Physical Interface BCBS Paperless Enrollment - Employees ...

ANCHOR User Interface Review 

Physical Interface – BCBS Paperless Enrollment 

Physical Interface 

BCBS Paperless Enrollment 

Description: 

This batch utility is run on a weekly basis to extract all retirees who have enrolled or cancelled coverage 

since the last report. This information should be sent as a text file to BCBS Rhode Island. 

File disposition: 

ANCHOR will produce this file and store it on the server. 

ERSRI will transfer the file to OLIS or BCBS at their discretion by the method/media of their choice (refer 

to VBCBS for transmission options). 

Control Report: 

The control report produced with this file will display counts of records, grouped by source type and 

activity code. 

Example: 

Source Activity Count 

---------- ----------- ------- 

B add 383 

B cnc 347 

C add 210 

C cnc 32 

Data Rules: 

File Format: Text file, no delimiters 

ALL TEXT IN FILE TO BE UPPERCASE. 

The file consists of records 400 characters in length. 

Rule 1: Find new policies created since the last extract. Select all policies where the Enrollment 

Transmittal Date is null and the ‘Bill by Carrier’ indicator is false or null. Write the ‘add’ activity 

record(s)[rule 2] to the extract for the policy owner (‘S’ – subscriber record) and set the enrollment 

transmittal date for that policy (in the LOB database) equal to the current business date. 

Rule 2: Extract AT LEAST one record for each healthcare policy being initiated (new enrollments). Extract 

one record for the policy holder, and one record for each covered individual on that policy. For each 

covered individual, write a ‘D’ – dependent record to the extract. 

Rule 3: If the write of the subscriber or any dependents for a policy fail, do not update the transmittal date 

and write an error to the control report. 

Rule 4: Find policies that have had end dates put on them since the last extract. Select all policies with an 

end date AND the Enddate Transmittal Date is null. Write the ‘cnc’ activity record to the extract and 

update the enddate transmittal date to the current business date. Extract one record for each healthcare 

policy being cancelled (the subscriber record). 

HP-SLED Page 1 of 4 1/7/2011



BCBS Item Name 

Required 

Position 

Length 

source identifier Yes 1 5 ‘PENSb’ 

source type Yes 6 1 'b', 'c' 

record type Yes 7 1 's', 'd' 

activity code Yes 8 

'add', 

3 'chg','cnc' 

subscriber id number No 11 15 SPACES 

dependent number No 26 3 SPACES 

subscriber social security number Yes 29 9 

dependent social security number Yes 38 9 

group number -- right justified 47 6 

subgroup number -- right justified 53 3 

new group number -- right justified 56 6 SPACES 

new subgroup number -- right justified 62 3 SPACES 

Valid Values Description Data Rule 

Source 

Identifier 

Where b stands for Blank. 

It is always ‘PENSb’ 

carrier code of 

the policy 

being 

reported, 'b' for BCBS, 'c' for CHip 

record type 

being 

reported. 

activity being 

reported 

BCBS ID 

number spaces 

BCBS ID 

number spaces 

group number 

that identifies 

ERSRI 

'S' for subscriber, 'd' for 

dependent; report at least 

one record for each policy; 

if coverage is for family, 

report one dependent 

record for each covered 

individual 

'add' = new 

coverage(policy) being 

reported, 'cnc' =cancel 

exisiting policy; Always an 

'add' or 'cnc', ERSRI will 

never report 'changes' 

If 'record type' is 's' or 'd', 

populate with policy holder 

SSN. 

If 'record type' is 'd', 

populate with covered 

individual SSN. 

Carrier_Grp_Id from 

BE_HC_Pkg; Right 

justified 

Always Blanks; Right 

justified 

only used by BCBS for 

'changes' which we will 

not report - always pop. 

W/ SPACES 

only used by BCBS for 

'changes' which we will 

not report - always pop. 

W/ SPACES 




group package number 65 3 

last name 68 15 

identifier for 

'Healthmate' 

or 'Plan65', 

etc. 

Carrier package Id from 

be_hc_pln_ref 

Last name of person 

being reported; truncated 

current first name 83 10 

First name of person 

being reported; truncated 

used by BCBS for 

changes only, always 

new first name 93 10 SPACES 

SPACES 

middle initial 103 1 Middle Initial; truncated 

title (jr, sr, iii, etc.) 104 3 

sex code 107 1 'm', 'f' 

relationship code 108 3 

marital status 111 1 'm', 's' 

subscriber contract type 112 3 'ind', 'fam' 

relationship of 

reported 

person to 

policy holder 

Name suffix of person 

being reported 

sub' = subscriber, 'sps' = 

spouse, 'chd' = child, 'stu' 

= student, 'hcd' = 

handicap; from ANCHOR 

database 'family 

relationship', dependent 

child = chd; dependent 

adult = hcd 

if rel. code = 'sps' then 'm'; 

marital status if child, stu, hcd then 's'; 

of person for subscriber, indicate 

being reported actual marital status. 

policy 

coverage 

coverage of the policy 

being reported; Individual 

or Family 

two-person indicator 115 1 SPACES not used by ERSRI 

current date of birth (yyyymmdd) 116 8 

new date of birth (yyyymmdd) 124 8 SPACES not used by ERSRI 

subscriber address 1 Yes 132 25 Address Line 1 

subscriber address 2 Yes 157 25 Address Line 2 

subscriber address 3 (foreign address 

use only) No 182 25 

Address Line 3, only if 

foreign address 

city No 207 16 not for foreign addresses 

state No 223 2 not for foreign addresses 

zip No 225 5 not for foreign addresses 

From the Policy; with 

pharmacy number No 230 10 

leading ZERO’s 

From the Policy; with 

PCP number No 240 10 

leading zeroes 

Start date of policy in 

effective date (yyyymmdd) Yes 250 8 

ANCHOR 




termination reason Yes 258 

always use 'ml' indicating a 

voluntary cancellation of 

2 'd', 'ml', 'dv', 'oi', 'oa', 'sr', 'nc' coverage 

employee number No 260 9 SPACES not used by ERSRI 

department number No 269 4 SPACES not used by ERSRI 

current health insurance indicator 273 2 SPACES not used by BCBS 

current dental insurance indicator 275 1 SPACES not used by BCBS 

cob id number 276 15 SPACES not used by BCBS 

subscriber phone number 291 10 999999999 

only pop if record type is 

's' subscriber 

filler 301 49 SPACES 

primary care physician cancel indicator 350 1 SPACES not used by ERSRI 

pharmacy cancel indicator 351 1SPACES not used by ERSRI 

effective change date indicator 352 1 SPACES not used by BCBS 

former health insurance carrier 353 2 SPACES not used by BCBS 

Medicare (HCFA) identification number 355 

99999999999 

12 9 

Medicare number of 

covered individual 

CHiP division (group) number 367 10 SPACES not used by BCBS 

employer status 377 2 SPACES not used by BCBS 

employee hire date (yyyymmdd) 379 8 SPACES not used by BCBS 

filler 388 12 SPACES filler 


ANCHOR Billing Rec File 

Description: 


Billing Rec File 

This batch utility is monthly, after the pension run, to extract all retirees who had a payroll deduction for 

Medicare Complete . This file is extracted from the file created by the batch utility ‘Extract Healthcare 

information’. 

Data Rules: 

1.File Format: Text file, comma delimited 

File Layout: 

Last name: Char(30) 

First name: Char(20) 

Social security Number: Char(9) 

Months being paid: Char(60) 

Amount being paid: Char(10) 

Package code : Char(5) 

HP‐SLED Page 1 of 1 1/7/2011


Physical Interface - COBRA Expiration File 


PI-COBRA Expiration File 

Description: 

The COBRA Expiration File is used for creating the COBRA Expiration Letters. 

The COBRA Expiration File is generated through an SQR process that reads the information from a 

temporary table in the database and creates a text file. This text file will be used to generate the COBRA 

Expiration Letters to be sent to the recipients. 

Data Rules: 

The following information must be reported on the file: 

Field Datatype Position Format Comments 

First Name, Alphanumeric 51 char from position 20 char First Name 

Middle 

1 to 51; 

+ 1 char Middle 

Initial, Last 

Initial + 34 char 

Name 

Last Name 

Address 1 Alphanumeric 30 char from position 

52 to 82; 


83 to 113 


114 to 144 

City Alphanumeric 28 char from position 

145 to 173; 

State Alphanumeric 2 char from position 

174 to 175; 

Zip 5 Numeric 5 char from position 

176 to 180; 

99999 

Zip 4 Numeric 4 char from position 

181 to 184; 

9999 

Province Alphanumeric 20 char from position 

185 to 205; 

Postal Code Alphanumeric 10 char from position 

206 to 216; 

Country Alphanumeric 30 char from position 

217 to 247; 

Greeting Alphanumeric 40 char from position 

248 to 288; 

Termination Numeric 6 char from position mm/cc/yy 

Date 

289 to 295 

User First Alphanumeric 51 char from position 20 char User First 

Name, User 

296 to 347 

Name + 1 char User 

Middle 

Middle Initial + 34 

Initial, User 

char User Last 

Last Name 

Name 

User Title Alphanumeric 51 char from position 

348 to 399 



Physical Interface - COBRA Expiration File 


ANCHOR Dental-record format 

State of Rhode Island payment file layout 

Field Name Field Type Field Length Example 

Group Code Character 4 8350 

Sub Location Character 4 0104 

SSN Character 9 XXXXXXXXX 

Contract Character 3 IND or FAM 

Last_Name Character 24 Espo 

First_Name Character 20 Anthony 

Begin_Date Character 8 20060501 

End_Date Character 8 20060601 

Premium Numeric 6,2 23.83 

Retro_Premium Numeric 6,2 47.66 - 2 months coverage 


ANCHOR Eligibility Rec File 

Description: 


Eligibility Rec File 


United‐Medicate Complete HMO. This file is extracted from the file created by the batch utility ‘Extract 

Healthcare information’. 

Data Rules: 

File Format: Text file, comma delimited 

1. Termination date would be blank if there is no end date 

2. If the permanent address is not present the temporary address would be displayed. 

Layout: 

Last name: Char(30) 

First name: Char(20) 

Social security Number: Char(9) 

Billing period date: Char(8) 

Termination date :Char(8) 

Street Address :Char(30) 

City: Char(20) 

State : Char(2) 

Zip code 5 :Char(5) 

Group number: Char(5) 


ANCHOR Healthcare Information File 

Description 

Subscriber 

Record : 

Group/Sub- 

Group Numbers 

Position 

Length 

1 9 

Package Number 10 3 

Owner SSN 13 13 

Subscriber Social 

Security Number 

Subscriber 

Contract Type 

Relationship 

Code 

26 9 

35 3 

38 3 

'FAM', 'IND' 

Valid Values Description data rules 

Carrier_Grp_id from 

BE_HC_pkg char(6) 

+ Carrier_Sub_Grp_id 

from BE_HC_pkg 

char(3) 

Carrier_Pkg_id from 

be_hc_pln_ref. 

We will just retain the 

Will list the owner 13 field length but it 

SSN 

will only by 9 char 

Socail Security 

Number SSN of the subscriber 

policy coverage 'FAM' if family, 'IND' 

if Individual 

SUB' always 'SUB' 

Last Name 41 15 truncate if necessary 

First Name 56 10 truncate if necessary 

Middle Initial 66 1 

Marital Status : 

M = Married 

67 1 

Date-of-Birth : 68 8 

Billing Period : 

From Date 

Billing Period : 

Thru Date 

76 8 

84 8 

'M','S','D','W','P' 

CCYYMMDD 

CCYYMMDD 

CCYYMMDD 

if a spouse policy, 'M'; 

if a retiree policy, if 

spouse relationship 

exists, 'M', else, 'S'; 

divorced, widowed 

and seperated not used 

in ANCHOR 

Date of birth of the 

policy person 

1 st day of the month 

following the pension 

run (9/26/2002 

pension run deducts 

premiums for 

October, so start date 

= 10/01/2002) 

Last day of the month 

following the pension 

run (9/26/2002 

pension run deducts 

premiums for 

October, so end date = 

10/31/2002) 



premium amount 92 10 

Tier 1 subsidy 

amount 

Tier 2 subsidy 

amount 

Tier 2 Subsidy 

category 

Retro premium 

amount 

Retro Subsidy 

Amount Tier 1 

Retro Subsidy 

Amount Tier 2 

RetroPayment 

Health Care 

Amount 

99999999V99 

102 10 

99999999V99 

112 10 

99999999V99 

122 10 

132 10 

'0','10','20','30','40','50','60','70','80','90',' 

100' 

99999999V99 

142 10 

99999999V99 

152 10 

99999999V99 

162 10 

99999999V99 

Regular Health 

care deduction 

amount 

Regular basic 

state subsidy 

amount 

Regular state 

subsidy amount 

Subsidy 

percentage 

Retro Health 

Care Deductions 

Retro deduction 

basic state subsidy 

amount 

Retro deduction 

state subsidy 

amount 

Retro Payments 

for Health Care 

if item type is 

'Healthcare - retiree', 

'Healthcare - spouse', 

Dental, Vision, 

pharmacy regardless 

of coverage (family or 

individual) put the 

pyrl_adj_hist amount 

here 

'Basic' state subsidy - 

the fixed subsidy 

amount 

the graduated subsidy 

amount that is based 

on service credit, etc. 

The percentage 

subsidy determined 

when the premiums 

were calculated. 

if item type is 'Retro 

Healthcare Retiree', 

'Retro Healthcare 

Spouse', 'retro vision', 

'retro dental' or 'retro 

pharm', regardless of 

coverage (family or 

individual) put the 

pyrl_adj_hist amount 

HP-SLED Page 2 of 4 1/7/2011 

here 

If a retro premium 

was deducted, this 

represents the First 

(Tier 1 / Basic) 

subsidy amount of the 

retro premium 

If a retro premium 

was deducted, this 

represents the Tier 2 


(variable) of the retro 

premium 

if item type is 'Retro 

Payment Healthcare 

Retiree', 'Retro 

Payment Healthcare 

Spouse', 'retro 

payment vision', 'retro 

payment dental' or 

'retro payment pharm', 

regardless of coverage 

(family or individual) 

put the


Retro Payment 

Subsidy Amount 

Tier 1 

Retro Payment 

Subsidy Amount 

Tier 2 

172 10 

Rule # 192 5 

99999999V99 

182 10 

99999999V99 

char(5) 

Rule Description 197 80 

record type 277 2 

'HC','V','D','P' 

Payroll Date 279 10 

CCYYMMDD 

Policy Owner 289 1 

pyrl_adj_hist/fnc_item 

amount here 

If a retro payment 

premium amount 

represents the First 

(Tier 1 / Basic) 

Retro payment subsidy amount of the 

basic state subsidy premium amount 

amount deducted 

If a retro payment 

premium amount 

represents the Tier 2 


Retro payment (variable) of the 

State Subsidy premium amount 

amount deducted 

Client rule code from 

Rule Cli Cd from plan healthcare rule 

BE_HC_Rule_Ref table 

Rule Description client rule description 

from 

from healthcare rule 

BE_HC_Rule_Ref table 

Is this a record for 

Health, Vision, Dental 

or Pharmacy? (what 

was the payroll 

deduction type?) 

date of last pension 

payroll 

'1','2' 1 = retiree; 2 = spouse 

Vendor 290 4 9999 

Billed By Carrier 294 1 boolean 

Retirement Plan 295 8 

Benefit Structure 303 4 

the retirement 

plan the retiree is 

part of (ERS, 

MERS, JDGS, 

STPL) 

vendor org_id 

associated with the 

associated policy 

plan_cli_cd from 

be_pln (policy - 

rcpnt_acct - bene_acct 

- plan) 

client cd from 

bene_struc_ref (policy 



Employee Group 307 4 

Retirement Type 311 2 

ERSRI 

healthcare plan 

ID 

ERSRI 

Healthcare Plan 

Name 

Owner sex 

Employer start 

date 

Date of 

retirement 

Service credit 

313 8 

321 

40 

361 1 

8 

362 

370 

8 

378 5 

Recipient Gender 383 

Recipient DoB 

Policy start date 

Health care 

contribution 

percentage 

384 

392 

400 

1 

8 

8 

5 

CCYYMMDD 

CCYYMMDD 

999V99 

CCYYMMDD 

CCYYMMDD 

999V99 

- rcpnt_acct - 

bene_acct - 

bene_struc_ref) 

emp group from 

bene_struc_ref (policy 

- rcpnt_acct - 

bene_acct - 

bene_struc_ref) 

Retirement Type of 

the benefit account 

HealthCare plan Id 

Health Care plan 

name 

this field will show 

the health care 

percentage that the 

retiree will be paying 

If a policy is a family policy then there will a record for every covered individual in the policy, for all the dependent 

records premium amount,Tier 1 subsidy amount,Tier 2 subsidy amount,Tier 2 Subsidy category,Retro premium 

amount,Retro Subsidy Amount Tier 1,Retro Subsidy Amount Tier 2,RetroPayment Health Care Amount,Retro 

Payment Subsidy Amount Tier 1,Retro Payment Subsidy Amount Tier 2 will be showns as ZERO 

And Rule #,Rule Description,Vendor,Billed By Carrier,Retirement Plan,Benefit Structure,Employee 

Group,Retirement Type,ERSRI healthcare plan ID,ERSRI Healthcare Plan Name will be have the value that of the 

subscriber details 


ANCHOR Medicare Billing File Layout 

Column Headings 

Field Name: Identifies what specific data should be placed in this field. 

