This reporting reminder describes how to report capitation payments in the T-MSIS Claim OT file.
Impacted Data Elements
- TYPE-OF-CLAIM (COT037)
- ENDING-DATE-OF-SERVICE (COT034, COT167)
- All capitation payments (TYPE-OF-CLAIM = “2” or “B”) should be reported with valid date values in the ENDING-DATE-OF-SERVICE (COT034, COT167) data elements.
- The ENDING-DATE-OF-SERVICE (COT034, COT167) data element reported on claim header record and the claim line record should be populated with a date.
- For capitation payments, the value reported in the ENDING-DATE-OF-SERVICE field should reflect the date on which the period of coverage related to this payment ends/ended.
T-MSIS File Type
T-MSIS Coding Blog