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{"sheet":"Document History Log","index":0,"n_rows":13,"n_cols":4,"rows_kept":13,"cut":false,"hidden":false,"merged":[[0,0,4,0],[0,1,0,2],[2,1,2,2],[11,0,11,3],[12,0,12,3],[5,0,5,3],[10,0,10,3]]}
[null,"HHSC UNIFORM MANAGED CARE MANUAL",null,"CHAPTER"]
[null,null,null,"5.24.12"]
[null,"NEMT Trip Activity",null,"EFFECTIVE DATE"]
[null,null,null,"2023-03-02"]
[null,null,null,"Version 2.3"]
["DOCUMENT HISTORY LOG"]
["STATUS1","DOCUMENT REVISION2","EFFECTIVE DATE","DESCRIPTION3"]
["Baseline",2,"2023-03-01","Initial version Uniform Managed Care Manual Chapter 5.24.12 \"NEMT Trip Activity.\"\n\nChapter 5.24.12 applies to contracts issued as a result of HHSC RFP numbers 529-12-0002, 529-10-0020, 529-13-0042, 529-15-0001, 529-13-0071, and Medicare-Medicaid Plans (MMPs) in the Dual Demonstration.  "]
["Revision",2.1,"2023-03-01","Administrative change to spreadsheet format "]
["Revision",2.2999999999999998,"2023-03-02","Administrative change to the Text File Layout tab to insert static rows for footer records, when needed."]
["1  Status should be represented as “Baseline” for initial issuances, “Revision” for changes to the Baseline version, and “Cancellation” for withdrawn versions."]
["2  Revisions should be numbered according to the version of the issuance and sequential numbering of the revision—e.g., “1.2” refers to the first version of the document and the second revision."]
["3  Brief description of the changes to the document made in the revision."]

{"sheet":"Submission Instructions","index":1,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":false,"merged":[]}
["Submission Instructions"]
["1.  Submit one NEMT Trip Activity text file layout each month, by Program. The NEMT Trip Activity text file is due 45 Days after the last Day of the reporting month. (Ex: Reporting for March 2022 is due no later than May 15, or the following business day if May 15 is a weekend or holiday)\n\n2.  The text file layout must be saved as a fixed-width text file with a .txt file extension.  A standard naming convention is not necessary because there will be specific, named locations in TexConnect where the file(s) will be uploaded. \n\n3.  The sequence is a count in numerical order of the individual rows of data contained in the text file. \n\n4.  Do not enter commas as they are implied. (Example:  The number of calls answered is 12,500.  Enter 12500.)\n\n5.  If a field is not applicable, enter blank spaces until the next field position is reached.  (Example: If the field is not applicable to the MCO's program.  The field width is five spaces.  The MCO will hit the space bar five times until the next field position is reached.)\n\n6.  If data entered is less than the field allows, enter spaces until the next field position is reached.  (Example:  If the field width is ten and only five characters are needed, tap the space bar five times until the next field position is reached.)\n\n7.  Upload the completed text file to the appropriate report name and program in TexConnect. "]

{"sheet":"Text File Layout","index":2,"n_rows":40,"n_cols":8,"rows_kept":40,"cut":false,"hidden":false,"merged":[]}
["Field  Description","Type","Size","Beginning Position","Ending Position","Value","Instructions","Validations"]
["Sequence","N",6,1,6,"NNNNNN","Enter the sequence/line number for each record/line item.","If including data from a subcontractor or vendor, ensure that the sequence numbers are not duplicated in the text file."]
["Footer Record Placeholder","AN",2,{"$f":"E2+1","v":7},{"$f":"D3+C3-1","v":8},"Leave blank","This is a placeholder field for text file layouts that require a footer record.","These fields should always be left blank."]
["MCO Name","AN",3,{"$f":"E3+1","v":9},{"$f":"D4+C4-1","v":11},"AET = Aetna\nAMC = Amerigroup\nBCB = Blue Cross & Blue Shield\nCFC = Community First\nCHC = Community Health Choice\nCKC = Cook Children’s\nDRC = Driscoll Children’s\nDTQ = DentaQuest\nEP1 = El Paso Health\nFCR = FirstCare\nMCN = MCNA Dental\nMOL = Molina\nPRK = Parkland Community\nSCW = Scott & White\nSET = Dell Children’s\nSUP = Superior\nTXC = Texas Children’s\nUHC = United\nUHD = United Dental","Enter the code for the MCO name. ","Do not submit for CHIP, CHIP Dental, or CMDS."]
