CMS MACBIS T-MSIS Reporting Reminder: Required non-claims segment effective and end date data elements in T-MSIS

Topic Description

This reporting reminder describes how to report required non-claims file segment effective and end date fields in the non-claims T-MSIS files (Eligible, Managed Care, Provider, TPL).

Impacted Data Elements

Eligible

Required

PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE (ELG026) (PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002)
PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE (ELG027) (PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002)
VARIABLE-DEMOGRAPHIC-ELEMENT-EFF-DATE (ELG057) (VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003)
VARIABLE-DEMOGRAPHIC-ELEMENT-END-DATE (ELG058) (VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003)
ELIGIBLE-ADDR-EFF-DATE (ELG075) (ELIGIBLE-CONTACT-INFORMATION-ELG00004)
ELIGIBLE-ADDR-END-DATE (ELG076) (ELIGIBLE-CONTACT-INFORMATION-ELG00004)
ELIGIBILITY-DETERMINANT-EFF-DATE (ELG099) (ELIGIBILITY-DETERMINANTS-ELG00005)
ELIGIBILITY-DETERMINANT-END-DATE (ELG100) (ELIGIBILITY-DETERMINANTS-ELG00005)
ENROLLMENT-EFF-DATE (ELG253) (ENROLLMENT-TIME-SPAN-SEGMENT-ELG00021)
ENROLLMENT-END-DATE (ELG254) (ENROLLMENT-TIME-SPAN-SEGMENT-ELG00021)

Conditional

HEALTH-HOME-SPA-PARTICIPATION-EFF-DATE (ELG109) (HEALTH-HOME-SPA-PARTICIPATION-INFORMATION-ELG00006)
HEALTH-HOME-SPA-PARTICIPATION-END-DATE (ELG110) (HEALTH-HOME-SPA-PARTICIPATION-INFORMATION-ELG00006)
HEALTH-HOME-ENTITY-EFF-DATE (ELG111) (HEALTH-HOME-SPA-PARTICIPATION-INFORMATION-ELG00006)
HEALTH-HOME-SPA-PROVIDER-EFF-DATE (ELG121) (HEALTH-HOME-SPA-PROVIDERS-ELG00007)
HEALTH-HOME-SPA-PROVIDER-END-DATE (ELG122) (HEALTH-HOME-SPA-PROVIDERS-ELG00007)
HEALTH-HOME-ENTITY-EFF-DATE (ELG123) (HEALTH-HOME-SPA-PROVIDERS-ELG00007)
HEALTH-HOME-CHRONIC-CONDITION-EFF-DATE (ELG132) (HEALTH-HOME-CHRONIC-CONDITIONS-ELG00008)
HEALTH-HOME-CHRONIC-CONDITION-END-DATE (ELG133) (HEALTH-HOME-CHRONIC-CONDITIONS-ELG00008)
LOCKIN-EFF-DATE (ELG142) (LOCK-IN-INFORMATION-ELG00009)
LOCKIN-END-DATE (ELG143) (LOCK-IN-INFORMATION-ELG00009)
MFP-ENROLLMENT-EFF-DATE (ELG155) (MFP-INFORMATION-ELG00010)
MFP-ENROLLMENT-END-DATE (ELG156) (MFP-INFORMATION-ELG00010)
STATE-PLAN-OPTION-EFF-DATE (ELG164) (STATE-PLAN-OPTION-PARTICIPATION-ELG00011)
STATE-PLAN-OPTION-END-DATE (ELG165) (STATE-PLAN-OPTION-PARTICIPATION-ELG00011)
WAIVER-ENROLLMENT-EFF-DATE (ELG174) (WAIVER-PARTICIPATION-ELG00012)
WAIVER-ENROLLMENT-END-DATE (ELG175) (WAIVER-PARTICIPATION-ELG00012)
LTSS-ELIGIBILITY-EFF-DATE (ELG184) (LTSS-PARTICIPATION-ELG00013)
LTSS-ELIGIBILITY-END-DATE (ELG185) (LTSS-PARTICIPATION-ELG00013)
MANAGED-CARE-PLAN-ENROLLMENT-EFF-DATE (ELG196) (MANAGED-CARE-PARTICIPATION-ELG00014)
MANAGED-CARE-PLAN-ENROLLMENT-END-DATE (ELG197) (MANAGED-CARE-PARTICIPATION-ELG00014)
ETHNICITY-DECLARATION-EFF-DATE (ELG205) (ETHNICITY-INFORMATION-ELG00015)
ETHNICITY-DECLARATION-END-DATE (ELG206) (ETHNICITY-INFORMATION-ELG00015)
RACE-DECLARATION-EFF-DATE (ELG216) (RACE-INFORMATION-ELG00016)
RACE-DECLARATION-END-DATE (ELG217) (RACE-INFORMATION-ELG00016)
DISABILITY-TYPE-EFF-DATE (ELG225) (DISABILITY-INFORMATION-ELG00017)
DISABILITY-TYPE-END-DATE (ELG226) (DISABILITY-INFORMATION-ELG00017)
1115A-EFF-DATE (ELG234) (1115A-DEMONSTRATION-INFORMATION-ELG00018)
1115A-END-DATE (ELG235) (1115A-DEMONSTRATION-INFORMATION-ELG00018)
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-EFF-DATE (ELG243) (HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME-ELG00020)
HCBS-CHRONIC-CONDITION-NON-HEALTH-HOME-END-DATE (ELG244) (HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME-ELG00020)

