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T-MSIS Coding Blog

The purpose of T-MSIS coding guidance is primarily to provide state T-MSIS implementation and maintenance teams with additional context about CMS reporting requirements and expectations. The topics reflect common areas of improvement in T-MSIS for many states based on communication and/or analysis of data submitted by states. If state programming and policy staff identify state-specific exceptions to global requirements and expectations, they may need to be addressed with CMS on a case-by-case basis.

T-MSIS Coding Blog

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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 instruction document specifies requirements for reporting a beneficiary’s race in the RACE-INFORMATION-ELG00016 segment and ethnicity in the ETHNICITY-INFORMATION-ELG00015 segment both in the T-MSIS Eligible file. This document outlines the challenges of the differing standards for reporting race and ethnicity in T-MSIS.

Reporting complete and consistent claims payment data elements is a T-MSIS Priority Item. This reporting reminder focuses on fee-for-service (FFS) reporting for amounts paid and billed within the Claims files in T-MSIS.

This document provides descriptions of T-MSIS Priority Items (TPIs) 1-32. TPIs are prioritized data quality focus areas in T-MSIS to help states improve Medicaid and CHIP data reporting accuracy and completeness.

The T-MSIS data dictionary defines “allowed amount” as the maximum amount “determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment.” In plain language, the allowed amount represents the maximum payer liability for a given service.

This document outlines the specifications for reporting the amount the Medicaid agency or managed care plan pays towards a beneficiary’s Medicare coinsurance and deductible amount in the T-MSIS claims files. The specifications in the guidance provide a detailed explanation on how the data...

This guidance document outlines the specifications for reporting health insurance premium payments (HIPP) (AKA premium assistance subsidy payments) on the OT file. The specifications in the guidance provide a detailed explanation on how the data elements should be....

This best practice document outlines the challenges states have faced when reporting the CHIP-CODE data element in the T-MSIS Eligible file. CHIP-CODE is used to distinguish among Medicaid, Medicaid Expansion CHIP, and Separate CHIP populations when looking at enrollment and utilization data.

ICD-10-CM diagnosis codes related to social determinants of health (SDOH), such as housing, employment, and food insecurity, range from Z55-Z65. These codes are a subset of “Z Codes” Z00-Z99 that are used to identify “factors influencing health status and contact with health services”. Use of SDOH “Z Code” data can help improve care coordination, patient experience, and health outcomes.

This guidance specifies state’s reporting requirements for an individual’s eligibility and enrollment into the Medicaid health home program as well as other relevant segments. This document outlines the challenges to reporting on the health home program in the Transformed Medicaid...

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