FTX.008.304

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TMSIS Dataguide

Medicaid.gov

Version:

MBESCBES-CATEGORY-OF-SERVICE

Data Element

DE Number

FTX304

System DE Number

FTX.008.304

File Name

FTX - FINANCIAL TRANSACTION

File Segment Number

File Segment Name

COST-SETTLEMENT-PAYMENT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code indicating the category of service for the paid claim. The category of service is the line item from the MBES/CBES expenditure form (e.g., CMS-64 Base, CMS-64.21U, CMS-21, etc.) that states use to report their expenditures and request federal financial participation.
Size	X(5)
FLF Start Position	734
FLF Stop Position	738
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 5 characters or less 2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL) 3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL) 4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL) 5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)

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

RULE ID	RULE Definition
RULE-8296	If a financial transaction is from an FTX file, then the MBESCBES category of service value reported must be compatible with specified T-MSIS picture format: X(5).
RULE-8611	If the MBESCBES category of service is populated and MBESCBES form is '64.9BASE' on the Cost Settlement Payment Transaction from a FTX file, then the MBESCBES category of service reported must be found in the list of valid values for '64.9BASE-FORM'.
RULE-8612	If the MBESCBES category of service is populated and MBESCBES form is '64.21U' on the Cost Settlement Payment Transaction from a FTX file, then the MBESCBES category of service reported must be found in the list of valid values for '64.21U-FORM'.
RULE-8613	If the MBESCBES category of service is populated and MBESCBES form is '21BASE' on the Cost Settlement Payment Transaction from a FTX file, then the MBESCBES category of service reported must be found in the list of valid values for '21BASE-FORM'.
RULE-8671	If the Cost Settlement Payment Transactions segment is populated from a FTX file, then the MBESCBES-CATEGORY-OF-SERVICE must be populated

Measure ID	Measure Name
RULE-8671	% missing: MBESCBES-CATEGORY-OF-SERVICE (FTX00008)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP315	CIP.003.315	MBESCBES-CATEGORY-OF-SERVICE	CIP00003	CLAIM-LINE-RECORD-IP
CLT261	CLT.003.261	MBESCBES-CATEGORY-OF-SERVICE	CLT00003	CLAIM-LINE-RECORD-LT
COT256	COT.003.256	MBESCBES-CATEGORY-OF-SERVICE	COT00003	CLAIM-LINE-RECORD-OT
CRX180	CRX.003.180	MBESCBES-CATEGORY-OF-SERVICE	CRX00003	CLAIM-LINE-RECORD-RX
FTX046	FTX.002.046	MBESCBES-CATEGORY-OF-SERVICE	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX091	FTX.003.091	MBESCBES-CATEGORY-OF-SERVICE	FTX00003	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX135	FTX.004.135	MBESCBES-CATEGORY-OF-SERVICE	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX177	FTX.005.177	MBESCBES-CATEGORY-OF-SERVICE	FTX00005	COST-SHARING-OFFSET
FTX219	FTX.006.219	MBESCBES-CATEGORY-OF-SERVICE	FTX00006	VALUE-BASED-PAYMENT
FTX264	FTX.007.264	MBESCBES-CATEGORY-OF-SERVICE	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX343	FTX.009.343	MBESCBES-CATEGORY-OF-SERVICE	FTX00009	FQHC-WRAP-PAYMENT
FTX391	FTX.095.391	MBESCBES-CATEGORY-OF-SERVICE	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
04/24/2025	4.0.7	FTX.008.304	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)
12/19/2024	4.0.1	FTX.008.304	UPDATE	Coding requirement	1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory	1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory
09/16/2024	4.0.0	FTX.008.304	UPDATE	File segment	None	74
09/16/2024	4.0.0	FTX.008.304	ADD	N/A		Created