04/15/2025 |
4.0.6 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional7. Value must be populated when Payer ID Type equals "01" |
04/11/2025 |
4.0.6 |
FTX.002.047 |
UPDATE |
Coding requirement |
Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional 7. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
03/26/2025 |
4.0.5 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional 7. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
02/27/2025 |
4.0.3 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
12/19/2024 |
4.0.1 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "01", then value must be populated6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional |
09/16/2024 |
4.0.0 |
FTX.002.047 |
UPDATE |
File segment |
None |
68 |
09/16/2024 |
4.0.0 |
FTX.002.047 |
ADD |
N/A |
|
Created |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9BASE|Medical Assistance Expenditures by Type of Service |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9 WAIVER|Medical Assistance Expenditures by Type of Service |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9P|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9P Waiver|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9 200K|Medical Assistance Expenditures by Type of Service |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9P 200K|Medical Assistance Expenditures by Type of Service for the Medical Assistance Program Prior Period Adjustments in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9I|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PI|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9TP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9TP WAIVER|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PE|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PEP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PEPWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PEWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9E|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EPWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9VIII|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9VIIIP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9VIIIP Waiver|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9E|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EPWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9T|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21U|Child Health Expenditures by Service |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21 WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21U WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Expenditure Categories |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21P|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21P WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21UP|Quarterly Medical Assistance Expenditures by Children’s Health Insurance Program expenditure categories |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21UP WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21BASE|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21P|Quarterly Children's Health Insurance Program |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21 WAIVER|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21PWAIVER|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |