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CMS MACBIS T-MSIS Reporting Reminder: State Plan Enrollment

Topic Description

The topic of this reporting reminder is to provide instruction for reporting the State-Plan-Enrollment data element in the Provider file for T-MSIS.

Impacted Data Elements


Reporting Reminder

In instances where a provider is enrolled in both the Medicaid and CHIP state plans, states can either report “1” (Medicaid) and “2” (CHIP) on two separate segments, or they can report “3” (Both) on one segment. States should never report providers that have “3” (Both) and “1” (Medicaid) or “2” (CHIP) on multiple active segments. If the provider is not state plan affiliated, states should report a valid value of “4” (Not state plan affiliated).

There is a new validation rule on the primary record type, PROV-MEDICAID-ENROLLMENT, that has been updated to check inconsistent values for State-Plan-Enrollment. STATE-PLAN-ENROLLMENT has also been added as a primary key as of April 19, 2019, allowing states to submit multiple values if they are using multiple segments with valid values “1” (Medicaid) and “2” (CHIP) to report providers with state plan affiliation of both Medicaid and CHIP.

T-MSIS File Type
T-MSIS Coding Blog


Collections: T-MSIS Coding Blog