Position Start: Indicates the starting position of the field. 

Position End: Indicates the ending position of the field. 

Field Length: Indicates the maximum number of bytes for the data. 

Identifies whether the field should be completed for the employee, 

dependent, or both. The following codes are used in this field: 

E = Indicates field is required for employee (subscriber) record 

D = Indicates field is required for dependent 

B = Indicates field is required for both employee and dependent 

Required: Identifies if the customer is required to populate this field with data. The 

following codes are used in this field: 

R = Required: The customer is required to populate this field as noted. 

O = Optional: The customer can determine through their eligibility process if 

they want to populate this field. 

C = Conditional: The customer may be required to populate these fields 

based on the values in other fields. 

Description: Defines the "Field Name". 

Values In: Specifies the Gateway Standard Format values that the customer will use to 

populate fields. 

Header Record Requirements: 

The header record must be the very first record on the file, and the format must be as follows: 

Field Name Position Position Field Field Required Description Values In 

Start End Length Type 

Header Filler 1 19 19 R Filler area must be spaces. Blank 

Header Detail 20 27 8 R Total number of detail records Must be a right justified, 

record Count 

excluding the Header Record. zero filled, numeric value. 

Header Filler 28 R Must be a pipe delimiter. A 

carriage return should 

immediately follow the pipe 

delimiter. No spaces or 

added characters should be 

sent between the pipe and the 

return. 

| 

Member Record Requirements 

Fields highlighted in yellow are required fields and must be sent on the file. All data should be 

left justified. No default or filler values should be placed in trailing spaces. All uppercase 

character data is preferred, but it some instances it is required. Fields requiring uppercase data 

are noted. Your Electronic Eligibility Analyst will advise you if any of the filler fields should be 

populated. 

Field Name Position 

Position Field Field Required Description Values In 


Version Indicator 1 5 5 B R Indicates layout version 

submitted. 

Use code: V1.20 





Submission 6 13 8 B R The 4-8 character ID assigned Your Electronic Eligibility 

Group ID 

by the Electronic Eligibility Analyst will inform you of 

Analyst for this submission 

group. The submission group 

ID must be in all capital 

letters. 

this code. 

14 25 12 B R LEAVE BLANK Blank 

Relationship 26 27 2 B R Identifies if the record is for 18= Employee 

Code 

an employee or dependent. 01= Spouse 

19= Child 

Note: If a relationship code of 20= Student 

20 (student) is sent, UHG will 34= Retiree 

generate a Student Status 02= Surviving Spouse 

Verification letter that will be 38= Collateral Dep 

mailed to the member. Do 23= Sponsored Dep 

not use relationship code 20 if 09= Stepchild 

UHG is not verifying student 21= Handicapped Dep 

status for your group. 22= Handicapped 

Student 

35= New Born 

53= Life Partner 

36= Other 

Employee ID 28 38 11 B R The unique employee Subscriber social security 

identifier. (See eligibility number should be used. 

guide for information on 

alternate identification 

numbers.) 

Format: 00 + 9-digit SSN 


Member Social 43 53 11 B O The member's Social Security Member's social security 


Number. If unknown this number. Format: 

field must be Leave Blank. 

Duplicate SSN's are not 

permitted. 

00 + 9-digit SSN 


Former EE ID 58 72 15 E O If the employee ID is 

The prior employee ID 

*not commonly 

changing the prior employee Format: 

used 

ID is entered in this field for 

reporting. 


Personnel ID 

*not commonly 

used 

73 83 11 E O Personnel ID number 


Employment 89 96 8 E R The date the employee YYYYMMDD 

Date 

started work with the 

company. 


Member Last 109 128 20 B R The member's last name. Member's last name 

Name 

No punctuation should be 

included. 

Member First 129 140 12 B R The member's first name. Member's first name 

Name 

Note: Due to system 

constraints, do not include 

middle name or middle initial 

in this field. No punctuation 

should be included. 


Member Middle 

Initial 

149 149 1 B O The member's middle initial. Member's middle initial 


Member Birth 

Date 

169 176 8 B R The member's date of birth. YYYYMMDD 






Member Gender 189 189 1 B R The member's gender. M = Male 

F = Female 

U = Unknown 

Member Marital 190 190 1 B R The member's marital status. B= Registered Domestic 

Status 

Partner 

D= Divorced 

I= Single 

M= Married 

R= Unreported 

S= Separated 

W= Widowed 

U= Unmarried/Unknown 

COB Flag 191 191 1 B O Indicates if member has other Y = Yes other coverage 

*not commonly 

coverage. If used should only N or Blank = No other 

used 

be sent for new enrollees and coverage 

then the information should 

be dropped from the file 

COB Date 192 211 20 B O Start date of Coordination of YYYYMMDD 

*not commonly 

Benefits (COB). If used 

used 

should only be sent for new 

enrollees and then the 

information should be 

dropped from the file. 

Language 212 214 3 E O Indicates primary language of Field should be left blank 

*not commonly 

used 

member. 

Permanent 215 246 32 B R Member's street address. Member's primary street 

Street Address 1 

This field is required for all 

members. No punctuation 

should be included. Both 

subscribers and dependents 

must have a permanent 

address passed on your file. 

address 

Permanent 247 278 32 B O The member's second line of Member's secondary 


street address (Apt Number, 

PO Box, Care of Address, 

Etc.). No punctuation should 

be included. This is an 

optional field and should be 

used only if Permanent Street 

address 1 is completed. 

street address 

Permanent City 279 298 20 B R The member's city. This field 

is required for all members. 


included. Both subscribers 

and their dependents must 

have a permanent city passed 

on your file. 

Member's city address 

Permanent State 299 300 2 B R The member's state. No 

punctuation should be 

included. Must be in all capital 

letters. 

Member's state address 

Permanent Zip 301 315 15 B R 5-digit zip code and 4-digit zip 5-digit zip code and 4- 

Code 

code extension. The 5-digit 

zip code is a required field for 

digit zip code extension. 

domestic addresses; the zip Canadian zip code 

code extension is optional and format: Canadian 

can be left blank. 

alphanumeric codes must 

have a space between 

Note: Do not include a dash the third and fourth byte 

(-) between the 5 digit zip of the postal code in this 

code and the 4 digit zip code field. For example, 

extension. 

A9A_9A9. 





Permanent 316 317 2 B R The Country the employee Must be 2 characters in 

Country Code 

resides in. 

For a complete listing of 

country codes use the 

following web address – 

http://www.iso.ch/iso/en/pro 

ds-services/iso3166ma/02iso- 

3166-code-lists/index.html 

length. For example, 

USA = US. 


Mailing Street 319 350 32 B C Member's mailing street Member's primary mailing 

Address 1 

address. The Mailing address street address 

fields should be used if the 

member has a mailing 

address different from that of 

the Permanent address. No 


included. 

Mailing Street 351 382 32 B C The member's second line of Member's secondary 

Address 2 

mailing street address (Apt 

Number, PO Box, Care of 

Address, Etc.). This is an 


used only if street address 1 

is completed. No punctuation 


mailing street address. 

Mailing City 383 402 20 B C Member's mailing city. No 


included. 

Member's mailing city. 

Mailing State 403 404 2 B C Member's mailing state. No 



letters. 

Member's mailing state 

Mailing Zip Code 405 419 15 B C 5-digit zip code and 4-digit zip 5-digit zip code and 4- 












extension. 

A9A_9A9. 

Mailing Country 420 421 2 B C The Country the employee Must be 2 characters in 

Code 

resides in. 








USA = US. 


Home Phone 423 432 10 B R Members 10 digit home phone Members home phone 

Number 

number. No dashes or spaces number. 

allowed. 

Death Date 433 440 8 E C Members death date YYYYMMDD 






XREF/Payee 453 454 2 E C This field should be completed 01 = spouse 

Indicator 

only if this record is for a 11 = Surviving 

survivor situation, or if Dependent 

sending an opt-out EE w/opt- 18 = Self 

in dependents. The code is 

used to indicate whom the 

XREF name/number belongs 

to. 

20 = Military 

XREF/Payee Last 455 474 20 E C Last name of survivor. Survivor's last name 

Name 

This field should only be 

completed if the payee 

indicator field is populated. 

XREF/Payee First 475 486 12 E C First name of survivor. Survivor's first name 

Name 

This field should be only 




XREF/Payee SSN 495 505 11 E C Social Security Number of Survivor's social security 

survivor. 

number 

This field should only be Format: 00 + 9-digit 



SSN. 


Special Util 4 510 521 12 E C Utility field that will feed data Blank or customer 

to TOPS. 

specific data. 

Sub-Department 522 529 8 E C The Sub-Department number This field should be left 

Nbr 

sorts employees on the blank. 

*not commonly 

invoice within employer's 

used 

specific sub-departments. 

Retirement Date 530 537 8 B C The date the member retires. YYYYMMDD 

This is required field for 

members with a retiree 

status. 


Primary 

546 559 14 B C Member's primary care Primary Care Physician 

Physician 

physician identification identification number 

MPIN/Location 

number. 

Format:0000+7-digit 

MPIN+0+2-digit Location 

Code. For example: 

00001234567012 


Primary 

562 569 8 B C The date the member’s YYYYMMDD 

Physician Start 

primary physician became or 

Date 

will become effective. 


Primary 

582 589 8 B O The date the member is no YYYYMMDD 

Physician Stop 

longer covered by this 

Date 

*not commonly 

used 

primary physician. 


Primary 

602 606 5 B O The independent practice Independent practice 

Physician IPA 

association number of the association number 

*not commonly 

used 

primary care physician. 

Primary 

607 608 2 B O Indicates if the member is a 25= Established Patient 

Physician Current 

current patient of the primary 26= Not Established 

Patient Indicator 

care physician. 

Patient 

72= Unknown 

Filler Field 609 609 1 Blank Blank 







Special Util 2 650 669 20 Utility field that will feed data Blank or customer 

to UBH. 


Special Util 3 670 689 20 Utility filed that will feed data Blank or customer 

to Billing. 


Salary Year 690 693 4 E C CCYY 

Salary 694 703 10 E C 

Salary In Area 

OOP 

704 708 5 E C 

Salary Out Area 

OOP 

709 713 5 E C 


Ded 

714 718 5 E C 


Ded 

719 723 5 E C 

Com-Util1 724 731 8 B O For future or customer 

specific field requirements. 



Member Utility1 740 747 8 B O For future or customer 


Special Utility1 748 755 8 B O For future or customer 


Coverage 1 756 758 3 B R Field used for first coverage Product Codes: 

Coverage Type 

type selected by member. EXM= Executive Medical 

Coverage type must be DCP= Dental Capitation 

passed with all capital letters. DEN= Dental 

EPO= Exclusive Provider 

Note: Normally Coverage Organization 

type 1 is for Medical 

HE= Hearing 

Coverage. MM is the 

AG= Preventative Care 

recommended code for HMO= Health 

medical coverage. 

Maintenance Organization 

MM= Major Medical 

AK may be used for stand- IND = Indemnity 

alone (S) coverage such as AS= Accident and 

OPTUM. 

Sickness 

MOD= Mail Order Drug 

PDG= Prescription Drug 

RX2= Mail Order Drug 

and Prescription Drug 

POS= Point of Service 

PPO= Preferred Provider 

Plan 

PRA= Practitioners 

VIS= Vision 

AK= Mental Health 

LTC= Long Term Care 

LTD= Long Term 

Disability 

STD= Short Term 

Disability 

UR= Utilization Review 

BLF= Basic Life 

SLF= Supplemental Life 

DEL= Dependent Life 

SAD= Supplemental 

AD&D 

Coverage 1 759 766 8 B R The date the member's YYYYMMDD 

Coverage Start 

coverage becomes effective 

Date 

with UHG. 






Coverage 1 779 786 8 B C The date member's coverage YYYYMMDD 

Coverage End 

is cancelled or will be 

Date 

cancelled. 

Coverage 1 

Coverage Paid 

Thru Date 

Coverage 1 

Structure Field 1 

Coverage 1 


Coverage 1 


Coverage 1 


Coverage 1 


787 798 12 B R 

Note: A Coverage End Date 

should only be passed if a 

member is terminating this 

coverage type with UHC. 

Coverage End Dates may not 

be more than 30-days in the 

future, and once a member 

terminates all coverage types 

and a term date is passed 

that member must be 

dropped off the file. 

LEAVE BLANK Blank 

799 806 8 B C The date in which the 

member has paid thru his/her 

COBRA coverage. 

This field only should be used 

in COBRA situations. 

YYYYMMDD 


819 825 7 B R Seven-digit customer number 

assigned by UHG. 

The entry will be the same for 

all records on the file. 


829 835 7 B R Policy Number of Customer. 

This number along with the 

plan variation code and 

reporting code make up the 

account structure. 

Seven digit Customer 

Number. 


NOTE: Must be seven 

digits long. If shorter 

than seven digits pre-fill 

with zeros to make the 

number seven digits. 

Seven digit Policy 

Number 

NOTE: Must be seven 






839 842 4 B R Four digit numeric Plan 

Variation code within account 

Plan Variation Code 

structure. NOTE: The Plan 

Variation and Reporting Code 

can be found in your copy of 

the Account Structure for this 

group. Your Client Services 

Manager can provide you with 

a copy of this structure. 

For example: 0004 


849 852 4 B R Four digit numeric reporting 

code within the account 

Reporting Code 










859 860 2 B C The Plan Code field is required Blanks = No Embedded 

for plans with Embedded Vision 

Vision Coverage. 

VE = Embedded Vision





Coverage 1 869 878 10 B C Field is reserved for customer Blank or Customer 


specific structure data. specific data. 











Structure Field 

10 


Coverage 1 919 921 3 B O The code indicates which CHD= Children Only 

Members 

members of the family are SD1= Employee and 1 

Covered 

covered for this particular Dep 

coverage. All members of the ECH= Employee and 

family should have the same Children 

Members Coverage Code. EMP= Employee Only 

ESP= Employee and 

THIS IS AN OPTIONAL FIELD Spouse 

BECAUSE UHG DERIVES THE FAM= Family 

INFORMATION BASED ON THE SPO= Spouse Only 

ACTIVE FAMILY MEMBERS IN CH1 = Child Only 

OUR SYSTEM. 

SPC= Spouse and 

Children 

SS1 = Subscriber, 

Spouse + 1 Dependent 

Coverage 1 922 923 2 B C This field is used to indicate TC = UHC Administered 

COBRA 

that the coverage being TY = Customer 

Indicator/Cancel 

reported is being continued as Administered 

Reason 

a result of a COBRA election. 

Your Electronic Eligibility 

Analyst will provide you with 

the appropriate code to use. 

NC = No HIPAA Cert 

Produced. 

Coverage 1 924 931 8 B O For future or customer 

Elig Util-1 



Elig Util-2 



Elig Util-3 



Elig Long Util-1 


Coverage 1 968 974 7 E C The flat amount of the life Dollar amount of life 

Life Flat Amount 

benefit. 

benefit 

Coverage 1 975 978 4 E C Value salary amount is Benefit factor dollar 

Life Benefit 

multiplied by to determine amount 

Factor 

dollar amount of benefit. 

Coverage 1 979 979 1 E C Indicates whether the Y= Dependent Rider was 

Rider Dep Flag 

subscriber selected the selected 

dependent coverage rider. N= Dependent Rider was 

not selected 

Blank= Dependent 

coverage not available 

Coverage 1 980 980 1 E C Indicates whether the Y= Critical Illness Rider 

Rider Critical 

subscriber selected the critical was selected 

Illness 

illness rider. 

N= Critical Illness Rider 

was not selected 

Blank= Critical Illness 



UHG 3005 File Format 

Specifications 

Version 1.20 

April 8, 2005

ANCHOR 

Overview 

The UHG 3005 file format was created in order to standardize the processing of electronic eligibility 

information as it passes through Employer eServices Electronic Eligibility Management System. This 

standardization will allow customers to benefit from all of the processing benefits of Employer eServices 

Electronic Eligibility Management System, as well as provide UnitedHealth Group with a more streamlined 

mapping procedure. The format encompasses processing requirements and incorporates the use of HIPAA 

input values to allow UnitedHealth Group to remain strategic and flexible within the market place. 

