated Input File Layout and ation errors Updated File Naming Convention Updated Input File Layout and ation errors Fields 1, 46, 59, 61and 97 updated Field Notes and Errors Updated Appendix A Error Processing Updated error code 120 Beacon Health Options Page 3 of 70

4 Introduction Purpose The Georgia Collaborative ASO Provider Batch Registration Guide document provides the data requirements to be implemented for all electronic registration submissions to the Georgia Collaborative ASO for individuals. The purpose of this document is to provide the information necessary to submit registration data electronically to the Georgia Collaborative ASO. The information herein describes specific requirement for processing data within the payer s system. Telecommunications Specifications Providers wishing to submit electronic registration data to the Georgia Collaborative ASO must obtain a Submitter ID/Password. If you do not have a Submitter ID you may obtain one by completing the Account Request form available on the Georgia Collaborative ASO website. If you already have a ProviderConnect user ID and password, you will be able to access the registration batch submission process. The Georgia Collaborative ASO can accommodate multiple submission methods for electronic registration data. Please refer to the Batch Submission Guide on the Georgia Collaborative ASO website at or further details. If you have any questions please contact the EDI Help Desk: e-supportservices@valueoptions.com subject line should begin with Batch Registration This will direct the to the correct internal resource for resolution Telephone: (8 a.m. 6 p.m. ET, Monday Friday) Fax: Beacon Health Options Page 4 of 70

5 Input File Layout and ation Errors Key for usage: Under Short Reg. Usage, Regular Reg. Usage and Demo Change: R Field is required N Field is not required (If known should be entered. When entered will be subjected to rules in field notes and errors column. When not entered should be blanks) C Field is conditionally required (condition under which the field is required is documented in the field notes and errors column) X Do not populate this field Under Format: N Numeric Value A Alpha-Numeric Value If input file is not in the correct format, see error code 006. All required fields must left justified. All alpha characters will be converted uppercase and returned in response files as uppercase. A CRLF (Carriage Return Line Feed) is required to indicate the end of a record and the start of a new one. Each record must be on a separate line. File Naming Convention: GAC123456_MMDDYYYY_001_BR.txt GAC = Submitter Provider ID MMDDYYYY = the date the file is created 001 = the sequential number of the file being sent that day (in case the multiple files are sent on the same day/date) BR = to designate what the file is being sent for: BA = Batch Auth; BD = Batch Discharge; and BR = Batch Registration Beacon Health Options Page 5 of 70

6 Field # Field Description Short Reg Usage Regular Reg Usage Demo Change Values Field Notes and Errors Length Start End Format Must be numeric. See error 020 (This error will stop the processing of the file). 1 Record Number R R R All 7 Characters must be populated. Prefill with zeroes when necessary. See error 011 (This error will stop the processing of the file). Each record should be incremented by 1. See error 012 (This error will stop the processing of the file) N 2 3 Registering Provider ID Registration Indicator R R R R R R I = Initial Registration R = Re- Registration D = Demographic change Example: first record would be , second record , , and so on. Must be valid Collaborative Provider number. See error A Must not be blank or invalid. See error A Must be valid date in the format MMDDYYYY. See error Registration Start Date R R X Required when Registration Indicator = I or R. See error N Must not be future date. See error 018. Beacon Health Options Page 6 of 70

7 5 6 Provider Internal Tag ID Individuals CID Number Cannot be backdated more than 6 months from current date. See error 019. Must be blank when Registration Indicator = D. See error 021. N N N For Provider s Use A C C R Required if Registration Indicator = R or D. See error A Must be numeric. See error 119. Must be blank when Individual Information Known = N. See error Medicaid ID N N N A Must not contain special characters. See error Medicare ID N N N Must not contain special characters. See error A 9 Last Name C R R Required unless Individual Information Known = N. See error A 10 Birth Surname N N N A 11 First Name C R R Required unless Individual Information Known = N. See error A 12 Middle Initial N N N A 13 Name Suffix N N N A 14 Preferred Name N N N A Must be numeric 15 Birth Date C R R Must be valid date in the format MMDDYYYY. See error 032. Cannot be greater than Current Date or Registration Start Date. See error N Beacon Health Options Page 7 of 70

8 Required unless Individual Information Known = N. See error 030. Must not change from child to adult or adult to child when Registration Indicator = D. See error 027 and 033. Individual must be 4 years of age or over. See error 120. Required if Social Security Number Unknown Indicator = blank. See error Social Security Number C C C The following are considered invalid SSN numbers: , , , , , , , , , , , or not numeric. See error N 17 Social Security Number Unknown C C C 18 Gender R R R Y Yes blank 1 Male Must be blank if Social Security Number Unknown = Y. See error 036. Required if Social Security Number = blank. See error 036. Must be Value. See error A Must not be blank or invalid. See error A Beacon Health Options Page 8 of 70

9 2 Female 3 - Transgender Male to Female 4 - Transgender Female to Male 5 Other/Unknown Should always show N for Provider Agencies. 19 Referral Registration R R X Y - Yes N No Must be Value when required. See error 254. Must not be selected with any other fund. See error A Must be blank when Registration Indicator = D. See error 255. Must be N for regular registrations. 20 Short term, Immediate Services Registration R R X Y - Yes N No Must be Value when required. See error 256. Must not be selected with any other fund. See error A Must be blank when Registration Indicator = D. See error 257. Is individual s information known? 21 Individual information known C C X Y = Yes N = No Required if fund selection is Short term, Immediate Services Registration. See error 258. Must be blank when Registration Indicator = D. See error A Must be blank when Short Term, Immediate Beacon Health Options Page 9 of 70

