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HubElectronic Data Interchange (EDI) File NamingConventionsSeptember 2019Version 35.1Quality Software Services, Inc.10480 Little Patuxent Parkway, Suite 1100Columbia, MD 21044Main: 301-977-7884Fax: 410-740-4281Hub Style Template - May 2018

HubEDI File Naming ConventionsTable of Contents1Introduction . 11.123Purpose . 1Filename Sections . 22.1Trading Partner Identifier . 22.2Application Identifier . 22.3Function Code . 22.4Date . 22.5Time . 22.6Environment Code . 32.7Direction . 3Filename Formats . 43.1Filename Format for Files Received by External Entities (Outbound from CMS) . 43.2Filename Format for Files Sent by External Entities (Inbound to CMS) . 44Filename Restrictions . 55Function Codes and Application IDs for EDI Transactions. 65.1Issuer-Related Transactions . 65.2SBE-Related Transactions .20Appendix A - Glossary of Terms, Acronyms, and Definitions.23Appendix B - Referenced Documents .28Appendix C - Record of Changes .29List of TablesTable 1 - Filename Format for Files Received by External Entities. 4Table 2 - Filename Format for Files Sent by External Entities . 4Table 3 - Length Restrictions . 5Table 4 - Issuer-Related Transactions . 6Table 5 - Sample Filenames - Inbound to CMS from Issuers . 9Table 6 - Sample Filenames - Outbound from CMS to Issuers.13Table 7 - SBE-Related Transactions .20Table 8 - Sample Filenames - Inbound to CMS from SBEs .20Table 9 - Sample Filenames - Outbound from CMS to SBEs .21Table 10 - Glossary of Terms, Acronyms, and Definitions .23Table 11 - Referenced Documents.28Table 12 - Record of Changes .29September 2019iiUse or disclosure of data in this document is subject to restriction.

