FTX.005.174

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TMSIS Dataguide

Medicaid.gov

Version:

COVERAGE-PERIOD-START-DATE

Data Element

DE Number

FTX174

System DE Number

FTX.005.174

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	The date representing the beginning of the period covered by the capitation payment or premium payment that the beneficiary is offsetting; for example, the first day of the calendar month of beneficiary enrollment in the managed care plan to which the off-setting amount is applied. If returning money to the beneficiary, this is the date representing the beginning of the period for which the beneficiary had previously made an offsetting payment that is now being returned to them.
Size	9(8)
FLF Start Position	805
FLF Stop Position	812
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 Cost Settlement 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-8169	If a financial transaction is from an FTX file, then the coverage period start date value reported must be a valid date of the form CCYYMMDD.
RULE-8650	If the Cost Sharing Offset segment is populated from a FTX file, then the COVERAGE-PERIOD-START-DATE must be populated
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-8749	If a financial transaction is a non-void, and the MSIS ID is populated on Cost Sharing Offset 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 premium 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.

Measure ID	Measure Name
MCR-31-003_3-13	% of MSIS IDs enrolled on Coverage Period Start Date
MCR-31-008_8-16	% of MSIS IDs enrolled on Coverage Period Start Date
RULE-8749	% of records with an MSIS ID not enrolled on COVERAGE-PERIOD -START-DATE
RULE-8755	% of records with a valid value for Payee ID (FTX00005) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8650	% missing: COVERAGE-PERIOD-START-DATE (FTX00005)

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.005.174	UPDATE	File segment	None	71
09/16/2024	4.0.0	FTX.005.174	ADD	N/A		Created