10 Services Registration = N. See error Registering for CBAY Fund Registering for Women s Treatment and Recovery Services Fund Women s treatment and recovery services fund R R X R R X X C X 1 CBAY MFP Fund 2 CBAY BIP Fund 3 CBAY State Fund 9 Not Registering for CBAY 1 Women s Treatment and Recovery Services - Residential 2 Women s Treatment and Recovery Services Outpatient 9 Not registering for Women s Treatment and Recovery Services Fund. When required must be Y when Last Name, First Name, and Birth Date are all populated. See error 261. Must be Value when required. See error 266. Must be blank when Registration Indicator = D. See error 267. Must be 9 when Short Term, Immediate Services Registration or Referral Registration = Y. See error 269. Must not be 3 when Individual is 18 or over and Lawful Presence = 2 or 4. See error 268. Must be Value when required. See error 290. Must be 9 when Gender = 1. See error 298. Must be blank when Registration Indicator = D. See error 291. Must be 9 when Short Term, Immediate Services Registration or Referral Registration = Y. See error 292. Must be 9 when Individual is 18 or over and Lawful Presence = 2 or 4. See error 293. Must be numeric. Must be valid date in the format MMDDYYYY. See error A A N Beacon Health Options Page 10 of 70

11 25 end date Registering for Treatment Court Fund (MH or Drug Court) R R X 26 Filler 1 X X X 27 Race Code R R R 1 - Treatment Court - MH 2 - Drug Court 9 - Not registering for Treatment Court Fund 1 - American Indian/Alaskan Native 2 - Native Hawaiian/Other Pacific Islander 3 - Black/African American 4 - White/Caucasian 5 - Asian 6 - Multiracial 7 Other Single Race 8 - Unknown/Refused Must be greater than Registration Start Date when Women s Treatment and Recovery Services Fund = 1 or 2. See error 301. Must be blank when Registration Indicator = D. See error 300. Must be Value when required. See error 262. Must be blank when Registration Indicator = D. See error 263. Must be 9 when Short Term, Immediate Services Registration or Referral Registration = Y. See error 264. Must be 9 when Individual is 18 or over and Lawful Presence = 2 or 4. See error 265. Filler for future use Must be blank. See error A A Value must be entered. See error A Beacon Health Options Page 11 of 70

12 Hispanic\ Latino Origin Marital Status Unknown Address Individual is Homeless Street Address Line 1 Street Address Line 2 R R R N R X C C C C C C C C C 34 City C C C Y -Yes N -No U - Unknown/Refused 1 - Single 2 - Separated 3 - Divorced 4 - Married 5 Widowed 6 - Partnered 7 - Unknown/Refused Y Yes blank Y Yes blank Value must be entered. See error A Value must be entered. See error 042. Must be blank when Registration Indicator = D. See error 043. Must be blank when Street Address Line 1 or 2 = entered. See error 044. Must be blank when Individual is Homeless = Y. See error 045. Must be Value. See error 046. Must be blank when Street Address Line 1 or 2 is entered. See error 047. Must be Value. See error 048. Must be entered when Unknown Address and Individual is Homeless is blank. See error A A A A N N N A Must be entered when Individual is Homeless = Y. See error A Beacon Health Options Page 12 of 70

13 Must be entered when Unknown Address is blank. See error State C C C 36 Zip Code C C C Must be valid per USPS. See error 050. Must be valid state. See error 051. Must be entered when City is entered. See error 118. Must be numeric Must be 5 characters Must be entered when Unknown Address and Individual is Homeless are blank. See error 053. Must be Zip Code. See error A A Zip Code Extension Individuals County N N N R R R Must be valid and match the City and State entered. See error 052. Must be numeric. See error 069. Must be 4 characters. See error 071. Must be entered and valid per County Code List (Appendix B). See error 054. Must be numeric. See error A A 39 Primary Home Phone Area Code C C C Either Primary Home Phone Area Code or No Phone must be indicated. See error 058. Must be populated if Primary Home Phone Exchange Number or Primary Home Phone Suffix are populated. See error A Must be 3 characters when entered. See error 056. Beacon Health Options Page 13 of 70

14 Must be numeric. See error Primary Home Phone Exchange Number C C C Must be populated if Primary Home Phone Area Code or Primary Home Phone Suffix are populated. See error A Must be 3 characters when entered. See error 056. Must be numeric. See error Primary Home Phone Suffix C C C Must be populated if Primary Home Phone Area Code or Primary Home Phone Exchange Number are populated. See error A 42 No Phone C C C Y Yes blank Must be 4 characters when entered. See error 056. Must be Value. See error 059. Must be blank when Primary or Secondary phone fields are populated. See error 060. Must be numeric. See error A 43 Secondary Phone Area Code N N N Must be populated if Secondary Home Phone Exchange Number or Secondary Home Phone Suffix are populated. See error A 44 Secondary Phone Exchange Number N N N Must be 3 characters when entered. See error 061. Must be numeric. See error 057. Must be populated if Secondary Home Phone Area Code or Secondary Home Phone Suffix are populated. See error A Beacon Health Options Page 14 of 70

15 Must be 3 characters when entered. See error 061. Must be numeric. See error Secondary Phone Suffix N N N Must be populated if Secondary Home Phone Area Code or Secondary Home Phone Exchange Number are populated. See error A Individual Address Alternate Contact Person Last Name Alternate Contact Person First Name Relationship to Individual N N N N C C N C C N C C 01 - Spouse/Significant Other 02 - Parent 03 - Sibling 04 - Child 05 - Grandparent 06 - In-Law Relative 07 - Other family member 08 - Friend Must be 4 characters when entered. See error 061. format = example@example.com. See error 062. Only valid values allowed are underscore ( _ ), decimal letters and numbers. Must be populated if Alternate Contact Person First Name or Relationship to Individual are populated. See error 064. Must be populated if Alternate Contact Person Last Name or Relationship to Individual are populated. See error 064. Must be populated if Alternate Contact Person Last Name or Alternate Contact Person First Name are populated. See error 064. Must be Value. See error A A A A Beacon Health Options Page 15 of 70

16 Alternate Contact Street Address Line 1 Alternate Contact Street Address Line 2 Alternate Contact City N C C N N N N C C 09 - Neighbor 10 - Roommate 11 - Case Worker 12 - School Counselor/Teacher 13 - Substitute Decision-Maker 14 Other Must be populated if Alternate Contact City, Alternate Contact State, or Alternate Contact Zip are populated. See error 083. Must not be populated if Alternate Contact Street Address Line 1 is blank. See error 085. Must be entered when Alternate Contact Street Address Line 1 Is populated. See error A A A 53 Alternate Contact State N C C Must be valid per USPS. See error 103. Must be entered when Alternate Contact City is populated. See error 105. Must be valid state. See error 105. Must be numeric A Must be 5 characters 54 Alternate Contact Zip N C C Must be entered when Alternate Contact State is populated. See error A Must be Zip Code. See error 108. Beacon Health Options Page 16 of 70