In the event that there are governmental or industry changes to the data that UnitedHealth Group is 

required to collect, UnitedHealth Group may modify the UHG 3005 file format. If that occurs, 

UnitedHealth Group would require the customer to change to the new version of the UHG 3005 file format 

within a calendar year. This customer change is required because the Electronic Eligibility Management 

System will not support more than two active versions of the format. 

The following pages provide detailed specifications on the format of the information that should be passed 

on the file. The format of the file provides for demographic information to be passed first, with coverage 

information following. The Employer eServices Electronic Eligibility Management System can currently 

process up to 4 coverage types. Coverage blocks 5-10 are not currently utilized, and are in dark gray on 

the file specifications starting on page 19. The UHG 3005 file format has been designed to accommodate 

future enhancements to our system. 

There are five categories of information that may be included on each record: 

Member Identification Information 

Address Information 

Survivor Information 

Primary Physician Information 

Coverage Information 

These categories of information are described below. 

Member Identification Information 

This category includes information specific to the member such as relationship code, social security 

number, employment date, full name, and date of birth. This information will uniquely identify each 

member of the family on the UnitedHealth Group eligibility system. Please note that middle initials or 

names may not be sent in the first name field as it creates a claim matching issue when a claim is 

processed for the member. 

The following special characters are acceptable within the following fields: 

First name & Payee First name: - ' () . , Hyphen, apostrophe, parentheses, period and comma. These 

characters will be converted to a space in our system. 

Middle name: no special characters are allowed. 

Last name & Payee Last name: - ' Hyphen and apostrophe. These characters will load directly into our 

system as is. The following characters will be converted to a space in our system: . , / * ~ () # % > < " 

Period, comma, slash, asterisk, tilde, parentheses, pound, percentage, greater than, less than, and quote. 


ANCHOR 

Address Information 

The UnitedHealth Group Eligibility System has the ability to store up to 2 addresses for each family, one 

permanent and one mailing address. Every record on your file must have the permanent address field(s) 

populated. This includes both employee and dependent records. The mailing address field(s) should only 

be populated if it is different from the permanent address field(s). 

In addition to the standard postal state abbreviations, AP and AE are also valid when used with 'APO' in 

the state field. 

Foreign Address Processing 

UnitedHealth Group prefers that foreign members be passed with the employer’s domestic HR mailing 

address as the expatriate’s permanent address. 

In the event that this is not an option, UnitedHealth Group has a special handling procedure for 

expatriates. If a foreign address is passed on your electronic file, we will load a UnitedHealth Group 

internal mailing address for the mailing address of the member, and the members foreign address in a 

permanent address field in our system. All member correspondence, including claim payments, EOB's, 

and ID cards, are routed internally for special handling of the member's mail. Mail is then re-mailed to the 

member's foreign address, with the correct postage affixed. 

Note: Puerto Rico and the Virgin Islands are U.S. Territories, therefore those addresses are considered 

domestic. However, Canadian addresses are considered foreign addresses. 

Survivor Information 

UnitedHealth Group requires that surviving member's coverage continue to be passed on the file under the 

deceased employee's identification number, along with the deceased employee's record. The four survivor 

information fields are: 

XREF/Payee Indicator position 453 

XREF/Payee Last Name 455 

XREF/Payee First Name 475 

XREF/Payee SSN 495 

These fields are used only for deceased employee records. When the Payee Indicator field is populated, 

UnitedHealth Group will direct all correspondence (ID cards, Explanations of Benefits, etc.) to the Payee 

name. The XREF data is passed on the deceased employee's record only, along with a date of death 

(position 433). No XREF data is to be passed on the surviving dependent records. 

Each member continuing coverage after the employee's death should be passed on the file along with the 

deceased employee's record. The relationship code (position 26) for each member continuing coverage 

must be populated with the appropriate code: 

02 (surviving spouse) 

19 (child) 

The XREF/Payee Indicator (position 453) should be populated with a 01 (surviving spouse) or 11 

(surviving dependent). 


ANCHOR 

The employee identification number for the entire family will continue to be the deceased employee’s 

identification number, and the XREF/Payee's social security number will be used as a cross-reference. If a 

claim is submitted under either the employee identification number or the XREF/Payee's social security 

number, this family’s record will be retrieved. Continuing the coverage under the deceased employee 

record allows for accurate claim history to be maintained for the family. 

Primary Physician Information 

If Primary Physician information will be passed on your eligibility file for new enrollees in a gatekeeper 

(managed care) medical plan, please pass the following fields: 

Primary Physician MPIN & Location Code 

Primary Physician Start Date 

Primary Physician Current Patient Indicator 

Coverage Data 

While the layout provides for up to 3005 bytes, the file format should be treated as a variable length file 

based on the number of coverage types/blocks being passed on the file. You should adjust your file length 

based on the maximum number of coverage types that will be passed for each member. With the 

exception of the header record, each record for every member should end at the same byte. For example, 

if you send Medical and RX coverage for every member on the file, then you should adjust your record 

length to be 1206 bytes as position 1206 follows the last field related to coverage type two. Instead of 

sending spaces out to position 3005 at the end of each record, we require that you truncate the record 

and send an "end of record indicator". The end of record indicator is a pipe (|). Each record on your file 

must have an end of record indicator as the last character, and this indicator must not appear anywhere 

other than at the end of each record. 

Please use the following guidelines when programming your file based on the coverage types you will be 

passing on your file to UnitedHealth Group: 

One Coverage Type: Each record would end in Position 0981 with a pipe delimiter (|). 

Two Coverage Types: Each record would end in Position 1206 with a pipe delimiter (|). 

Three Coverage Types: Each record would end in Position 1431 with a pipe delimiter (|). 

Four Coverage Types: Each record would end in Position 1656 with a pipe delimiter (|). 

Your Account Management Team will supply the account structure (policy number, plan variation & 

reporting codes) to you. 


ANCHOR 

Fields & Descriptions 

The following pages describe the file format in detail. If you have any questions regarding the file 

specifications, please contact your deployment analyst. 

Column Headings 

Field Name: Identifies what specific data should be placed in this field. 

Position Start: Indicates the starting position of the field. 

Position End: Indicates the ending position of the field. 

Field Length: Indicates the maximum number of bytes for the data. 

Field Type: Identifies whether the field should be completed for the employee, dependent, or 

both. The following codes are used in this field: 

E = Indicates field is required for employee (subscriber) record 

D = Indicates field is required for dependent 

B = Indicates field is required for both employee and dependent 

Required: Identifies if the customer is required to populate this field with data. The following 

codes are used in this field: 

R = Required: The customer is required to populate this field as noted. 

O = Optional: The customer can determine through their eligibility process if they 

want to populate this field. 

C = Conditional: The customer may be required to populate these fields based on the 

values in other fields. 

Description: Defines the "Field Name". 

Values In: Specifies the Gateway Standard Format values that the customer will use to populate 

fields. 

File Name Requirements 

Your file name must be formatted as follows: 

SUBMITID.U.YYYYMMDDHHMM.gsf 

SUBMITID = Submitter ID or Submission Group name (8 characters maximum). All capital letters are 

required. Your Electronic Eligibility Analyst will provide you with the Submitter ID. 

U = Indicates the UnitedHealth Group UNET system platform. The U must be a capital letter. 

YYYYMMDDHHMM = The Date and time stamp is the creation time and date of the file. It must be 

supplied by the customer on every file submitted for processing. The date and time stamp, along with the 

Submitter ID, creates the unique customer file name, which will be linked to the Employer eServices 

Electronic Eligibility Management System to provide eligibility statistics to the customer. 

gsf = Is the file extension used to denote the UHG 3005 Format. All lowercase letters are required. 

Header Record Requirements: 

The header record must be the very first record on the file, and the format must be as follows: 


ANCHOR 



Header Filler 1 17 17 R Filler area must be spaces. Blank 

Header Detail 18 25 8 R Total number of detail records Must be a right justified, 

record Count 

excluding the Header Record. zero filled, numeric value. 

Header Filler 26 R Must be a pipe delimiter. A 

carriage return should 

immediately follow the pipe 

delimiter. No spaces or 

added characters should be 

sent between the pipe and the 

return. 

| 

Member Record Requirements 

Fields highlighted in yellow are required fields and must be sent on the file. All data should be left 

justified. No default or filler values should be placed in trailing spaces. All uppercase character data is 

preferred, but it some instances it is required. Fields requiring uppercase data are noted. Your Electronic 

Eligibility Analyst will advise you if any of the filler fields should be populated. 

Note: Attached is a sample of the UHG 3005 file format, with the header record and member records. 

The file is best viewed with TextPad or UltraEdit. 



Version Indicator 1 5 5 B R Indicates layout version 

submitted. 

Use code: V1.20 

Submission 6 13 8 B R The 4-8 character ID assigned Your Electronic Eligibility 

Group ID 

by the Electronic Eligibility Analyst will inform you of 

Analyst for this submission 

group. The submission group 

ID must be in all capital 

letters. 

this code. 


Relationship 26 27 2 B R Identifies if the record is for 18= Employee 

Code 

an employee or dependent. 01= Spouse 

19= Child 

Note: If a relationship code of 20= Student 

20 (student) is sent, UHG will 34= Retiree 

generate a Student Status 02= Surviving Spouse 

Verification letter that will be 38= Collateral Dep 

mailed to the member. Do 23= Sponsored Dep 

not use relationship code 20 if 09= Stepchild 

UHG is not verifying student 21= Handicapped Dep 

status for your group. 22= Handicapped 

Student 

35= New Born 

53= Life Partner 

36= Other 

Employee ID 28 38 11 B R The unique employee Subscriber social security 

identifier. (See eligibility number should be used. 

guide for information on 

alternate identification 

numbers.) 

Format: 00 + 9-digit SSN 



ANCHOR 



Member Social 43 53 11 B O The member's Social Security Member's social security 


Number. If unknown this number. Format: 

field must be Leave Blank. 

Duplicate SSN's are not 

permitted. 



Former EE ID 58 72 15 E O If the employee ID is 

The prior employee ID 

*not commonly 

changing the prior employee Format: 

used 

ID is entered in this field for 

reporting. 


Personnel ID 

*not commonly 

used 

73 83 11 E O Personnel ID number 


Employment 89 96 8 E R The date the employee YYYYMMDD 

Date 

started work with the 

company. 


Member Last 109 128 20 B R The member's last name. Member's last name 

Name 


included. 

Member First 129 140 12 B R The member's first name. Member's first name 

Name 

Note: Due to system 

constraints, do not include 

middle name or middle initial 

in this field. No punctuation 



Member Middle 

Initial 

149 149 1 B O The member's middle initial. Member's middle initial 


Member Birth 

Date 

169 176 8 B R The member's date of birth. YYYYMMDD 


Member Gender 189 189 1 B R The member's gender. M = Male 

F = Female 

U = Unknown 

Member Marital 190 190 1 B R The member's marital status. B= Registered Domestic 

Status 

Partner 

D= Divorced 

I= Single 

M= Married 

R= Unreported 

S= Separated 

W= Widowed 

U= Unmarried/Unknown 

COB Flag 191 191 1 B O Indicates if member has other Y = Yes other coverage 

*not commonly 

coverage. If used should only N or Blank = No other 

used 

be sent for new enrollees and coverage 

then the information should 

be dropped from the file 

COB Date 192 211 20 B O Start date of Coordination of YYYYMMDD 

*not commonly 

Benefits (COB). If used 

used 

should only be sent for new 

enrollees and then the 

information should be 

dropped from the file. 

Language 212 214 3 E O Indicates primary language of Field should be left blank 

*not commonly 

used 

member. 


ANCHOR 



Permanent 215 246 32 B R Member's street address. Member's primary street 


This field is required for all 

members. No punctuation 

should be included. Both 

subscribers and dependents 

must have a permanent 

address passed on your file. 

address 

Permanent 247 278 32 B O The member's second line of Member's secondary 


street address (Apt Number, 

PO Box, Care of Address, 

Etc.). No punctuation should 

be included. This is an 


used only if Permanent Street 

address 1 is completed. 

street address 

Permanent City 279 298 20 B R The member's city. This field 

is required for all members. 


included. Both subscribers 

and their dependents must 

have a permanent city passed 

on your file. 

Member's city address 

Permanent State 299 300 2 B R The member's state. No 



letters. 

Member's state address 

Permanent Zip 301 315 15 B R 5-digit zip code and 4-digit zip 5-digit zip code and 4- 

Code 












extension. 

A9A_9A9. 

Permanent 316 317 2 B R The Country the employee Must be 2 characters in 

Country Code 

resides in. 








USA = US. 


Mailing Street 319 350 32 B C Member's mailing street Member's primary mailing 

Address 1 

address. The Mailing address street address 

fields should be used if the 

member has a mailing 

address different from that of 

the Permanent address. No 


included. 

Mailing Street 351 382 32 B C The member's second line of Member's secondary 

Address 2 

mailing street address (Apt 

Number, PO Box, Care of 

Address, Etc.). This is an 


used only if street address 1 

is completed. No punctuation 


mailing street address. 


ANCHOR 



Mailing City 383 402 20 B C Member's mailing city. No 


included. 

Member's mailing city. 

Mailing State 403 404 2 B C Member's mailing state. No 



letters. 

Member's mailing state 

Mailing Zip Code 405 419 15 B C 5-digit zip code and 4-digit zip 5-digit zip code and 4- 












extension. 

A9A_9A9. 

Mailing Country 420 421 2 B C The Country the employee Must be 2 characters in 

Code 

resides in. 








USA = US. 


Home Phone 423 432 10 B R Members 10 digit home phone Members home phone 

Number 

number. No dashes or spaces number. 

allowed. 

Death Date 433 440 8 E C Members death date YYYYMMDD 


XREF/Payee 453 454 2 E C This field should be completed 01 = spouse 

Indicator 

only if this record is for a 11 = Surviving 

survivor situation, or if Dependent 

sending an opt-out EE w/opt- 18 = Self 

in dependents. The code is 

used to indicate whom the 

XREF name/number belongs 

to. 

20 = Military 

XREF/Payee Last 455 474 20 E C Last name of survivor. Survivor's last name 

Name 

This field should only be 



XREF/Payee First 475 486 12 E C First name of survivor. Survivor's first name 

Name 

This field should be only 




XREF/Payee SSN 495 505 11 E C Social Security Number of Survivor's social security 

survivor. 

number 

This field should only be Format: 00 + 9-digit 



SSN. 


Special Util 4 510 521 12 E C Utility field that will feed data Blank or customer 

to TOPS. 


Sub-Department 522 529 8 E C The Sub-Department number This field should be left 

Nbr 

sorts employees on the blank. 

*not commonly 

invoice within employer's 

used 

specific sub-departments. 


ANCHOR 



Retirement Date 530 537 8 B C The date the member retires. YYYYMMDD 

This is required field for 

members with a retiree 

status. 


Primary 

546 559 14 B C Member's primary care Primary Care Physician 

Physician 

physician identification identification number 

MPIN/Location 

number. 

Format:0000+7-digit 

MPIN+0+2-digit Location 

Code. For example: 

00001234567012 


Primary 

562 569 8 B C The date the member’s YYYYMMDD 

Physician Start 

primary physician became or 

Date 

will become effective. 


Primary 

582 589 8 B O The date the member is no YYYYMMDD 

Physician Stop 

longer covered by this 

Date 

*not commonly 

used 

primary physician. 


Primary 

602 606 5 B O The independent practice Independent practice 

Physician IPA 

association number of the association number 

*not commonly 

used 

primary care physician. 

Primary 

607 608 2 B O Indicates if the member is a 25= Established Patient 

Physician Current 

current patient of the primary 26= Not Established 

Patient Indicator 

care physician. 

Patient 

72= Unknown 




Special Util 2 650 669 20 Utility field that will feed data Blank or customer 

to UBH. 


Special Util 3 670 689 20 Utility filed that will feed data Blank or customer 

to Billing. 


Salary Year 690 693 4 E C CCYY 

Salary 694 703 10 E C 


OOP 

704 708 5 E C 


OOP 

709 713 5 E C 


Ded 

714 718 5 E C 


Ded 

719 723 5 E C 





Member Utility1 740 747 8 B O For future or customer 


Special Utility1 748 755 8 B O For future or customer 



ANCHOR 



Coverage 1 756 758 3 B R Field used for first coverage Product Codes: 

Coverage Type 

type selected by member. EXM= Executive Medical 

Coverage type must be DCP= Dental Capitation 

passed with all capital letters. DEN= Dental 


Note: Normally Coverage Organization 

type 1 is for Medical 

HE= Hearing 

Coverage. MM is the 


recommended code for HMO= Health 

medical coverage. 



AK may be used for stand- IND = Indemnity 

alone (S) coverage such as AS= Accident and 

OPTUM. 

