FTX.002.043

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TMSIS Dataguide

Medicaid.gov

Version:

CAPITATION-PERIOD-START-DATE

Data Element

DE Number

FTX043

System DE Number

FTX.002.043

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	The date representing the beginning of the period covered by the capitation or sub-capitation payment or recoupment; for example, the first day of the calendar month of beneficiary enrollment in the managed care plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).
Size	9(8)
FLF Start Position	887
FLF Stop Position	894
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Value must be before or the same as the associated Capitation Period End Date 3. Value of the CC component must be equal to "20" 4. Mandatory

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

RULE ID	RULE Definition
RULE-8041	If a financial transaction is from an FTX file, then the capitation period start date value reported must be a valid date of the form CCYYMMDD.
RULE-8647	If the Individual Capitation Payment segment is populated from a FTX file, then the CAPITATION-PERIOD-START-DATE must be populated
RULE-8719	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Capitation Payment segment from the FTX file and the PAYEE ID type is either Sub-capitated network provider ID or State contracted FFS provider ID assigned by state, then the PAYEE ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the capitation period start date on the financial transaction.
RULE-8728	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Capitation Payment segment from the FTX file and the PAYEE ID Type is State contracted FFS provider NPI, then the PAYEE ID value reported must be equal to a provider NPI on a provider identifier segment from a PRV file where the effective and end dates of the provider identifier segment overlap with the capitation period start date on the financial transaction.
RULE-8737	If a financial transaction is a non-void, and the payer ID is populated on Individual Capitation Payment segment from the FTX file and the payer id type is Sub-capitated network provider ID, then the payer ID value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the capitation period start date on the financial transaction.
RULE-8746	If a financial transaction is a non-void, and the MSIS ID is populated on Individual Capitation Payment segment, then the MSIS ID value reported must be equal to a MSIS ID on a enrollment time span segment from a ELG file where the effective and end dates of the enrollment time span segment overlap with the capitation period start date on the financial transaction.
RULE-8752	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Capitation Payment segment from the FTX file and the PAYEE ID Type is Capitated plan ID, then the PAYEE ID value reported must be equal to a State Plan Identification Number on a managed care main segment from a MCR file where the managed care contract effective and end dates of the managed care main segment overlap with the capitation period start date on the financial transaction.
RULE-8761	If a financial transaction is a non-void, and the PAYER ID is populated on Individual Capitation Payment segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER ID value reported must be equal to a State Plan Identification Number on a managed care main segment from a MCR file where the managed care contract effective and end dates of the managed care main segment overlap with the capitation period start date on the financial transaction.
RULE-8767	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Capitation Payment segment from the FTX file and the PAYEE ID Type is Beneficiary, then the PAYEE ID value reported must be equal to a MSIS Identification Number on a primary demographics eligibility segment from a ELG file where the primary demographic element effective and end dates of the primary demographics eligibility segment overlap with the capitation period start date on the financial transaction.
RULE-8776	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Capitation Payment segment from the FTX file and the PAYEE ID Type is Insurance carrier, then the PAYEE ID value reported must be equal to a Insurance Carrier ID Number on a TPL entity contact information segment from a TPL file where the TPL Entity Contact Information effective and end dates of the TPL entity contact information segment overlap with the capitation period start date on the financial transaction.

Measure ID	Measure Name
MCR-31-003_3-11	% of MSIS IDs enrolled on Capitation Period Start Date
MCR-31-008_8-14	% of MSIS IDs enrolled on Capitation Period Start Date
RULE-8746	% of records with an MSIS ID not enrolled on CAPITATION-PERIOD-START-DATE
RULE-8752	% of records with a valid value for Payee ID (FTX00002) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8761	% of records with a valid value for Payer ID (FTX00002) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8647	% missing: CAPITATION-PERIOD-START-DATE (FTX00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	FTX.002.043	UPDATE	File segment	None	68
09/16/2024	4.0.0	FTX.002.043	ADD	N/A		Created