Managed Care

Required

MANAGED-CARE-CONTRACT-EFF-DATE (MCR020) (MANAGED-CARE-MAIN-MCR00002)
MANAGED-CARE-CONTRACT-END-DATE (MCR021) (MANAGED-CARE-MAIN-MCR00002)
MANAGED-CARE-MAIN-REC-EFF-DATE (MCR030) (MANAGED-CARE-MAIN-MCR00002)
MANAGED-CARE-MAIN-REC-END-DATE (MCR031) (MANAGED-CARE-MAIN-MCR00002)
MANAGED-CARE-LOCATION-AND-CONTACT-INFO-EFF-DATE (MCR039) (MANAGED-CARE-LOCATION-AND-CONTACT-INFO-MCR00003)
MANAGED-CARE-LOCATION-AND-CONTACT-INFO-END-DATE (MCR040) (MANAGED-CARE-LOCATION-AND-CONTACT-INFO-MCR00003)
MANAGED-CARE-SERVICE-AREA-EFF-DATE (MCR059) (MANAGED-CARE-SERVICE-AREA-MCR00004)
MANAGED-CARE-SERVICE-AREA-END-DATE (MCR060) (MANAGED-CARE-SERVICE-AREA-MCR00004)
MANAGED-CARE-OP-AUTHORITY-EFF-DATE (MCR069) (MANAGED-CARE-OPERATING-AUTHORITY-MCR00005)
MANAGED-CARE-OP-AUTHORITY-END-DATE (MCR070) (MANAGED-CARE-OPERATING-AUTHORITY-MCR00005)
MANAGED-CARE-PLAN-POP-EFF-DATE (MCR078) (MANAGED-CARE-PLAN-POPULATION-ENROLLED-MCR00006)
MANAGED-CARE-PLAN-POP-END-DATE (MCR079) (MANAGED-CARE-PLAN-POPULATION-ENROLLED-MCR00006)

Conditional

DATE-ACCREDITATION-ACHIEVED (MCR087) (MANAGED- CARE-ACCREDITATION-ORGANIZATION-MCR00007)
DATE-ACCREDITATION-END (MCR088) (MANAGED- CARE-ACCREDITATION-ORGANIZATION-MCR00007)

Provider

Required

PROV-ATTRIBUTES-EFF-DATE (PRV020) (PROV-ATTRIBUTES-MAIN-PRV00002)
PROV-ATTRIBUTES-END-DATE (PRV021) (PROV-ATTRIBUTES-MAIN-PRV00002)
PROV-LOCATION-AND-CONTACT-INFO-EFF-DATE (PRV044) (PROV-LOCATION-AND-CONTACT-INFO-PRV00003)
PROV-LOCATION-AND-CONTACT-INFO-END-DATE (PRV045) (PROV-LOCATION-AND-CONTACT-INFO-PRV00003)
PROV-IDENTIFIER-EFF-DATE (PRV079) (PROV-IDENTIFIERS-PRV00005)
PROV-IDENTIFIER-END-DATE (PRV080) (PROV-IDENTIFIERS-PRV00005)
PROV-TAXONOMY-CLASSIFICATION-EFF-DATE (PRV090) (PROV-TAXONOMY-CLASSIFICATION-PRV00006)
PROV-TAXONOMY-CLASSIFICATION-END-DATE (PRV091) (PROV-TAXONOMY-CLASSIFICATION-PRV00006)
PROV-MEDICAID-EFF-DATE (PRV098) (PROV-MEDICAID-ENROLLMENT-PRV00007)
PROV-MEDICAID-END-DATE (PRV099) (PROV-MEDICAID-ENROLLMENT-PRV00007)

