{"text_format":"3","workbook":"xlsx","n_sheets":4,"sheets":["Instructions","Header","Claim","Trailer"],"not_rendered":{"images":1,"defined_names":3},"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":56,"n_cols":2,"rows_kept":56}
["Carrier Rollover Claim File"]
[]
[]
["A","File Submission"]
[1,"Submit your file to the WageWorks FTP Site, per the arrangements made through your Project Manager."]
[null,"TEST FTP site:   ftp.wageworks.com test folder"]
[]
[null,"LIVE/Production FTP site:   ftp.wageworks.com claims folder"]
[]
["B","Record Processing Status"]
[1,"Each record in the file received by WageWorks will be processed and given one of the following statuses:"]
[2,"Invalid = No data for the record will be used"]
[3,"Used to Adjudicate Card Transaction = Data was found to be a match and used to substantiate a direct card transaction initiated by the participant"]
[4,"Possible Duplidate = determined to be a possible duplicate of another claim already on file. Held pending investigation"]
[5,"Used to create pay me back claim = A claim was created for the participant for reimbursement according to balance available"]
[]
["C","General Record Rejection Reasons"]
[1,"Field level rejection reasons are described below in the file format."]
[2,"Date is not valid."]
[3,"Data does not meet field level requirements."]
[4,"Data exceeds field length or does not meet fixed length."]
[5,"Required field is null.  "]
[6,"Cannot uniquely ID Eligible/Participant."]
[7,"Employer or Plan does not support files with this carrier"]
[8,"Service Dates are outside of the range of the plan"]
[9,"Employee does not participant in a plan that allows rollover or card substantiation"]
[]
["D","Record Types"]
[1,"H = Header - identifies date format, file type  (optional)"]
[2,"D = Claim Record - details out of pocket information paid by a member for a carrier adjudicated claim"]
[3,"T = Trailer - identifies total information (optional)"]
[]
["E","Field Requirements"]
[1,"Fixed Field Length or pipe delimited file"]
[2,"Character fields left justified, space filled"]
[3,"Numeric field right justified, zero filled"]
[4,"Amount fields use physical decimal places"]
[5,"Provide values in order as illustrated for applicable record type below."]
[6,"Records must be provided in ASCII format with each terminated with CR (carriage return) or CR/LF.  "]
[]
["F","File Naming Standards"]
[1,"Sample File Name (Production):  RO_123_5678_SSN_CLIENT_YYYYMMDD.TXT"]
[2,"Sample File Name (TEST): TEST_RO_123_5678_SSN_CLIENT_YYYYMMDD.TXT"]
[3,"RO = Rollover Claim File - identifies type of file"]
[4,"123 = WageWorks Partner ID - number assigned to the Carrier by Wageworks through the Implementation Project Manager"]
[5,"5678 = WageWorks Mapping ID - the number assigned to the internal mapping that is to be used to process the file."]
[6,"SSN = Identifier used on file. This may be SSN, HEALTHPLANID, EEID, ERFIELD10"]
[7,"CLIENT = The name or abreviated name of the client for which claims are being sent."]
[8,"YYYYMMDD = date file was created in YYYYMMDD format"]
[9,".TXT = Unencrypted file"]
[10,".TXT.PGP = Encrypted File (ASCII Armored encrypted)"]
[11,".TXT.ASC = Encrypted File (ASCII Armored encrypted)"]
[12,"Maximum length of file name = 70 characters"]
[]
[]
[null,"Fixed Length file or a Delimited file (pipe, comma, etc.)"]

{"sheet":"Header","index":1,"n_rows":5,"n_cols":12,"rows_kept":5}
["#","Field","Required?","Allowable Values","Null Permitted?","Default Value","Start Position","Length","Description","Comments","Additional Processing","Reject Reason"]
[1,"Record Type","Y","H (Header)","N","NA",1,1,"Identifies the type of record that follows","Identifies type of record",null,"Null = Missing record type."]
[2,"File Type","Y","RO","N","RO",{"$f":"G2 +H2","v":2},2,"Type of file - Rollover Claims"]
[3,"Partner ID","Y",null,"N","NA",{"$f":"G3 +H3","v":4},9,"Number identifying carrier","Assigned by WageWorks"]
[4,"File Date","Y",null,"N","NA",{"$f":"G4 +H4","v":13},8,"File Creation Date","YYYYMMDD format"]

