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{"sheet":"Internal Use Only","index":0,"n_rows":15,"n_cols":1,"rows_kept":15,"cut":false,"hidden":false,"merged":[]}
["Group Name:"]
["Employer Group ID:"]
["Submitter ID:"]
[]
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["Version: v1.10"]

{"sheet":"Enrollment Template","index":1,"n_rows":1,"n_cols":46,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Member Group ID for Oxford 2.0 - Group Code for Oxford Required","Subscriber SSN Required","Subscriber \nMiddle Initial\nOptional","Subscriber\nLast Name\nRequired","Subscriber\nFirst Name\nRequired","Subscriber \nDate of Birth\nRequired","Subscriber\nDate of Hire\nRequired","Subscriber\nDate of Marriage\nDO NOT USE OR REMOVE","Subscriber\nSex\nRequired","Subscriber\nEffective Date\nRequired","Subscriber \nCOBRA Qual Event\nConditional","Subscriber\nCOBRA Qual Date\nConditional","Relationship\nRequired","Dependent SSN\nRequired","Dependent\nLast Name\nRequired","Dependent\nFirst Name\nRequired","Dependent \nMiddle Initial\nOptional","Dependent\nDate of Birth\nRequired","Dependent\nSex\nRequired","Dependent\nEffective Date\nRequired","\nAddress Line 1\nRequired","\nAddress Line 2\nConditional","City\nRequired","State\nRequired","Zip\nRequired","Home Area Code\nOptional","Home Phone Number\nOptional","Business Area Code  Optional\n","Business Phone Number - Optional","COB Indicator \nDO NOT USE OR REMOVE","Dependent\nDisabled Flag\nConditional","Subscriber \nDisenroll Reason Code\nConditional","Primary Care \nPhysician Code\nConditional","OB/GYN Code\nConditional","Benefit Bundle Option ID for Oxford 2.0 -      CSP Code for Oxford\nRequired","Benefit Bundle Change indicator \nConditional","Benefit Bundle Change Date\nConditional","External Billing Preference  ID for Oxford 2.0 - BG Code for Oxford \nRequired","External Billing Preference ID Change Flag\nConditional","External Billing Preference ID Change Date\nConditional","Processing Code\nRequired","Subscriber Termination Date\nDO NOT USE OR REMOVE","Dependent Termination Date\nDO NOT USE OR REMOVE","Dependent Disenroll Reason Code\nDO NOT USE OR REMOVE","Company Code\nDO NOT USE OR REMOVE","External Population ID Conditional"]

{"sheet":"Field Definitions","index":2,"n_rows":47,"n_cols":6,"rows_kept":47,"cut":false,"hidden":false,"merged":[]}
["Field Name","Field Length","Field Type","Values",null,"Enrollment Template Column"]
["Member Group ID for Oxford 2.0 - Group Code for Oxford",10,"Required","Text","Provided by Oxford for New Clients","A"]
["Subscriber SSN",9,"Required","Numeric","Social Security Number of the subscriber. This field must be populated for all subscriber and dependent records. Blanks, zeroes, and other forms of invalid Social Security Numbers are not to be used.","B"]
["Subscriber Middle Initial",1,"Optional","Text",null,"C"]
["Subscriber Last Name",25,"Required","Text",null,"D"]
["Subscriber First Name",25,"Required","Text",null,"E"]
["Subscriber Date of Birth",8,"Required","MM/DD/YYYY","Date of Birth is mandatory. Blanks, zeroes, and other forms of invalid dates are not to be used.","F"]
["Subscriber Date of Hire",8,"Required","MM/DD/YYYY","Date of Hire is mandatory. Blanks, zeroes, and other forms of invalid dates are not to be used.","G"]
["Subscriber Date of Marriage",8,"Do Not Use","MM/DD/YYYY","Subscriber's Date of Marriage","H"]
["Subscriber Sex",1,"Required","\"F\" = Female\n\"M\" = Male","Only use the F and M abreviations.  Do not spell out the words Female and Male.","I"]
["Subscriber Effective Date",8,"Required","MM/DD/YYYY","Subscriber Original Effective Date","J"]
["Subscriber COBRA Qual Event",6,"Conditional","QE1 -  NJ Plan - Termination of Employment\nQE3 - Divorce\nQE4 - Death of subscriber\nQE22 - NY Plan - Termination of Employment\nQE25 - CT Plan - Termination of Employment",null,"K"]
["Subscriber COBRA Qual Date",8,"Conditional","MM/DD/YYYY",null,"L"]
["Relationship",1,"Required","P = Primary Subscriber\nS = Spouse\nD = Dependent\nC = Domestic Partner",null,"M"]
["Dependent SSN",9,"Required","Numeric","Social Security Number of the dependent. This field must be populated for all dependent records. Blanks, zeroes, and other forms of invalid Social Security Numbers are not to be used.","N"]
["Dependent Last Name",25,"Required","Text",null,"O"]
["Dependent First Name",25,"Required","Text",null,"P"]
["Dependent Middle Initial",1,"Optional","Text",null,"Q"]
["Dependent Date of Birth",8,"Required","MM/DD/YYYY","Date of Birth is mandatory. Blanks, zeroes, and other forms of invalid dates are not to be used.","R"]
