FTX.005.163

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TMSIS Dataguide

Medicaid.gov

Version:

PAYEE-ID

Data Element

DE Number

FTX163

System DE Number

FTX.005.163

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

File Segment Name

COST-SHARING-OFFSET

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. For beneficiary Cost Sharing Offset, the beneficiary is always the payee.
Size	X(30)
FLF Start Position	299
FLF Stop Position	328
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 30 characters or less 2. Value must equal MSIS Identification Number (ELG.002.019) 3. 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-8158	If a financial transaction is from an FTX file, then the payee id value reported must be compatible with specified T-MSIS picture format: X(30).
RULE-8722	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset 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 coverage period start date on the financial transaction.
RULE-8731	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset 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 coverage period start date on the financial transaction.
RULE-8755	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset 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 coverage period start date on the financial transaction.
RULE-8770	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset 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 coverage period start date on the financial transaction.
RULE-8779	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset 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 coverage period start date on the financial transaction.
RULE-8806	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Sharing Offset segment from the FTX file and the PAYEE ID Type is State, then the PAYEE ID value reported must be equal to the value populated for submitting state.

Measure ID	Measure Name
MCR-28-001-1	% of plan IDs with capitation payment ratios <0.9 or >1.1 (non-PCCM)
MCR-65-001-1	% of Comprehensive MCO (MANAGED-CARE-PLAN-TYPE = 01, 04) enrollees with no capitation payments for comprehensive MCO
MCR-65-002-2	% of PACE plan (MANAGED-CARE-PLAN-TYPE = 17) enrollees with no capitation payments for PACE
MCR-65-003-3	% of Transportation PAHP (MANAGED-CARE-PLAN-TYPE = 15) enrollees with no capitation payments for Transportation PAHPs
MCR-65-004-4	% of Dental PAHP (MANAGED-CARE-PLAN-TYPE = 14) enrollees with no capitation payments for Dental PAHPs
MCR-65-005-5	% of Pharmacy PAHP (MANAGED-CARE-PLAN-TYPE = 18) enrollees with no capitation payments for Pharmacy PAHPs
MCR-65-006-6	% of Mental Health PIHP (MANAGED-CARE-PLAN-TYPE = 08, 10, 12) enrollees with no capitation payments for Mental Health PIHPs
MCR-65-007-7	% of Mental Health PAHP (MANAGED-CARE-PLAN-TYPE = 09, 11, 13) enrollees with no capitation payments for Mental Health PAHPs
MCR-65-008-8	% of LTSS (MANAGED-CARE-PLAN-TYPE = 07, 19) enrollees with no capitation payments for LTSS
MCR-65-009-9	% of Disease Management (MANAGED-CARE-PLAN-TYPE = 02, 03, 16) enrollees with no capitation payments for Disease Management
MCR-65-010-10	% of ACO (MANAGED-CARE-PLAN-TYPE = 60) enrollees with no capitation payments for ACOs
MCR-65-011-11	% of Health/Medical Home (MANAGED-CARE-PLAN-TYPE = 70) enrollees with no capitation payments for Health/Medical Home
MCR-65-012-12	% of Integrated Care for Dual Eligibles (MANAGED-CARE-PLAN-TYPE = 80) enrollees with no capitation payments for Integrated Care for Dual Eligibles
RULE-8722	% of records with a PAYEE ID that is not found on the provider file during the coverage period start date

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
FTX033	FTX.002.033	PAYEE-ID	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX078	FTX.003.078	PAYEE-ID	FTX00003	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX119	FTX.004.119	PAYEE-ID	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX206	FTX.006.206	PAYEE-ID	FTX00006	VALUE-BASED-PAYMENT
FTX250	FTX.007.250	PAYEE-ID	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX293	FTX.008.293	PAYEE-ID	FTX00008	COST-SETTLEMENT-PAYMENT
FTX332	FTX.009.332	PAYEE-ID	FTX00009	FQHC-WRAP-PAYMENT
FTX373	FTX.095.373	PAYEE-ID	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	FTX.005.163	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.163	ADD	N/A		Created