Sickness 







Plan 


VIS= Vision 




Disability 


Disability 






AD&D 

Coverage 1 759 766 8 B R The date the member's YYYYMMDD 


coverage becomes effective 

Date 

with UHG. 



Coverage End 


Date 

cancelled. 

Coverage 1 

Coverage Paid 

Thru Date 

787 798 12 B R 

Note: A Coverage End Date 

should only be passed if a 

member is terminating this 

coverage type with UHC. 

Coverage End Dates may not 

be more than 30-days in the 

future, and once a member 

terminates all coverage types 

and a term date is passed 

that member must be 

dropped off the file. 

LEAVE BLANK Blank 






YYYYMMDD 



ANCHOR 



Coverage 1 819 825 7 B R Seven-digit customer number Seven digit Customer 




Number. 

all records on the file. NOTE: Must be seven 






Coverage 1 829 835 7 B R Policy Number of Customer. Seven digit Policy 




Number 

reporting code make up the NOTE: Must be seven 







Coverage 1 839 842 4 B R Four digit numeric Plan Plan Variation Code 












Coverage 1 849 852 4 B R Four digit numeric reporting Reporting Code 












Coverage 1 859 860 2 B C The Plan Code field is required Blanks = No Embedded 




VE = Embedded Vision 
















10 



ANCHOR 




Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 

a result of a COBRA election. NC = No HIPAA Cert 

Produced. 

Coverage 1 

Elig Util-1 

Coverage 1 

Elig Util-2 

Coverage 1 

Elig Util-3 

Coverage 1 


Coverage 1 


Coverage 1 

Life Benefit 

Factor 

Coverage 1 


Coverage 1 


Illness 

924 931 8 B O 

Your Electronic Eligibility 

Analyst will provide you with 

the appropriate code to use. 

For future or customer 


932 939 8 B O For future or customer 






968 974 7 E C The flat amount of the life 

benefit. 

975 978 4 E C Value salary amount is 

multiplied by to determine 


979 979 1 E C Indicates whether the 

subscriber selected the 

dependent coverage rider. 

HP-SLED Page 13 of 33 1/7/2011 

Dollar amount of life 

benefit 

Benefit factor dollar 

amount 

Y= Dependent Rider was 

selected 

N= Dependent Rider was 

not selected 



980 980 1 E C Indicates whether the Y= Critical Illness Rider 






coverage not available

ANCHOR 



Coverage 2 981 983 3 B R Field used for second 

Product Codes: 

Coverage Type 

coverage type selected by EXM= Executive Medical 

member. Coverage type DCP= Dental Capitation 

must be passed with all DEN= Dental 

capital letters. 


Organization 

Note: If Rx coverage is HE= Hearing 

offered usually PDG or RX2 is AG= Preventative Care 

sent for coverage 2. 

HMO= Health 


*If a second coverage is MM= Major Medical 

not being offered a pipe IND = Indemnity 

delimiter can be sent in AS= Accident and 

position 981 with a Sickness 

carriage return 


immediately following in PDG= Prescription Drug 

position 982. NO OTHER RX2= Mail Order Drug 

INFORMATION SHOULD BE and Prescription Drug 

SENT ON THIS MEMBER’S POS= Point of Service 

LINE AFTER THE PIPE PPO= Preferred Provider 

DELIMITER. Skip all other Plan 

fields and start a new line PRA= Practitioners 

for the next member VIS= Vision 

covered. 




Disability 


Disability 






AD&D 

Coverage 2 984 991 8 B R The date member's coverage YYYYMMDD 


Date 

becomes effective. 



Coverage End 


Date 

cancelled. 

Coverage 2 

Coverage Paid 

Thru Date 

Coverage 2 








YYYYMMDD 


1044 1050 7 B R Seven-digit customer number Seven digit Customer 



Number. 








ANCHOR 







Number 








Coverage 2 1064 1067 4 B R Four digit numeric Plan Plan Variation Code 












































10 



Members 


Covered 










OUR SYSTEM. 


Children 




ANCHOR 




COBRA 




Reason 


Produced 

Coverage 2 

Elig Util-1 

1149 1156 8 B O 

Coverage 2 

Elig Util-2 

1157 1164 8 B O 

Coverage 2 

Elig Util-3 

1165 1172 8 B O 

Coverage 2 


1173 1192 20 B O 



benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







ANCHOR 



Coverage 3 1206 1208 3 B R Field used for first member’s Product Codes: 

Coverage Type 

coverage type. 

EXM= Executive Medical 

DCP= Dental Capitation 

Note: Coverage Type must be DEN= Dental 

entered with all capital EPO= Exclusive Provider 

letters. 

Organization 

HE= Hearing 

Note: Usually Coverage 3 is AG= Preventative Care 

used for Dental (DEN) or HMO= Health 

Vision (VIS) Coverage. Talk Maintenance 

to your Electronic Eligibility Organization 

Analyst if you have a question MM= Major Medical 

about which code to use. IND = Indemnity 

AS= Accident and 

*If a third coverage is not Sickness 

being offered a pipe MOD= Mail Order Drug 

delimiter can be sent in PDG= Prescription Drug 

position 1206 with a RX2= Mail Order Drug 



immediately following in POS= Point of Service 

position 1207. NO OTHER PPO= Preferred Provider 

INFORMATION SHOULD BE Plan 

SENT ON THIS MEMBER’S PRA= Practitioners 

LINE AFTER THE PIPE VIS= Vision 

DELIMITER. Skip all other AK= Mental Health 

fields and start a new line LTC= Long Term Care 

for the next member LTD= Long Term 

covered 

Disability 


Disability 






AD&D 



Date 




Coverage End 


Date 

cancelled. 


Coverage 3 1249 1256 8 B C The date in which the YYYYMMDD 

Coverage Paid 


Thru Date 









Number. 








ANCHOR 







Number 








Coverage 3 1289 1292 4 B R Four-digit numeric Plan Plan Variation Code 



structure. 





structure. 






















10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 3 

Elig Util-1 

1374 1381 8 B O 

Coverage 3 

Elig Util-2 

1382 1389 8 B O 

Coverage 3 

Elig Util-3 

1390 1397 8 B O 

Coverage 3 


1398 1417 20 B O 



benefit. 

benefit 


ANCHOR 




Life Benefit 


Factor 






not selected 






Illness 







Coverage Type 






letters. 

Organization 

HE= Hearing 

Note: Usually Coverage 4 is AG= Preventative Care 

used for Dental (DEN), Vision HMO= Health 

(VIS), or Optum (Mental Maintenance 

Health Coverage). Talk to Organization 

your Electronic Eligibility MM= Major Medical 

Analyst if you have a question IND = Indemnity 

about which code to use. AS= Accident and 

Sickness 

*If a fourth coverage is MOD= Mail Order Drug 

not being offered a pipe PDG= Prescription Drug 

delimiter can be sent in RX2= Mail Order Drug 

position 1431 with a and Prescription Drug 



immediately following in PPO= Preferred Provider 

position 1432. NO OTHER Plan 

INFORMATION SHOULD BE PRA= Practitioners 

SENT ON THIS MEMBER’S VIS= Vision 

LINE AFTER THE PIPE AK= Mental Health 

DELIMITER. Skip all other LTC= Long Term Care 

fields and start a new line LTD= Long Term 

for the next member Disability 

covered. 


Disability 






AD&D 



Date 




Coverage End 


Date 

cancelled. 



ANCHOR 




Coverage Paid 


Thru Date 










Number. 








Number 





structure. 





structure. 






















10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 4 

Elig Util-1 

1599 1606 8 B O 


ANCHOR 



Coverage 4 

Elig Util-2 

1607 1614 8 B O 

Coverage 4 

Elig Util-3 

1615 1622 8 B O 

Coverage 4 


1623 1642 20 B O 



benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







Coverage Type 






letters. 

Organization 

HE= Hearing 

*If a second coverage is AG= Preventative Care 

not being offered a pipe HMO= Health 

delimiter can be sent in Maintenance 

position 1656 with a Organization 



immediately following in IND = Indemnity 

position 91657. NO OTHER AS= Accident and 

INFORMATION SHOULD BE Sickness 

SENT ON THIS MEMBER’S MOD= Mail Order Drug 

LINE AFTER THE PIPE PDG= Prescription Drug 

DELIMITER. Skip all other RX2= Mail Order Drug 

fields and start a new line and Prescription Drug 

for the next member POS= Point of Service 

covered 


Plan 


VIS= Vision 




Disability 


Disability 






AD&D 



Date 



ANCHOR 




Coverage End 


Date 

cancelled. 


Coverage Paid 


Thru Date 









Number. 







Number 




structure. 




structure. 

Coverage 5 1759 1768 10 B C The Plan Code field is required Blank = No Embedded 





Coverage 5 1769 1778 10 B C Field is reserved for customer CES: 


specific structure data. Blank or Customer out of 

pocket amount. 

Coverage 5 1779 1788 10 B C Field is reserved for customer CES: 


specific structure data. Blanks or Customer 

deductible amount. 









10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 5 

Elig Util-1 

1824 1831 8 B O 

Coverage 5 

Elig Util-2 

1832 1839 8 B O 


ANCHOR 



Coverage 5 

Elig Util-3 

1840 1847 8 B O 

Coverage 5 


1848 1867 20 B O 



benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







Coverage Type 






letters. 

Organization 

HE= Hearing 


HMO= Health 

Maintenance 

Organization 


IND = Indemnity 


Sickness 







Plan 


VIS= Vision 




Disability 


Disability 






AD&D 



Date 



Coverage End 


Date 

cancelled. 


ANCHOR 




Coverage Paid 


Thru Date 









Number. 







Number 




structure. 




structure. 




















10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 6 

Elig Util-1 

2049 2056 8 B O 

Coverage 6 

Elig Util-2 

2057 2064 8 B O 

Coverage 6 

Elig Util-3 

2065 2072 8 B O 

Coverage 6 


2073 2092 20 B O 


ANCHOR 





benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







Coverage Type 






letters. 

Organization 

HE= Hearing 


HMO= Health 

Maintenance 

Organization 




Sickness 







Plan 


VIS= Vision 




Disability 


Disability 






AD&D 



Date 



Coverage End 


Date 

cancelled. 


ANCHOR 




Coverage Paid 


Thru Date 









Number. 







Number 




structure. 




structure. 




















10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 7 

Elig Util-1 

Coverage 7 

Elig Util-2 

Coverage 7 

Elig Util-3 

Coverage 7 


2274 2281 8 B O 

2282 2289 8 B O 

2290 2297 8 B O 

2298 2317 20 B O 


ANCHOR 





benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







Coverage Type 






letters. 

Organization 

HE= Hearing 


HMO= Health 

Maintenance 

Organization 




Sickness 







Plan 


VIS= Vision 




Disability 


Disability 






AD&D 



Date 



Coverage End 


Date 

cancelled. 


ANCHOR 




Coverage Paid 


Thru Date 









Number. 







Number 




structure. 




structure. 




















10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 8 

Elig Util-1 

Coverage 8 

Elig Util-2 

Coverage 8 

Elig Util-3 

Coverage 8 


2499 2506 8 B O 

2507 2514 8 B O 

2515 2522 8 B O 

2523 2542 20 B O 


ANCHOR 





benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







Coverage Type 






letters. 

Organization 

HE= Hearing 


HMO= Health 

Maintenance 

Organization 




Sickness 







Plan 


VIS= Vision 




Disability 


Disability 






AD&D 



Date 



Coverage End 


Date 

cancelled. 


ANCHOR 




Coverage Paid 


Thru Date 









Number. 







Number 




structure. 




structure. 




















10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 9 

Elig Util-1 

2724 2731 8 B O 

Coverage 9 

Elig Util-2 

2732 2739 8 B O 

Coverage 9 

Elig Util-3 

2740 2747 8 B O 

Coverage 9 


2748 2767 20 B O 


ANCHOR 





benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







Coverage Type 






letters. 

Organization 

HE= Hearing 


HMO= Health 

Maintenance 

Organization 




Sickness 







Plan 


VIS= Vision 




Disability 


Disability 






AD&D 



Date 



Coverage End 


Date 

cancelled. 


ANCHOR 




Coverage Paid 


Thru Date 









Number 







Number 




structure. 




structure. 




















10 



Members 


Covered 










OUR SYSTEM. 


Children 




COBRA 




Reason 


Produced 

Coverage 10 

Elig Util-1 

2949 2956 8 B O 

Coverage 10 

Elig Util-2 

2957 2964 8 B O 

Coverage 10 

Elig Util-3 

2965 2972 8 B O 

Coverage 10 


2973 2992 20 B O 


ANCHOR 





benefit. 

benefit 


Life Benefit 


Factor 






not selected 






Illness 







ANCHOR Health care Supplemental NCPJ 

Interface: Generate Health care ,Supplemental, NCPJ 

Description: 

Generates files for Health care ,Supplemental, NCPJ 

Data Rules: 

The data file is comma delimited. The data file is fixed column and variable length. i.e if a column (field) 

is empty or spaces there will be only a comma (no space). 

GL‐REC. 

02 GL‐STATUS PIC X(3). 

02 GL‐COMMA01 PIC X. 

02 GL‐SET‐OF‐BOOKS‐ID PIC 1. 


02 GL‐USER‐JE‐SOURCE‐NAME PIC X(18). 


02 GL‐USER‐JE‐CATEGORY‐NAME PIC X(12). 


02 GL‐ACTUAL‐FLAG PIC X. 

02 GL‐COMMA04A PIC X. 

02 GL‐ACCOUNTING‐DATE. 

03 GL‐ACCOUNTING‐DATE‐DD PIC 99. 

03 GL‐ACCOUNTING‐DATE‐DASH1 PIC X. 

03 GL‐ACCOUNTING‐DATE‐MON PIC XXX. 

03 GL‐ACCOUNTING‐DATE‐DASH2 PIC X. 

03 GL‐ACCOUNTING‐DATE‐YY PIC 99. 


ANCHOR Health care Supplemental NCPJ 


02 GL‐SEGMENT1 PIC X(2). 








02 GL‐AMOUNT‐AREA. 

03 GL‐ENTERED‐DR PIC X(6). 


03 GL‐ENTERED‐DR PIC X(5). 


02 FILLER REDEFINES GL‐AMOUNT‐AREA. 

03 GL‐ENTERED‐CR PIC X(14). 



02 GL‐COST‐CENTER PIC X(13). 



Physical Interface – Annual Benefit Recipient Statements File 


Annual Benefit Recipient Statements File 

Description: 

This file contains benefit summary data for retirees and benefit recipients. 

Data Rules: 

This is not a delimited file. All fields need to be appropriately padded to occupy their full length. 

Rule 1: Extract all benefit recipients who are in "Estimated", "Final" or “Suspended” status. 

RT-SSN: SSN of the retiree; char(9); 

RT-LAST-NAME: Last name of the retiree; char(30); 

RT-MID-INIT: Middle Initial of the retiree; char(1); 

RT-FIRST-NAME: First name of the retiree; char(20) 

RT-RETIRE-TYPE: Type of Retirement; Service, Disability, Survivor Benefit; char(12); 

RT-RETIRE-SUB-TYPE: Sub-type of retirement; Accidental, Ordinary; char(10); 

RT-DOB: Date of Birth of the retiree; MMDDCCYY; 

RT-DOD: Date of Death of the retiree; MMDDCCYY; 

Rule: Retiree’s date of death will only be populated on a survivor’s file, not on a retiree’s. Otherwise it will 

be blank. 