17 55 Alternate Contact Zip Extension N N N Must be valid and match the City and State entered. See error 063. Must be numeric. See error 073. Must be 4 characters. See error 075. Must be numeric. See error A 56 Alternate Phone Number Area Code N C C Must be populated if Alternate Phone Number Exchange Number or Alternate Phone Number Suffix are populated. See error A Must be 3 characters when entered. See error 067. Must be numeric. See error Alternate Phone Number Exchange Number N C C Must be populated if Alternate Phone Number Area Code or Alternate Phone Number Suffix are populated. See error 067. Must be 3 characters when entered. See error 067. Must be numeric. See error A 58 Alternate Phone Number Suffix N C C Must be populated if Alternate Phone Number Area Code or Alternate Phone Number Exchange Number are populated. See error A Must be 4 characters when entered. See error 067. Must be a whole number. See error Individual's Income N C X Must be entered when Individual Income Unknown is blank. See error N Beacon Health Options Page 17 of 70

18 Must be blank when Registration Indictor = D. See error 212. Must be blank when Individual Income Unknown = U. See error Individual Income Unknown N C X U - Unknown/Refused blank Must fill with leading zeros as necessary. Required on regular registrations if individual s income is blank. See error 211. Must be Value. See error 213. Must be blank when Registration Indicator = D. See error 214. Must be a whole, numeric number. See error A Must be entered when Household Income Unknown is blank. See error Household Income N C X Must be blank when Registration Indicator = D. See error 201. Must be greater than or equal to Individual Income. See error N Must be blank when Household Income Unknown = U. See error Household Income Unknown N C X U Unknown/Refused blank Must fill with leading zeros as necessary. Required on regular registrations if household income is blank. Must be Value. See error 217. Must be blank when Registration Indicator = D. See error A Beacon Health Options Page 18 of 70

19 63 Household Size N R X 64 Filler 2 X X X 65 Filler 3 X X X 66 Lawful Presence R R X U Unknown/Refused 1 Yes 2 - No 3 - N/A 4 - Unknown/Refused Must be a Value. See error 202. Must be blank when Registration Indicator = D. See error 203. Filler for future use. Must be blank. See error 039. Filler for future use. Must be blank. See error 039. Question: Is individual lawfully present in the United States? Must be Value. See error 204. Must be Blank when Registration Indicator = D. See error A A A A 67 Medicaid Status N C X Y Yes N No U Unknown/Refused Blank Must be blank when Individual is 19 or over. See error 115. Must be entered when Individual is under 19 years of age. See error 206. Must be valid Value when entered. See error A Beacon Health Options Page 19 of 70

20 68 69 Private Health Insurance PeachCare Application Status N C X N C X Y Yes N No U Unknown/Refused blank 01 - Parent/guardian has never applied for PeachCare 02 - Parent/guardian has applied for PeachCare and application is currently pending 03 - Parent/guardian has a denial letter for PeachCare/Medicaid that was issued more than 10 months ago 04 - Individual is in transition from foster care to parental custody 05 - Individual was granted an exception for 60 days of funds access and provider has documentation from DBHDD Must be blank when Registration Indicator = D. See error 114. Must be Value. See error 227. Must be blank when Individual is 19 or over. See error 116. Must be entered when Medicaid Status = N or U. See error 207. Must be blank when Registration Indicator = D. See error 208. Required when Private Health Insurance = N. See error 209. Must be blank when Private Health Insurance = Y or U. See error 225. Must be blank when Registration Indicator = D. See error A A Beacon Health Options Page 20 of 70

21 06 - Other allowable situation for temporary funds access (if selected, require an explanation in Other allowable situation for temporary funds access) 07 - Individual s Status is undocumented (not considered lawfully present in the U.S.) years old and not eligible for other benefits 09 - Parent/ guardian has denial letter for PeachCare/ Medicaid within the past 10 months (for other than procedural reasons) 10 - Individual was granted an exception for 12 months funds access and provider has documentation from DBHDD 11 - Parent/guardian has applied for PeachCare/ Medicaid and has denial letter for procedural reasons (not following through on requirements for application completion; missed Beacon Health Options Page 21 of 70

22 appointments etc.) 12 - Parent/guardian refuses to provide additional required information 13 - DBHDD State Office has determined that individual is no longer eligible for C&A Funds 14 Unknown User entered field. 70 Other allowable situation for temporary funds access N C X Must be entered when PeachCare Application Status = 06. See error 215. Must be blank when PeachCare Application Status is not = 06. See error A Veteran Status Language/ English Proficiency Other Language N R R N R R N R R Y - Yes N No U - Unknown/Refused 1 - Very well 2 - Well 3 - Not well 4 - Not at all 5 - Unknown/Refused Must be blank when Registration Indicator = D. See error 216. Must be Value. See error A Question: How well do you speak English? Must be Value. See error 070. Question: Do you prefer to speak or use a language A A Beacon Health Options Page 22 of 70

23 Language Specification Hearing Loss (selfidentified) Hearing Loss (other identified) N C C N R R N R R Y Yes N No U -Unknown/Refused 01 - ASL 02 - Spanish 03 - Chinese 04 - Tagalog 05 - French 06 - Vietnamese 07 - German 08 - Korean 09 - Russian 10 - Italian 11 - Portuguese 12 - Japanese 13 - Arabic 14 - Yiddish 15 - Hebrew 16 - Other 17 - Unknown/Refused Y - Yes N No U - Unknown/Refused Y - Yes N No U - Unknown/ Refused other than English? Must be Value. See error 072. Question: For persons speaking or using a language other than English (answering yes to the question above); What is the language? Required when Other Language = Y. See error 074. Must be blank when Other Language = N or U. See error 081. Question: Are you deaf or do you have serious difficulty hearing? Must be Value. See error 076. Question: Is there indication from sources other than the individual (e.g. third party report; interviewer's observation; medical records, etc.) that the individual has hearing loss? Must be Value. See error A A A Beacon Health Options Page 23 of 70

