MCR.002.020

MANAGED-CARE-CONTRACT-EFF-DATE

Data Element

DE Number

MCR020

System DE Number

MCR.002.020

File Name

MCR - MANAGED CARE PLAN INFORMATION

File Segment Number

MCR00002

File Segment Name

MANAGED-CARE-MAIN

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The start date of the managed care contract period with the state.
Size	9(8)
FLF Start Position	34
FLF Stop Position	41
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Mandatory 3. Value must occur before Managed Care Contract End Date (MCR.002.021)

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

RULE ID	RULE Definition
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-8766	If a financial transaction is a non-void, and the PAYER ID is populated on Miscellaneous Payment segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER 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 payment period start date on the financial transaction.
RULE-8765	If a financial transaction is a non-void, and the PAYER ID is populated on FQHC Wrap Payment segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER 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 wrap period start date on the financial transaction.
RULE-8764	If a financial transaction is a non-void, and the PAYER ID is populated on Cost Settlement Payment segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER 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 cost settlement period start date on the financial transaction.
RULE-8763	If a financial transaction is a non-void, and the PAYER ID is populated on State Directed Payment Separate Payment Term segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER 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 payment period start date on the financial transaction.
RULE-8762	If a financial transaction is a non-void, and the PAYER ID is populated on Value Based Payment segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER 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 performance period start date on the financial transaction.
RULE-8761	If a financial transaction is a non-void, and the PAYER ID is populated on Individual Capitation Payment segment from the FTX file and the PAYER ID Type is Capitated plan ID, then the PAYER 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 capitation period start date on the financial transaction.
RULE-8760	If a financial transaction is a non-void, and the PAYEE ID is populated on Miscellaneous 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 payment period start date on the financial transaction.
RULE-8759	If a financial transaction is a non-void, and the PAYEE ID is populated on FQHC Wrap 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 wrap period start date on the financial transaction.
RULE-8758	If a financial transaction is a non-void, and the PAYEE ID is populated on Cost Settlement 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 cost settlement period start date on the financial transaction.
RULE-8757	If a financial transaction is a non-void, and the PAYEE ID is populated on State Directed Payment Separate Payment Term 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 payment period start date on the financial transaction.
RULE-8756	If a financial transaction is a non-void, and the PAYEE ID is populated on Value Based 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 performance period start date on the financial transaction.
RULE-2382	If the managed care plan ID is populated on a managed care participation ELG file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
RULE-8754	If a financial transaction is a non-void, and the PAYEE ID is populated on Group 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-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-8752	If a financial transaction is a non-void, and the PAYEE ID is populated on Individual Capitation 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 capitation period start date on the financial transaction.
RULE-7201	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an RX file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the prescription fill date is within the contract effective and end dates on the managed care main segment.
RULE-7200	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an OT file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the beginning date of service on the claim is within the contract effective and end dates on the managed care main segment.
RULE-7199	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an LT file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the beginning date of service on the claim is within the contract effective and end dates of the managed care main segment.
RULE-7198	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an IP file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the admission date on the claim is within the contract effective and end dates of the managed care main segment.
RULE-2990	If the affiliated program type is equal to '2' (health plan (state assigned health plan ID)) on a provider affiliated programs PRV file segment and the provider affiliated programs prov affiliated program end date is greater than the states tmsis cutover date then the effective and end dates on the provider affiliated programs segment must fall with the effective and end dates of one or more continuous mangaged care main segments.
RULE-2561	If the managed are main segment has a value populated for managed care contract effective date and a value populated for managed care contract end date, then the contract effective date is less than or equal to the contract end date.
RULE-2559	If a segment is a managed care main segment from an MCR file, then the managed care contract effective date value reported must be a valid date of the form CCYYMMDD.
RULE-2384	If the managed care participation plan type is populated on a managed care participation segment and the managed care main plan type is populated on the managed care main file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then managed care participation managed care plan type equals the managed care main managed care plan type and the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.

Measure ID	Measure Name
RULE-8757	% of records with a valid value for Payee ID (FTX00007) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8766	% of records with a valid value for Payer ID (FTX00095 ) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8765	% of records with a valid value for Payer ID (FTX00009) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8764	% of records with a valid value for Payer ID (FTX00008) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8763	% of records with a valid value for Payer ID (FTX00007) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8762	% of records with a valid value for Payer ID (FTX00006) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8761	% of records with a valid value for Payer ID (FTX00002) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8760	% of records with a valid value for Payee ID (FTX00095 ) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8759	% of records with a valid value for Payee ID (FTX00009) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8758	% of records with a valid value for Payee ID (FTX00008) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7198	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-8756	% of records with a valid value for Payee ID (FTX00006) that do not have a corresponding MCR Managed Care Main segment for the same time period
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-8754	% of records with a valid value for Payee ID (FTX00004) that do not have a corresponding MCR Managed Care Main segment for the same time period
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-8752	% of records with a valid value for Payee ID (FTX00002) that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7702	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7201	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7200	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7199	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period

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	MCR.002.020	UPDATE	File segment	None	79
09/16/2024	4.0.0	MCR.002.020	ADD	N/A		Created