| 04/02/2025 |
4.0.6 |
CLAIM-DX-IP |
UPDATE |
Record segment definition |
A record segment to capture data about the diagnosis code(s) associated with a claim. -test |
A record segment to capture data about the diagnosis code(s) associated with a claim. |
| 04/02/2025 |
4.0.6 |
CLAIM-DX-IP |
UPDATE |
Record segment definition |
A record segment to capture data about the diagnosis code(s) associated with a claim. |
A record segment to capture data about the diagnosis code(s) associated with a claim. -test |
| 04/02/2025 |
4.0.6 |
CLAIM-DX-IP |
UPDATE |
Record segment definition |
A record segment to capture data about the diagnosis code(s) associated with a claim. -test |
A record segment to capture data about the diagnosis code(s) associated with a claim. |
| 02/20/2025 |
4.0.3 |
SOGI |
REMOVE |
N/A |
Removed |
|
| 12/10/2024 |
4.0.1 |
MANAGED-CARE-ID |
UPDATE |
Title |
MANAGED-CARE-PLAN-ID |
MANAGED-CARE-ID |
| 11/05/2024 |
4.0.0 |
File Segment Layouts |
UPDATE |
Icon |
None |
27 |
| 12/10/2024 |
4.0.1 |
MCR - MANAGED CARE PLAN INFORMATION |
UPDATE |
Overview |
Managed Care File – Managed Care Entity Record Segment Relationships Description Each managed care entity in T-MSIS must have a record in the T-MSIS managed care file. Each managed care record is comprised of up to seven different types of record segments. The MANAGED-CARE-MAIN (MCR00002) segment is the parent segment to five segments: MANAGED-CARE-LOCATION-AND-CONTACT-INFO (MCR00003), MANAGED-CARE-SERVICE-AREA (MCR00004), MANAGED-CARE-OPERATING-AUTHORITY (MCR00005), MANAGED-CARE-PLAN-POPULATION-ENROLLED (MCR00006), MANAGED-CARE-ACCREDITATION-ORGANIZATION (MCR00007) and MANAGED-CARE-PLAN-ID (MCR00010) all of which join to MANAGED-CARE-MAIN and to each other on the following two data elements: 1. SUBMITTING-STATE2. STATE-PLAN-ID-NUM |
Managed Care File – Managed Care Entity Record Segment RelationshipsDescriptionEach managed care entity in T-MSIS must have a record in the T-MSIS managed care file. Each managed care record is comprised of up to seven different types of record segments. The MANAGED-CARE-MAIN (MCR00002) segment is the parent segment to five segments: MANAGED-CARE-LOCATION-AND-CONTACT-INFO (MCR00003), MANAGED-CARE-SERVICE-AREA (MCR00004), MANAGED-CARE-OPERATING-AUTHORITY (MCR00005), MANAGED-CARE-PLAN-POPULATION-ENROLLED (MCR00006), MANAGED-CARE-ACCREDITATION-ORGANIZATION (MCR00007) and MANAGED-CARE-PLAN-ID (MCR00010) all of which join to MANAGED-CARE-MAIN and to each other on the following two data elements:SUBMITTING-STATESTATE-PLAN-ID-NUM |
| 02/20/2025 |
4.0.3 |
ELG - ELIGIBLE |
UPDATE |
Overview |
Eligible File – Eligible Person Record Segment RelationshipsDescriptionEach eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty-one different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUMThe exception, the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM3. HEALTH-HOME-SPA-ID4. HEALTH-HOME-ENTITY-NAME |
Eligible File – Eligible Person Record Segment RelationshipsDescriptionEach eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty-one different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:SUBMITTING-STATEMSIS-IDENTIFICATION-NUMThe exception, the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:SUBMITTING-STATEMSIS-IDENTIFICATION-NUMHEALTH-HOME-SPA-IDHEALTH-HOME-ENTITY-NAME |
| 09/16/2024 |
4.0.0 |
TPL - THIRD-PARTY LIABILITY |
UPDATE |
Overview |
Third-Party Liability (TPL) File – TPL Record Segment RelationshipsDescription:Each instance of potential third-party liability for T-MSIS eligibles must have a record in the T-MSIS TPL file. There are two sets of information captured (called “subject areas”) in the TPL file: One set of records captures general information about non-Medicaid, non-Medicare health insurers, while the other set of records captures information about third party sources of funds that individual Medicaid/CHIP eligibles have.TPL Health Insurance Entity Subject AreaTwo types of record segments comprise the “TPL health insurance entity subject area:” the TPL-ENTITY-CONTACT-INFORMATION (TPL00006) and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES (TPL00004) segments. There is a one-to-many relationship between these segment types (one TPL-ENTITY-CONTACT-INFORMATION segment type to many TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments). The TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segment joins to the TPL-ENTITY-CONTACT-INFORMATION segment on two fields:1. SUBMITTING-STATE2. INSURANCE-CARRIER-ID-NUMMedicaid/CHIP Enrollees with TPL Funding Subject AreaThree types of segments make up the “Medicaid/CHIP Enrollees with TPL Funding Subject Area.” The TPL-MEDICAID-ELIGIBLE-PERSON-MAIN(TPL00002) segment type is the parent segment, with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO (TPL00003) and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION (TPL00005) being the subordinate segments. The two subordinate segments join to TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM |
