Technical Instruction History
| Date | Description of Change |
| 07/27/2022 | Original technical instructions issued. |
| 09/30/2022 | Updated the ELG-IDENTIFIER-TYPE values in Tables 13, 17, and 20. |
Brief Issue Description
States may need to assign new identifier numbers (IDs) for their providers (provider IDs) or beneficiaries (MSIS IDs) for various reasons. Valid provider IDs and MSIS IDs are important for linking across and within the T-MSIS files, linking to other datasets, and analyzing Medicaid and CHIP data. These technical instructions outline the process and steps for reporting a change in provider IDs or MSIS IDs (i.e., the state assigned unique beneficiary ID) to T-MSIS. The last section of this document presents examples using a few real-world scenarios.
Background Discussion
Context
The T-MSIS dataset is critical to Medicaid and CHIP program monitoring, integrity, and analytics, and is used to support quality of care, beneficiary access and enrollment, and program improvement efforts. For various reasons, states may need to re-enumerate all or a subset of provider IDs or beneficiary IDs (MSIS IDs). Whenever a state re-enumerates provider IDs or MSIS IDs, they must ensure that the historical record of the old ID is properly archived and a relationship between the old and new ID is established and maintained in T-MSIS.
Challenge
T-MSIS relies on several record segments and data elements to identify and link unique Medicaid providers and beneficiaries across files, including previously reported T-MSIS data. Such linkages allow T-MSIS to associate beneficiaries to providers and the services rendered by those providers. Prior to the implementation of the approach detailed in these technical instructions, states that have re-enumerated provider IDs or MSIS IDs were required to resubmit all previously submitted T-MSIS claims and non-claims data, replacing the old provider IDs or MSIS IDs with the new provider IDs or MSIS IDs. While the resubmission of all claims and non-claims files with the new ID values is an effective approach to ensure that T-MSIS can accurately associate beneficiaries to the providers, it is not a sustainable approach.
Ensuring the accuracy, consistency, and reconciliation of resubmitted claims and non-claims data requires a significant amount of effort from states and CMS. The resubmission approach is administratively burdensome and resource intensive for both states and CMS. For states it requires retrospectively updating previously submitted files with the new provider IDs or MSIS IDs, validating the accuracy and completeness of the updates, and submitting the updated files to T-MSIS. For CMS it requires the processing and managing of large amounts of duplicate data (i.e., the updated and previously submitted data), validating the accuracy and completeness of the resubmission, and working with states to resolve any errors. After consulting three states currently in the process of changing their provider IDs or MSIS IDs, and reviewing impacts of prior changes by other states, CMS has implemented an approach—detailed in this document—to minimize the administrative and resource burden associated with the resubmission of claims and non-claims files for re-enumerated provider IDs or MSIS IDs.
CMS Technical Instructions
The approach detailed in this technical instruction document provides an alternative to resubmission of all T-MSIS claims and non-claims data when states re-enumerate provider IDs or MSIS IDs. This updated approach relies on the submission of a crosswalk of the new and old IDs in select file segments: PROV-IDENTIFIERS-PRV00005 for Provider ID changes and ELG-IDENTIFIERS-ELG00022 for MSIS ID changes. When this crosswalk is used, CMS no longer requires or recommends that states re-submit updated claims data solely for the purpose of retroactively changing provider IDs and MSIS IDs.
Any new provider or MSIS IDs reported in the claims or non-claims data without following these technical instructions will trigger data quality errors.
State actions detailed in these technical instructions include:
- Notifying CMS of upcoming ID change;
- Retaining complete history associated with the old IDs;
- Reporting the new IDs and the ID crosswalk records; and
- Choosing a non-claim file submission method.
The Federal System will retain and maintain old and new provider IDs and MSIS IDs (Step 5) and will use this information to link data associated with the old and new MSIS IDs for the purposes of analysis, reporting, and monitoring.
1. Notify CMS of State Plans to Assign New Provider and/or Beneficiary (MSIS) ID Numbers
States should inform CMS of Provider ID or MSIS ID changes as soon as the state plans to change their enumeration schema, including information about when the implementation will occur. Early communication is key to prevent any unnecessary data quality errors.
States should contact their assigned T-MSIS point-of-contact to obtain the template for states to use to notify to CMS of an upcoming provider ID or MSIS ID change (see Table 1 for a screenshot of the template).
