FTX.002.036

PAYEE-MCR-PLAN-TYPE

Data Element

DE Number

FTX036

System DE Number

FTX.002.036

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

FTX00002

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 payee, when applicable. The valid value code set 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	533
FLF Stop Position	534
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 Payee ID Type is in [02,03], then value must be populated 4. If Payee ID Type is not [02,03], 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-8034	If a financial transaction is from an FTX file, then the payee managed care plan type value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-8409	If the payee managed care plan type is populated on the Individual Capitation PMPM transaction from a FTX file, then the payee managed care plan type reported must be found in the list of valid values.

Measure ID	Measure Name
MCR-54-002-2	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
MCR-9-015-10	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date in a future month
MCR-9-016-9	# of capitated payments to PHPs with Capitation Period End Date in a future month
MCR-9-017-8	# of capitated payments for PCCM with Capitation Period End Date in a future month
MCR-13-006_1-18	% of PCCM capitation payment records with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
MCR-9-006_1-18	% of PCCM capitation payment records with a non-missing plan ID that do not have a corresponding managed care participation PCCM plan
MCR-13-018-20	% of PHP capitation payment records with a non-missing plan ID that do not have a corresponding managed care participation PHP plan
MCR-13-019-21	% of Comprehensive MCO capitation payment records with a non-missing plan ID that do not have a corresponding managed care participation Comprehensive MCO plan
MCR-9-018-20	% of PHP capitation payment records with a non-missing plan ID that do not have a corresponding managed care participation PHP plan
MCR-9-019-21	% of Comprehensive MCO capitation payment records with a non-missing plan ID that do not have a corresponding managed care participation Comprehensive MCO plan
EL-8-002-2	Enrollment, capitation payments, capitation ratios, encounters (by claim file type) and encounter ratios (by claim file type) by plan ID with plan ID linking to MC file
MCR-53-001-1	Total # of managed care enrollments
MCR-53-002-2	Total # of managed care capitations
MCR-53-003-3	Total # of managed care encounters
MCR-54-001-1	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
MCR-9-014-11	# of capitated payments for PCCM with Capitation Period End Date prior to the previous month
MCR-54-003-3	# of plans with at least 100 enrollments or 100 encounters, 0 capitations
MCR-54-004-4	# of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3)
MCR-54-005-5	# of plans with at least 100 capitations or 100 encounters, 0 enrollments
MCR-54-006-6	# of plans with at least 100 enrollments and some encounters that have IP ratios outside of the expected range (0.01 - 2)
MCR-54-007-7	# of plans with at least 100 enrollments and some encounters that have OT ratios outside of the expected range (0.1 - 20)
MCR-54-008-8	# of plans with at least 100 enrollments and some encounters that have RX ratios outside of the expected range (0.02 - 5)
MCR-54-009-9	# of plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
MCR-54-010-10	# of plans where MC plan type does not match EL plan type
MCR-54-011-11	# of PCCM plan IDs
MCR-54-012-12	# of PCCM plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
MCR-55-001-1	Traditional PCCM capitation ratio
MCR-55-002-2	Enhanced PCCM capitation ratio
MCR-55-003-3	PACE capitation ratio
MCR-55-004-4	Health home capitation ratio
MCR-13-014-11	# of capitated payments for PCCM with Capitation Period End Date prior to the previous month
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
MCR-13-002-1	# of records with capitated payments to HMOs, HIOs or PACE plans
MCR-13-003-3	# of records with capitated payments to PHPs
MCR-13-004-2	# of records with capitated payments for PCCM
MCR-13-006-7	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date in the current month
MCR-13-007-6	# of capitated payments to PHPs with Capitation Period End Date in the current month
MCR-13-008-5	# of capitated payments for PCCM with Capitation Period End Date in the current month
MCR-13-009-16	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date in the previous month
MCR-13-010-15	# of capitated payments to PHPs with Capitation Period End Date in the previous month
MCR-13-011-14	# of capitated payments for PCCM with Capitation Period End Date in the previous month
MCR-13-012-13	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date prior to the previous month
MCR-13-013-12	# of capitated payments to PHPs with Capitation Period End Date prior to the previous month
EXP-22-001-2	Sum of Payment or Recoupment Amount for HMOs, HIOs, or PACE
MCR-13-015-10	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date in a future month
MCR-13-016-9	# of capitated payments to PHPs with Capitation Period End Date in a future month
MCR-13-017-8	# of capitated payments for PCCM with Capitation Period End Date in a future month
MCR-9-002-1	# of records with capitated payments to HMOs, HIOs or PACE plans
MCR-9-003-3	# of records with capitated payments to PHPs
MCR-9-004-2	# of records with capitated payments for PCCM
MCR-9-006-7	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date in the current month
MCR-9-007-6	# of capitated payments to PHPs with Capitation Period End Date in the current month
MCR-9-008-5	# of capitated payments for PCCM with Capitation Period End Date in the current month
MCR-9-009-16	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date in the previous month
MCR-9-010-15	# of capitated payments to PHPs with Capitation Period End Date in the previous month
MCR-9-011-14	# of capitated payments for PCCM with Capitation Period End Date in the previous month
MCR-9-012-13	# of capitated payments to HMOs, HIOs or PACE plans with Capitation Period End Date prior to the previous month
MCR-9-013-12	# of capitated payments to PHPs with Capitation Period End Date prior to the previous month

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
FTX166	FTX.005.166	PAYEE-MCR-PLAN-TYPE	FTX00005	COST-SHARING-OFFSET
FTX209	FTX.006.209	PAYEE-MCR-PLAN-TYPE	FTX00006	VALUE-BASED-PAYMENT
FTX253	FTX.007.253	PAYEE-MCR-PLAN-TYPE	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX296	FTX.008.296	PAYEE-MCR-PLAN-TYPE	FTX00008	COST-SETTLEMENT-PAYMENT
FTX335	FTX.009.335	PAYEE-MCR-PLAN-TYPE	FTX00009	FQHC-WRAP-PAYMENT
FTX376	FTX.095.376	PAYEE-MCR-PLAN-TYPE	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	FTX.002.036	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.036	ADD	N/A		Created