Maryland IMMUNET System

Transcription

1 Maryland IMMUNET System HMO Data Exchange Specifications Application Version 1.0 Last Updated: November 25,

2 Maryland State Immunization Information System Maryland State Immunization Information System (IMMUNET) allows HMO Organizations to query client demographic and immunization data for their plan participants. In order for HMO Organizations to perform HMO Data Exchange with IMMUNET, the following steps must be performed: 1. HMO Organizations that would like to exchange data with IMMUNET should contact the IMMUNET Help Desk at (410) or by IMMUNET staff will explain the HMO Data Exchange process to your organization. The IMMUNET staff will also activate your organization in IMMUNET and create the required HMO user accounts. 2. Once your organization and user accounts have been activated, your organization will begin the data exchange testing process. The IMMUNET staff will require test Client Data, Immunization Data and Query files to verify they are formatted correctly and can be successfully uploaded through the IMMUNET user interface. The IMMUNET staff will assist with troubleshooting any file format issues found during this testing process but it is the responsibility of the HMO Organization to format the files correctly. 3. After the testing process has been successfully completed and approved by the IMMUNET Staff, the HMO Organization can begin submitting actual files to the IMMUNET Production environment. 4. In order for an HMO Organization to successfully query a plan participant, an association to the client in IMMUNET must be established. To establish an association to a client in IMMUNET, the HMO Organization will be required to submit a Client file that includes demographic information including a unique HMO Chart Number. Note: The Client Data file specifications begin on page 3 of this document. The Immunization Data file specifications begin on page 4 of this document. 5. Once the Client Data file has been successfully uploaded into IMMUNET, the Chart Number will be assigned to the matching clients. At this point, the association to the client has been established and the client can now be queried by the HMO Organization. 6. An optional Immunization Data file can also be uploaded into IMMUNET. When the associated client is queried by the HMO Organization, the client s immunization history will also be returned. 7. HMO Organizations must submit a Query file in IMMUNET to return Demographic and Immunization data. In order for a client to be returned in the outbound Query Response files, an exact match must occur. The Query file specifications begin on page 8 of this document. Note: If more than one client matches the Query file submission, IMMUNET will not return any Demographic or Immunization data for those clients. An exact match is required for HMO Data Exchange. 7. Once the Query file has been processed, IMMUNET will return Demographic and Immunization data for matching clients. If no matches were found, multiple matches found or errors occurred during file processing, an Exception file will be returned. The Demographic, Immunization and Exception file specifications begin on page 9 of this document. The files can be viewed or saved by the HMO user. 2

3 Submitting Client Data files: HMO data is passed to IMMUNET using a Client Data file. The file will be linked via a 24-character Record Identifier supplied by the HMO. This identifier will uniquely identify each client in IMMUNET. Character fields need to be left justified and blank-filled, number fields right justified and blank-filled, and date fields in format MMDDYYYY with leading zeroes. If an HMO organization is unable to supply any information for a specified field, the entire field needs be filled with spaces. Below are the fields to include in the Client Data file. Files need to be generated using the ASCII character set. Records will be fixed length and need to be terminated with a carriage return/line feed. If you have questions on concerning Client Data files, contact the IMMUNET Help Desk at dhmh.mdimmunet@maryland.gov. Client Data file specifications: Column Data type Required Default Notes Record Identifier Char(24) Y Supplied by sender, used to link a Client to Immunization records. Client Status Char(1) A Use the IMMUNET code set for Client Status. First Name Char(25) Y If client does not have a first name, NO FIRST NAME must be entered in this field. Middle Name Char(25) Last Name Char(35) Y Name Suffix Char(10) JR, III, etc. Birth Date Date(8) Y MMDDYYYY Death Date Date(8) MMDDYYYY Mother s First Name Mother s Maiden Char(25) Char(35) These are mandatory fields in IMMUNET. However, if the information is unavailable for historical records, fill these fields with blanks. Last Name Sex (Gender) Char(1) Use the IMMUNET code set for Sex (Gender). Race Char(1) Use the IMMUNET code set for Race. Ethnicity Char(2) Use the IMMUNET code set for Ethnicity. Contact Allowed Char(2) 02 Controls whether notices are sent. Use the IMMUNET code set for Contact. If <null> default to 02. Consent to Share Char(1) <null> Use Y or <null> Note: If a client 19 years of age or older has signed and submitted the ImmuNet Opt Out form, enter a N in this field to reject the client and related immunization records from being loaded via data exchange. Chart Number Char(20) Y Identifier within the sending organization s system Responsible Party First Name Char(25) The name of the contact person for the client if other than self. Responsible Party Middle Name Char(25) 3