24 77 78 Vision Loss (self- identified) Vision Loss (other identified) N R R N R R Y - Yes N No U - Unknown/ Refused Y - Yes N No U - Unknown/ Refused Question: Are you blind or do you have serious difficulty seeing even when wearing glasses? Must be Value. See error 080. Question: Is there indication from sources other than the individual (e.g. third party report; interviewer's observation; medical records, etc.) that the individual has uncorrected vision loss? Must be Value. See error 082. Must be Value. See error A A Mode(s) of Communication Utilized - ASL Mode(s) of Communication Utilized - Other Manual Communication (cued speech; gestures; signed exact English, other signed languages, etc.) Mode(s) of Communication Utilized - Communication Aids N R R N R R N R R Y - Yes N No Y - Yes N - No Y - Yes N - No At least one Mode of Communication (ASL, Other Manual Communication, Communication Aids, Communicate Verbally, Other Communication) must =Y. See error 087. Must be Value. See error 086. At least one Mode of Communication (ASL, Other Manual Communication, Communication Aids, Communicate Verbally, Other Communication) must =Y. See error 087. Must be Value. See error 088. At least one Mode of Communication (ASL, Other Manual Communication, Communication Aids, Communicate A A A Beacon Health Options Page 24 of 70

25 82 (any type of device used for communication) Mode(s) of Communication Utilized - Communicate verbally (regardless of proficiency) N R R Y - Yes N - No Verbally, Other Communication) must =Y. See error 087. Must be Value. See error 090. At least one Mode of Communication (ASL, Other Manual Communication, Communication Aids, Communicate Verbally, Other Communication) must =Y. See error 087. Must be Value. See error A Mode(s) of Communication Utilized - Other communication Preferred Mode of Communication N R R N R R Y - Yes N - No 1 - ASL 2 - Other Manual Communication (cued speech; gestures; signed exact English, other signed languages, etc.) 3- Communication Aids (any type of device used for communication) 4 - Communicate verbally (regardless of proficiency) 5 - Other communication At least one Mode of Communication (ASL, Other Manual Communication, Communication Aids, Communicate Verbally, Other Communication) must =Y. See error 087. Question: What is the individual's preferred mode of communication? Must be Value. See error A A Beacon Health Options Page 25 of 70

26 Guardian Indicator Parent/Legal Guardian /Representative Last Name Parent/Legal Guardian /Representative First Name Parent/Legal Guardian /Representative Address Line 1 Parent/Legal Guardian /Representative Address Line 2 Parent/Legal Guardian /Representative City Parent/Legal Guardian /Representative State Parent/Legal Guardian /Representative N R R N C C N C C N C C Y Yes N No U Unknown/Refused Question: Is the individual a minor or does s/he have a legal Guardian/ Representative? Must be Value. See error 096. Must be Y when Parent/Legal Guardian Information is populated. See error 095. Must be entered when Guardian Indicator = Y. See error 098. Must be entered when Guardian Indicator = Y. See error 098. Must be entered when Guardian Indicator = Y. See error A A A A N N N A N C C N C C N C C Must be entered when Guardian Indicator = Y. See error 102. Must be valid per USPS. See error 102 Must be entered when Guardian Indicator = Y. See error 104. Must be State. See error 104. Must be numeric. Must be 5 characters A A A Beacon Health Options Page 26 of 70

27 Zip Code Must be entered when Guardian Indicator = Y and be valid. See error 107. Must be for City and State entered. See error Parent/Legal Guardian /Representative Zip Code Extension N N N Must be numeric and valid. See error 097. Must be 4 characters. See error 099. Must be numeric. See error A 94 Parent/Legal Guardian /Representative Phone Area Code N C C Must be populated if Parent/Legal Guardian/Representative Phone Exchange or Suffix are populated. See error 109. Must be 3 characters when entered. See error 109. Must be numeric. See error A 95 Parent/Legal Guardian /Representative Phone Exchange N C C Must be populated if Parent/Legal Guardian/Representative Area Code or Suffix are populated. See error 109. Must be 3 characters when entered. See error 109. Must be numeric. See error A 96 Parent/Legal Guardian /Representative Phone Suffix N C C Must be populated if Parent/Legal Guardian/Representative Area Code or Exchange are populated. See error A Must be 4 characters when entered. Beacon Health Options Page 27 of 70

28 97 Parent/Legal Guardian /Representative address N N N See error 109. format = example@example.com. See error 111. Only valid values allowed are underscore ( _ ), decimal letters and numbers A Beacon Health Options Page 28 of 70

29 Field # Trailer Record One trailer record should be included on the file as the last line of the file. Field Description 1 Trailer R Required Values Notes Length Start End Format Must Equal TRAILER Must be entered, See error 001. (This error will stop processing of file). Must have data lines before trailer. See error 002 (This error will stop processing of file) A Must be numeric. See error 003 (This error will stop processing of file). 2 Record Count R Must be 7 digits See error 004 (This error will stop processing of file). (Example: Instead of 1, should read ) N Must be equal to the number detail lines submitted. See error 005 (This error will stop processing of file). Beacon Health Options Page 29 of 70

30 Response Files Naming Convention Response files to submitted batch files will have the following naming conventions: Positions 1 10: Submission ID # (Date and Sequence Number) Date: Positions 1 3 represent year (ex: 015 = 2015) Position 4 represent month: 1 9, A, B, C (ex: November = B) Positions 5 6 represent day (ex: 01 31) Sequence Number: Positions 7 10 represent sequence number Position 11: Letter indicating type of batch file: R = Registration Position 12: Letter indicating type of response file R for Summary File A for Accepted File P for Pended File E for Error/Rejected File I for Pended Resolution File Date and Time Stamp MMDDYY Example RA.MMDDYY , would be an example of an Initial Accepted File name Summary File File will be returned to the provider with the following file name: original submission number with suffix of RR. If there is a file level error (see appendix A) then only a summary file will be returned with the error message of why the file was rejected. Beacon Health Options Page 30 of 70

