FTX.002.031

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TMSIS Dataguide

Medicaid.gov

Version:

PAYER-MCR-PLAN-TYPE

Data Element

DE Number

FTX031

System DE Number

FTX.002.031

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

File Segment Name

INDIVIDUAL-CAPITATION-PMPM

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	This describes the type of managed care plan or care coordination model of the payer, when applicable. The valid value list is comprised of the standard managed care plan type list from the MCR and ELG files and a complementary list of care coordination models.
Size	X(2)
FLF Start Position	299
FLF Stop Position	300
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 2 characters 2. Value must be in Managed Care Plan Type List (VVL) 3. If Payer ID Type equals "02", then value must be populated 4. If Payer ID Type does not equal "02", then value must not be populated 5. Conditional

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-8029	If a financial transaction is from an FTX file, then the payer managed care plan type value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-8407	If the payer managed care plan type is populated on the Individual Capitation PMPM transaction from a FTX file, then the payer managed care plan type reported must be found in the list of valid values.

Measure ID	Measure Name
EXP-22-001-2	Sum of Payment or Recoupment Amount for HMOs, HIOs, or PACE
EXP-22-006-3	Average Payment or Recoupment Amount for HMOs, HIOs, or PACE
EXP-24-002-2	Sum of Payment or Recoupment Amount for HMOs, HIOs, or PACE
EXP-24-006-3	Average Payment or Recoupment Amount for HMOs, HIOs or PACE

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
FTX371	FTX.095.371	PAYER-MCR-PLAN-TYPE	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	FTX.002.031	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.031	ADD	N/A		Created