Topic Description
This reporting reminder provides guidance for states to report TOT-MEDICAID-PAID-AMT, MEDICAID-PAID-AMT, and SERVICE-TRACKING-PAYMENT-AMT in the Claims file for service tracking claims, or payments made for multiple enrollees that are not billed and paid at the enrollee level.
Impacted Data Elements
- MEDICAID-PAID-AMT (CIP254, CLT208, COT178, CRX125)
- TOT-MEDICAID-PAID-AMT (CIP114, CLT065, COT050, CRX041)
- SERVICE-TRACKING-PAYMENT-AMT (CIP124, CLT074, COT060, CRX051)
Reporting Reminder
States use service tracking claims to report payments made for services rendered to enrollees when the services are not billed and paid at the single enrollee/provider/visit level of detail. Service tracking payments have TYPE-OF-CLAIM 4 (Medicaid or Medicaid-expansion Service Tracking Claim), D (Separate CHIP (Title XXI) Service Tracking Claim), or X (Non-Medicaid/CHIP service tracking claims). States should populate the TOT-MEDICAID-PAID-AMT and the SERVICE-TRACKING-PAYMENT-AMT fields differently for service tracking payments than they would for fee-for-service claims (TYPE-OF-CLAIM=1, A, U) and capitation payments (TYPE-OF-CLAIM=2, B, V), which are used to report payments for specific or a specified set of enrollees. Additional information about reporting financial transactions can be found in the T-MSIS Data Dictionary Appendix P.02.
- For service tracking payments:
- States should set the TOT-MEDICAID-PAID-AMT equal to zero, as the service tracking payment amount will be populated instead.
- States should also populate the SERVICE-TRACKING-PAYMENT-AMT with the lump sum amount paid to the provider.
- For non-service tracking payments:
- States should populate the TOT-MEDICAID-PAID-AMT with the amount paid to the provider or health plan.
- States should also 0-fill the SERVICE-TRACKING-PAYMENT-AMT field for claims that are not service tracking payments.
Because there is no data element on the claim line record segment specifically designated to capture service tracking payment amounts at the claim line level, states should populate MEDICAID-PAID-AMT with the amount of Medicaid funds disbursed.