["Reporting Month","N",2,12,13,"01 = January\n02 = February\n03 = March\n04 = April\n05 = May\n06 = June\n07 = July\n08 = August\n09 = September\n10 = October\n11 = November\n12 = December","Enter the month for the data being reported. "]
["State Fiscal Year","N",4,14,17,"YYYY","Enter the reporting State Fiscal Year in the YYYY format (e.g., 2022).","SFY 2021 (September 1, 2020 - August 31, 2021) \nSFY 2022 (September 1, 2021 - August 31, 2022)"]
["Program","N",2,18,19,"01 = STAR\n02 = STAR+PLUS\n03 = STAR Health\n04 = STAR Kids\n05 = CHIP\n06 = CMDS\n07 = CHIP Dental\n10 = MMP","Enter the Program code for the data reported. ","Do not submit for CHIP, CHIP Dental, or CMDS."]
["Plan Code","AN",2,20,21,"XX ","Enter the MCO plan code. If the plan code has a leading zero, it must also be entered. ","Verify that the plan code(s) are correct for the Program entered. "]
["Trip Requested By","AN",1,22,22,"M = Member\nP = Provider\nL = Legally Authorized Representative (LAR)\nO = Other","Enter the value for the individual that initiated contact to request the NEMT Services. "]
["Other Trip Requested By","AN",150,23,172,"Free text field","Must be completed when \"O = Other\" is selected as the Trip Requested By.","Required when Row 9 is \"O=Other\". "]
["Date Trip Requested","N",8,173,180,"MMDDYYYY","Enter the date the trip was requested. ","Date received must be in the reporting month. "]
["Medicaid ID","N",9,181,189,"NNNNNNNNN","Enter the Member's state issued Medicaid Identification Number. "]
["Transportation Provided By","AN",3,190,192,"DRT = Demand Response Transportation\nITP = Individual Transportation Participant\nTNC = Transportation Network Company","Identify who provided the NEMT Service. "]
["Transportation Provider Name","N",150,193,342,"Free text field","Enter the transportation provider name. "," Leave blank if Row 13 is \"ITP = Individual Transportation Participant\"."]
["Trip 1 Approval Number","AN",20,343,362,"XXXXXXXXXXXXXXXXXXXX","Enter the approval number for the first leg of the trip. ","Required."]
["Trip 2 Approval Number","AN",20,363,382,"XXXXXXXXXXXXXXXXXXXX","Enter the approval number for the second leg of the trip if, provided. ","Must be completed if a return trip was requested."]
[" Trip 3 Approval Number","AN",20,383,402,"XXXXXXXXXXXXXXXXXXXX","Enter the approval number for the third leg of the trip, if applicable. ","Leave blank if there is no third leg of the trip."]
["Add-on Trip Approval Number","AN",20,403,422,"XXXXXXXXXXXXXXXXXXXX","Enter the approval number for the Add-on leg of the trip, if applicable. ","Leave blank if there is no Add-on leg of the trip."]
["Was the Trip Completed?","AN",1,423,423,"Y = Yes \nN = No","Enter \"Y\" if a single leg or round trip (two legs) transportation was provided. Enter \"N\" if the approved trip was not completed in its entirety. "]
["Date Trip Completed","N",8,424,431,"MMDDYYYY","Enter the date the trip was completed. ","If Row 19 is \"N\", leave blank. "]
["Reason Trip Not Completed","AN",1,432,432,"N= Member No Show\nC = Cancelled\nH = Has not occurred\nP = Provider No Show\nO = Other","Enter the reason the trip was not completed. ","Required if Row 20 is blank. "]
["Other Reason Trip Not Completed","AN",150,433,582,"Free text field","Must be completed when \"H = Has not occurred\" or  \"O = Other\" is selected as the Reason Trip Not Completed.","Required when Row 21 is \"H = Has not occurred\" or \"O = Other\". "]
["Was the Trip Canceled?","AN",1,583,583,"Y=Yes \nN=No","Enter \"Y\" if the trip was canceled.  Enter \"N\" if the trip was not canceled. "]
["Trip Canceled By","AN",2,584,585,"ME = Member Canceled\nMC = MCO Canceled\nPR = Healthcare Provider Canceled\nMT = Transportation Provider Canceled\nOT = Other","Enter the value for the individual that canceled the request for NEMT Services. ","Required when Row 23 is \"Y\"."]
