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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

CMS Reporting Reminder

CMS Technical Instructions: Required Date Data Elements in the T-MSIS Claims Files and FTX files

Technical Instructions History

Date Description of Change

07/02/2018

Original reporting reminder issued

06/24/2022

Update reporting reminder with existing line level data elements for beginning and ending date of services on the LT file.

Technical instructions updated in correspondence with the V3.0.0 data dictionary update:

  • Add header level data elements for beginning and ending date of services on the IP file.

11/19/2024

Technical instructions updated in correspondence with the V4.0.0 data dictionary update:

  • Added new data elements in the new Financial Transactions file type.

Brief Issue Description

This technical instruction document describes how to report required date fields in the T-MSIS claims and financial transactions files.

Impacted Data Elements

  • Claim IP
    • ADMISSION-DATE (CIP094) (CLAIM-HEADER-RECORD-IP-CIP00002)
    • DISCHARGE-DATE (CIP096) (CLAIM-HEADER-RECORD-IP-CIP00002)
    • BEGINNING-DATE-OF-SERVICE (CIP290) (CLAIM-HEADER-RECORD-IP-CIP00002)[1]
    • ENDING-DATE-OF-SERVICE (CIP291) (CLAIM-HEADER-RECORD-IP-CIP00002)[1]
    • BEGINNING-DATE-OF-SERVICE (CIP243) (CLAIM-LINE-RECORD-IP-CIP00003)
    • ENDING-DATE-OF-SERVICE (CIP244) (CLAIM-LINE-RECORD-IP-CIP00003)
  • Claim LT
    • BEGINNING-DATE-OF-SERVICE (CLT048) (CLAIM-HEADER-RECORD-LT-CLT00002)
    • ENDING-DATE-OF-SERVICE (CLT049) (CLAIM-HEADER-RECORD-LT-CLT00002)
    • BEGINNING-DATE-OF-SERVICE (CLT196) (CLAIM-LINE-RECORD-LT-CLT00003)
    • ENDING-DATE-OF-SERVICE (CLT197) (CLAIM-LINE-RECORD-LT-CLT00003)
  • Claim OT
    • BEGINNING-DATE-OF-SERVICE (COT033) (CLAIM-HEADER-RECORD-OT-COT00002)
    • ENDING-DATE-OF-SERVICE (COT034) (CLAIM-HEADER-RECORD-OT-COT00002)
    • BEGINNING-DATE-OF-SERVICE (COT166) (CLAIM-LINE-RECORD-OT-COT00003)
    • ENDING-DATE-OF-SERVICE (COT167) (CLAIM-LINE-RECORD-OT-COT00003)
  • Claim RX
    • PRESCRIPTION-FILL-DATE (CRX085) (CLAIM-HEADER-RECORD-RX-CRX00002)
  • Financial Transactions
    • CAPITATION-PERIOD-START-DATE[2](FTX043) (INDIVIDUAL-CAPITATION-PMPM -FTX00002)
    • CAPITATION-PERIOD-END-DATE[2](FTX044) (INDIVIDUAL-CAPITATION-PMPM-FTX00002)
    • PREMIUM-PERIOD-START-DATE[2](FTX088) (INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT-FTX00003)
    • PREMIUM-PERIOD-END-DATE[2](FTX089) (INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT-FTX00003)
    • PREMIUM-PERIOD-START-DATE[2](FTX132) (GROUP-INSURANCE-PREMIUM-PAYMENT -FTX00004)
    • PREMIUM-PERIOD-END-DATE[2](FTX133) (GROUP-INSURANCE-PREMIUM-PAYMENT -FTX00004)
    • COVERAGE-PERIOD-START-DATE[2](FTX174) (COST-SHARING-OFFSET-FTX00005)
    • COVERAGE-PERIOD-END-DATE[2](FTX175) (COST-SHARING-OFFSET-FTX00005)
    • PERFORMANCE-PERIOD-START-DATE[2](FTX216) (VALUE-BASED-PAYMENT-FTX00006)
    • PERFORMANCE-PERIOD-END-DATE[2](FTX217) (VALUE-BASED-PAYMENT-FTX00006)
    • PAYMENT-PERIOD-START-DATE[2](FTX259) (STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM-FTX00007)
    • PAYMENT-PERIOD-END-DATE[2](FTX260) (STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM-FTX00007)
    • COST-SETTLEMENT-PERIOD-START-DATE[2](FTX301) (COST-SETTLEMENT-PAYMENT -FTX00008)
    • COST-SETTLEMENT-PERIOD-END-DATE[2](FTX302) (COST-SETTLEMENT-PAYMENT -FTX00008)
    • WRAP-PERIOD-START-DATE[2](FTX340) (FQHC-WRAP-PAYMENT-FTX00009)
    • WRAP-PERIOD-END-DATE[2](FTX341) (FQHC-WRAP-PAYMENT-FTX00009)
    • PAYMENT-PERIOD-START-DATE[2](FTX384) (MISCELLANEOUS-PAYMENT-FTX00095)
    • PAYMENT-PERIOD-END-DATE[2](FTX385) (MISCELLANEOUS-PAYMENT-FTX00095)

Technical Instructions

  • The list of impacted date data elements is always required to be reported, unless otherwise specified below.
  • Discharge Date (IP – header):
    • As specified in the reporting reminder on DISCHARGE-DATE from the June 8, 2018, MACBIS CMS Coding Information listserv, this data element must be reported in CCYYMMDD format, even if it must be reformatted from the state’s source system.
    • This date should be on or after DATE-OF-BIRTH in the T-MSIS Eligible file and on or before the DATE-OF-DEATH (when applicable) in the T-MSIS Eligible file, on or before the ADJUDICATION-DATE and on or after the ADMISSION-DATE.
    • Discharge date on interim claims for long stays can be conditionally missing.
    • DISCHARGE-DATE is expected to be available even when the patient dies and can be conditionally missing if the patient is still a patient. If the patient is still admitted as a patient, the patient status code should indicate as such (PATIENT-STATUS).
  • Service Begin and End Dates (IP – header and line, LT – header and line, OT – header and line (End Date only)):
    • States should use the following guidelines when mapping service beginning and end dates from their state’s source systems. The beginning and end dates of service for the IP claim line, LT claim header, and some OT claim header and claim line segments can come from a date range qualified by RD8 of an 837i claim.
      • For claims with a ‘RD8’ date qualifier, states should populate the beginning date of service in T-MSIS with the first date from that range and the ending date of service in T-MSIS with the second date in that range.
      • For claims with a ‘D8’ date qualifier, states should use a conditional rule to populate both the T-MSIS beginning and ending date of service with the one date qualified by ‘D8’ in the 837i if no range is available.
      • The same is true when only an ‘R8’ date on a 837p, 837d, and 820 (coverage period) is mapped to the T-MSIS OT file beginning and ending date of service.
    • When the beginning and ending date of service are missing, automated validation rules could be triggered, and states may need to modify their mappings or programs and possibly submit replacement files to resolve the problem.
  • Start Dates and End Dates on the FTX segments:
    • States should always report a start date representing the beginning of the period covered by the payment or recoupment. The start date should be a valid calendar date and must be before or the same as the associated end date.
    • The end date should represent the end of the period covered by the payment or recoupment.

Endnotes

[1] This is a new data element as of T-MSIS Data Dictionary V3.0.0.

[2] This is a new data element as of T-MSIS Data Dictionary V4.0.0.