Table 1. Template for State to Use to Notify CMS of an Upcoming Provider ID or MSIS ID Change
| State | Entity ID Type Submitting State Provider ID/ MSIS-ID |
Data Element Name | Entity ID Change Effective Reporting Period (YYYYMM) | Assigning new IDs to All the Providers/Beneficiaries that states had submitted since MSIS/T-MSIS Cutover Period or Subset of all the Providers/Beneficiaries | State Comments |
| XX | Submitting State Provider ID | SUBMITTING-STATE-PROV-ID | 202206 | Subset of Providers | |
| XX | MSIS-ID | MSIS-IDENTIFICATION-NUM | 202206 | All Beneficiaries |
States must notify CMS when a Large System Enhancement (LSE) occurs effecting provider IDs or MSIS IDs. CMS understands that some MSIS ID changes occur in state databases monthly and with low frequency. For example, a state may Merge multiple Medicaid IDs for a single beneficiary under a single MSIS ID, or Unmerge (disassociate beneficiaries), or apply a TCAM (when a beneficiary transitions between CHIP and Medicaid). For these low-occurrence Merge, Unmerge, and TCAM scenarios, states do not need to first notify CMS, but must follow the remaining instructions. Refer to the Technical Instructions for Reporting Eligible Identifiers in T-MSIS for a more complete description of Merge, Unmerge, and TCAM reasons for change.
2. Retain Complete History of Old Provider ID or Old MSIS ID Information
States should carry over the complete history since cutover associated with the old provider ID or old MSIS ID to the new provider or MSIS ID in all the relevant segments (e.g., PROV-ATTRIBUTES-MAIN-PRV00002, PROV-LOCATION-AND-CONTACT-INFO-PRV00003, PROV-AFFILIATED-GROUPS-PRV00008, PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002, VARIABLE-DEMOGRAPHICS-ELIGIBILITY-ELG00003, and ELIGIBILITY-DETERMINANTS-ELG00005).
Because each state system is different, these technical instructions do not detail how states should successfully retain the history of the old IDs. Specifically, states should:
- Carry the provider information associated with the old Provider ID in all related record segments to the new Provider ID record segments
- Carry the beneficiary information associated with the old MSIS ID in all related record segments to the new MSIS ID record segments
3. Report New IDs and ID Crosswalk Segments (Old ID to New ID)
States should report the new provider or MSIS IDs and report a new record segment that crosswalks the old ID to the new ID. The timing of when to submit ID changes to T-MSIS should align with when the state began reporting the new provider IDs or MSIS IDs on T-MSIS claims. Specifically, states should report the new IDs and crosswalk in the first reporting period after the state began reporting the new provider IDs or MSIS IDs on T-MSIS claims.
3a. Create Provider ID Crosswalk Segments (Old ID to New ID)
States should create and report a new PROV-IDENTIFIERS-PRV00005 segment that crosswalks the “old” to the "new” provider IDs. Specifically, states should:
- Report the new provider ID in the SUBMITTING-STATE-PROV-ID data element and in the PROV-IDENTIFIER data element.
- Report the valid value ‘9’ in the PROV-IDENTIFIER-TYPE data element. Reporting a value of ‘9’ in the PROV-IDENTIFIER-TYPE data element informs the Federal System that the PROV-IDENTIFIERS-PRV00005 segment includes the provider ID crosswalk and signals the linkage between old and new provider IDs. In the PROV-IDENTIFIERS-PRV00005 segment with PROV-IDENTIFIER-TYPE = ‘9’ report the:
- New provider ID in the SUBMITTING-STATE-PROV-ID data element and
- Old provider ID in the PROV-IDENTIFIER data element.
- Ensure that the old provider ID effective date (PROV-IDENTIFIER-EFF-DATE) and end date (PROV-IDENTIFIER-END-DATE) in the PROV-IDENTIFIERS-PRV00005 segment are within the earliest effective date (PROV-ATTRIBUTES-EFF-DATE) and the latest end date (PROV-ATTRIBUTES-END-DATE) in the PROVIDER-MAIN-PRV00002 parent segment of the new provider record.
3b. Create Beneficiary (MSIS) ID Crosswalk Segments (Old ID to New ID)
States should create and report a new ELG-IDENTIFIERS-ELG00022 segment that crosswalks the “old” to the “new” MSIS-IDENTIFICATION-NUM value. Specifically, states should:
- Report the new MSIS ID in the MSIS-IDENTIFICATION-NUM data element and in the ELIG-IDENTIFIER data element.
