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This document describes the purpose and layout of the file of test Medicare beneficiary data provided to responsible reporting entities (RREs) and agents for Section 111 Liability Insurance (Including Self-Insurance), No-Fault and Workers' Compensation Mandatory Reporting (Non-GHP or NGHP). Please see Chapter IV, Chapter 9 of the NGHP User Guide for more information on the testing process.
The NGHP test beneficiary data can be found in either of these downloadable files. You can download the test beneficiary data by clicking on the file name below. To save a copy to your workstation, right-click a link and select "Save Target As." The data is provided in two formats, in a Microsoft Office Excel 2003 file (.xls) and in a MS-DOS text file (.txt).
The file names are:
Purpose
Test Medicare beneficiary data is provided in downloadable files to NGHP RREs and agents for use in testing the exchange of Query Input and Claim Input Files for Section 111 Mandatory Reporting. The test data will contain SSN, HICN, last name, first name, middle initial, date of birth, and gender for test beneficiaries. It also provides the start date of Medicare entitlement and an end date if one applies. It will not include claim information. It is provided in order to ensure RREs can test conditions where a match to a Medicare beneficiary is found. The data reflect entirely fictional individuals and will not match to any Medicare beneficiary data in the production environment. Use of this test data is limited to Section 111 NGHP Query and Claim Input File testing.
RREs or their reporting agents may use the data in the corresponding fields for the injured party on Query and Claim Input Files in order to test conditions where a match to a Medicare beneficiary is found. RREs or their reporting agents are responsible for creating all other data for required fields on test files. Twenty-five (25) test Medicare beneficiaries have been created. Each test beneficiary may be used on multiple Claim Input File Detail Records as needed. The entries for last names Gargery and Gradgrind will produce a match on 5-digit SSN, and one hit on four of four matching criteria. The two entries for last names Podsnap and Podsnat will produce a match on the 5-digit SSN and multiple hits on four of four matching criteria, thus should generate a DP error on submission.
Use of the test Medicare beneficiary data is optional. RREs and agents may submit data for actual injured parties from their production claims systems on Section 111 test files in addition to or as an alternative to the use of test beneficiary data.
File Format
The Excel file is comprised of one spreadsheet with nine columns. The first row in the spreadsheet contains header labels for each column, namely HICN, SSN, Last Name, First Name, Middle Initial, Date of Birth, Gender, Medicare Start Date, and Medicare End Date. The remaining rows contain the data for the twenty-five test Medicare beneficiaries.
The record layout of the MS-DOS text file is described in the table below. Each record has a carriage return line feed (CRLF) at its end. Each record contains a total of 86 bytes of data. Fields are of fixed length and there are no field delimiters used.
| Field | Length | Starting Position | Ending Position | Description |
| HICN | 12 | 1 | 12 | Fictitious Medicare Health Insurance Claim Number for test beneficiary. Unique identifier assigned to test individual. |
| SSN | 9 | 13 | 21 | Fictitious Social Security Number for test beneficiary. |
| Last Name | 24 | 22 | 45 | Last or surname of the test beneficiary. |
| First Name | 15 | 46 | 60 | First or given name of the test beneficiary. |
| Middle Initial | 1 | 61 | 61 | First character of the middle name of the test beneficiary. |
| Date of Birth | 8 | 62 | 69 | Date of Birth of test beneficiary. Format: CCYYMMDD |
| Gender | 1 | 70 | 70 | Code to reflect the sex of the test beneficiary. Values: 1 = Male 2 = Female |
| Medicare Start Date | 8 | 71 | 78 | Start Date of Medicare Entitlement (when current coverage under Medicare began). |
| Medicare End Date | 8 | 79 | 86 | End Date of Medicare entitlement (when most recent coverage under Medicare ended). Will contain all zeros if entitlement/coverage is active (not ended). |
Example X12 271 for Testing HEW software
The example X12 271 query response file is provided below in downloadable form to allow NGHP RREs to test the HEW software and/or the RRE's own translation software.
The example file is in X12 format and includes mock data for test beneficiary Part C and Part D enrollment(s) to illustrate how additional data provided in concordance with the PAID Act will be returned, and to allow RREs to translate the X12 into the expanded 271 flat file format.
To test the HEW software, download the Example X12 271 text file, then run the 271 Inbound function (using S111/VDSA processing format). The HEW application version 5.0 (or greater) will translate the example X12 271 file into a flat file response, populating Part C and Part D fields for the test beneficiary as outlined in the NGHP User Guide.
The following beneficiary records (data scenarios) are included in the Example NGHP X12 271 Query Response file:
| Scenario | Description | Test Beneficiary Medicare ID |
| 1 | Part A effective date and Part B effective date only (no term dates), No Part C or D data | TTT000000013 |
| 2 | Part A effective date and Part B effective date only (no term dates), Part C effective date only (not termed), 1 Part C occurrence with Contract details, No Part D data | TTT000000014 |
| 3 | Part A effective date and Part B effective date only (no term dates), Part C effective and term dates, 1 Part C occurrence with Contract details, No Part D data | TTT000000015 |
| 4 | Part A effective date and Part B effective date only (no term dates), Part C effective date only (not termed), 1 Part C occurrence with Contract details, Part D effective date only (not termed), 1 Part D occurrence with Contract details | TTT000000016 |
| 5 | Part A effective date and Part B effective date only (no term dates), Part C effective and term dates, 1 Part C occurrence with Contract details, Part D effective and term dates, 1 Part D occurrence with Contract details | TTT000000017 |
| 6 | Part A effective and term date, Part B effective and term date, No Part C or D data | TTT000000018 |
| 7 | Part A effective date and Part B effective date only (no term dates), Part D effective date only (not termed), 1 Part D occurrence with Contract details, No Part C data | TTT000000019 |
| 8 | Part A effective date and Part B effective date only (no term dates), Part D effective and term dates, 1 Part D occurrence with Contract details, No Part C data | TTT000000021 |
| 9 | Part A effective date and Part B effective date (not termed), 12 Part C enrollments within 3 years of process date, 12 Part D enrollments within 3 years of process date (Part C and D enrollments include Contract details) | TTT000000011 |
| 10 | Part A effective date, No Part B entitlement, multiple Part C enrollments within and beyond 3 years of the process date (only those within 3 years are returned), multiple Part D enrollments within and beyond 3 years (only those within 3 years are returned) | TTT000000012 |
| 11 | Part A effective date, Part B effective date, multiple Part C enrollments, multiple Part D enrollments:
| TTT000000024 |
| 12 | Part A effective date and Part B effective date (not termed), multiple Part C and multiple Part D enrollments:
| TTT000000011 and/or TTT000000012 |
September 2024
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