FTX.003.088

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TMSIS Dataguide

Medicaid.gov

Version:

PREMIUM-PERIOD-START-DATE

Data Element

DE Number

FTX088

System DE Number

FTX.003.088

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

File Segment Name

INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The date representing the beginning of the period covered by the premium payment; for example, the first day of the calendar month of beneficiary coverage in the insurance 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	635
FLF Stop Position	642
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 Coverage 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-8085	If a financial transaction is from an FTX file, then the premium period start date value reported must be a valid date of the form CCYYMMDD.
RULE-8648	If the Insurance Premium Payment Transaction segment is populated from a FTX file, then the PREMIUM-PERIOD-START-DATE must be populated
RULE-8720	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Health Insurance Premium 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 premium period start date on the financial transaction.
RULE-8729	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Health Insurance Premium 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 premium period start date on the financial transaction.
RULE-8747	If a financial transaction is a non-void, and the MSIS ID is populated on Individual Health Insurance Premium Payment segment, then the MSIS ID value reported must be equal to a submitting state 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 premium period start date on the financial transaction.
RULE-8753	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Health Insurance Premium 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 premium period start date on the financial transaction.
RULE-8768	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Health Insurance Premium 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 premium period start date on the financial transaction.
RULE-8777	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Health Insurance Premium 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 premium period start date on the financial transaction.

Measure ID	Measure Name
MCR-31-003_3-12	% of MSIS IDs enrolled on Premium Period Start Date
MCR-31-008_8-15	% of MSIS IDs enrolled on Premium Period Start Date
RULE-8747	% of records with an MSIS ID not enrolled on PREMIUM-PERIOD-START-DATE
RULE-8753	% of records with a valid value for Payee ID (FTX00003) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8648	% missing: PREMIUM-PERIOD-START-DATE (FTX00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
FTX132	FTX.004.132	PREMIUM-PERIOD-START-DATE	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
03/14/2025	4.0.4	FTX.003.088	UPDATE	Definition	The date representing the beginning of the period covered by the premium payment or recoupment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).	The date representing the beginning of the period covered by the premium payment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month).
09/16/2024	4.0.0	FTX.003.088	UPDATE	File segment	None	69
09/16/2024	4.0.0	FTX.003.088	ADD	N/A		Created