31 If there is not a file level error than the summary file will contain Upload Status codes of 0 (Accepted), 1 (Rejected), & 2 (Pended). Records with an Upload Status = 0 will also appear on the Accepted Records File. Records with an Upload Status = 1 will also appear on the Error Records File. Records with an Upload Status = 2 will also appear on the Pended Records File. This file will mirror the Input File with the following fields added to the end. The order record in this file (and all response files) will reflect that of the input file. Field # Field Name Field Description Length Format 98 Upload Status File Upload Status (0,1,2) 0 = Accepted 1 = Rejected 2 = Pended 1 A Three records will be added to the end of the Summary File; a count of all records that include an error, a count of all records that were accepted, and a count of all records that were pended. Count of Accepted Records Field Label Field # (Column Header) Domain Values / Possible Responses Length Format 1 Record Number ACCEPT 7 A 2 Record Count Total count of records in the Summary File where Upload Status = 0 15 A ++ Des Count of Rejected Records Field # Field Label (Column Header) Domain Values / Possible Responses Length Format Beacon Health Options Page 31 of 70

32 1 Record Number REJECT 7 A 2 Record Count Total count of records in the Summary File where Upload Status = 1 15 A Count of Pended Records Field Label Field # (Column Header) Record 1 Number Domain Values / Possible Responses Length Format PENDED 7 A 2 Record Count Total Count of records in the Summary File where Upload Status = 2 15 A For example: Provider input file contains 50 records, 10 records in error with 2 errors per record, 35 records accepted with two funds assigned to each individuals, and 5 records pended for possible duplicates with 2 funds assigned to each individual. Current Summary File will contain 50 records New Error Records File will contain 20 records New Accepted Records File will contain 70 records New Pended Records File will contain 10 records Counts on the three trailer records in Summary File: ACCEPTED REJECTED PENDED Accepted Records File File will be returned to the provider with the following file name: original submission number with suffix of RA. File will contain all records from the Summary File that had an Upload Status = 0. This file contains additional fields for Individuals Number, Beacon Health Options Page 32 of 70

33 Funding Source, Registration Number, Effective Date, Expiration Date and Comments. One accepted record will be generated for each fund assigned or for each rejected fund on an accepted registration. The order of the records in this file will reflect the same order of the records of in the Input File. If the Registration Indicator = D and Upload Status = 0, the record will only report once with the funding source, effective date and expiration date blank The Accepted Response Output file will contain the CID to use for the individual being registered. If it was changed from what was submitted there will be a registration comment: Incoming CID has been replaced with corrected CID. This file will mirror the Input File with the following field added to the end. The order record in this file will reflect that of the input file. Field # Field Name Field Description Length Format 98 UPLOAD File Upload Status (0,1,2) STATUS 0 = Accepted 1 A 99 BATDAT Batch Date (example: 12/31/2015 will show as ) 7 A 100 BATSEQ Batch Sequence 5 A 101 SEQNUM Sequence Number 5 A 102 MRASEQ MRA Sequence Number 5 A 103 MEMNM1 Individuals number assigned by the batch registration process (CID or TEMP ID) 15 A 104 FNDSRC Funding Source 4 A 105 STRDAT Equal to Registration Start Date - MMDDYYYY 8 A 106 EXPDAT Equal to Calculated Expiration Date - MMDDYYYY 8 A 107 REGCDE Registration Code 3 A 108 REGCMT Registration Comments 100 A Beacon Health Options Page 33 of 70

34 Error Records File File will be returned to the provider with the following file name: original submission number with suffix of RE. This file layout contains all records from Summary File where Upload Status = 1. Additional fields have been added to the layout to account for error information: Error Code, Error Description. Each input record is replicated on the Error Records File for each Error Code generated. For example, if an input record hits up against 4 different errors in processing, 4 records will appear on Error File for that input record; one for each Error Code and Error Description. The order of the records in this file will reflect the same order of the records of in the input file. The Error Description can be found by matching the Error Code to the Error Code/Descriptions List below. The file layout will mirror the Input File Layout with the following fields added to the end. The order record in this file will reflect that of the input file. Field# Field Name Field Description Length Format 98 UPLOAD File Upload Status (0,1,2) STATUS 1 = Rejected 1 A 99 ERRCDE Error Code 3 A 100 ERRDSC Error Description 100 A Pended Records File File will be returned to the provider with the following file name: original submission number with suffix of RP. File will contain all records from Summary File that had an Upload Status = 2. This file contains additional fields for Temporary ID, Funding Source, registration number, effective date, expiration date, and Comments. One pended file record will be generated for each fund assigned or for each rejected fund on a pended registration. The order of the records in this file will reflect the same order of the records of in the input file. Beacon Health Options Page 34 of 70

35 If the Registration Indicator = D and Upload Status = 2, the record will only report once with the funding source, effective date and expiration date blank. If there are multiple CIDs found for one individual or there is a potential that this individual is someone we already have on file then the registration will pend for investigation. There will be a temporary ID assigned and the registration will be reported on the pended registration output file. This registration should not be submitted again. You will receive a pended resolution output file with the CID for this individual once this has been resolved. The registration record and funds will be transferred from the TEMP ID to this individual s CID. You can submit for authorization under the TEMP ID. The file layout will mirror the Input File Layout with the following fields added to the end. The order record in this file will reflect that of the input file. Field # Field Name Field Description Length Format 98 UPLOAD File Upload Status (0,1,2) STATUS 2 = Pended 1 A 99 BATDAT Batch Date (example: 12/31/2015 will show as ) 7 A 100 BATSEQ Batch Sequence 5 A 101 SEQNUM Sequence Number 5 A 102 MRASEQ MRA Sequence Number 5 A 103 MEMNM1 Temp individuals number assigned by the batch registration process 15 A 104 FNDSRC Funding Source 4 A 105 STRDAT Equal to Registration Start Date - MMDDYYYY 8 A 106 EXPDAT Equal to Calculated Expiration Date - MMDDYYYY 8 A Beacon Health Options Page 35 of 70