Third-Party Liability (TPL) File – TPL Record Segment RelationshipsDescriptionEach instance of potential third-party liability for T-MSIS eligibles must have a record in the T-MSIS TPL file. There are two sets of information captured (called “subject areas”) in the TPL file: One set of records captures general information about non-Medicaid, non-Medicare health insurers, while the other set of records captures information about third party sources of funds that individual Medicaid/CHIP eligibles have.TPL Health Insurance Entity Subject AreaTwo types of record segments comprise the “TPL health insurance entity subject area:” the TPL-ENTITY-CONTACT-INFORMATION (TPL00006) and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES (TPL00004) segments. There is a one-to-many relationship between these segment types (one TPL-ENTITY-CONTACT-INFORMATION segment type to many TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments). The TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segment joins to the TPL-ENTITY-CONTACT-INFORMATION segment on two fields:1. SUBMITTING-STATE2. INSURANCE-CARRIER-ID-NUMMedicaid/CHIP Enrollees with TPL Funding Subject AreaThree types of segments make up the “Medicaid/CHIP Enrollees with TPL Funding Subject Area.” The TPL-MEDICAID-ELIGIBLE-PERSON-MAIN(TPL00002) segment type is the parent segment, with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO (TPL00003) and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION (TPL00005) being the subordinate segments. The two subordinate segments join to TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM |
| 09/16/2024 |
4.0.0 |
TPL-ENTITY-CONTACT-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL-MEDICAID-ELIGIBLE-PERSON-MAIN |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-TPL |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL - THIRD-PARTY LIABILITY |
UPDATE |
Definition |
Temporary |
Beneficiary level third-party liability (TPL) data and insurance carrier level data. |
| 09/16/2024 |
4.0.0 |
TPL - THIRD-PARTY LIABILITY |
UPDATE |
Overview |
|
Third-Party Liability (TPL) File – TPL Record Segment RelationshipsDescription:Each instance of potential third-party liability for T-MSIS eligibles must have a record in the T-MSIS TPL file. There are two sets of information captured (called “subject areas”) in the TPL file: One set of records captures general information about non-Medicaid, non-Medicare health insurers, while the other set of records captures information about third party sources of funds that individual Medicaid/CHIP eligibles have.TPL Health Insurance Entity Subject AreaTwo types of record segments comprise the “TPL health insurance entity subject area:” the TPL-ENTITY-CONTACT-INFORMATION (TPL00006) and TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES (TPL00004) segments. There is a one-to-many relationship between these segment types (one TPL-ENTITY-CONTACT-INFORMATION segment type to many TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segments). The TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES segment joins to the TPL-ENTITY-CONTACT-INFORMATION segment on two fields:1. SUBMITTING-STATE2. INSURANCE-CARRIER-ID-NUMMedicaid/CHIP Enrollees with TPL Funding Subject AreaThree types of segments make up the “Medicaid/CHIP Enrollees with TPL Funding Subject Area.” The TPL-MEDICAID-ELIGIBLE-PERSON-MAIN(TPL00002) segment type is the parent segment, with TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO (TPL00003) and TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION (TPL00005) being the subordinate segments. The two subordinate segments join to TPL-MEDICAID-ELIGIBLE-PERSON-MAIN (TPL00002) segment on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM |
| 09/16/2024 |
4.0.0 |
