CMS MACBIS T-MSIS Reporting Reminder: Required date data elements in the T-MSIS Claims files

Reporting Reminder History

Topic Description

This reporting reminder describes how to report required claims date fields in the T-MSIS files.

Impacted Data Elements

• Claim IP
  • ADMISSION-DATE (CIP094) (CLAIM-HEADER-RECORD-IP-CIP00002)
  • DISCHARGE-DATE (CIP096) (CLAIM-HEADER-RECORD-IP-CIP00002)
  • BEGINNING-DATE-OF-SERVICE (CIP290) (CLAIM-HEADER-RECORD-IP-CIP00002)^[1]
  • ENDING-DATE-OF-SERVICE (CIP291) (CLAIM-HEADER-RECORD-IP-CIP00002)^[1]
  • BEGINNING-DATE-OF-SERVICE (CIP243) (CLAIM-LINE-RECORD-IP-CIP00003)
  • ENDING-DATE-OF-SERVICE (CIP244) (CLAIM-LINE-RECORD-IP-CIP00003)
• Claim LT
  • BEGINNING-DATE-OF-SERVICE (CLT048) (CLAIM-HEADER-RECORD-LT-CLT00002)
  • ENDING-DATE-OF-SERVICE (CLT049) (CLAIM-HEADER-RECORD-LT-CLT00002)
  • BEGINNING-DATE-OF-SERVICE (CLT196) (CLAIM-LINE-RECORD-LT-CLT00003)
  • ENDING-DATE-OF-SERVICE (CLT197) (CLAIM-LINE-RECORD-LT-CLT00003)
• Claim OT
  • BEGINNING-DATE-OF-SERVICE (COT033) (CLAIM-HEADER-RECORD-OT-COT00002)
  • ENDING-DATE-OF-SERVICE (COT034) (CLAIM-HEADER-RECORD-OT-COT00002)
  • BEGINNING-DATE-OF-SERVICE (COT166) (CLAIM-LINE-RECORD-OT-COT00003)
  • ENDING-DATE-OF-SERVICE (COT167) (CLAIM-LINE-RECORD-OT-COT00003)
• Claim RX
  • PRESCRIPTION-FILL-DATE (CRX085) (CLAIM-HEADER-RECORD-RX-CRX00002)

Reporting Reminders

• The list of impacted date data elements are always required to be reported, unless otherwise specified below.
• Discharge Date (IP – header):
  • As specified in the reporting reminder on DISCHARGE-DATE from the June 8, 2018 MACBIS CMS Coding Information listserv, this data element must be reported in CCYYMMDD format, even if it must be reformatted from the state’s source system.
  • This date should be on or after DATE-OF-BIRTH in the T-MSIS Eligible file and on or before the DATE-OF-DEATH (when applicable) in the T-MSIS Eligible file, on or before the ADJUDICATION-DATE and on or after the ADMISSION-DATE.
  • Discharge date on interim claims for long stays can be conditionally missing.
  • DISCHARGE-DATE is expected to be available even when the patient dies, and can be conditionally missing if the patient is still a patient. If the patient is still admitted as a patient, the patient status code should indicate as such (PATIENT-STATUS).
• Service Begin and End Dates (IP – header and line, LT – header and line, OT – header and line (End Date only)):
  • States should use the following guidelines when mapping service beginning and end dates from their state’s source systems. The beginning and end dates of service for the IP claim line, LT claim header, and some OT claim header and claim line segments can come from a date range qualified by RD8 of an 837i claim.
    • For claims with a ‘RD8’ date qualifier, states should populate the beginning date of service in T-MSIS with the first date from that range and the ending date of service in T-MSIS with the second date in that range.
    • For claims with a ‘D8’ date qualifier, states should use a conditional rule to populate both the T-MSIS beginning and ending date of service with the one date qualified by ‘D8’ in the 837i if no range is available.
    • The same is true when only an ‘R8’ date on a 837p, 837d, and 820 (coverage period) is mapped to the T-MSIS OT file beginning and ending date of service.
  • When the beginning and ending date of service are missing, automated validation rules could be triggered and states may need to modify their mappings or programs and possibly submit replacement files to resolve the problem.

[1] This is a new data element as of T-MSIS Data Dictionary V3.0.0.