36 Pended Records Output File File will be returned to the provider with the following file name: original submission number with suffix of RI. File will contain all records resolved from the prior Pended Records File. File will show CID for each pended record as well as Temporary ID for the individual that was assigned in the Pended Records File. The Record number and the Provider assigned ID for the individual, from the Input File, will also show in the Pended Records Output File. Layout for the file is shown below. Field # Field Name Field Description Length Format 1 Record Number Record number from Input file 7 N 2 Provider Number Provider Identification Number 15 A 3 Provider Internal Tag ID Provider assigned ID for the Individual 15 A 4 Individuals Number Individuals assigned CID 15 A 5 Last Name Last Name 60 A 6 First Name First Name 35 A 7 Date of birth Date of birth 7 N 8 Temporary Individual Number Temporary ID from Pended Records file 15 A 9 Batch Date Part of Registration number 7 N 10 Batch Sequence Part of Registration number 5 N 11 Sequence Number Part of Registration number 5 N 12 MRA Sequence Number Part of Registration number 5 N 13 Resolution Code* Resolution Code 8 A 14 Resolution Description* Resolution Description 200 A *Please see Appendix G Beacon Health Options Page 36 of 70

37 Appendix A Error Processing Below is a list of all Error Codes and the corresponding Error Message. ERROR CODE/DESCRIPTIONS FILE LEVER ERRORS: 001 TRAILER RECORD IS REQUIRED 002 FILE SUBMISSION IS BLANK 003 RECORD COUNT MUST BE NUMERIC 004 RECORD COUNT MUST BE 7 DIGITS 005 RECORD COUNT MISMATCH 006 INPUT FILE NOT SUBMITTED IN CORRECT FORMAT, PLEASE CORRECT AND RESUBMIT 011 RECORD NUMBER MUST BE A 7 DIGIT NUMBER 012 RECORD NUMBERS MUST INCREASE BY RECORD NUMBER MUST BE NUMERIC FIELD LEVEL ERROR CODES - NON-DEMOGRAPHIC: 013 REGISTERING PROVIDER ID NOT FOUND 014 REGISTRATION INDICATOR IS MISSING/INVALID 015 NO PRIOR REGISTRATION ON FILE 016 REGISTRATION START DATE IS MISSING 017 REGISTRATION START DATE MUST BE IN THE FORMAT MMDDYYYY 018 REGISTRATION START DATE CANNOT BE A FUTURE DATE 019 REGISTRATION START DATE EXCEEDS BACK DATING LIMIT. PLEASE USE MORE CURRENT DATE 021 REGISTRATION START DATE MUST BE BLANK ON A DEMOGRAPHIC CHANGE FIELD LEVEL ERROR CODES - DEMOGRAPHICS W/O FUND IMPACT 026 INDIVIDUALS ID NUMBER (CID) IS REQUIRED FOR RE- REGISTRATION AND DEMOGRAPHIC CHANGES Comments Beacon Health Options Page 37 of 70

38 027 ON A DEMO CHANGE THE DATE OF BIRTH CANNOT CROSS BETWEEN ADULT AND CHILD 028 LAST NAME IS MISSING 029 FIRST NAME IS MISSING 030 DATE OF BIRTH IS MISSING/INVALID 031 DATE OF BIRTH CANNOT BE GREATER THAN REGISTRATION START DATE 032 DATE OF BIRTH MUST BE IN THE FORMAT MMDDYYYY 033 ON A DEMO CHANGE THE DATE OF BIRTH CANNOT CROSS BETWEEN CHILD AND ADULT 034 SSN OR SSN UNKNOWN INDICATOR MUST BE POPULATED 035 SSN IS INVALID 036 EITHER SSN OR SSN UNKNOWN MUST BE INDICATED, BUT BOTH CANNOT BE POPULATED 037 SSN INDICATOR INVALID VALUE 038 GENDER IS MISSING/INVALID 039 FILLER MUST BE BLANK Appears multiple times in layout. 040 RACE IS MISSING/INVALID 041 ETHNICITY IS MISSING/INVALID 042 MARITAL STATUS IS MISSING/INVALID 043 MARITAL STATUS MUST BE BLANK ON DEMOGRAPHIC CHANGES 044 UNKNOWN ADDRESS MARKED AS Y, AND STREET ADDRESS FIELDS ARE POPULATED 045 UNKNOWN ADDRESS AND NO ADDRESS CANNOT BOTH BE SELECTED 046 UNKNOWN ADDRESS INVALID VALUE 047 NO ADDRESS MARKED AS Y, AND STREET ADDRESS FIELDS ARE POPULATED 048 NO ADDRESS INVALID VALUE 049 ADDRESS LINE 1 MISSING 050 CITY IS MISSING/INVALID 051 STATE IS MISSING/INVALID Beacon Health Options Page 38 of 70

39 052 INDIVIDUAL S CITY, STATE, AND ZIP CODE IS NOT A VALID USPS COMBINATION 053 ZIP CODE IS MISSING/INVALID 054 COUNTY IS MISSING/INVALID 055 INDIVIDUALS PHONE NUMBER MUST BE NUMERIC Appears multiple times in layout. 056 PRIMARY HOME PHONE IS INCOMPLETE Appears multiple times in layout. 057 SECONDARY PHONE NUMBER MUST BE NUMERIC 058 EITHER PRIMARY HOME PHONE OR NO PHONE MUST BE POPULATED 059 NO PHONE INVALID VALUE 060 NO PHONE MARKED AS YES, PHONE NUMBER IS POPULATED 061 SECONDARY PHONE NUMBER IS INCOMPLETE Appears multiple times in layout. 062 INDIVIDUAL S MUST BE IN A VALID FORMAT 063 ALTERNATE CONTACT S CITY, STATE, AND ZIP CODE IS NOT A VALID USPS COMBINATION 064 ALTERNATE CONTACT INFORMATION IS INCOMPLETE 065 ALTERNATE CONTACTS PHONE NUMBER MUST BE NUMERIC 066 ALTERNATE CONTACT RELATIONSHIP IS INVALID 067 ALTERNATE CONTACT PHONE NUMBER IS INCOMPLETE Appears multiple times in layout. 068 VETERAN STATUS INVALID OR MISSING WHEN REQUIRED 069 INDIVIDUALS ZIP CODE EXTENSION IS NOT NUMERIC 070 LANGUAGE/ENGLISH PROFICIENCY INVALID OR MISSING WHEN REQUIRED 071 INDIVIDUALS ZIP CODE EXTENSION IS LESS THAN 4 BYTES. 072 OTHER LANGUAGE INVALID OR MISSING WHEN REQUIRED 073 ALTERNATE CONTACTS ZIP CODE EXTENSION IS NOT NUMERIC 074 LANGUAGE SPECIFICATION INVALID OR MISSING WHEN REQUIRED 075 ALTERNATE CONTACT ZIP CODE EXTENSION IS LESS THAN 4 BYTES Beacon Health Options Page 39 of 70