TPL - THIRD-PARTY LIABILITY |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-BED-TYPE-INFO |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-AFFILIATED-PROGRAMS |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-AFFILIATED-GROUPS |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-MEDICAID-ENROLLMENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-TAXONOMY-CLASSIFICATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-IDENTIFIERS |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-LICENSING-INFO |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-LOCATION-AND-CONTACT-INFO |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PROV-ATTRIBUTES-MAIN |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-PROVIDER |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV - PROVIDER |
UPDATE |
Definition |
Temporary |
Provider enrollment with Medicaid and MCOs including demographics and characteristics data. |
| 09/16/2024 |
4.0.0 |
PRV - PROVIDER |
UPDATE |
Overview |
|
Provider File – Provider Record Segment Relationships Description Each provider in T-MSIS (regardless of whether the provider is a single individual, a group of practitioners, a facility, or a group of facilities) must have a record in the T-MSIS provider’s file. Each provider record is comprised of up to nine different types of record segments. The PROV-ATTRIBUTES-MAIN (PRV00002) segment is the parent segment to five segments: PROV-TAXONOMY-CLASSIFICATION (PRV00006), PROV-MEDICAID-ENROLLMENT (PRV00007), PROV-AFFILIATED-GROUPS (PRV00008), PROV-AFFILIATED-PROGRAMS (PRV00009), and PROV-LOCATION-AND-CONTACT-INFO (PRV00003), all of which join to PROV-ATTRIBUTES-MAIN on the following two data elements: 1. SUBMITTING-STATE2. SUBMITTING-STATE-PROV-IDIn addition, the PROV-LOCATION-AND-CONTACT-INFO (PRV00003) segment is a parent segment to three additional subordinate segments: PROV-IDENTIFIERS (PRV00005), PROV-LICENSING-INFO (PRV00004), PROV-BED-TYPE-INFO (PRV00010). These three segments join to the PROV-LOCATION-AND-CONTACT-INFO segment on:1. SUBMITTING-STATE2. SUBMITTING-STATE-PROV-ID3. PROV-LOCATION-ID |
| 09/16/2024 |
4.0.0 |
PRV - PROVIDER |
ADD |
N/A |
|
Created |
| 12/10/2024 |
4.0.1 |
MANAGED-CARE-PLAN-ID |
UPDATE |
Record segment name |
MANAGED-CARE-PLAN-ID |
MANAGED-CARE-ID |
| 09/16/2024 |
4.0.0 |
MANAGED-CARE-PLAN-ID |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MANAGED- CARE-ACCREDITATION-ORGANIZATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MANAGED-CARE-PLAN-POPULATION-ENROLLED |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MANAGED-CARE-OPERATING-AUTHORITY |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MANAGED-CARE-SERVICE-AREA |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MANAGED-CARE-LOCATION-AND-CONTACT-INFO |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MANAGED-CARE-MAIN |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-MANAGED-CARE |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR - MANAGED CARE PLAN INFORMATION |
UPDATE |
Definition |
Temporary |
Managed Care Organizations (MCO) plan level participation and characteristics data. |
| 09/16/2024 |
4.0.0 |
MCR - MANAGED CARE PLAN INFORMATION |
UPDATE |
Overview |
|
Managed Care File – Managed Care Entity Record Segment Relationships Description Each managed care entity in T-MSIS must have a record in the T-MSIS managed care file. Each managed care record is comprised of up to seven different types of record segments. The MANAGED-CARE-MAIN (MCR00002) segment is the parent segment to five segments: MANAGED-CARE-LOCATION-AND-CONTACT-INFO (MCR00003), MANAGED-CARE-SERVICE-AREA (MCR00004), MANAGED-CARE-OPERATING-AUTHORITY (MCR00005), MANAGED-CARE-PLAN-POPULATION-ENROLLED (MCR00006), MANAGED-CARE-ACCREDITATION-ORGANIZATION (MCR00007) and MANAGED-CARE-PLAN-ID (MCR00010) all of which join to MANAGED-CARE-MAIN and to each other on the following two data elements: 1. SUBMITTING-STATE2. STATE-PLAN-ID-NUM |
| 09/16/2024 |
4.0.0 |
MCR - MANAGED CARE PLAN INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MISCELLANEOUS-PAYMENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FQHC-WRAP-PAYMENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COST-SETTLEMENT-PAYMENT |
ADD |
N/A |
|
Created |
| 10/16/2024 |
4.0.0 |
STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM |
UPDATE |
Record segment definition |
A record segment to capture State Directed Payment Separate Payment Term payments. |
A record segment to capture State Directed Payments which are made under separate payment terms. |
| 09/16/2024 |
4.0.0 |
STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
VALUE-BASED-PAYMENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COST-SHARING-OFFSET |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