{"sheet":"Claim","index":2,"n_rows":33,"n_cols":12,"rows_kept":33}
["#","Field","Required?","Allowable Values","Null Permitted?","Default Value","Start Position","Max Length","Description","Comments","Additional Processing","Reject Reason"]
[1,"Record Type","Y","D (Claim Detail)","N","NA",1,1,"Type of record that proceeds","Identifies type of record",null,"Null = Missing record type."]
[2,"SSN","Y (If used. Otherwise field 4 is required.)","Numeric","Y (If field is not used.)","NA",{"$f":"G2 +H2","v":2},9,"Subscriber SSN","Required if Identifier type (see instructions file naming convention) is SSN and not Carrier Employee ID . Used to match to participant in WW database",null,"Null = Missing Unique ID."]
[3,"Carrier Group Number (Partner ID)","Y","Alphanumeric","N","NA",11,20,"Unique identifier assigned by WageWorks to the Carrier providing claims data","WageWorks will provide you with the Partner ID to use in this field."]
[4,"WW Employer Id","Y","Numeric","N","NA",31,9,"Unique identifier assigned by WageWorks to the Program Sponsor who offers plans to the Eligible/Participant identified in this record.","Required to identify employer on file",null,"Null = Missing WW Group ID.  No Match = Unknown WW Group ID."]
[5,"Carrier Employee ID","Y (If used. Otherwise field 2 is required.)","Alphanumeric","Y (If field is not used.)","NA",40,15,"Carrier defined employee identifier","Required if identifier type (see instructions file naming convention) is anything other than SSN. Used to match to participant in WW database based on identifier type provided.",null,"Null = Missing Unique ID."]
[6,"Employee Last Name","N","Alphanumeric","Y","Null",55,30,"Last name of Subscriber"]
[7,"Employee First Name","N","Alphanumeric","Y","Null",85,20,"First name of Subscriber"]
[8,"Original Claim Number","Y","Alphanumeric","N","NA",105,30,"Claim Number assigned by the carrier"]
[9,"Claim Line Number (Service Line)","Y","Alphanumeric","N","NA",135,3,"Claim Line Number assigned by the carrier","Data is expected to be at the service line level. This field identifies the line number at the carrier level."," "]
[10,"Claim Adjudication Date","N","Date","Y","Null",138,8,"Date carrier adjudicated the claim","YYYYMMDD format"]
[11,"Claim Unique Identifier","N","Alphanumeric","Y","Null",146,30,"Unique identifier of claim","This will be used to tie back to the original claim when negative adjustments come in. Negative adjustments will be ignored if this is not populated","If populated and out of pocket amount is negative, find original claim and populate recovery table"]
[12,"Re-Adjudication (adjustments)","N","Character: Y(Yes), N(No)","Y","N",176,1,"Y = readjudication of previous claim, N = new claim","Any adjustment to a claim already send should have a value of \"Y\""]
[13,"Re-Adjudication Date","N","Date","Y","Null",177,8,"Date claim was readjudicated","YYYYMMDD format"," "]
[14,"Patient Last Name","N","Alphanumeric","Y","Null",185,30,"Patient (member) last name"]
[15,"Patient First Name","N","Alphanumeric","Y","Null",215,20,"Patient (member) first name"]
[16,"Claim Type","Y","Alphanumeric","N","MED",235,3,"Type of claim- MED = medical, DEN = Dental, RX = Prescription, VIS = Vision"]
[17,"Service Start date","Y","Date","N","NA",238,8,"Date Service Started","YYYYMMDD format"," ","Service outside of plan period."]
[18,"Service Through Date","Y","Date","N","NA",246,8,"Date Service Completed","YYYYMMDD format",null,"Service outside of plan period."]
[19,"Provider Name","Y","Alphanumeric","Y","Null",254,40,"Name of service provider"]
[20,"Original Charge","N","Numeric Amount","Y","Null",294,8,"Amount initially charged by service provider"]
[21,"Covered Amount","N","Numeric Amount","Y","Null",302,8,"Amount covered by insurance (excludes any amount over reasonable and customary, etc.)"]
[22,"COB Amount","N","Numeric Amount","Y","Null",310,8,"Coordination of Benefits - Amount paid by another provider"]
[23,"Deductible Amount","Y, if applicable","Numeric Amount","Y","Null",318,8,"Amount applied to subscribers deductible"]
[24,"Co-Insurance Amount","Y, if applicable","Numeric Amount","Y","Null",326,8,"Amount applied to coinsurance according to plan rules"]
[25,"Copay Amount","Y, if applicable","Numeric Amount","Y","Null",334,8,"Amount applied to subscribers copay"]
[26,"Payment Amount (total OOP amount for WageWorks to pay the member)","Y","Numeric Amount","N","Null",342,8,"Total out of pocket amount for member","Will be used as reimbursable amount in the event of a pay me back claim being created.  This is NOT the payment amount by the carrier"]
[27,"Carrier Defined Code1","N","Alphanumeric","Y","Null",350,8,"Internal rejection reason or description from carrier. ","Description required","If populated, look up table populated with carriers internal descriptions to determine payability."]
[28,"Carrier Defined Code 2","N","Alphanumeric","Y","Null",358,8,"Internal rejection reason or description from carrier. ","Description required","If populated, look up table populated with carriers internal descriptions to determine payability."]
[29,"ICD9 Code   or            IDC10 Code","N","Alphanumeric","Y","Null",366,15,"Diagnosis code from American Medical Association","This value appears on all reports and ER Site search function for identification purposes.  "]
[30,"CPT Code","N","Alphanumeric","Y","Null",381,8,"Procedure code from American Medical Association","Will be used to determine if amount is cosmetic. If this code is not populated, Wageworks will assume the claim is payable under the FSA plan."]
[31,"For Future Use 1",{"$nulls":4},389]
[32,"For Future Use 2 ",{"$nulls":4},389]

{"sheet":"Trailer","index":3,"n_rows":7,"n_cols":12,"rows_kept":7}
["#","Field","Required?","Allowable Values","Null Permitted?","Default Value","Start Position","Length","Description","Comments","Additional Processing","Reject Reason"]
[1,"Record Type","Y","T (Trailer)","N","NA",1,1,"Identifies the type of record that follows","Identifies type of record",null,"Null = Missing record type."]
[2,"File Type","Y","RO","N","RO",{"$f":"G2 +H2","v":2},2,"Type of file - Rollover Claims"]
[3,"Partner ID","Y",null,"N","NA",{"$f":"G3 +H3","v":4},9,"Number identifying carrier","Assigned by WageWorks"]
[4,"File Date","Y",null,"N","NA",{"$f":"G4 +H4","v":13},8,"File Creation Date","YYYYMMDD format"]
[5,"Total Records","Y",null,"N","NA",{"$f":"G5 +H5","v":21},20,"Total number of records on file"]
[6,"Total Payment Amount","Y",null,"N","NA",{"$f":"G6 +H6","v":41},20,"Sum of payment amounts on file"]