June 3rd, 2025

New

Claims

Claims Separate ProgramCost Data Upload

Program Administrator users can now upload local ProgramCost data independently of other claims-related data, improving flexibility in preparing and organizing submissions ahead of final claim submission.

Key Changes

Upload Flexibility: Users can now upload ProgramCost alone, or with the full claims dataset, using ZIP or XLSX formats.

Updated Upload Combinations:

  1. All five tables: ProgramCost, Measure, Claim, Site, ContactClaim

  2. Claims data only: Measure, Claim, Site, ContactClaim

  3. ProgramCost only

Validation Changes:

  • Primary key checks between ProgramCost and Measure tables will not block records from being accepted during file upload.

  • Validation errors related to mismatches will be shown in the Upload Summary and CET card as table warnings.

  • CET cannot run on claims if there are table warnings.

  • Final claims cannot be submitted unless ProgramCost and Measure data pass primary key and field validations.

Supporting Updates:

  • Claims user guide updated to reflect the new process.

  • Updates to the "Upload Claim" guidance.

Note: This change does not apply to Statewide submissions