4 Column Data type Required Default Notes Responsible Party Char(35) Last Name Responsible Party Char(2) Use the IMMUNET code set for Relationship. Relationship Street Address Char(55) The primary address of the client/contact. PO Box Route Line Char(55) Other Address Line Char(55) City Char(52) State Char(2) Zip Char(9) If +4 zip is used, the first 5 characters and second 4 characters are concatenated into a single value, without separators. County Char(5) Client s county of residence. Use the IMMUNET code set for Counties. Phone Char(17) Format as digits only starting with the area code, ex Sending Organization Immunization Data Column Char(10) Data type Required Default Notes 4 This is ID of the provider organization that owns this client and corresponding immunization records. Contact the IMMUNET Help Desk for the appropriate organization ID * This field is optional if an organization is sending all of its own records. This field is required if an organization other than the organization that owns the record(s) is transmitting this file. Record Identifier Char(24) Y Supplied by sender, used to link Immunizations to a Patients record. Vaccine Group Char(16) * Use the IMMUNET code set for Vaccine CPT Code Char(5) * Codes. *Either Vaccine Group or CPT Code is required. Trade Name Char(24) Use the IMMUNET code set for Vaccine Codes. Vaccination Date Date(8) Y MMDDYYYY Administration Route Code Char(2) Use the IMMUNET code set for Administration Route. Body Site Code Char(4) Use the IMMUNET code set for Body Site. Reaction Code Char(8) Use the IMMUNET code set for Reaction. Manufacturer Code Char(4) Use the IMMUNET code set for Manufacturers. Immunization Information Source Char(2) 00 Indicates whether this immunization was administered by your organization or the

5 Column Data type Required Default Notes immunization information is historical from client record. Use 00 for an immunization which was administered by the sending organization. For Historical Doses, please use values 01 through 08. Use the IMMUNET code set for Immunization Information Source. Lot Number Char(30) Converted records will be stored in IMMUNET as historical records, so the Lot Number will not correspond to inventory tracked in IMMUNET, but Lot Number can still be stored as historical information. Provider Name Char(50) The historical provider name. Administered By Name Char(50) The name of the person who administered the vaccination. Site Name Char(30) The name of the clinic site where the vaccination occurred. Sending Organization Char(10) This is ID of the provider organization that owns this patient and corresponding immunization records. Contact the IMMUNET Help Desk for the appropriate organization ID. * This field is optional if an organization is sending all of its own records. This field is required if an organization other than the organization that owns the record(s) is transmitting this file. Financial Class (VFC Eligibility Status) Vaccine Purchased With (Funding Type) Char(4) Char(3) Populate with appropriate HL7 table 0064 values Valid Values V00 (VFC Eligibility not determined/unknown), V01 (Not VFC eligible), V02 (VFC Eligible - Medicaid/Medicare Managed Care), V03 (VFC Eligible Uninsured), V04 (VFC Eligible American Indian /Alaskan Native), V05 (VFC Eligible Underinsured), and CH00 (Healthy Kids Not VFC eligible). Populate with appropriate value from HL7 table NIP008 Valid values PVF (private fund) or PBF (public funds) IMMUNET Code Set: Table Item Code Description Client Status A Active M Moved or Gone Elsewhere N Inactive P Permanently inactive deceased 5

6 Table Item Code Description Sex (Gender) F Female M Male U Unknown Race I American Indian or Alaska Native A Asian or Pacific Islander B Black or African-American W White O Other U Unknown Ethnicity NH Non-Hispanic H Hispanic Relationship 18 Self 61 Aunt 62 Brother 33 Father 87 Foster Father 88 Foster Mother 97 Grandfather 98 Grandmother 26 Guardian 32 Mother B7 Sister 64 Spouse 48 Stepfather 49 Stepmother D3 Uncle MD003 MD005 MD009 MD011 MD013 MD015 MD017 MD019 MD021 MD023 MD025 MD027 MD029 MD031 MD033 MD035 Anne Arundel Baltimore Calvert Caroline Carroll Cecil Charles Dorchester Frederick Garret Harford Howard Kent Montgomery Prince George s Queen Anne s 6