RT-RETIRE-DATE: Date of retirement; MMDDCCYY; 

RT-RETIRE-OPTION: Retirement option in which the benefits are paid; char(2); 

RT-SURV-1-SSN: SSN of the first survivor; char(9); 

RT-SURV-1-NAME: Name of the first survivor; concatenated last name, middle initial, first name; char 

(51); 

RT-SURV-1-DOB: Date of Birth of the first survivor; MMDDCCYY; 

RT-SURV-2-SSN: SSN of the second survivor; char(9); 

RT-SURV-2-NAME: Name of the second survivor; concatenated last name, middle initial, first name; 

char (51); 

RT-SURV-2-DOB: Date of Birth of the second survivor; MMDDCCYY; 

RT-SURV-3-SSN: SSN of the third survivor; char(9); 

RT-SURV-3-NAME: Name of the third survivor; concatenated last name, middle initial, first name; 

char (51); 

RT-SURV-3-DOB: Date of Birth of the third survivor; MMDDCCYY; 

RT-BASE-PENSION-AMT: Current monthly base pension amount; 99,999.99; 

RT-GROSS-PENSION-AMT: Current monthly gross pension amount; 99,999.99; 

RT-MTHLY-SSA-AMT: Current monthly Social Security Allowance amount; 99,999.99; 

RT-MTHLY-SUPP-AMT: Current monthly Supplemental amount; 99,999.99; 

RT-QDRO-1-SSN: SSN of the first QDRO recipient; char(9); 

RT-QDRO-1-NAME: Name of the first QDRO recipient; concatenated last name, middle initial, first name 

char(51); 

RT-MTHLY-QDRO-1-AMT: Current monthly QDRO-1 amount; 99,999.99; 

RT-QDRO-2-SSN: SSN of the second QDRO recipient; char(9); 

RT-QDRO-2-NAME: Name of the second QDRO recipient; concatenated last name, middle initial, first 

name char(51); 


RT-QDRO-3-SSN: SSN of the third QDRO recipient; char(9); 



Physical Interface – Annual Benefit Recipient Statements File 

RT-QDRO-3-NAME: Name of the third QDRO recipient; concatenated last name, middle initial, first name 

char(51); 


RT-MTHLY-ADHOC-ADJ-AMT: Current monthly Adhoc adjustment amount; 99,999.99; 

RT-MTHLY-CONT-ADJ-AMT: Current monthly Continuing adjustment amount; 99,999.99; 

RT-MTHLY-LEGIS-ADJ-AMT: Current monthly Legislative adjustment amount; 99,999.99; 

RT-FED-TAX-AMT: Current Federal Tax withheld amount; 99,999.99; 

RT-ST-TAX-AMT: Current State Tax withheld amount; 99,999.99; 

RT-RECIP-MRTL-STAT: Marital Status of the benefit recipient; char(7); 

RT-RECIP-TAX-EXEMPTS: Tax exemptions of the benefit recipient; numeric(1); 

RT-INDV-HLTH-INS: Current Individual Health Insurance amount; 99,999.99; 

RT-DNTL-INS: Current Dental Insurance amount; 99,999.99; 

RT-VSN-INS: Current Vision Insurance amount; 99,999.99; 

RT-FAM-HLTH-INS: Current Family Health Insurance amount; 99,999.99; 

RT-BLUE-HMO-INS: Current BlueChip HMO Insurance amount; 99,999.99; 

RT-GRP-LIFE-INS: Current Group Life Insurance amount; 99,999.99; 

RT-OPTN-LIFE-INS: Current Optional Life Insurance amount; 99,999.99; 

RT-CRDT-UNION-DED: Current Credit Union deduction amount; 99,999.99; 

RT-UNION-DUES: Current Union Dues amount; 99,999.99; 

RT-CANCER-INS: Current Cancer Insurance amount; 99,999.99; 

RT-COLG-BND-FUND: Current College Bound Fund amount; 99,999.99; 

RT-LONG-TRM-CARE: Current Long Term Care amount; 99,999.99; 

RT-FAM-COURT: Current Family Court amount; 99,999.99; 

RT-AFLAC: Current AFLAC amount; 99,999.99; 

RT-LEGIS-DTH-BNFT-FEE: Current Legislative Death Benefit Maintenance Fee; 99,999.99; 

RT-SECA: Current SECA (State Employees Charitable Association) amount; 99,999.99; 

RT-COBRA-FEE: Current COBRA Administration Fee; 99,999.99; 

RT-MISC-DED: Current Miscellaneous deduction amount; 99,999.99; 

RT-NET-PENSION-AMT: Current monthly net pension amount; 99,999.99; 



Physical Interface – Vision Enrollment Informaiton 


Credit Union Interface 

Description: 


the Credit Union. This information should be sent as a text file to Rhode Island State Employee’s Credit 

Union. 

File disposition: 

ANCHOR will produce this file and store it on the server. 

ERSRI will transfer the file to OLIS or the credit Union at their discretion by the method/media of their 

choice. 

Control Report: 

The control report produced with this file will display counts of records, grouped by source type and 

activity code. 

Example: 

Count Current Deductions 

------- ------------------------ 

6758 756,874.32 

Data Rules: 

File Format: Text file, no delimiters 

The file consists of records 80 characters in length. 

Rule 1: Extract recipient and deduction information for all recipients who had a credit union deduction for 

the current period. 

Description 

Required 

Position 

Length 

Valid 

Values/Format 

Description data rules 

Record Type Yes 1 3 

“065” Constant 

Filler No 4 2 

Spaces Constant 

SSN Yes 6 9 000000000 SSN SSN of recipient 

Filler No 15 8 

Spaces Constant 

FirstTwo Yes 23 2 

First two Characters of First two characters 

last name of last name 

Filler Yes 25 7 Spaces Constant 



Physical Interface – Vision Enrollment Informaiton 

Deduction amount Yes 32 7 

Curly brace must 

exist as last digit. 

$25.00 deduction 

amount would be 

right justified, spaces 

999999{ on the left” 250{“ 

Filler Yes 39 42 Spaces Constant 


Beneficiary Management System 

600 Byte Input Record Description 

Field Field Positions Field Field Field Criteria Edit Edit Edit Edit 

No Length From To Type Description Criteria Schedule Type Message 

1 2 1 2 N RECORD TYPE. 47 47 All H 0001 BAD RECORD TYPE OR 

CONTROL NO 

2 1 3 3 N FILLER Default to zeroes N/A N/A N/A N/A 

3 6 4 9 N ALTERNATE CONTROL Default to zeros. N/A N/A N/A N/A 

4 8 10 17 N FILLER Default to zeros. N/A N/A N/A N/A 

5 8 18 25 N EFFECTIVE DATE OF 

CCYYMMDD 

NUMERIC All H 0030 INVALID EFFECTIVE DATE 

ENROLLEE RECORD 

Not = zeros 

OF ENROLLEE 

6 10 26 35 N ENROLLEE 

Right justify, zero fill. NUMERIC All H 0031 INVALID SSN/CERT 

SSN / CERT 

not = zeros 


00=Active 

00, 07,26,40 All H 0032 INVALID ENROLLEE 

STATUS 

07=retired 

STATUS 

26=deceased 

‘26’ or ‘40’ and D, T H 0048 - INVALID STATUS 

40=terminated 

enrollee on file 

ENROLLEE NOT ON FILE 

8 6 38 43 N DATE OF HIRE YYMMDD 

Default is zeros 

NUMERIC A,R S 0033 INVALID DATE OF HIRE 

9 2 44 45 A DOH-CENTURY CC, left justify, zero fill N/A N/A N/A N/A 

10 1 46 46 N FILLER Default to zeros. N/A N/A N/A N/A 

11 3 47 49 N PLAN NUMBER- Default to zeros N/A N/A N/A N/A 

12 1 50 50 N SEX M=MALE 

F=FEMALE 


CCYYMMDD 

BIRTH DATE 


14 26 59 84 A ENROLLEE NAME. 

Left justify, space fill. Uppercase 

only. Use the following format: 

JOHNSON,JOHN A 

SMITH JR, J A 

SMITH IV, JOHN A 

WILLIS-SMITH, J A 

6/23/2011 1:59 PM 

M, F, SPACE A,R S 0034 INVALID SEX CODE 

NUMERIC 

Not = zeros 

A,R S 0035 INVALID BIRTH DATE 

Not = spaces All H 0036 INVALID ENROLLEE NAME 

15 11 85 95 N Filler Default to zeros. N/A N/A N/A N/A 

16 6 96 101 N SPOUSE BIRTH DATE YYMMDD 

NUMERIC A,R S 0035 INVALID BIRTH DATE 


Not = zeros 

17 1 102 102 N Filler Default to zeros. N/A N/A N/A N/A 

18 1 103 103 A ENROLLEE SMOKING 

N = Non Smoker 

N, S, SPACE A,R S 0041 INVALID SMOKING CODE 

STATUS 

S = Smoker 

19 1 104 104 A EOI REQUIRED FLAG Y=YES, Default is spaces. Y, SPACE N/A N/A N/A 

20 1 105 105 N EARNINGS TYPE 0 = DEFAULT 

1 = ANNUAL 

0,1, 2,3 A, R S 0037 INVALID EARNINGS TYPE





21 7 106 112 N EARNINGS Whole $$ amt of enrollee’s 

earnings. Right justify and zero 

fill. Required if benefits are 

calculated using earnings. 

Default is zeros. 

Earnings $25,500.50 

Report as : 0025500 

22 8 113 120 N DATE LAST WORKED 

CCYYMMDD 


6/23/2011 1:59 PM 

NUMERIC 

Numeric 

IF not = zeros, must 

be = or > effective 

date of enrollee 

record. 

23 2 121 122 A SPOUSE DOB-CENTURY CC, left justify, zero fill N/A N/A N/A N/A 

A, R S 0038 INVALID EARNINGS 

AMOUNT 

A, R S 0039 INVALID DATE LAST 

WORKED 

24 1 123 123 A SPOUSE SMOKING STATUS N = Non Smoker 

S = Smoker 

N, S, SPACE A,R S 0041 INVALID SMOKING CODE 

25 7 124 130 A FILLER Default is spaces. N/A N/A N/A N/A 

26 35 131 165 A MAILING ADDRESS LINE 1 -. Left justify , space fill. 

Default is spaces. 

Must be uppercase. 

27 35 166 200 A MAILING ADDRESS LINE 2 Left justify , space fill. 



28 8 201 208 A CUSTOMER SPECIFIC 

Left justify , space fill. 



29 9 209 217 A TOTAL REQUESTED EE 

COVG (TRM3)-PENDING EOI 

APPROVAL 

30 9 218 226 A TOTAL REQUESTED SP 

COVG (TRM4) - PENDING 

EOI APPROVAL 

31 9 227 235 A TOTAL REQUESTED CH 

COVG (TRM5)- PENDING 

EOI APPROVAL 

Right justify, zero fill. Whole $$ 

amt of enrollee’s benefit. Default 

is zeros. Benefit: $25,500.50 



amt of spouse’s benefit. Default 

is zeros. Benefit: $25,500.50 



amt of child’s benefit. Default is 

zeros. Benefit: $25,500.50 


32 21 236 256 A MAILING ADDRESS CITY Left justify , space fill. 



33 2 257 258 A MAILING ADDRESS STATE. Left justify , space fill. 



N/A A, R, T N/A N/A 



Numeric, If EOI 

REQUIRED FLAG 

is spaces/invalid, this 

field won’t be edited. 


REQUIRED FLAG 




REQUIRED FLAG 



A, R S 0043 INVALID COVERAGE 

AMOUNT 


AMOUNT 


AMOUNT 


N/A A, R, T N/A N/A





34 9 259 267 A MAILING ADDRESS ZIP 

CODE 

35 1 268 268 A 

6/23/2011 1:59 PM 

HOURLY/SALARY 

INDICATOR 

36 11 269 279 A WORK TELEPHONE 

NUMBER 

37 11 280 290 A HOME TELEPHONE 

NUMBER - 

Left justify , space fill. 


1 = Hourly 

2= Salaried 



Phone no: 

1-(123)456-7890 

Report as: 

11234567890 


Phone no: 

1-(123)456-7890 

Report as: 

11234567890 

If reported, must be 

numeric. 

A, R, T S 0040 INVALID ZIP CODE 

N/A N/A N/A N/A 

. N/A N/A N/A 

. N/A N/A N/A 

38 22 291 312 A FILLER Default is spaces. N/A N/A N/A N/A 

39 288 313 600 LIFE COVERAGE AREA 

See Below See Below 

The section below OCCURS 8 TIMES in the Life Coverage Area. 

4 A COVERAGE CODE - If occurrence is used should 

contain covg code(see table 

below) Default is spaces . 

Valid coverage code or spaces. A, R H 0024 INVALID COVG CODE 

8 N COVERAGE 

CCYYMMDD 

Numeric 

A, R S 0019 INVALID COVG EFF-DATE 

EFFECTIVE DATE 

Default is zeros. IF not = zeros, must be = or > 

date of hire. 

If covg code is spaces or invalid, 

this field will not be edited. 

7 N CONTROL NUMBER Right justify, zero fill. NUMERIC 

valid CSA 

All H 0002 BAD CONTROL NO. 

3 N SUFFIX Right justify, zero fill. NUMERIC A,R H 0020 INVALID SUFFIX 

5 N ACCOUNT Right justify, zero fill. NUMERIC A,R H 0021 INVALID ACCT 

9 N COVERAGE BENEFIT 

AMOUNT 

Right justify, zero fill. 

Whole $$ amt of enrollee’s 

benefit. 


Benefit: $25,500.50 


Numeric 

If covg code is spaces or invalid, 

this field will not be edited. 


AMOUNT





NOTES - EDIT TYPE - EDIT SCHEDULE - 

H = HARD EDIT - Record will not be processed. A - Edit is performed if Enrollee Status is 00. 

Error message will be displayed on error report. R - Edit is performed if Enrollee Status is 07. 

D - Edit is performed if Enrollee Status is 27. 

S = SOFT EDIT - Record will be processed. T - Edit is performed if Enrollee Status is 40. 

Error message will be displayed on error report. 

ALL- Edit is performed if Enrollee Status is equal to ‘00’ , ‘07’, ‘26’ or ‘40’. 

File Notes: 

Coverage Codes Description 

TRM1 Basic Non-contributory Employee Life Insurance 

TRM3 Supplemental Employee Contributory Life Insurance 

TRME Executive Term Life 

TRM7 Basic Spouse Life Insurance 

TRM8 Basic Child Life Insurance 

TRM4 Supplemental Spouse contributory Life Insurance 

ADD1 Basic Employee Non-Contributory Accidental Death & Dismemberment Insurance 

TRM5 Supplemental Child Contributory Life Insurance 

ADD3 Supplemental Employee Accidental Death and Dismemberment Insurance 

ADD6 Supplemental Family Accidental Death and Dismemberment Insurance 

STD1 Basic non-contributory Short Term Disability 

LTD1 Basic non-contributory Long Term Disability 

STDV Voluntary contributory Short Term Disability 

LTDV Voluntary contributory Long Term Disability 

ADD7 Supplemental Employee and Spouse Accidental Death 

ADD8 Supplemental Employee and Child Accidental Death 

This is a standard text file (extension .txt) with each record having a fixed length of 600 bytes, ending in a carriage return. Large files may be 

zipped (extension.zip) 

Shaded fields are mandatory for any file. Non-shaded fields can be filled w/default values (see field criteria column). Some non-shaded fields 

may be required, depending upon plan design and the nature of services being provided by Aetna. 

6/23/2011 1:59 PM





All data should be transmitted in Upper case. This is mandatory. 

6/23/2011 1:59 PM


Physical Interface - Payroll Check for Direct Deposit 


Payroll Check for Direct Deposit 

Description: 

This file will provide the direct deposit notifications for each benefit recipient and will be sent to the 

Treasury Office for printing. 

Data Rules: 

Rule 1: YTD totals will include Retroactive payments. 

Rule 2: Multiple checks will be generated for each benefit recipient that receives money from multiple 

plans. 

Rule 3: Benefit Recipients can receive multiple checks from the same plan if they have several accounts. 

For example, if a benefit recipient has their own retirement account and a survivor account under the same 

plan, they will receive two benefit checks. 

Rule 4: Dollar signs will not be included in the check tape. 

Rule 5: If any of the address line does not exist it will be left as blank. 

Following data will be printed on the check stub: 

Payroll Check 

Item Name Position 

Length 

Sample/Valid 

Values Description Data Rule 

Name of the recipient receiving 

Last Name+ ‘,’ + First Name +’ ‘ + 

Middle initial+ ‘ ‘ + Suffix. Left aligned 

and filled with spaces for rest of the 

Name 1 55 John,Wright L JR the check 

length 

Current Date 56 10 10282002 Business date MMDDCCYY 

Check Number 66 10 9999999999 

Check effective 

date 76 10 10302002 

Unique number generated 

automatically on each payroll 

run 

Address line 1 86 60 Line 1 in Address 


The date that is Two days after 

the payroll run date MMDDCCYY 

Numeric. Right Aligned. Packed with 

Zero's in front for the remaining 

characters. 

Alphanumeric. Left Aligned. Filled with 

spaces for the remaining characters in 

the end 



the end 





Address line 4 


266 60 


326 60 

386 60 Reserve 

Line 4 in Address .(for Foreign: 

CityName or Province name 

Postal code) 

City,State Zipcode – 

ZipPlus.(for Foreign: Country. ) 

Bank name 446 40 ABN Amro Name of the Recipient bank 

Destination 

Account number 486 17 9999999 

Recipient Bank Account 

Number 

Destination routing 

number 503 9 99999999 Recipient Bank Routing Number Alphanumeric. 

Account prefix 512 20 

Checking or 

Savings Recipient Bank Account Type 

Item1 Amount 532 8 12345.12 First Positive Item in the check 

Item1 Description 540 40 

Item2 Amount 580 8 12345.12 


Taxable Base 

Benefit Item description 

Second Positive item in the 

check 

Non Taxable 

Base Benefit Item description 

Item3 Amount 628 8 12345.12 Third Positive item in the check 

Item3 Description 636 40 COLA Item description 

Item4 Amount 676 8 12345.12 Fourth Positive item in the check 

Item4 Description 684 40 Supplimental Item description 



the end 



the end 



the end 



the end 



the end 

Alphanumeric. Right Aligned. Filled 

with zeros in the front for the remaining 

characters. 



the end 



characters. 

