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Payer file column map
Every payer names its columns differently. One file says MBR_ID, another says SUBSCRIBER_NO. This CSV maps common header variants to one standard set of columns, so you can merge attribution files, gap reports and risk lists into a single outreach list. Use it as a starting map and add the headers your payers actually send.
How to use it:
Find each header in your payer file in the `common_header_variants` column. Matching should ignore case, spaces, underscores and hyphens.
Rename it to the `standard_column` name.
Convert values to the `standard_format`.
Anything you can't match, keep in a separate "unmapped" list and check with the payer. Don't guess.
standard_column,common_header_variants,standard_format,required,notes
member_id,"Member ID | MemberID | MBR_ID | MEMBER_NBR | Member_Number | Subscriber ID | SUBSCRIBER_NO | Sub_ID | Enrollee ID | Health Plan ID",Text (keep leading zeros),Required,"Store as text. Payer member ID is not the Medicare Beneficiary Identifier (MBI). If a file has both, keep both in separate columns."
mbi,"MBI | Medicare ID | Medicare_Beneficiary_ID | MEDICARE_NBR | HICN",Text (11 characters),Optional,"HICN is the retired Medicare number. Keep only if your program needs it."
first_name,"First Name | FIRST_NM | FNAME | Member First Name | MBR_FIRST_NAME | Given Name",Text,Required,"Trim spaces. Don't change capitalization in the source file."
last_name,"Last Name | LAST_NM | LNAME | Member Last Name | MBR_LAST_NAME | Surname | Family Name",Text,Required,"Some files send one combined field: see full_name."
full_name,"Member Name | MBR_NAME | Name | Patient Name | Full Name",Text,Optional,"Split into first and last only when the order is clear (for example LAST, FIRST)."
dob,"DOB | Date of Birth | Birth_Date | BIRTH_DT | Member_DOB | MBR_DOB | Birthdate",YYYY-MM-DD,Required,"Watch for MM/DD/YYYY, YYYYMMDD and spreadsheet serial numbers (for example 23456). Convert all to YYYY-MM-DD."
phone,"Phone | Phone Number | PHONE_NBR | Home Phone | HOME_PH | Primary Phone | Mobile | Cell | Cell Phone | Contact Phone | Member Phone",10 digits (no punctuation),Required for calls and texts,"Strip punctuation and a leading 1. Flag numbers that aren't 10 digits."
phone_source,"(rarely in payer files)",payer | patient_provided | unknown,Required for calls and texts,"Set to 'payer' for numbers from this file. The TCPA free-to-patient exemption only covers the number the patient gave you."
pcp_npi,"PCP NPI | PCP_NPI | Attributed NPI | ATTRIB_NPI | Assigned Provider NPI | Prov_NPI | Rendering NPI | Provider NPI",10 digits,Required,"NPIs are 10 digits with a check digit. Validate against the NPI registry. Note whether the file means PCP or rendering provider."
pcp_name,"PCP Name | PCP | Attributed Provider | Assigned PCP | Provider Name | PROV_NM",Text,Optional,"Use NPI for matching. Use name only for display."
measure_name,"Measure | Measure Name | MEASURE_NM | Measure ID | MEASURE_CD | Gap | Gap Name | Gap Description | Quality Measure | HEDIS Measure | Submeasure",Text (use a standard code list),Required for gap lists,"Codes vary: BCS or BCS-E (breast cancer screening), COL or COL-E (colorectal cancer screening), CBP (blood pressure control), EED (diabetes eye exam), GSD (glycemic status), and PDC-DR / PDC-RASA / PDC-STA (adherence). Keep a lookup table per payer."
gap_status,"Gap Status | Status | GAP_STATUS | Compliant | Compliance | Numerator | NUM_FLAG | Met | Open/Closed | Gap Open",open | closed | excluded,Required for gap lists,"Values vary: Y/N, 1/0, Met/Not Met, Compliant/Non-Compliant. Some payers use 1 for met and others for open. Confirm with each payer's file legend before converting."
due_date,"Due Date | DUE_DT | Due By | Gap Due Date | Measure End Date | Close By | Deadline",YYYY-MM-DD,Optional,"If missing, many measures close at the end of the measurement year. Confirm with the payer."
last_visit_date,"Last Visit | Last Visit Date | LAST_VISIT_DT | Last PCP Visit | LAST_DOS | Last Date of Service | Most Recent Visit",YYYY-MM-DD,Optional,"Payer claims lag. Your own schedule may show a more recent visit."
risk_score,"Risk Score | RAF | RAF Score | RAF_SCORE | HCC Score | Risk_Score | CMS Risk Score | Risk Factor",Decimal (for example 1.234),Optional,"Note which model and year the score uses, if the file says. Scores from different models aren't comparable."
language,"Language | Preferred Language | PREF_LANG | Primary Language | LANG_CD | Spoken Language",Text or ISO 639-1 code (for example en; es),Optional,"Codes vary (SPA, ES, Spanish). Normalize to one list."
consent_status,"(rarely in payer files) | Opt Out | DNC | Do Not Call | Contact Preference | Consent",ok_to_contact | opted_out | unknown,Required for calls and texts,"Payer files rarely carry your consent or opt-out status. Source it from your own records and merge it in. When unknown, don't call or text."
opt_out_date,"(rarely in payer files) | Opt Out Date | DNC Date",YYYY-MM-DD,Optional,"Keep the date and channel of any opt-out from any source."Compliance notes
- Payer files hold PHI. Upload them only into tools covered by a signed business associate agreement on the plan you're using (45 CFR 164.504(e)).
- Bring only the columns you need. Minimum necessary (45 CFR 164.502(b)) means dropping diagnosis, claims and cost columns unless your program uses them.
- Track where each phone number came from. The free-to-patient exemption at 47 CFR 64.1200(a)(9)(iv)(A) covers only "the wireless telephone number provided by the patient." A payer-supplied number doesn't qualify.
- Opt-outs follow the patient, not the file. Revocation by any reasonable method must be honored within 10 business days (64.1200(a)(10)). Merge your opt-out list into every new file before outreach.
Upload a payer file to Rivvi's free plan and ask it to map the columns; it enriches rows against CMS and NPI registry data and remembers each payer's layout for next month. Get started for free.
These templates are a starting point, not legal advice. Review them with your compliance lead or counsel before use.