40 076 HEARING LOSS - SELF IDENTIFIED INVALID OR MISSING WHEN REQUIRED 077 MEDICAID ID MUST NOT CONTAIN SPECIAL CHARACTERS 078 HEARING LOSS - OTHER IDENTIFIED INVALID OR MISSING WHEN REQUIRED 079 MEDICARE ID MUST NOT CONTAIN SPECIAL CHARACTERS 080 VISION LOSS - SELF IDENTIFIED INVALID OR MISSING WHEN REQUIRED 081 LANGUAGE SPECIFICATION SHOULD BE BLANK WHEN OTHER LANGUAGE IS NOT YES 082 VISION LOSS - OTHER IDENTIFIED INVALID OR MISSING WHEN REQUIRED 083 ALTERNATE CONTACT ADDRESS LINE 1 CANNOT BE BLANK IF ALTERNATE CONTACT CITY, STATE OR ZIP ARE POPULATED 084 MODE OF COMM USED - ASL INVALID OR MISSING WHEN REQUIRED 085 ALTERNATE CONTACT LINE 2 CANNOT BE POPULATED WITHOUT AN ADDRESS LINE MODE OF COMM USED OTHER MANUAL INVALID OR MISSING WHEN REQUIRED 087 AT LEAST ONE MODE OF COMMUNICATION MUST BE CHOSEN 088 MODE OF COMM USED COMM AIDS INVALID OR MISSING WHEN REQUIRED 089 FUTURE USE 090 MODE OF COMM USED VERBAL INVALID OR MISSING WHEN REQUIRED 091 FUTURE USE 092 MODE OF COMM USED OTHER COMM INVALID OR MISSING WHEN REQUIRED 093 FUTURE USE 094 PREFERRED MODE OF COMM INVALID OR MISSING WHEN REQUIRED 095 GUARDIAN FIELDS POPULATED WHEN INDICATOR IS MARKED AS NO OR UNKNOWN 096 GUARDIAN INDICATOR INVALID OR MISSING WHEN REQUIRED 097 GUARDIANS CONTACTS ZIP CODE EXTENSION IS NOT NUMERIC 098 GUARDIAN NAME IS MISSING 099 GUARDIANS ZIP CODE EXTENSION IS LESS THAN 4 BYTES 100 GUARDIAN ADDRESS LINE 1 IS MISSING 101 FUTURE USE 102 GUARDIAN CITY IS MISSING/INVALID Beacon Health Options Page 40 of 70

41 103 ALTERNATE CONTACT CITY IS MISSING/INVALID 104 GUARDIAN STATE IS MISSING/INVALID 105 ALTERNATE CONTACT STATE IS MISSING/INVALID 106 GUARDIANS PHONE NUMBER MUST BE NUMERIC 107 GUARDIAN ZIP IS MISSING/INVALID 108 ALTERNATE CONTACT ZIP CODE IS MISSING/INVALID 109 GUARDIAN PHONE NUMBER IS INCOMPLETE Appears multiple times in layout. 110 GUARDIAN CITY, STATE, AND ZIP CODE IS NOT A VALID USPS COMBINATION 111 GUARDIAN/REPRESENTATIVE MUST BE IN A VALID FORMAT FOR THIS REGISTRATION 112 CANNOT SUBMIT MEDICAID ID WHEN INDIVIDUALS INFORMATION IS NOT KNOWN 113 FUTURE USE 114 MEDICAID STATUS MUST BE BLANK FOR DEMOGRAPHIC CHANGE 115 INDIVIDUAL IS 19 OR OVER, MEDICAID STATUS SHOULD BE LEFT BLANK 116 INDIVIDUAL IS 19 OR OVER, PRIVATE HEALTH INSURANCE SHOULD BE LEFT BLANK 117 CITY IS REQUIRED WHEN INDIVIDUAL IS HOMELESS 118 STATE IS REQUIRED WHEN INDIVIDUALS CITY IS POPULATED 119 INDIVIDUAL S CID MUST BE NUMERIC 120 CANNOT REGISTER, INDIVIDUAL IS UNDER 4 YEARS OF AGE INDIVIDUALS UNDER 4 ARE NOT ELIGIBLE, IF PREVIOUSLY REGISTERED, PLEASE CONTACT CUSTOMER SERVICE FIELD LEVEL ERROR CODES - DEMOGRAPHICS W/ FUND IMPACT 200 HOUSEHOLD INCOME IS MISSING/INVALID 201 HOUSEHOLD INCOME MUST BE BLANK DEMOGRAPHIC CHANGE 202 FAMILY SIZE IS MISSING/INVALID 203 FAMILY SIZE MUST BE BLANK FOR DEMOGRAPHIC CHANGE 204 LAWFUL PRESENCE INVALID OR MISSING WHEN REQUIRED 205 LAWFUL PRESENCE MUST BE BLANK FOR DEMOGRAPHIC CHANGE 206 MEDICAID STATUS IS INVALID OR MISSING FOR INDIVIDUAL UNDER 19 Beacon Health Options Page 41 of 70