["Dependent Sex",1,"Required","\"F\" = Female\n\"M\" = Male","Only use the F and M abreviations.  Do not spell out the words Female and Male.","S"]
["Dependent Effective Date",8,"Required","MM/DD/YYYY","Enter Dependents original effective date.","T"]
["Address Line 1",60,"Required","Street or PO Box Address of Employee","Subscriber and dependent records must be completed","U"]
["Address Line 2",60,"Optional","Apt. Number, Suite Number","Subscriber and dependent records must be completed","V"]
["City",28,"Required","City","Subscriber and dependent records must be completed","W"]
["State",2,"Required","Two-Letter State Abbreviation","Subscriber and dependent records must be completed","X"]
["Zip",5,"Required","5-Digit Zip","Subscriber and dependent records must be completed","Y"]
["Home Area Code",3,"Optional","3-Digit Area Code for Home Phone","Optional value - Field can be blank or populated for both the subscriber and dependent records ","Z"]
["Home Phone Number",7,"Optional","Member's Home Phone Number","Optional value - Field can be blank or populated for both the subscriber and dependent records ","AA"]
["Business Area Code",3,"Optional","3-Digit Area Code for Business Phone","Optional value - Field can be blank or populated for both the subscriber and dependent records ","AB"]
["Business Phone Number",7,"Optional","Employee's Business Phone Number","Optional value - Field can be blank or populated for both the subscriber and dependent records ","AC"]
["COB Indicator - Not ever used",1,"Do Not Use","\"Y\" = yes\n\"N\" = no If Prior Insurance ","Indicate if other coverage exists.","AD"]
["Dependent Disabled Flag",1,"Do Not Use","Y, N, or blank","Populate only if dependent is disabled.","AE"]
["Subscriber Disenroll Reason Code",6,"Conditional","ME0 - Subscriber Left Employer.   \nME6  - Member Dropped -- Deceased.               ME14 - per Company/Employer's Instructions.\nME17 - Member Dropped -- Discontinuing COBRA\n","Reason is mandatory if reporting disenrolling records.\n","AF"]
["Primary Care Physician Code",10,"Conditional","PCP ID # (Alpha-numeric)","Collected at the initial enrollment only.","AG"]
["OB/GYN Code",10,"Conditional","OB/GYN ID # (alpha-numeric)","Collected at the initial enrollment only.","AH"]
["Benefit Bundle Option ID for Oxford 2.0 or CSP code for Oxford","10","Required","Benefit Bundle Option ID needs to be enter for Oxford 2.0 Groups and Contract Specific Package (CSP)  Code needs to be entered for Oxford groups.","Subscriber and dependent records must be completed","AI"]
["Benefit Bundle Change indicator Flag",1,"Conditional","\"Y\" or \"N\" or Blank","Used when reporting effecive date changes tothe Benefit Bundles.","AJ"]
["Benefit Bundle Change Date Change Date",8,"Conditional","MM/DD/YYYY","Use to report date benefit bundle change effective.","AK"]
["External Billing Preference  ID for Oxford 2.0 - BG Code for Oxford ",10,"Required","External Billing Preference  ID  for Oxford 2.0 groups  or Billing Group Code for Oxford groups","Subscriber and dependent records must be completed","AL"]
["External Billing Preference ID Change Flag",1,"Conditional","\"Y\" or \"N\" or Blank","Used when reporting effecive date changes to the External Billing Preference ID","AM"]
["External Billing Preference ID Change Date",8,"Conditional","MM/DD/YYYY","Use to report date change is effective.","AN"]
["Processing Code",1,"Required","A=Add\nT=Terminate\nC=Change ",null,"AO"]
["Subscriber Termination Date",8,"Conditional","MM/DD/YYYY","Last Date of coverage for subscriber.","AP"]
["Dependent Termination Date",8,"Conditional","MM/DD/YYYY","Last date of coverage for dependent.","AQ"]
["Dependent Disenroll Reason Code",6,"Conditional","ME0 - Subscriber Left Employer.   \nME6  - Member Dropped -- Deceased.               ME14 - Per Company/Employer's Instructions.\nME17 - Member Dropped -- Discontinuing COBRA","Reason is mandatory if reporting disenrolling records.","AR"]
["Company Code",15,"Do Not Use","Text","Additional code for Company Designation","AS"]
["External Population ID",15,"Conditional","Oxford 2.0 only situational values","Subscriber and dependent records must be completed","AT"]

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["Date & Time","Total Errors"]
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["2008-04-30T10:31:31",1]
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["2009-07-14T11:01:54",0]
["2009-07-14T11:02:11",1]
["2009-07-14T11:03:27",1]
["2009-07-14T11:07:26",1]