Alphabetic. Left Aligned. Filled with 


the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 




Item5 Amount 724 8 12345.12 Fifth Positive item in the check 

Item5 Description 732 40 Adhoc Item description 

Item6 Amount 772 8 12345.12 Sixth Positive item in the check 

Item6 Description 780 40 Legislative Item description 

Item7 Amount 820 8 12345.12 

Seventh Positive item in the 

check 

Item7 Description 828 40 Continual Item description 

Item8 Amount 868 8 12345.12 Eighth Positive item in the check 


Teachers 

Survivor benefit Item description 

Item9 Amount 916 8 12345.12 Ninth Positive item in the check 


RetroPymt 

Taxable Benefit Item description 

Item10 Amount 964 8 12345.12 Tenth Positive item in the check 


Gross Pay 1012 11 1234567.12 

RetroPymt Non 


Sum of all the positive items for 

the month. Some of the item 

may not get printed due to space 

crunch, but the gross amount 

will sum up all the positive 

amount including those that does 

not appear on the check 

Item11 Amount 1023 8 12345.12 First deduction item in the check 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



characters. 




Item11 Description 1031 40 Federal Tax Item description 

Item12 Amount 1071 8 12345.12 

Second deduction item in the 

check 

Item12 Description 1079 40 State Tax Item description 

Item13 Amount 1119 8 12345.12 

Third deduction item in the 

check 

Item13 Description 1127 40 Item description 

Item14 Amount 1167 8 12345.12 


fourth deduction item in the 

check 

Health Insurance 

Recipient" Item description 

Item15 Amount 1215 8 12345.12 Fifth deduction item in the check 

Item135Description 1223 40 

Item16 Amount 1263 8 12345.12 


Item17 Amount 1311 8 12345.12 


Spouse Item description 

Sixth deduction item in the 

check 

Group life 

insurance Item description 

Seventh deduction item in the 

check 

Item17 Description 1319 40 Cancer insurance Item description 

Item18 Amount 1359 8 12345.12 

Eighth deduction item in the 

check 

Item18 Description 1367 40 Credit union Item description 

Item19 Amount 1407 8 12345.12 

Ninth deduction item in the 

check 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 




Item19 Description 1415 40 Union Dues Item description 

Item20 Amount 1455 8 12345.12 

Tenth deduction item in the 

check 

Item20 Description 1463 40 AFLAC Item description 

Item21 Amount 1503 8 12345.12 

Eleventh deduction item in the 

check 

Item21 Description 1511 40 Family Court Item description 

Item22Amount 1551 8 12345.12 

Twelfth deduction item in the 

check 

Item22 Description 1559 40 Long term Care Item description 

Item23 Amount 1599 8 12345.12 


Item24 Amount 1647 8 12345.12 

Thirteenth deduction item in the 

check 

College bound 

Fund Item description 

Fourteenth deduction item in the 

check 

Item24 Description 1655 40 Abc Deduction Item description 

Item25 Amount 1695 8 12345.12 

Fifteenth deduction item in the 

check 


Item26 Amount 1743 8 12345.12 

Sixteenth deduction item in the 

check 


Item27 Amount 1791 8 12345.12 

Seventeenth deduction item in 

the check 




the end 



characters. 

Alphabetic. Filled with spaces for the 

remaining characters 



characters. 





characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 



characters. 



the end 




Item28 Amount 1839 8 12345.12 

Eighteenth deduction item in the 

check 


YTD Item03 1887 11 1234567.12 Year to date item amount 






Gross YTD Pay 1953 11 123456789.1 Year to date Gross Amount 










characters. 



the end 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 



characters. 











Net Check 2118 11 1234567.12 

Check Message1 2129 160 









Abc 

xxxxxxxxxxxxxx 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Net Amount = Gross Amount – 

Deductions(Including Federal 

Tax and Stat Tax). 

Check Messages for the 

recipient 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 



characters. 



characters. 



characters. 



characters. 



characters. 

Numeric. Filled with spaces for the 

remaining characters. 





characters. 



the end 



the end 



the end 



the end 



the end 



the end 



the end 



the end 







Marital Federal 3729 40 

Marital State 3769 40 

Exemptions 

Federal 3809 2 

Exemptions State 3811 2 

Abc 


x 

"Single"or"Marrie 

d"or"Divorced"or 

"Unknown"or"Wi 


recipient 

dowed" Federal Tax Marital status 

"Single"or"Marrie 

d"or"Divorced"or 

"Unknown"or"Wi 

dowed" State Tax Marital status 

"01" or"02" or 

any number 

"01" or"02" or 

any number 

Number of exemptions for 

Federal Tax 

Number of exemptions for State 

Tax 

Additional Federal 3813 4 Blank Federal tax Additional 

Additional State 3817 4 Blank State tax Additional 

Order of Positive Items that may appear in the Check: 

1. Taxable Benefit 

2. Non Taxable Benefit 

3. COLA 

4. Supplemental 

5. Adhoc Benefit Adjustment 

6. Continuous Benefit Adjustment 

7. Legislative Benefit Adjustment 

8. Teacher Survivor Benefit Amt 

9. Lumpsum COLA Adjustment 

10. RetroPymt Adj Taxable Base 

11. RetroPymt Adj Non-Taxable Base 

12. RetroPymt COLA 

13. RetroPymt Supplemental 

14. RetroPymt Adhoc Benefit Adj 

15. RetroPymt Continuing Bnft Adj 

16. RetroPymt Legislative Bnft Adj 

17. RetroPymt Tchr Surv Bnft 

18. RetroPymt Lumpsum COLA 

19. RetroPymt Family Court 

20. Retro Health Insurance – Recipient 

21. Retro Health Insurance – Spouse 

22. Retro Health Insurance Recipient Vision 

23. Retro Health Insurance Recipient Dental 

24. Retro Health Ins Recipient Prescription 

25. Retro Health Insurance Spouse Vision 

26. Retro Health Insurance Spouse Dental 

27. Retro Health Insurance Spouse Prescription 

28. RetroPymt Cancer Insurance 

29. RetroPymt Long Term Care 





the end 





characters. 



characters. 



characters. 



characters. 




30. RetroPymt AFLAC 

31. RetroPymt IRS Levy 

32. RetroPymt Legislator Death Benefit Maintenance Fee 

33. RetroPymt Account Receivable 

34. RetroPymt Group Life Insurance 

35. RetroPymt Optional Life Insurance 

36. RetroPymt Credit Union Deduction 

37. RetroPymt College Bound Fund 

38. RetroPymt Union Dues 

39. RetroPymt SECA 

40. RetroPymt Federal Tax 

41. RetroPymt State Tax 

If any of the items does not exist for a recipient then the next preceding item will be shown. 

Order of Deductions that may appear in the Check: 

1. Family Court 

2. Health Insurance – Recipient 

3. Health Insurance – Spouse 

4. Health Insurance Recipient Vision 

5. Health Insurance Recipient Dental 

6. Health Ins Recipient Prescription 

7. Health Insurance Spouse Vision 

8. Health Insurance Spouse Dental 

9. Health Insurance Spouse Prescription 

10. Cancer Insurance 

11. Long Term Care 

12. AFLAC 

13. IRS Levy 

14. Legislator Death Benefit Maintenance Fee 

15. Account Receivable 

16. Group Life Insurance 

17. Optional Life Insurance 

18. Credit Union Deduction 

19. College Bound Fund 

20. Union Dues 

21. SECA 

22. Miscellaneous 

23. Federal Tax 

24. State Tax 




Physical Interface - Payroll Check 


Payroll Check 

Description: 

This file will provide the check details for each benefit recipient and will be sent to the Treasury Office for 

printing. 

Data Rules: 

Rule 1: YTD totals will include Retroactive payments. 

Rule 2: Multiple checks will be generated for each benefit recipient that receives money from multiple 

plans. 

Rule 3: Benefit Recipients can receive multiple checks from the same plan if they have several accounts. 

For example, if a benefit recipient has their own retirement account and a survivor account under the same 

plan, they will receive two benefit checks. 

Rule 4: Dollar signs will not be included in the check tape. 

Rule 5: The file will be sorted by pull-check indicator for each benefit recipient i.e. the benefit checks for 

recipients with pull-check indicator set to ‘True’ will appear first. 

Rule 6: If any of the address line does not exist it will be left as blank. 

Following data will be printed on the check stub: 

Payroll Check 

Item Name Position 

Length 

Sample/Valid 

Values Description Data Rule 

Name of the recipient receiving 

Last Name+ ‘,’ + First Name +’ ‘ + 

Middle initial+ ‘ ‘ + Suffix. Left 

aligned and filled with spaces for 

Name 1 55 John,Wright L JR the check 

rest of the length 

Current Date 56 10 10282002 Business date MMDDCCYY 

Check Number 66 10 9999999999 

Check effective 

date 76 10 10302002 

Unique number generated 

automatically on each payroll 

run 



The date that is Two days after 

the payroll run date MMDDCCYY 

Numeric. Right Aligned. Packed 

with Zero's in front for the 


Alphanumeric. Left Aligned. Filled 

with spaces for the remaining 

characters in the end 










266 60 


326 60 

386 60 Reserve 

Line 4 in Address .(for Foreign: 

CityName or Province name 

Postal code) 

City,State Zipcode – 

ZipPlus.(for Foreign: Country. ) 













Bank name 446 40 Spaces Name of the Recipient bank Blank for Paper Checks 

Destination 

Account number 

Destination routing 

486 17 Spaces 

number 503 9 Spaces 

Recipient Bank Account 

Number Blank for Paper Checks 

Recipient Bank Routing 

Number Blank for Paper Checks 

Account prefix 512 20 Spaces Recipient Bank Account Type Blank for Paper Checks 

Item1 Amount 532 8 12345.12 First Positive Item in the check 


Item2 Amount 580 8 12345.12 


Taxable Base 

Benefit Item description 

Second Positive item in the 

check 

Non Taxable 

Base Benefit Item description 

Item3 Amount 628 8 12345.12 Third Positive item in the check 

Item3 Description 636 40 COLA Item description 

Item4 Amount 676 8 12345.12 

Fourth Positive item in the 

check 

Item4 Description 684 40 Supplemental Item description 

Item5 Amount 724 8 12345.12 Fifth Positive item in the check 




Alphabetic. Left Aligned. Filled 



























Item5 Description 732 40 Adhoc Item description 

Item6 Amount 772 8 12345.12 Sixth Positive item in the check 

Item6 Description 780 40 Legislative Item description 

Item7 Amount 820 8 12345.12 

Seventh Positive item in the 

check 

Item7 Description 828 40 Continual Item description 

Item8 Amount 868 8 12345.12 


Eighth Positive item in the 

check 

Teachers 

Survivor benefit Item description 

Item9 Amount 916 8 12345.12 Ninth Positive item in the check 


Item10 Amount 964 8 12345.12 


Gross Pay 1012 11 1234567.12 

Item11 Amount 1023 8 12345.12 

RetroPymt 


Tenth Positive item in the 

check 

RetroPymt Non 


Sum of all the positive items 

for the month. Some of the 

item may not get printed due to 

space crunch, but the gross 

amount will sum up all the 

positive amount including those 

that does not appear on the 

check 

First deduction item in the 

check 

Item11 Description 1031 40 Federal Tax Item description 














































Item12 Amount 1071 8 12345.12 

Second deduction item in the 

check 

Item12 Description 1079 40 State Tax Item description 

Item13 Amount 1119 8 12345.12 

Third deduction item in the 

check 

Item13 Description 1127 40 Item description 

Item14 Amount 1167 8 12345.12 


Item15 Amount 1215 8 12345.12 

Item135Description 1223 40 

Item16 Amount 1263 8 12345.12 


Item17 Amount 1311 8 12345.12 

fourth deduction item in the 

check 


Recipient" Item description 

Fifth deduction item in the 

check 


Spouse Item description 

Sixth deduction item in the 

check 

Group life 

insurance Item description 

Seventh deduction item in the 

check 

Item17 Description 1319 40 Cancer insurance Item description 

Item18 Amount 1359 8 12345.12 

Eighth deduction item in the 

check 

Item18 Description 1367 40 Credit union Item description 

Item19 Amount 1407 8 12345.12 

Ninth deduction item in the 

check 

Item19 Description 1415 40 Union Dues Item description 




















































Item20 Amount 1455 8 12345.12 

Tenth deduction item in the 

check 

Item20 Description 1463 40 AFLAC Item description 

Item21 Amount 1503 8 12345.12 

Eleventh deduction item in the 

check 

Item21 Description 1511 40 Family Court Item description 

Item22Amount 1551 8 12345.12 

Twelfth deduction item in the 

check 

Item22 Description 1559 40 Long term Care Item description 

Item23 Amount 1599 8 12345.12 


Item24 Amount 1647 8 12345.12 

Thirteenth deduction item in 

the check 

College bound 

Fund Item description 

Fourteenth deduction item in 

the check 


Item25 Amount 1695 8 12345.12 

Fifteenth deduction item in the 

check 


Item26 Amount 1743 8 12345.12 

Sixteenth deduction item in the 

check 


Item27 Amount 1791 8 12345.12 

Seventeenth deduction item in 

the check 


Item28 Amount 1839 8 12345.12 

Eighteenth deduction item in 

the check 




Alphabetic. Filled with spaces for 

the remaining characters 























































Gross YTD Pay 1953 11 123456789.1 Year to date Gross Amount 


































































Net Check 2118 11 1234567.12 











Abc 


Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Abc 


x 

Net Amount = Gross Amount – 

Deductions(Including Federal 

Tax and Stat Tax). 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 


recipient 



















































Marital Federal 3729 40 

Marital State 3769 40 

Exemptions 

Federal 3809 2 

Exemptions State 3811 2 

"Single"or"Marri 

ed"or"Divorced"o 

r"Unknown"or" 

Widowed" Federal Tax Marital status 

"Single"or"Marri 

ed"or"Divorced"o 

r"Unknown"or" 

Widowed" State Tax Marital status 

"01" or"02" or 

any number 

"01" or"02" or 

any number 


Federal Tax 


State Tax 

Additional Federal 3813 4 Blank Federal tax Additional 

Additional State 3817 4 Blank State tax Additional 

Order of Positive Items that may appear in the Check: 

1. Taxable Benefit 

2. Non Taxable Benefit 

3. COLA 

4. Supplemental 

5. Adhoc Benefit Adjustment 

6. Continuous Benefit Adjustment 

7. Legislative Benefit Adjustment 

8. Teacher Survivor Benefit Amt 

9. Lumpsum COLA Adjustment 

10. RetroPymt Adj Taxable Base 

11. RetroPymt Adj Non-Taxable Base 

12. RetroPymt COLA 

13. RetroPymt Supplemental 

14. RetroPymt Adhoc Benefit Adj 

15. RetroPymt Continuing Bnft Adj 

16. RetroPymt Legislative Bnft Adj 

17. RetroPymt Tchr Surv Bnft 

18. RetroPymt Lumpsum COLA 

19. RetroPymt Family Court 

20. Retro Health Insurance – Recipient 

21. Retro Health Insurance – Spouse 

22. Retro Health Insurance Recipient Vision 

23. Retro Health Insurance Recipient Dental 

24. Retro Health Ins Recipient Prescription 

25. Retro Health Insurance Spouse Vision 

26. Retro Health Insurance Spouse Dental 

27. Retro Health Insurance Spouse Prescription 

28. RetroPymt Cancer Insurance 

29. RetroPymt Long Term Care 

30. RetroPymt AFLAC 

31. RetroPymt IRS Levy 





















32. RetroPymt Legislator Death Benefit Maintenance Fee 

33. RetroPymt Account Receivable 

34. RetroPymt Group Life Insurance 

35. RetroPymt Optional Life Insurance 

36. RetroPymt Credit Union Deduction 

37. RetroPymt College Bound Fund 

38. RetroPymt Union Dues 

39. RetroPymt SECA 

40. RetroPymt Federal Tax 

41. RetroPymt State Tax 


Order of Deductions that may appear in the Check: 

1. Family Court 

2. Health Insurance – Recipient 

3. Health Insurance – Spouse 

4. Health Insurance Recipient Vision 

5. Health Insurance Recipient Dental 

6. Health Ins Recipient Prescription 

7. Health Insurance Spouse Vision 

8. Health Insurance Spouse Dental 

9. Health Insurance Spouse Prescription 

10. Cancer Insurance 

11. Long Term Care 

12. AFLAC 

13. IRS Levy 

14. Legislator Death Benefit Maintenance Fee 

15. Account Receivable 

16. Group Life Insurance 

17. Optional Life Insurance 

18. Credit Union Deduction 

19. College Bound Fund 

20. Union Dues 

21. SECA 

22. Miscellaneous 

23. Federal Tax 

24. State Tax 



ANCHOR IRS Reporting Tape delimited file 

Report: PI‐ IRS Reporting Tape delimited file 

Description: 

The 1099r Print tape is generated through an SQR process that reads the information from a temporary 

table in the data base and prints the information out on a tape for 1099R printing, with tilde as the 

delimiter . This file will later be used to be merged in the word document . 

