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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

MCR - MANAGED CARE PLAN INFORMATION

File

View Changelog
File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
MCR00001 FILE-HEADER-RECORD-MANAGED-CARE A record segment containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
MCR00002 MANAGED-CARE-MAIN A record segment to capture basic, generally static information about a managed care entity.
MCR00003 MANAGED-CARE-LOCATION-AND-CONTACT-INFO A record segment to capture addresses, phone numbers, fax numbers, and email addresses of the managed care organization.
MCR00004 MANAGED-CARE-SERVICE-AREA A record segment to capture the zip codes, counties, or other geographic descriptors that define the managed care entity’s service area.
MCR00005 MANAGED-CARE-OPERATING-AUTHORITY A record segment to capture information about the operating authority, waivers, and demonstrations under which a managed care entity is contracted with the state.
MCR00006 MANAGED-CARE-PLAN-POPULATION-ENROLLED A record segment to capture the identity of the Medicaid/CHIP eligibility groups that the managed care entity is authorized to enroll.
MCR00007 MANAGED- CARE-ACCREDITATION-ORGANIZATION A record segment to capture information concerning the accreditations that the managed care entity has.
MCR00010 MANAGED-CARE-ID A record segment to capture information concerning the ID(s) associated with a managed care plan.
Definition
Managed Care Organizations (MCO) plan level participation and characteristics data.

Overview

Managed Care File – Managed Care Entity Record Segment Relationships

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:

SUBMITTING-STATE

STATE-PLAN-ID-NUM