GROUP-INSURANCE-PREMIUM-PAYMENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
INDIVIDUAL-CAPITATION-PMPM |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-FTX |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FTX - FINANCIAL TRANSACTION |
UPDATE |
Definition |
Temporary |
Information about financial transactions. |
| 09/16/2024 |
4.0.0 |
FTX - FINANCIAL TRANSACTION |
UPDATE |
Overview |
|
Financial Transactions File – FTX Record Segment Relationships Description Unlike the other T-MSIS file types, the Financial Transactions file does not contain relationships among the segments. Each segment in this file represents a different type of financial transaction, except for the “miscellaneous” segment which can represent multiple types of financial transactions. The purpose of the “miscellaneous” segment is to represent financial transactions which are not common across states and/or occur in relatively low volumes within most states, as well as to provide a flexible mechanism for CMS and/or states to add new financial transactions in a much shorter time cycle than would be possible by adding an entirely new segment. The “miscellaneous” segment utilizes a generalized set of data elements and an expandable valid value list to distinguish different types of financial transactions from one another. |
| 09/16/2024 |
4.0.0 |
FTX - FINANCIAL TRANSACTION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
SOGI |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
ELG-IDENTIFIERS |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
ENROLLMENT-TIME-SPAN-SEGMENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
1115A-DEMONSTRATION-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
DISABILITY-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
RACE-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
ETHNICITY-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MANAGED-CARE-PARTICIPATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
LTSS-PARTICIPATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
WAIVER-PARTICIPATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
STATE-PLAN-OPTION-PARTICIPATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MFP-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
LOCK-IN-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
HEALTH-HOME-CHRONIC-CONDITIONS |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
HEALTH-HOME-SPA-PROVIDERS |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
HEALTH-HOME-SPA-PARTICIPATION-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
ELIGIBILITY-DETERMINANTS |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
ELIGIBLE-CONTACT-INFORMATION |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
VARIABLE-DEMOGRAPHICS-ELIGIBILITY |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRIMARY-DEMOGRAPHICS-ELIGIBILITY |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-ELIGIBILITY |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
ELG - ELIGIBLE |
UPDATE |
Definition |
Temporary |
Enhanced information about beneficiary enrollment and eligibility including person level demographic and eligibility data. |
| 09/16/2024 |
4.0.0 |
ELG - ELIGIBLE |
UPDATE |
Overview |
|
Eligible File – Eligible Person Record Segment RelationshipsDescriptionEach eligible person in T-MSIS has a record in the T-MSIS eligibility file. Each of these records is comprised of up to twenty-one different types of record segments. The PRIMARY-DEMOGRAPHICS-ELIGIBILITY (ELG00002) segment is the parent segment and all other segments, except for the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, join to it on the following two data elements:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUMThe exception, the HEALTH-HOME-SPA-PROVIDERS (ELG00007) segment, is a child of the HEALTH-HOME-SPA-PARTICIPATION-INFORMATION (ELG00006) segment and joins to it on:1. SUBMITTING-STATE2. MSIS-IDENTIFICATION-NUM3. HEALTH-HOME-SPA-ID4. HEALTH-HOME-ENTITY-NAME |
| 09/16/2024 |
4.0.0 |
ELG - ELIGIBLE |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-DX-RX |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-LINE-RECORD-RX |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-HEADER-RECORD-RX |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-RX |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX - CLAIM PHARMACY |
UPDATE |
Definition |
Temporary |
Pharmacy claims and managed care encounter records. |
| 09/16/2024 |