This file is similar to the report Weekly 1099R Batch Job, except that it has one 

additional column for the State Tax With Held amount. 

Data Rules: 

Page Break: N/A 

Sort By: N/A 

Note: The file will not have any delimiter separating the various columns. 

Field # Field Name Size Contents 

1 Gross 11 Gross Amount 

2 Taxable 

11 Taxable Amount 

3 payer_Tin 

4 payee_ssn 

5 withheld 

6 totalpercent 

7 payer_name 

8 payer_addr1 

9 payer_city 

10 payer_st 

11 payerzip 

12 payerzip4 

13 payeefst 

14 payee_m_name 

15 payeelast 

16 payee_addr 

17 payee_city 

18 payeest 

9 Payer Tin number 

9 Payee SSN 

11 Fed tax withheld 

5 Distribution % 

33 Payer Name 

28 Payer Address 

10 Payer City 

2 Payer City 

5 Payer Zip 

4 Payer Zip 4 

20 Payee First name 

20 Payee Middle Name 

20 Payee Last name 

30 Payee Address 

28 Payee City 

2 Payee State 


ANCHOR IRS Reporting Tape delimited file 


19 payeezip 

5 Payee Zip 

20 payeeaccountno 

21 distcode 

22 taxdefer 

23 totaldist 

24 corrind 

9 Payee Account number 

9 Distribution code 

1 Tax deference 

1 Distribution indicator 

4 1 -Correction indicator 

25 stwithheld 11 State tax withheld 



Tape - Regular 1099R IRS Reporting Tape 

Tape 

PI-Regular 1099R IRS Reporting Tape 




Contents 

Report: PI- Regular 1099R IRS Reporting Tape ..................................... 

Description: ................................................................................................................................................ 3 

Data Rules: ................................................................................................................................................. 4 

Record 1: Transmitter T Record ............................................................................................................. 4 

Record 2: Payer “A” ............................................................................................................................... 5 

Record 3: Payee “B” ............................................................................................................................... 6 

Record 4: Payer “C” ............................................................................................................................... 9 

Record 5: End of Transmissions “F” Record ........................................................................................ 10 




Report: PI- Regular 1099R IRS Reporting Tape 

Description: 

This is the Annual IRS Reporting tape for regular 1099R's. 

The 1099R reporting tape is generated through an SQR process that reads the information 

from a temporary table in the database and prints the information out on a tape for the 

IRS. 

The 1099R reporting Tape is created only if the run is an actual run. If the job is 

requested on a trial basis, do not create a tape. 




Data Rules: 

Page Break: N/A 

Sort By: N/A 

Note: The file will not have any delimiter separating the various columns. 

Record 1: Transmitter T Record 


1 Record Type 1 Enter a T. From Table E_IRS1099R_tape_ref 

2 Payment Year 4 Enter the appropriate tax year (e.g., 1999, 2000, 

2001, etc.). 

3 Prior Year Data Indicator 1 Enter a P for Prior Year or enter a blank. 

4 Transmitter’s TIN 9 From Table TP_Anl_N_Daily 1099R.tax_id_nr 

5 Transmitter Control Code 5 From Table BE_IRS1099R_tape_ref. 

6 Replacement Alpha Character 2 Enter blanks unless replacing data (refer to IRS 

Publication 1220 if replacing data). 

7 Blank 5 Enter blanks. 

8 Test File Indicator 1 Enter blank unless sending a test file in which 

case enter T. 

9 Foreign Entity Indicator 1 Enter a blank. 

10 Transmitter Name 40 From Table BE_IRS1099R_tape_ref. 

11 Transmitter Name (continuation) 40 Enter blanks. 

12 Company Name 40 From Table BE_IRS1099R_tape_ref. 

13 Company Name (continuation) 40 Enter blanks. 

14 Company Mailing Address 40 From Table BE_IRS1099R_tape_ref. 

15 Company City 40 From Table BE_IRS1099R_tape_ref. 

16 Company State 2 From Table BE_IRS1099R_tape_ref. 

17 Company Zip Code 9 From Table BE_IRS1099R_tape_ref. 


19 Total Number of Payees 8 Enter the total number of payee ‘B’ records 

reported on the file. 

20 Contact Name 40 From Table BE_IRS1099R_tape_ref. 

21 Contact’s Phone Number and Extension 15 From Table BE_IRS1099R_tape_ref. 

22 Magnetic Tape File Indicator 2 From Table BE_IRS1099R_tape_ref. 

23 Electronic File Name 15 Enter blanks. 


25 Blank 2 Enter blanks or carriage return/line feed 

(CR/LF) characters. 

Total Record Length 750 




Record 2: Payer “A” 


1 Record Type 1 Enter an A. From Table E_IRS1099R_tape_ref. 


2001, etc.). 


4 Payer’s Taxpayer Identification Number 

(TIN) 

9 From Table BE_IRS1099R_tape_ref. 

5 Payer Name Control 4 Enter blanks. 

6 Last Filing Indicator 1 Enter blank. 

7 Combined Federal/State Filer 1 Enter blank. 

8 Type of Return 1 Enter a 9. From Table BE_IRS1099R_tape_ref. 

9 Amount Codes 12 Enter 12459 and seven (7) spaces to the right of 

the 9. From Table BE_IRS1099R_tape_ref. 


11 Original File Indicator 1 Enter a 1 unless this is a replacement or a 

correction file. If a replacement or correction 

file, enter a blank. 

12 Replacement File Indicator 1 Enter a blank unless this is a replacement file. 

If a replacement file, enter a 1. 

13 Correction File Indicator 1 Enter a blank unless this is a correction file. If 

a correction file, enter a 1. 

14 Blank 1 Enter a blank. 

15 Foreign Entity Indicator 1 Enter a blank. 

16 First Payer Name Line 40 From Table BE_IRS1099R_tape_ref. 

17 Second Payer Name Line 40 Enter blanks. 

18 Transfer Agent Indicator 1 Enter a 0. From Table BE_IRS1099R_tape_ref. 

19 Payer Shipping Address 40 From Table BE_IRS1099R_tape_ref. 

20 Payer City 40 From Table BE_IRS1099R_tape_ref. 

21 Payer State 2 From Table BE_IRS1099R_tape_ref. 

22 Payer Zip Code 9 From Table BE_IRS1099R_tape_ref. 

23 Payer’s Phone Number and Extension 15 From Table BE_IRS1099R_tape_ref. 








Record 3: Payee “B” 


1 Record Type 1 Enter B. From Table BE_IRS1099R_tape_ref. 


2001, etc.). From Table 

BE_IRS1099R.clndr_yr_nr. 

3 Corrected Return Indicator 1 Enter a blank unless correction file (refer to 

IRS Publication 1220 page 39) From Table 

BE_IRS1099R.crrctd_in. 

4 Name Control 4 Enter blanks. 

5 Type of TIN 1 Enter 2 for a payment to an individual. Enter 1 

for a payment to an organization (e.g., estate or 

6 Payee’s Taxpayer Identification Number 

(TIN) 

trust). 

9 Enter recipient’s Social Security Number or 

enter organization’s TIN where applicable. 

From Table BE_IRS1099R.ss_nr. 

7 Payer’s Account Number for Payee 20 Enter applicable recipient account id. 

8 Payer’s Office Code 4 Enter blanks. 


10 Payment Amount 1 12 Box – 1: Enter calendar year-to-date gross 

benefit amount. From Table 

BE_IRS1099R.gross_bene_amt. 

11 Payment Amount 2 12 Box – 2: Enter calendar year-to-date taxable 

benefit amount. From Table 

BE_IRS1099R.taxable_amt 

12 Payment Amount 3 12 Enter zeroes. From Table 

BE_IRS1099R_tape_ref. 

13 Payment Amount 4 12 Box – 4: Enter calendar year-to-date federal tax 

withholding amount. From Table 

BE_IRS1099R.fed_tax_wthld_amt. 

14 Payment Amount 5 12 Box 9b - Enter the after-tax employee 

contributions recovered tax-free during the 

applicable calendar year (calendar year-to-date 

non-taxable benefit amount which is equal to 

the gross benefit amount minus the taxable 

benefit amount). From Table 

BE_IRS1099R.exclsn_amt. 







18 Payment Amount 9 12 Enter the after-tax employee contributions to be 

recovered tax-free in future years if this is the 

first year that the recipient received benefits (or 

enter zeroes if there are performance issues 

associated with extracting this data). Always 

enter zeroes for lump sum distributions. From 

Table BE_IRS1099R.tot_empe_cntrb. 

19 Payment Amount A 12 Enter zeroes. From Table 






20 Payment Amount B 12 Enter zeroes. From Table 


21 Payment Amount C 12 Enter zeroes. From Table 


22 Reserved 48 Enter blanks. 

23 Foreign Country Indicator 1 Enter a 1 where applicable or enter a blank. 

Note use a free format for the payee city, state, 

and ZIP code when the foreign address 

indicator is used. 

24 First Payee Name Line 40 Enter the name of the recipient. From Table 

BE_IRS1099R.full_nm. 

25 Second Payee Name Line 40 Enter blanks. 


27 Payee Mailing Address 40 Enter mailing address of recipient. From Table 

TP_Anl_N_Daily_1099R.rcpnt_addr_ln1, 

TP_Anl_N_Daily_1099R.rcpnt_addr_ln2. 


29 Payee City 40 Enter the city, town, or post office. From Table 

TP_Anl_N_Daily_1099R.city. 

30 Payee State 2 Enter the valid U.S. Postal Service state 

abbreviation for states or the appropriate postal 

identifier. From Table 

TP_Anl_N_Daily_1099R.state. 

31 Payee Zip Code 9 Enter the valid nine digit ZIP Code assigned by 

the U.S. Postal Service. From Table 

TP_Anl_N_Daily_1099R.zip. 


33 Blank 1 Enter blank. 

34 Document Specific Distribution code 2 Box – 7: Enter the appropriate distribution 

code(s). Codes currently used include 1 

(refunds only), 2, 3 (annuitants only), 4, 7, G 

(refunds only), and H (refunds only) (refer to 

IRS Publication 1220 pages 58, 59, IRS Pub. 

Instructions for Forms 1099 pages 35 and 36, 

and Use Case - Batch Program – Extract 1099R 

Data). From Table BE_IRS1099R.dstrb_cd. 

35 Taxable Amount Not Determined 

1 Box – 2b: Enter blank. 

Indicator 

36 IRA/SEP/SIMPLE Indicator 1 Enter blank. 

37 Total Distribution Indicator 1 Box – 2b: Enter a 1, 1 = G for refunds and 

blank for monthly annuitants (refer to IRS 

Publication 1220 pages 60). From Table 

BE_IRS1099R.irs_1099r_in. 

38 Percentage of Total Distribution 2 Box – 9a: Enter appropriate percentage for 

death refunds and blanks for annuitants (refer 

to IRS Publication 1220 pages 60). From Table 

BE_IRS1099R.dstrb_pct. 


40 Special Data Entries 60 Enter blanks. 

41 State Income Tax Withheld 12 Enter blanks. 

42 Local Income Tax Withheld 12 Enter blanks. 

43 Combined Federal/State Code 2 Enter blanks. 











Record 4: Payer “C” 


1 Record Type 1 Enter C. From Table BE_IRS1099R_tape_ref. 

2 Number of Payees 8 Enter the total number of B Records covered by 

the preceding A Record. 


4 Control Total 1 18 Enter the total gross benefit amount for all B 

Records covered by the preceding A Record. 

5 Control Total 2 18 Enter the total taxable benefit amount for all B 

Records covered by the preceding A Record. 

6 Control Total 3 18 Enter zeroes. From Table 


7 Control Total 4 18 Enter the total federal tax withholding amount for 

all B Records covered by the preceding A 

Record. 

8 Control Total 5 18 Enter the total non-taxable benefit amount for all 

B Records covered by the preceding A Record. 







12 Control Total 9 18 Enter the total future after-tax contribution 

amounts for all B Records covered by the 

preceding A Record (or zeroes if a decision is 

made to not report this data). 

13 Control Total A 18 Enter zeroes. From Table 


14 Control Total B 18 Enter zeroes. From Table 


15 Control Total C 18 Enter zeroes. From Table 


16 Blank 517 Enter blanks. From Table 


17 Blank 2 Enter blanks or carriage return/line feed (CR/LF) 

characters. 





Record 5: End of Transmissions “F” Record 


1 Record Type 1 Enter F. From Table BE_IRS1099R_tape_ref. 

2 Number of “A” Records 8 From Table BE_IRS1099R_tape_ref. 

3 Zero 21 Enter zeroes. From Table BE_IRS1099R_tape_ref. 


5 Blank 2 Enter blanks or carriage return/line feed (CR/LF) 

characters. 



ANCHOR PI-Admin 

Interface: Generate email 

Description: 

This data file has the email addresses based on Contact type parameter chosen 

File Layout: 

Email : alphanumeric 40, database; 

Data Rules: 

The data file is comma delimited. 



Interface: Member Labels 

Description: 

This data file has the member label data for the specified parameter. 

File Layout: 

First Name: alphanumeric 20, database; 

Middle Initial: alphanumeric 1, database; 

Last Name: alphanumeric 30, database; 

Suffix: alphanumeric 4, database; 

Guardian / c-o Line: alphanumeric 30,database; 

Address Line 1: alphanumeric 30, database; 



City Name: alphanumeric 30, database; 

State Code: alphabetic 2, database; 

Zip Code 5: numeric 5, database; 


Foreign Province Name: Alphanumeric 20, database; 

Country Code: Alphanumeric 20, database; 

Foreign Postal Code: Alphanumeric 10, database; 

Data Rules: 

The data file is comma delimited. The data file is fixed column and variable length. i.e if a column (field) is 

empty or spaces there will be only a comma (no space). 



Interface: Retiree Labels 

Description: 

This data file has the retiree label data for the specified parameter. 





File Layout: 

Guardian / c-o Line: alphanumeric 30,database; 











Data Rules: 





Interface: Organization Labels 

Description: 

This data file has the organization label data for the specified parameter. 

File Layout: 

Contact First Name: Alphanumeric 20, database; 

Contact Middle Initial: Alphanumeric 1, database; 

Contact Last Name: Alphanumeric 30, database; 

Contact Suffix: Alphanumeric 4, database; 

Contact Type: Alphanumeric 20, database; 

Organization Name: Alphanumeric 40, database; 

Address Line 1: Alphanumeric 30, database; 



City Name: Alphanumeric 28, database; 

State Code: Alphanumeric 2, database; 

Zip Code 5: Numeric 5, database; 

Zip Code 4: Numeric 4, database; 




Data Rules: 





Interface: TSB Recipient List 

Description: 

This data file has the TSB recipient list data for the specified parameter. 

File layout: 





Guardian / c-o Line: alphanumeric 30, database; 











Data Rules: 




ANCHOR PI-BAA 

Interface BCP Death Audit Information Tape 

Data Rules: 

Field Position Length Datatype Default 

--------------------------------------------------------------------------------------------------- 

JOB-O 1 4 A NORM * 

SSN-O 5 9 N 

LNAME-O 14 15 A 

FNAME-O 29 12 A 

SEX-O 41 1 A 

ZIP-O 42 5 N 

DOB-MM-O 47 2 N 

SLASH1-O 49 1 A 

DOB-DD-O 50 2 N 

SLASH2-O 52 1 A 

DOB-YY-O 53 4 N 

ACCT-8-O 57 8 A 1430 ** 

FILLER-O 65 14 A 

* - Default values for all records 

** - Account Number assigned to ERSRI by Pension Benefit Information. 

Three files are generated 

1.DeathAuditTapeBeneficiaries 

2.DeathAuditTapeMembers 

3.DeathAuditTapeRetirees 


ANCHOR PI-BAA 

Interface: Disability Extract 

Description: 

This data file has the disability retiree data. 

Data Rules: 















Contact First Name: alphanumeric 20, database; 

Contact Middle Initial: alphanumeric 1, database; 

Contact Last Name: alphanumeric 30, database; 

ERSRI Telephone number : Alphanumeric 10, database; 




ANCHOR PI-BAA 

Interface: Student extract 

Description: 

Extract all student recipients by plan whose 18th birthday falls during the next month, who are in 

Estimated or Final or Pending status. 

