U.S. Flag

An official website of the United States government

CMS MACBIS T-MSIS Reporting Reminder: Coding Requirements for Claim OT Dates of Service

Topic Description

There are several coding requirements for BEGINNING-DATE-OF-SERVICE and ENDING-DATE-OF-SERVICE in the Claim OT file that do not apply to certain prospective payments (i.e., payments made for future periods of coverage). In a forthcoming version of the T-MSIS Data Dictionary, the language to clarify this will be made explicit. 

Impacted Data Elements

  • BEGINNING-DATE-OF-SERVICE (COT033, COT166)
  • ENDING-DATE-OF-SERVICE (COT034, COT167)

Reporting Reminder

Updates to coding requirements for the BEGINNING-DATE-OF-SERVICE and ENDING-DATE-OF-SERVICE will be included in a forthcoming version of the T-MSIS Data Dictionary to exclude prospective payments because certain requirements are not applicable to capitation payments or service tracking payments. The following coding requirements do not apply to capitation payments or service tracking payments:

  • COT033-0003: The beginning date of service must occur before or be the same as the end of time period for all claims except capitation payments and service tracking payments
  • COT033-0005: Date must occur before or be the same as adjudication date for all claims except capitation payments and service tracking payments
  • COT034-0004: ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE for all claims except capitation payments and service tracking payments
  • COT034-0007: Date must occur before or be the same as End of Time Period for all claims except capitation payments and service tracking payments
  • COT166-0004: Date must occur before or be the same as adjudication date for all claims except capitation payments and service tracking payments
  • COT167-0004: ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE for all claims except capitation payments and service tracking payments
  • COT167-0007: Date must occur before or be the same as End of Time Period for all claims except capitation payments and service tracking payments

Please refer to the T-MSIS data dictionary for the full set of coding requirements applicable to these data elements.

Category
T-MSIS File Type
Collection
T-MSIS Coding Blog

RETURN TO T-MSIS CODING BLOG

Collections: T-MSIS Coding Blog