This technical instruction defines, specifies, and differentiates T-MSIS data elements related to select beneficiary cost sharing information (i.e., copayment, coinsurance, and deductible data). States have varied interpretations of related T-MSIS beneficiary data elements. Consistent reporting allows for accurate interpretation of the data and decreases the administrative burden placed on states and CMS to validate the data.

This technical instruction applies to Medicaid and CHIP fee-for-service (FFS) claims and managed care encounters.

This guidance document outlines best practice for reporting provider bed information in the T‐MSIS provider file. States report data about a provider’s facility beds on the T‐MSIS Provider File PROV‐BED‐TYPE‐INFO‐PRV‐00010 record segment, reported via the segment’s data elements, including BED‐TYPE‐CODE, BED‐COUNT, BED‐TYPE‐EFF‐DATE, and BED‐TYPE‐END‐DATE.

CMS is introducing a new RESTRICTED-BENEFIT-CODE (ELG097) value to identify individuals dually eligible for Medicare/Medicaid who are enrolled in the Medicare Part B immunosuppressive drug (ID) benefit coverage.

States may need to assign new identifier numbers (IDs) for their providers (provider IDs) or beneficiaries (MSIS IDs) for various reasons. Valid provider IDs and MSIS IDs are important for linking across and within the T-MSIS files, linking to other datasets, and analyzing Medicaid and CHIP data.

This technical instructions document outlines the challenges states have faced in reporting complete, accurate, and consistent data for personal care services (PCS) and home health care services (HHCS) in Transformed Medicaid Statistical Information System (T-MSIS) records and provides clarification for reporting these data. The guidance in this document addresses reporting complete and accurate data on PCS and HHCS in the T-MSIS Other Claims (OT) file.

This reporting reminder describes T-MSIS data elements that collect payments to providers for covered services on a claim. This reporting reminder is applicable to Medicaid and Children’s Health Insurance Program (CHIP) fee for service (FFS) claims and managed care encounters.

Complete and consistent state reporting of an individual’s eligibility status, including any changes, will be a critical component of CMS monitoring states’ transitions back to normal eligibility and enrollment operations in Medicaid and the Children’s Health Insurance Program (CHIP) after the end of the Public Health Emergency. This reporting reminder notes expectations for state reporting of ELIGIBILITY-CHANGE-REASON (ELG095) in the ELIGIBILITY-DETERMINANTS-ELG00005 segment of the T-MSIS Eligible File as well as an update to the definition of this data element.

This technical instructions document identifies the challenges states have faced when reporting payments by managed care plans to sub-capitated entities (referred to as “sub-capitation payments” below) for the management or provision of specific enrollee services as well as the associated encounter records for the services provided. The state T-MSIS technical instructions below explain how to report sub-capitation payments, the associated sub-capitated encounter records, and sub-capitated provider affiliation to T-MSIS, including the T-MSIS file to which they should be mapped and how key data elements should be populated.

This technical instruction document outlines the challenges states have faced when reporting quantity and unit of measure fields in the IP, LT, OT, and RX files and provides guidance to states on this topic.

The accuracy and completeness of provider specialization information will be added as a T-MSIS priority issue in the spring of 2020. The ability to identify provider specialization in T-MSIS is vital for investigating a number of different research questions.