42 207 PRIVATE HEALTH INSURANCE IS REQUIRED IF INDIVIDUAL DOESN T HAVE MEDICAID 208 PRIVATE HEALTH INSURANCE MUST BE BLANK FOR DEMOGRAPHIC CHANGE 209 PEACHCARE APP STATUS INVALID OR MISSING WHEN REQUIRED 210 PEACHCARE APP STATUS MUST BE BLANK FOR DEMOGRAPHIC CHANGE 211 INDIVIDUALS INCOME IS MISSING/INVALID 212 INDIVIDUALS INCOME MUST BE BLANK FOR DEMOGRAPHIC CHANGE 213 INDIVIDUAL S INCOME UNKNOWN/REFUSED IS MISSING/INVALID 214 INDIVIDUAL S INCOME UNKNOWN/REFUSED MUST BE BLANK FOR DEMOGRAPHIC CHANGE 215 OTHER ALLOWABLE SITUATION MUST BE POPULATED FOR THIS PEACHCARE APPLICATION SELECTION 216 OTHER ALLOWABLE SITUATION MUST BE BLANK FOR DEMOGRAPHIC CHANGE 217 HOUSEHOLD INCOME UNKNOWN/REFUSED IS MISSING/INVALID 218 HOUSEHOLD INCOME UNKNOWN/REFUSED MUST BE BLANK FOR DEMOGRAPHIC CHANGE 220 PRIOR WOMEN S TREATMENT AND RECOVER SERVICES FUND NOT ON FILE 221 INCOMING MEDICAID STATUS YES - MEDICAID IS NOT ACTIVE, PRIVATE HEALTH FIELD CANNOT BE BLANK 225 PEACHCARE STATUS MUST BE BLANK WHEN YES OR UNKNOWN/REFUSED IS SELECTED FOR PRIVATE HEALTH INSURANCE 226 OTHER ALLOWABLE SITUATIONS SHOULD BE BLANK WHEN PEACHCARE APPLICATION STATUS IS NOT PRIVATE HEALTH INSURANCE IS MISSING OR INVALID 228 HOUSEHOLD INCOME MUST BE GREATER THAN OR EQUAL TO INDIVIDUALS INCOME 229 INDIVIDUAL S INCOME CANNOT BE POPULATED WHEN INDIVIDUAL INCOME UNKNOWN = U 230 FAMILY INCOME CANNOT BE POPULATED WHEN FAMILY INCOME UNKNOWN = U FIELD LEVEL ERROR CODES - FUND SOURCES: Beacon Health Options Page 42 of 70

43 251 FUTURE USE 252 CANNOT SELECT ANY OTHER FUND WHEN THIS FUND IS SELECTED 253 FUTURE USE 254 REFERRAL INDICATOR IS MISSING/INVALID 255 REFERRAL INDICATOR MUST BE BLANK ON DEMOGRAPHIC CHANGES 256 TEMPORARY INDICATOR IS MISSING/INVALID 257 TEMPORARY INDICATOR MUST BE BLANK ON DEMOGRAPHIC CHANGES 258 INDIVIDUAL UNKNOWN INDICATOR IS INVALID FOR THIS REGISTRATION 259 INDIVIDUAL UNKNOWN INDICATOR MUST BE BLANK ON DEMOGRAPHIC CHANGES 260 INDIVIDUAL UNKNOWN INDICATOR MUST BE BLANK DEMOGRAPHIC CHANGE 261 UNKNOWN IS SELECTED WHEN ALL RELATED FIELDS ARE POPULATED 262 TREATMENT COURT INDICATOR IS MISSING/INVALID 263 TREATMENT COURT INDICATOR MUST BE BLANK ON DEMOGRAPHIC CHANGES 264 TREATMENT COURT FUND CANNOT BE SELECTED CANNOT BE SELECTED WITH OTHER FUND SELECTED 265 TREATMENT COURT FUND CANNOT BE SELECTED WHEN LAWFULLY PRESENT IS NO OR UNKNOWN 266 CBAY_MFP INDICATOR IS MISSING/INVALID 267 CBAY_MFP INDICATOR MUST BE BLANK ON DEMOGRAPHIC CHANGES 268 CBAY STATE FUND CANNOT BE SELECTED WHEN LAWFULLY PRESENT IS NO OR UNKNOWN 269 CBAY CANNOT BE SELECTED CANNOT BE SELECTED WITH OTHER FUND SELECTED FUTURE USE 290 WOMENS TREATMENT AND RECOVERY SERVICES INDICATOR IS MISSING/INVALID 291 WOMENS TREATMENT AND RECOVERY SERVICES INDICATOR MUST BE BLANK ON DEMOGRAPHIC CHANGES 292 WOMENS TREATMENT AND RECOVERY SERVICES CANNOT BE SELECTED WITH OTHER FUND SELECTED Beacon Health Options Page 43 of 70

44 293 WOMENS TREATMENT AND RECOVERY SERVICES CANNOT BE SELECTED WHEN LAWFULLY PRESENT IS NO OR UNKNOWN FUTURE USE 298 THIS FUND CANNOT BE SELECTED WHEN INDIVIDUAL IS MALE 299 WOMENS TREATMENT AND RECOVERY SERVICES END DATE MUST BE IN THE FORMAT MMDDYYYY 300 WOMENS TREATMENT AND RECOVERY SERVICES END DATE MUST BE BLANK ON DEMOGRAPHIC CHANGES 301 WOMENS TRTMNT & RECOVERY SERVICES END DATE CAN'T BE BEFORE REG START DATE IF WTS FUND IS SELECTED PROVIDER ERRORS: 326 PROVIDER IS NOT CONTRACTED FOR FUND BEST MATCH ERRORS: 500 INCOMING CID NOT ON FILE 501 INCOMING MEDICAID NOT ON FILE 502 INCOMING FIRST NAME DOES NOT MATCH THE FIRST NAME ON FILE FOR THE INDIVIDUAL S CID 503 INCOMING LAST NAME DOES NOT MATCH THE LAST NAME ON FILE FOR THE INDIVIDUAL S CID 504 INCOMING BIRTH DATE DOES NOT MATCH THE BIRTHDATE ON FILE FOR THE INDIVIDUAL S CID 505 INCOMING FIRST NAME DOES NOT MATCH THE FIRST NAME ON FILE FOR THE INCOMING MEDICAID NUMBER 506 INCOMING LAST NAME DOES NOT MATCH THE LAST NAME ON FILE FOR THE INCOMING MEDICAID NUMBER 507 INCOMING BIRTHDATE DOES NOT MATCH THE BIRTHDATE ON FILE FOR THE INCOMING MEDICAID NUMBER 508 INCOMING FIRST NAME DOES NOT MATCH THE FIRST NAME ON FILE FOR THE INCOMING SOCIAL SECURITY NUMBER Beacon Health Options Page 44 of 70