Conditional

PROV-LICENSE-EFF-DATE (PRV065) (PROV-LICENSING-INFO-PRV00004)
PROV-LICENSE-END-DATE (PRV066) (PROV-LICENSING-INFO-PRV00004)
PROV-AFFILIATED-GROUP-EFF-DATE (PRV111) (PROV-AFFILIATED-GROUPS-PRV00008)
PROV-AFFILIATED-GROUP-END-DATE (PRV112) (PROV-AFFILIATED-GROUPS-PRV00008)
PROV-AFFILIATED-PROGRAM-EFF-DATE (PRV121) (PROV-AFFILIATED-PROGRAMS-PRV00009)
PROV-AFFILIATED-PROGRAM-END-DATE (PRV122) (PROV-AFFILIATED-PROGRAMS-PRV00009)
BED-TYPE-EFF-DATE (PRV130) (PROV-BED-TYPE-INFO-PRV00010)
BED-TYPE-END-DATE (PRV131) (PROV-BED-TYPE-INFO-PRV00010)

TPL

Required

ELIG-PRSN-MAIN-EFF-DATE (TPL025) (TPL-MEDICAID-ELIGIBLE-PERSON-MAIN-TPL00002)
ELIG-PRSN-MAIN-END-DATE (TPL026) (TPL-MEDICAID-ELIGIBLE-PERSON-MAIN-TPL00002)

Conditional

INSURANCE-COVERAGE-EFF-DATE (TPL048) (TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO-TPL00003)
INSURANCE-COVERAGE-END-DATE (TPL049) (TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO-TPL00003)
INSURANCE-CATEGORIES-EFF-DATE (TPL059) (TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES-TPL00004)
INSURANCE-CATEGORIES-END-DATE (TPL060) (TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES-TPL00004)
OTHER-TPL-EFF-DATE (TPL068) (TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION-TPL00005)
OTHER-TPL-END-DATE (TPL069) (TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION-TPL00005)

Optional

TPL-ENTITY-CONTACT-INFO-EFF-DATE (TPL084) (TPL-ENTITY-CONTACT-INFORMATION-TPL00006)
TPL-ENTITY-CONTACT-INFO-END-DATE (TPL085) (TPL-ENTITY-CONTACT-INFORMATION-TPL00006)

Reporting Reminders

When a segment is reported, the segment effective date is always required.
Below are examples of required, conditional, and optional date fields and non-claims segment effective and end dates grouped by their file type and required, conditional, and optional status.
- Required: Required date fields should always be reported. For example, ENROLLMENT-EFF-DATE (ELG253) should always be reported. For historical segments that are no longer active, the ENROLLMENT-END-DATE (ELG254) should always be reported when applicable. Even if a segment is active indefinitely, the end date should never be missing, and states should use a default high end-date of 99991231 in this circumstance.
- Conditional: Conditional date fields should be reported if applicable. For example, if an individual is enrolled in a waiver, WAIVER-ENROLLMENT-EFF-DATE (ELG174) and WAIVER-ENROLLMENT-END-DATE (ELG175) should always be reported. WAIVER-ENROLLMENT-END-DATE (ELG175) should be reported with the date the individual’s enrollment in the waiver ends, or if the individual’s participation is still active, then it should never be missing and should be reported with the default high end-date of 99991231. If an individual is not enrolled in a waiver, then no WAIVER-PARTICIPATION-ELG00012 segment would be reported for the individual and therefore neither the effective nor end dates are required under that condition.
- Optional: Optional date fields are optional to report but should be reported when available. For example, TPL-ENTITY-CONTACT-INFO-EFF-DATE (TPL084) and TPL-ENTITY-CONTACT-INFO-END-DATE (TPL085) are optional data elements to report in the TPL file, but if the segment is reported, then the effective and end dates should always be populated (not blank or space-filled). If the segment is still active, TPL-ENTITY-CONTACT-INFO-END-DATE (TPL085) should never be missing and should be reported with the default high end-date of 99991231.