4.0.0 |
CRX - CLAIM PHARMACY |
UPDATE |
Overview |
|
Claim RX File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS pharmacy claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments) |
| 09/16/2024 |
4.0.0 |
CRX - CLAIM PHARMACY |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-DX-OT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-LINE-RECORD-OT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-HEADER-RECORD-OT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-OT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT - CLAIM OTHER |
UPDATE |
Definition |
Temporary |
Professional, Dental, Outpatient Institutional claims and encounter, capitation payments and other financial transactions. |
| 09/16/2024 |
4.0.0 |
COT - CLAIM OTHER |
UPDATE |
Overview |
|
Claim OT File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS other claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments) |
| 09/16/2024 |
4.0.0 |
COT - CLAIM OTHER |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-DX-LT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-LINE-RECORD-LT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-HEADER-RECORD-LT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-LT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT - CLAIM LONG-TERM CARE |
UPDATE |
Definition |
Temporary |
Institutional long-term care facility claims and managed care encounter records |
| 09/16/2024 |
4.0.0 |
CLT - CLAIM LONG-TERM CARE |
UPDATE |
Overview |
|
Claim LT File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS long-term care claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments) |
| 09/16/2024 |
4.0.0 |
CLT - CLAIM LONG-TERM CARE |
ADD |
N/A |
|
Created |
| 04/02/2025 |
4.0.6 |
CLAIM-DX-IP |
UPDATE |
Record segment definition |
A record segment to capture data about the diagnosis code(s) associated with a claim. |
A record segment to capture data about the diagnosis code(s) associated with a claim. -test |
| 09/16/2024 |
4.0.0 |
CLAIM-DX-IP |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-LINE-RECORD-IP |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLAIM-HEADER-RECORD-IP |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
FILE-HEADER-RECORD-IP |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP - CLAIM INPATIENT |
UPDATE |
Definition |
Temporary |
Inpatient hospital facility claims and managed care encounter records. |
| 09/16/2024 |
4.0.0 |
CIP - CLAIM INPATIENT |
UPDATE |
Overview |
|
Claim IP File – Claim Record Segment RelationshipsDescriptionEach claim record in the T-MSIS inpatient claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:1. SUBMITTING-STATE2. ICN-ORIG3. ICN-ADJ4. ADJUDICATION-DATE5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments) |
| 09/16/2024 |
4.0.0 |
CIP - CLAIM INPATIENT |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
File Segment Layouts |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
File Segment Layouts |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
FTX - FINANCIAL TRANSACTIONS |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
CRX - CLAIM PHARMACY |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
TPL - THIRD-PARTY LIABILITY |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
PRV - PROVIDER |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
MCR - MANAGED CARE PLAN INFORMATION |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
ELG - ELIGIBLE |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
CLT - CLAIM LONG-TERM CARE |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
COT - CLAIM OTHER |
REMOVE |
N/A |
Removed |
|
| 09/16/2024 |
4.0.0 |
CIP - CLAIM INPATIENT |
REMOVE |
N/A |
Removed |
|
| 09/11/2024 |
4.0.0 |
FTX - FINANCIAL TRANSACTIONS |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
CRX - CLAIM PHARMACY |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
TPL - THIRD-PARTY LIABILITY |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
PRV - PROVIDER |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
MCR - MANAGED CARE PLAN INFORMATION |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
ELG - ELIGIBLE |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
CLT - CLAIM LONG-TERM CARE |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
COT - CLAIM OTHER |
ADD |
N/A |
|
Created |
| 09/11/2024 |
4.0.0 |
CIP - CLAIM INPATIENT |
ADD |
N/A |
|
Created |
| 09/04/2024 |
4.0.0 |
File Segment Layouts |
ADD |
N/A |
|
Created |
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