HubEDI File Naming Conventions1 IntroductionOn March 23, 2010, the President signed into law the Patient Protection and Affordable CareAct (PPACA) (P.L. 111-148). On March 30, 2010, the President signed into law the Healthcareand Education Reconciliation Act (HCERA) of 2010 (P.L. 111-152. These two laws comprise theAffordable Care Act (ACA).The ACA creates new competitive private health insurance markets, or Exchanges, whichprovide millions of Americans and small businesses access to affordable coverage. Exchangeshelp individuals and small employers shop for, select, and enroll in high quality, private healthplans that fit their needs. Exchanges are required to incorporate interoperable and securestandards and protocols the Secretary of the Department of Health and Human Services (HHS)developed in accordance with § 3021 of the Public Health Service (PHS) Act.This is a living document that evolves, and that the Quality Software Services, Incorporated(QSSI) Hub Team, or the Team, updates upon identification of more timely and effectiveprocedures.See Appendix B - Referenced Documents for a list and description of documents this documentreferences or that are applicable to the development and use of this document.1.1 PurposeThe ACA requires the use of a single, streamlined application to determine eligibility forenrollment in a qualified health plan (QHP), and for insurance affordability programs, includingadvance payment of the premium tax credit (APTC), Cost-Sharing Reductions (CSRs),Medicaid, Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP)where applicable. As part of the eligibility determination process, the system may also use thisdata to identify Applicants who qualify for an exemption from the individual responsibilityrequirement. The ability of an individual to access the appropriate coverage across multipleinsurance affordability programs through a single, streamlined application and coordinatedeligibility process means that no matter how an individual submits an application, or whichinsurance affordability program the Applicant may be eligible for, an individual experiences aconsistent process and receives a consistent eligibility determination, without the need to submitinformation to multiple entities.An Issuer provides, or issues, insurance to an Applicant. The Issuer and the Exchange transferdata through ASC X12 files. An Enterprise File Transfer (EFT) solution facilitates thiscommunication of data. To make the movement of files easier, the filenames of the filestransferred must be easy to understand and have a common format.This document explains formats for the filenames that external entities (like Issuers) receive andsend through EFT.September 20191Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming Conventions2 Filename SectionsThe filenames proposed for usage by external entities consist of the following sections: Trading Partner (TP) Identifier (ID)Application IDFunction CodeDateTimeEnvironment CodeDirection2.1 Trading Partner IdentifierThe TP ID section of the filename is the identification number assigned to the TP.2.2 Application IdentifierThe Application ID section of the filename is an ID for the application that processes the files.This section specifies the target application where the system routes the file. This is a staticvalue in most cases.For Hub-related files, use DSH as the Application ID.See Section 5 - Function Codes and Application IDs for EDI Transactions for the Application IDlist. See Section 4 - Filename Restrictions for field restrictions.2.3 Function CodeThe Function Code section of the filename is an alphanumeric code indicating the functionalpurpose of the file within the application. This also helps identify specific processing once thesystem routes the file to the application. Application owners work with their Partners and definethese codes for the various files exchanged.See Section 5 - Function Codes and Application IDs for EDI Transactions for the function codeslist. See Section 4 - Filename Restrictions for field restrictions.2.4 DateThe Date section of the filename specifies the date the file transferred in DYYMMDD formatwhere YY is the last two digits of the year, MM is the month, and DD is the day of the month.The first D is static text.2.5 TimeThe Time section of the filename specifies the time created (timestamp) for the file inTHHMMSSmmm format where HH is hours, MM is minutes, SS is seconds, and mmm ismilliseconds. The T is static text and exactly nine numerals must follow.September 20192Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming Conventions2.6 Environment CodeThe Environment Code section of the filename is a single character code indicating theenvironment to which the system transfers the file. Permitted values are as follows: P for Production Environment (PROD)T for Test Environment (TEST) and Implementation Environment (IMP)1AI for IMP22.7 DirectionThe Direction section of the filename indicates the direction in which the data flows, towards theCenters for Medicare & Medicaid Services (CMS) or away from CMS: IN for to CMSOUT for from CMSSee Section 4 - Filename Restrictions for field restrictions.September 20193Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming Conventions3 Filename FormatsThis section presents the format filenames must follow to allow Hub processing.3.1 Filename Format for Files Received by ExternalEntities (Outbound from CMS)The files sent from CMS to Partners must follow the format in Table 1 - Filename Format forFiles Received by External Entities.Table 1 - Filename Format for Files Received by External D130214T145543452POUTFormat: ionExample: 1234567890.999.D130223.T145543411.P.OUTNote: A period (.) is the separator for file segments.3.2 Filename Format for Files Sent by ExternalEntities (Inbound to CMS)The files sent to CMS from Partners must follow the format in Table 2 - Filename Format forFiles Sent by External Entities.Table 2 - Filename Format for Files Sent by External EntitiesItemSection Section SectionSectionFieldTPIDLength/ Format 1-10ExampleSectionAppIdFuncCode Date31-6DYYMMDD THHMMSSmmm 12IC834D130215IN1234567890 DSHTimeSection SectionT145543453EnvPDirectionFormat: DirectionExample: 1234567890.DSH.IC834.D130223.T145543452.P.INNote: A period (.) is the separator for file segments.September 20194Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming Conventions4 Filename RestrictionsTable 3 - Length Restrictions presents length restrictions for filename sections.Table 3 - Length RestrictionsSectionLengthCommentsApplication ID3Hub, Federally Facilitated Exchange (FFE), Multidimensional InsuranceData Analytics System (MIDAS), etc.Date7DYYMMDD where first character D is static text and remaining charactersare date in YYMMDD formatDirection2-3IN for files coming into CMS and OUT for files going out of CMSEnvironmentCode1P for PROD, T for TEST or IMP1A, I for IMP2Function Code3-6I834, 999, S820, etc.Time10THHMMSSmmm where character T is static text and remainingcharacters are time in HHMMSSmmm formatTP ID5-10Identifies TP transmitting/receiving files with CMSSeptember 20195Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming Conventions5 Function Codes and Application IDs for EDITransactionsThis section presents function codes and Application IDs for EDI transactions.5.1 Issuer-Related TransactionsTable 4 - Issuer-Related Transactions presents a list of function codes related to the Issuercommunity including State-Based Exchange (SBE) Issuers, both inbound to CMS and outboundfrom CMS.Table 4 - Issuer-Related TransactionsInbound D9September 20196Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming N/AMOIPA0N/AMSWTCHN/AOP834TN/AORPHN7September 20197Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming FLN/ARI834TSeptember 20198Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming ConventionsTable 5 - Sample Filenames - Inbound to CMS from Issuers presents a list of sample filenames for files inbound to CMS fromIssuers.Table 5 - Sample Filenames - Inbound to CMS from IssuersTransactionFile TypeTransaction CodeFunction CodeApplication IDExample (Issuers with TP ID as 1234567890)1A Workbooks Sent toCMSZIP 001023.P.INAcknowledgement(ACK) FileEDI[TA1] .INBusiness ApplicationAcknowledgement(BAA) for BenefitEnrollmentMaintenance (834Transaction) forIndividual MarketExtensible BA.D130223.T145543452.P.INBAA for BenefitEnrollmentMaintenance (834Transaction) for SmallBusiness HealthOptions Program(SHOP) .T145543452.P.INBAA for PaymentOrder/RemittanceAdvice (820Transaction) forIndividual Market(Initial and .T145543452.P.IN[999]005010X231A1September 20199Use or disclosure of data in this document is subject to restriction .

HubEDI File Naming ConventionsTransactionFile TypeTransaction CodeFunction CodeApplication IDExample (Issuers with TP ID as 1234567890)BAA for PaymentOrder/RemittanceAdvice (820Transaction) for SHOPMarket (Initial 223.T145543452.P.INBenefit Enrollment andMaintenance (834Transaction) ConfirmationTransaction forIndividual D130223.T145543452.P.INBenefit Enrollment andMaintenance (834Transaction) ConfirmationTransaction for 834.D130223.T145543452.P.INBenefit Enrollment andMaintenance (834Transaction) - MonthlyInbound Audit file forIndividual 67890.DSH.IA834.D130223.T145543452.P.INBenefit Enrollment andMaintenance (834Transaction) - MonthlyInbound Audit file forSHOP 67890.DSH.SA834.D130223.T145543452.P.INSeptember 201910Use or disclosure of data in this document is subject to restriction .