Data Rules: 








Address Line 4: City, State Code,Zip Code 5 -Zip Code 4: alphanumeric 30, database; 

Fall year: Alphanumeric 4 

Spring year: Alphanumeric 4 





The data file is tilde delimited. The data file is fixed column and variable length. i.e if a column (field) is 



ANCHOR PI-BAA 

Interface: Extract Marital Status Letter 

Description: 

Extract all survivors spouses whose retirement date anniversary is 2 months from the run date and send 

each a letter requiring verification of their single status 

Data Rules: 





SSN: alphanumeric 9 , database; 





Due Date : Month ,day,year (format) 





Calendar year: Alphanumeric 4,calendar year 




ANCHOR PI-BAA 

Interface: SRA Extract 

Description: 

Extract all retirees who have chose the SRA plus option and who would turn 62 next month 

Data Rules: 




SSN: alphanumeric 9 , database; 









Effective date : Alphanumeric 10, database; 

New Amt : Alphanumeric 10, database; 

Old amount: Alphanumeric 10, database; 





PI-Check File 

Interface 

Check File 



PI-Check File 

Contents 

PI- Check File ................................................................................................................................................. 3 

Description ..................................................................................................................................................... 3 

Data Rules ...................................................................................................................................................... 4 



PI-Check File 

PI- Check File 

Description, 

This is a text file containing formatted check payment data. This file will be used by an off-site check 

printing facility for the printing of ERSRI issued checks. 

The Check File is fixed length and does not contain delimiters. If the reported data is not long enough to 

fill the number of spaces allowed, preceding zeros should be entered for a numeric field, and spaces should 

be added to the end of an alphanumeric field. 



PI-Check File 

Data Rules, 

The following information will be included on the file: 

Field Data type Position Format Comments 

Check Effective Numeric 8 char from position mmddccyy 

Date 

1 to 8; 

Check Amount Numeric 11 char from 

position 9 to 19; 

ZZZZZZZZ.ZZ 

Payment 

Numeric 10 char from 

Instruction 

Number 

position 20 to 29. 

Check Message Alphanumeric 160 char from 


Gross Amount- Alphanumeric 12 char from ‘Gross Amount’ 

Heading 


Gross Amount Numeric 11 char from 


ZZZZZZZZ.ZZ 

Non-taxable Alphanumeric 18 char from ‘Non-taxable 

Amount-Heading 

position 213 to 230. Amount’ 

Non-taxable Numeric 11 char from ZZZZZZZZ.ZZ 

Amount 


Taxable Amount- Alphanumeric 14 char from ‘Taxable 

Heading 

position 242 to 255. Amount’ 

Taxable Amount Numeric 11 char from 


ZZZZZZZZ.ZZ 

Allocations- Alphanumeric 11 char from ‘Allocations’ 

Heading 


Allocations Numeric 11 char from ZZZZZZZZ.ZZ 

Amount 


Rollover-Heading Alphanumeric 8 char from position 

289 to 296. 

‘Rollover’ 

Rollover Amount Numeric 11 char from 


ZZZZZZZZ.ZZ 

Tax withheld- Alphanumeric 12 char from ‘Tax withheld’ 

Heading 


Tax withheld Numeric 11 char from 


ZZZZZZZZ.ZZ 

Net Amount- Alphanumeric 10 char from ‘Net Amount’ 

Heading 


Net Amount Numeric 11 char from 


ZZZZZZZZ.ZZ 

Payee ID Alphanumeric 9 char from position For a 

352 to 360; person/organizati 

on the format will 

be #########. 

Plan Name Alphanumeric 40 char from 

position 361 to 400; 

Payee Name Alphanumeric 51 char from For a person 

position 401 to 451; payee: 

First Name, 

Middle Initial, 



PI-Check File 

Payee Suffix Alphanumeric 4 char from position 

452 to 455. 

Payee care of Alphanumeric 30 char from 

name 

position 

456 to 485. 

Payee Address Alphanumeric 30 char from 

Line1 



Line2 



Line3 


Payee City Alphanumeric 28 char from 


Payee State Alphanumeric 2 char from position 

604 to 605. 

Payee Zip Alphanumeric 10 char from 


Bank Account Alphanumeric 40 char from 

Name 


Bank Account Alphanumeric 16 char from 

Number 


Bank Routing Alphanumeric 9 char from position 

Number 

672 to 680 

Check ID Numeric 8 char from position 

681 to 688 

End of Record Alphanumeric 1 char at position 

Character 

689 

Last Name; 

For an 

organization 

payee: 

The first 51 

characters will be 

included, as they 

are stored in the 

database. 

c/o + Name 

Populated only for 

person payee. 

Check Effective Date: Date the Cash Disbursements check file creation batch job uses to determine if a 

check is eligible for printing to check print file. 

Check Amount: Net amount of check to be printed on the check. 

Payment Instruction Number: Number assigned to a check, when a check record is created in ANCHOR. 

Check Message: Free format text message to be printed on the check. 

Gross Amount-Heading: Text “Gross Amount”. 

Gross Amount: Gross Amount of the check to be printed. 

Non-taxable Amount-Heading: Text “Non-taxable Amount” 

Non-taxable Amount: Non-taxable portion of the gross amount. 

Taxable Amount-Heading: Text “Taxable Amount”. 

Taxable Amount: Taxable portion of the gross amount. 

Allocations-Heading: Text “Allocations”. 

Allocations Amount: Sum of allocation amounts (i.e. QDRO, Employer Holdback). 

Rollover-Heading: Text “Rollover”. 

Rollover Amount: Rollover portion of the gross amount. 

Tax withheld-Heading: Text “Tax withheld” 


‘@’


PI-Check File 

Tax withheld Amount: Amount of tax withheld on the gross amount. 

Net Amount-Heading: Text “Net Amount”. 

Net Amount: The net amount (after deductions). 

Payee ID: SSN for a person payee; Tax ID for an organization payee. 

Plan Name: Name of the plan associated with the payee. 

Payee Name: Name of the payee. 

Payee Suffix: Suffix part of payee’s name e.g. Jr., Sr., III etc. 

Payee care of name: Name of payee’s care of person (c/o + name concatenated) 

Payee Address Line1: First line of payee address. 

Payee Address Line2: Second line of payee address. 

Payee Address Line3: Third line of payee address. 

Payee City: City of payee address. 

Payee State: State of Payee address. 

Payee Zip: Zip Code of payee address. 

Bank Account Name: Bank account name associated with the payee. 

Bank Account Number: Bank account number associated with the payee. 

Bank Routing Number: Bank routing number associated with the payee. 

Check ID: Unique sequential number assigned to each check record. 

End of Record Character: ‘@’ indicating the end of each check record. 


ANCHOR PI-Citizens File 

Interface: Citizens Bank 

Description: 

This file is generated as part of the General Payment batch cycle .This file is passed on the 

Citizens Bank. 

File Layout: 

Standard Input Format for Account Reconciliation 

Citizens Bank 

Account Reconcilement Standard Input Format 

Positions Length Description Comment 

01-10 10 Account Number Right justified, left zero 

filled 

11-20 10 Serial Number Right justified, left zero 

filled 

21-30 10 Dollar Amount Right justified, left zero 

filled 

31-36 6 Issue Date MMDDYY 

37-37 1 Record Type V = Void 

38-47 10 Additional Data 1 

48-52 5 Additional Data 2 

53-80 28 Filler 

Record Size is 80 



Interface - Contribution Actuarial Tape 


Contribution Actuarial Tape 




Contents 

Interface: Contribution Actuarial Tape ........................................................................................................... 3 

Description: ................................................................................................................................................ 3 

Data Rules: ................................................................................................................................................. 3 




Interface: Contribution Actuarial Tape 

Description: 

This will put the data previously extracted in the BP-Extract Contribution Actuarial Data job from the text 

file to tape format for the actuarial firm. The data will be sorted in the following order: plan, SSN. The 

extract file will be a tilda-delimited file (variable length, fixed column); 

Data Rules: 

The format of the tape is as follows: 

Plan Code: Alphabetic 4 Character, From DB; 

SSN: Numeric 9 digit, From DB; 

Member's First Name: AlphaNumeric 20, From DB; 

Member's Last Name: AlphaNumeric 30, From DB; 

Sex: Alphabetic 4, From DB; 

Date of Birth: Numeric 8 digit, mmddyyyy, From DB; 

Member's current Status: Alphabetic 4, From DB; 

Member's Prior Fiscal year status: Alphabetic 4, From DB; 

Total Contributing Service Credit: Numeric 11 digit, 999.99999999, From DB; 

Total Non-Contributing Service Credit: Numeric 11 digit, 999.99999999, From DB; 

Pre-Tax LTD contributions: Numeric 8 digit, 999999.99, From DB; 

Post-Tax LTD contributions: Numeric 8 digit, 999999.99, From DB; 

Fiscal YTD wages : Numeric 8 digit, 999999.99, From DB; 

Prior Fiscal YTD wages: Numeric 8 digit, 999999.99, From DB; 

STPL Pensionable wages for the Fiscal Year: Numeric 8 digit, 999999.99, Manually populated (only for 

State police Plan); 

Date of Last contribution: Numeric 8 digit, mmddyyyy, From DB; 

Indicator to show if account is vested: Alphabetic 4, From DB; 

Current/Last Employer Agency Number: Numeric 4 digit, From DB; 

Current/Last Benefit Structure: Alphabetic 4, From DB; 

Current/Last Employer's Employer Group: Alphabetic 4, From DB; 

Projected annual contractual salary with current/last employer: Numeric 8 digit, 999999.99, From DB; 

Schedule Type : Numeric 2digit From DB; 



Interface - GL Transaction File 


GL Transaction File 




Contents 

Interface: GL Transaction File ....................................................................................................................... 3 

Description: ................................................................................................................................................ 3 

Data Rules: ................................................................................................................................................. 4 




Interface: GL Transaction File 

Description: 

This file will list all the formatted GL transactions that were extracted during the batch 

program for extracting and formatting GL transactions. This file will be used for 

importing formatted ANCHOR GL transactions to Peoplesoft. For each set of 

transactions created in ANCHOR there will be at least two records in the PeopleSoft file. 




Data Rules: 

Field Length Position Format 

Effective Date 10 1 to 10 mm/dd/ccyy 

Plan 4 11 to 14 e.g.: MERS, ERS, STPL, JDGS 

Account 5 15 to 19 e.g.: 11101 

Transaction Code 20 20 to 39 e.g.:REFUND 

ANCHOR Posting Date 10 40 to 49 mm/dd/ccyy 

Empr Code 4 50 to 53 e.g: 1000, 2001 etc 

Debit/Credit Indicator 1 54 to 54 „D‟ or „C‟ 

Amount 12 55 to 66 999999999.99 


Effective Date: The date that the transaction is effective in ANCHOR and PeopleSoft. 

Plan: The plan for which the transaction occurred. 

Account: The account number in the “chart of accounts” that the transaction will be posted against. 

Transaction Code: The code that indicates what occurred in the ANCHOR system to cause the transaction. 

Refer to the GL transactions document for specific transaction codes. 

ANCHOR Posting Date: The date the transaction occurred in ANCHOR. 

Empr Code: The employer that the transaction should be posted against. 

Debit/Credit Indicator: Indicates whether the transaction will be posted as a debit or a credit. 

Amount: The amount the transaction will be posted for. 


ANCHOR PI-Load Employer Rates 

Interface: Load Employer Rates 

Description: 

The following file would be picked up by the Rate changes batch job to update the rates of the employers 

in ANCHOR 

File Layout: 

Email : alphanumeric 40, database; 

Data Rules: 

The data file is tilde delimited file. 

File Format: 

Agency # :Name of the Agency 

Effective date :The date the new rate is effective as of 

Cola Selection :The type of COLA associated with the agency 

Employee Contribution Rate: in the following format VVV..VVVVVV 

Employer Contribution Rate :in the following format VVV..VVVVVV 

Federally Funded Rate:in the following format VVV..VVVVVV 

Department of Education Rate:in the following format VVV..VVVVVV 



Interface - Member Account Annual Statements data file 


Member Account Annual Statements data file 




Contents 

Interface: Member Account Annual Statements data file ............................................................................... 3 

Description: ................................................................................................................................................ 3 

Data Rules: ................................................................................................................................................. 3 




Interface: Member Account Annual Statements data file 

Description: 

This data file has information on a member for their Member Account Annual Statement, which may be 

sent to external agency for printing. . The extract file will be a tilda-delimited file (variable length, fixed 

column); 

Data Rules: 

Annual Statement generation date: Numeric 8 digit, mmddccyy, From DB; 

Member information: 

Member Name: Alphanumeric 51, From DB; 

Member SSN: Numeric 9 digit, From DB; 

Member Address: 

Line 1: Alphanumeric 30, From DB; 




City Name: Alphanumeric 28, From DB; 

State: Alphabetic 4, From DB; 

Zip code: Numeric 5 digit, from DB; 

Zip plus4 cd: Numeric 4 digit, from DB; 

Frgn post cd: Alphabumeric 20, From DB; 

Frgn prov nm : Alphanumeric 10, From DB; 

Member Birthdate: Numeric 8 digit, mmddyyyy, From DB; 


Member Account Information: 

Plan: Alphanumeric 40, From DB; 

Current Employer Name: Alphanumeric 40, From DB; 

Current Employer Agency Code: Numeric 4 digit, From DB; 

Member Account Valid flag: Alphabetic 4, From DB; 

Break-up of Service Credit (upto 15): 

Service Credit Description: Alphanumeric 40, From DB; 

Service Credit qty: Numeric 5 digit, ZZ9.99, From DB; 

Total Years of SC: Numeric 5 digit, ZZ9.99, From DB; 

Pre-Tax contribution: Numeric 10 digit, 99999999.99, From DB; 

Post-Tax Contribution: Numeric 10 digit, 99999999.99, From DB; 

Total Contribution: Numeric 11 digit, 999999999.99, From DB; 

Survivor benefit: Numeric 10 digit, 99999999.99, From DB; 

Interest paid for purchases: Numeric 10 digit, 99999999.99, From DB; 

OSC purchase information (Up-to ten) 

Type: Alphanumeric 40, From DB; 




Total amount of agreement: Numeric 10 digit, 99999999.99, From DB; 

Contribution: Numeric 10 digit, 99999999.99, From DB; 

Interest: Numeric 10 digit, 99999999.99, From DB; 

Payment Received: Numeric 10 digit, 99999999.99, From DB; 

Completion Date: Numeric 8 digit, mmddyyyy, From DB; 

Status: Alphanumeric 40, From DB; 

Rule: OSC purchase information for the following type of OSC purchase will not be retrieved : Granted 

Prior Service, Granted Military, Legislator Life Insurance, Rollover Prior Service. 

Beneficiary information: (up-to five (total)) 

Name: Alphanumeric 40, From DB; 


Birthdate: Numeric 8 digit, mmddyyyy, From DB; 

Relationship: Alphanumeric 30, From DB; 

Beneficiary type: Alphabetic 20, From DB; 

Beneficiary Category: Alphabetic 20, From DB; 

OAP: Alphabetic 3, From DB; 

Percentage: Numeric 5 digit, 999.99, From DB; 

SSN/TIN: Alphanumeric 20, From DB; 

Family Member: (up-to five) 

Name: Alphanumeric 40, From DB; 


Birthdate: Numeric 8 digit, mmddyyyy, From DB; 

Relationship: Alphanumeric 30, From DB; 

SSN: Numeric 9, From DB; 

Benefit Estimate: 

Final Average Salary: Numeric 10 digit, 99999999.99, From DB; 

SRA Option : Numeric 10 digit, 99999999.99, From DB; 

Maximum Option: Numeric 10 digit, 99999999.99, From DB; 

Option 1: Numeric 10 digit, 99999999.99, From DB; 

Option 2: Numeric 10 digit, 99999999.99, From DB; 

Death Benefit: Alphabetic 40, From DB; 

Schedule Type: Numeric 1,From DB 


ANCHOR PI‐Positive Pay extract.doc 

Interface: Positive Pay extract 

Description: 

This data file contains the check information from the General payments.. 

File Layout: 

Check number: Length ( 10) 

Check amount : Length (11) 

Check effective date: Length (6) 

Bank spaces : Length (6) 

Bank Account number : Length (10) 

Zero filler : Length (1) 

Bank spaces: Length (10) 

Zero filler : Length (10) 

Bank spaces :Length (45) 

Data Rules: 

1.Creates Separate files for each plan and is ordered by Bank account number. 


ANCHOR Retro Pension Check Information 

Interface: Retro Pension Check Information 

Description: 

This file displays information regarding the retro payment checks from the General payments run 

File Layout: 

Name (ordered First Middle Last - this should be concatenated) 

address - 1 

address - 2 

address - 3 

City 

State 

Zip - 5 

Zip - 4 

net check amount 

Data Rules: 

The data file is comma delimited.

Physical Interface BCBS Paperless Enrollment - Employees ...

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