["2009-07-14T11:18:53",0]
["2009-07-14T11:19:02",0]
["2009-07-14T11:19:27",0]
["2009-07-14T11:19:44",0]
["2009-07-14T11:20:13",0]
["2009-07-14T11:20:40",1]
["2009-07-14T11:24:56",2]
["2009-07-14T11:25:10",1]
["2009-07-14T11:25:26",1]
["2009-07-14T11:25:34",2]
["2009-07-14T11:27:43",1]
["2009-07-14T11:30:07",1]
["2009-07-14T11:30:15",1]
["2009-07-14T11:32:40",1]
["2009-07-14T11:33:02",0]
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["2009-07-14T11:35:33",1]
["2009-07-14T11:38:10",1]
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["2009-07-14T11:40:22",2]
["2009-07-14T11:47:21",2]
["2009-07-14T11:47:29",3]
["2009-07-14T13:11:20",1]
["2009-07-14T13:11:28",0]
["2009-07-14T13:11:37",2]
["2009-07-14T13:20:33",1]
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["2009-07-14T17:24:21",2]
["2009-07-14T17:24:33",0]
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["2009-07-14T17:29:18",1]
["2009-07-14T17:29:25",0]
["2009-07-14T17:30:00",1]
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["2009-07-14T17:30:21",1]
["2009-07-14T17:30:30",1]
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["2009-07-28T09:27:53",0]
["2009-07-28T09:35:59",270]
["2009-07-28T09:45:55",67]
["2009-07-28T09:58:43",0]
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["2009-07-29T08:21:48",1]
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["2010-01-22T16:04:16",14]
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["2011-07-18T09:42:50",43]
["2013-04-04T14:07:16",0]
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{"sheet":"Records in Error","index":4,"n_rows":1,"n_cols":4,"rows_kept":1,"cut":false,"hidden":false,"merged":[]}
["Row Number","Field Name","Invalid Value","Error Description"]

{"sheet":"Example","index":5,"n_rows":5,"n_cols":46,"rows_kept":5,"cut":false,"hidden":false,"merged":[]}
[null,"Below is an example a family with an employee, spouse and child being added."]
["Member Group ID for Oxford 2.0 - Group Code for Oxford Required","Subscriber SSN Required","Subscriber \nMiddle Initial\nOptional","Subscriber\nLast Name\nRequired","Subscriber\nFirst Name\nRequired","Subscriber \nDate of Birth\nRequired","Subscriber\nDate of Hire\nRequired","Subscriber\nDate of Marriage\nDO NOT USE OR REMOVE","Subscriber\nSex\nRequired","Subscriber\nEffective Date\nRequired","Subscriber \nCOBRA Qual Event\nConditional","Subscriber\nCOBRA Qual Date\nConditional","Relationship\nRequired","Dependent SSN\nRequired","Dependent\nLast Name\nRequired","Dependent\nFirst Name\nRequired","Dependent \nMiddle Initial\nOptional","Dependent\nDate of Birth\nRequired","Dependent\nSex\nRequired","Dependent\nEffective Date\nRequired","\nAddress Line 1\nRequired","\nAddress Line 2\nConditional","City\nRequired","State\nRequired","Zip\nRequired","Home Area Code\nOptional","Home Phone Number\nOptional","Business Area Code  Optional\n","Business Phone Number - Optional","COB Indicator \nDO NOT USE OR REMOVE","Dependent\nDisabled Flag\nConditional","Subscriber \nDisenroll Reason Code\nConditional","Primary Care \nPhysician Code\nConditional","OB/GYN Code\nConditional","Benefit Bundle Option ID for Oxford 2.0 -      CSP Code for Oxford\nRequired","Benefit Bundle Change indicator \nConditional","Benefit Bundle Change Date\nConditional","External Billing Preference  ID for Oxford 2.0 - BG Code for Oxford \nRequired","External Billing Preference ID Change Flag\nConditional","External Billing Preference ID Change Date\nConditional","Processing Code\nRequired","Subscriber Termination Date\nDO NOT USE OR REMOVE","Dependent Termination Date\nDO NOT USE OR REMOVE","Dependent Disenroll Reason Code\nDO NOT USE OR REMOVE","Company Code\nDO NOT USE OR REMOVE","External Population ID Conditional"]
[12512783,123456789,null,"Hill","Jill","1970-02-05","2015-05-20",null,"F","2019-01-01",null,null,"P",null,null,null,null,null,null,null,"123 Main St.","Apt. 25","Anywhere","CT",99123,555,7653684,null,null,null,null,null,null,null,1234567,null,null,1322,null,null,"A"]
[12512783,123456789,null,null,null,null,null,null,null,null,null,null,"S",111223344,"Hill","Jack",null,"1968-04-10","M","2019-01-01","123 Main St.","Apt. 25","Anywhere","CT",99123,555,7653684,null,null,null,null,null,null,null,1234567,null,null,1322,null,null,"A"]
[12512783,123456789,null,null,null,null,null,null,null,null,null,null,"D",555667777,"Hill","David","T","2014-10-05","M","2019-01-01","123 Main St.","Apt. 25","Anywhere","CT",99123,555,7653684,null,null,null,null,null,null,null,1234567,null,null,1322,null,null,"A"]