["Other Trip Cancelled By ","AN",150,586,735,"Free text field","Must be completed when \"OT=Other\" is selected as the Trip Canceled By.","Required when Row 24 is \"OT=Other\"."]
["Trip Cancellation Reason","N",11,736,746,"01 = Cancelled Prior to Trip\n02 = Driver/Member did not provide timely/sufficient documentation\n03 = No Vendor Available\n04 = Trip Rescheduled\n05 = Transportation Provider Cancelled in Error\n06 = Patient Cancelled/ Refused\n07 = Member Had Alternate Transportation\n08 = Trip Not Finalized\n99 = Other","If the trip was canceled, select the appropriate trip cancellation reason. ","Required when Row 23 is \"Y\"."]
["Other Trip Cancellation Reason Detail","AN",150,747,896,"Free text field","Must be completed when \"99=Other\" is selected as the Trip Cancellation Reason.","Required when Row 26 is \"99=Other\"."]
["Was this trip a hospital discharge?","AN",1,897,897,"Y=Yes \nN=No","Enter \"Y\" if the trip was a hospital discharge.  Enter \"N\" if the trip was not a hospital discharge. "]
["If hospital discharge, did the trip occur within 3 hours of notification to the MCO or subcontractor?","AN",1,898,898,"Y=Yes \nN=No","Enter \"Y\" if the trip due to a hospital discharge occurred within 3 hours of notification. Enter \"N\" if the trip due to a hospital discharge did not occur within 3 hours. "]
["Footer Record Details",null,null,null,null,null,"The footer record fields below must be completed for each individual plan code. Some information entered will be duplicative (*), but is requested so that HHSC can calculate totals by plan code.  ","Footer records are required. "]
["Sequence*","N",6,1,6,"NNNNNN","Enter the sequence/line number for each record/line item. The footer sequence will not be a duplicate of a previous sequence number in this file. (Ex: If the last non-footer record is 000025, the first footer record will be 000026).","Do not start the sequence count over, this is a continuation of the last sequence number used."]
["Footer Code","AN",2,{"$f":"E31+1","v":7},{"$f":"D32+C32-1","v":8},"FT","Enter FT to show the start of the footer."]
["MCO Name*","AN",3,{"$f":"E32+1","v":9},{"$f":"D33+C33-1","v":11},"AET = Aetna\nAMC - AMERIGROUP\nBCB = Blue Cross & Blue Shield\nCFC = Community First\nCHC - Community Health Choice\nCKC = Cook Children’s\nDRC = Driscoll Children’s\nDTQ = DentaQuest\nEP1 = El Paso Health\nFCR = FirstCare\nMCN = MCNA Dental\nMOL = Molina\nPRK = Parkland Community\nSCW = Scott & White\nSET = Dell Children’s\nSUP = Superior\nTXC = Texas Children’s\nUHC = United\nUHD = United Dental","Enter the code for the MCO name.","Do not submit for CHIP, CHIP Dental, or CMDS."]
["Reporting Month*","N",2,12,13,"01 = January\n02 = February\n03 = March\n04 = April\n05 = May\n06 = June\n07 = July\n08 = August\n09 = September\n10 = October\n11 = November\n12 = December","Enter the month for the data being reported. "]
["State Fiscal Year*","N",4,14,17,"YYYY","Enter the state fiscal year in the YYYY format (e.g., 2022).","SFY 2021 (September 1, 2020 - August 31, 2021) \nSFY 2022 (September 1, 2021 - August 31, 2022)"]
["Program*","N",2,18,19,"01 = STAR\n02 = STAR+PLUS\n03 = STAR Health\n04 = STAR Kids\n05 = CHIP\n06 = CMDS\n07 = CHIP Dental\n10 = MMP","Enter the Program for the claims data reported. "]
["Plan Code*","AN",2,20,21,"XX ","Enter the MCO plan code. If the plan code has a leading zero, it must also be entered. ","Verify that the plan code(s) are correct for the Program entered. "]
["Footer Code","AN",2,null,null,"FT","Enter FT to show the start of the footer."]
["Total # of On Time Pick-ups","N",6,{"$f":"E37+1","v":22},27,"NNNNNN","Enter the total number of trips where the Member was picked up and dropped off within 15 minutes, but no more than one (1) hour prior to their scheduled appointment time."]
["Total # of On Time Drop-offs","N",6,28,33,"NNNNNN","Enter the total number of trips where the Member was picked up within an hour of notifying the MCO, subcontractor, or provider to initiate the trip. "]