7 Table Item Code Description MD037 Saint Mary s MD039 Somerset MD041 Talbot MD043 Washington MD045 Wicomico MD047 Worcester MD510 Baltimore city 7

8 HMO Query Specification: An HMO can query the immunization information system by using HMO Query files. These files will contain the client s name, date of birth and chart number or Medicaid number. Character fields need to be left justified and blank-filled and date fields in format MMDDYYYY with leading zeroes. If a site is unable to supply any information for a specified field, the entire field needs be filled with blanks. Below are the fields to include in the HMO Query file. The file needs to be generated using the ASCII character set. Records will be fixed length and need to be terminated with a carriage return/line feed. HMO Query Format Column Data Type Required Notes Record Type Char(1) Y C or M for Commercial or Medicaid Record Identifier Char(20) Y The HMO Chart Number or Medicaid number used by this organization for the client. First Name Char(25) Y Middle Name Char(25) N Last Name Char(35) Y Birth Date Char(8) Y MMDDYYYY Example: Records need to be blank filled. In the following example, blanks are represented with the * character for illustrative purposes. C ************JOHN*********************MICHAEL******************SMITH****************************** From this sample file we can see the HMO is querying on a Commercial Record by the use of C in character 1. The client s Chart Number for the HMO is indicated in characters The client s name is John Michael Smith. The client has a birth date of 01/01/

9 HMO Query Results: If the HMO Query file finds an exact match, IMMUNET will return the client s Demographic and Immunization data in two response files. The Demographic and Immunization files are fixed length and will include the following data elements: Demographic: Column Field Length Position Notes Chart Number or Medicaid Number First Name Middle Name Last Name Birth Date MMDDYYYY Example: The Demographic file will contain blank spaces to fulfill the defined field lengths. In the following example, blanks are represented with the * character for illustrative purposes ************JOHN*********************MICHAEL******************SMITH****************************** From this sample file we can see the HMO query resulted in one matching client. The client s Chart Number for the HMO is indicated in characters The client s name is John Michael Smith. The client has a birth date of 01/01/1999. Immunization: Column Field Length Position Notes Chart Number or Medicaid Number CPT Vaccine Group Administered Date MMDDYYYY Filler 1 50 Example: The Immunization file will contain blank spaces to fulfill the defined field lengths. In the following example, blanks are represented with the * character for illustrative purposes ************90658Influenza******* * ************90648Hib************* * 9

10 From this sample file we see that Chart Number returned two immunization records. CPT 90658, Vaccine Group Influenza was Administered on 01/01/2013. CPT 90648, Vaccine Group Hib was Administered on 02/01/2013. HMO Query Results continued: If the HMO Query does not find an exact match or if the file does not follow the correct format, IMMUNET will return an Exception response file. The Response file is fixed length and will include the following data elements: Exception: Column Field Length Position Notes Record Type 1 1 Record Type might display in position 21 depending on Error Message returned. Chart Number or Medicaid Number Error Message Begins in 22 Examples: The Exception file will contain blank spaces to fulfill the defined field lengths. In the following example, blanks are represented with the * character for illustrative purposes. C ************Query record is too short. From this sample file we can see the HMO queried using a Commercial Record by the use of C in character 1. The client s Chart Number for the HMO is indicated in characters The Error Message Query record is too short indicates the Exception that was returned after the HMO Query file was processed in IMMUNET and it did not meet the defined field lengths ************CThe chart number was not found in the IMMUNET database for this provider organization. The Chart Number submitted by the HMO was indicated in characters From this sample file we can see the HMO queried using a Commercial Record by the use of C in character 21. The Error Message The chart number was not found in the IMMUNET database for this provider organization indicates the Exception that was returned after the HMO Query file did not find a matching client in IMMUNET. 10