- Report valid value ‘2’ in the ELG-IDENTIFIER-TYPE data element. Reporting a value of ‘2’ in the ELG-IDENTIFIER-TYPE data element informs the Federal System that the record includes the MSIS ID crosswalk and signals the linkage between old and new MSIS IDs. In the ELG-IDENTIFIERS-ELG00022 segment with ELG-IDENTIFIER-TYPE = ‘2’ segment, report the:
- New MSIS ID in the MSIS-IDENTIFICATION-NUM data element and
- Old MSIS ID in the ELIG-IDENTIFIER data element and
- REASON-FOR-CHANGE (LSE, MERGE, UNMERGE, TCAM). Refer to Reporting Eligible Identifiers in T-MSIS.
- Ensure that the old MSIS ID effective date (ELG-IDENTIFIER-EFF-DATE) and end date (ELG-IDENTIFIER-END-DATE) in the ELIGIBLE-IDENTIFIER-ELG00022 segment are within the earliest effective date (PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE) and the latest end date (PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE) in the PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 parent segment of the new beneficiary record.
4. Choosing a Non-Claims File Submission Method
While states may continue to use their declared submission method when reporting new Provider or MSIS IDs, CMS strongly encourages states make a temporary declaration change to the TFFR submission method for the reporting period when the ID changes are necessary due to a Large System Enhancement. CMS recommends TFFR in the case of LSE based on experience that this type of submission is less likely to result in loss of data and additional state actions to address.
4a. For Provider ID changes states may for any submission method:
- For providers assigned a new ID: Report all record segments with new SUBMITTING-STATE-PROV-ID when the state began reporting the new provider IDs on T-MSIS claims. Do not report any record segments with the old SUBMITTING-STATE-PROV-ID, other than in the PROV-IDENTIFIERS-PRV00005 segment where the old SUBMITTING-STATE-PROV-ID is now reported as a PROV-IDENTIFIER value only.
- For providers not assigned a new ID: Continue to report all the record segments with their old (i.e., their existing) SUBMITTING-STATE-PROV-ID.
4b. For MSIS ID changes states may for any submission method:
- For the beneficiaries assigned a new MSIS-IDENTIFICATION-NUM: report all the record segments with the new MSIS-IDENTIFICATION-NUM when the state began reporting the new MSIS IDs on T-MSIS claims. Do not report any record segment with the old MSIS-IDENTIFICATION-NUM value, other than the ELG-IDENTIFIERS-ELG00022 segment where the old MSIS-IDENTIFICATION-NUM is now reported as an ELG-IDENTIFIER value
- For the beneficiaries not assigned a new MSIS ID: continue to report all the record segments with their old (i.e., existing) MSIS-IDENTIFICATION-NUM.
5. Federal System Maintains Old and New IDs
The Federal System will maintain the records for the old and new SUBMITTING-STATE-PROV-ID values and will use this information to link data associated with the old and new provider IDs for the purposes of analysis, reporting, and monitoring.
Examples of Reporting Provider or MSIS ID Changes
Five examples are provided: 1. All provider IDs are changed during a LSE; 2. A subset of provider IDs are changed during a LSE; 3. All beneficiary IDs are changed during a LSE; 4. A subset of beneficiary IDs are changed during a LSE; and 5. Beneficiary IDs change due to merge activities.
Example 1. All Provider IDs Change During Large System Enhancement
A state decides to assign new provider IDs during an LSE to all providers that have been reported to T-MSIS since MSIS/T-MSIS cutover. The state intends to report to T-MSIS the new provider IDs starting in the Jun-2022 reporting period.
1. State communicates to CMS in advance
Using the CMS provided template, the state notifies CMS of the intended provider ID change (i.e., changes to reported SUBMITTING-STATE-PROV-ID values) for all providers. This notice should be communicated to CMS as soon as the state is certain of its plans to change the IDs.
Table 2 illustrates the information that the state submitted, using the CMS template, to notify CMS of the upcoming change in provider IDs. This includes the reporting state, the data element that will be updated, the reporting period that the new IDs will be reported to T-MSIS, and for whom the new IDs are being assigned.
Table 2. State Notifies CMS - All Provider IDs Change During LSE
| State | Entity ID Type Submitting State Provider ID/ MSIS-ID |
Data Element Name | Entity ID Change Effective Reporting Period (YYYYMM) | Assigning new IDs to All the Providers/Beneficiaries that states had submitted since MSIS/T-MSIS Cutover Period or Subset of all the Providers/Beneficiaries | State Comments |
| XX | Submitting State Provider ID | SUBMITTING-STATE-PROV-ID | 202206 | All Providers |
2. In the reporting period prior to introducing the new provider IDs, states report the old SUBMITTING-STATE-PROV ID values in all segments of their PRV submission
In the reporting period prior to the introduction of the provider ID change, May 2022 in this example, the state reports the old SUBMITTING-STATE-PROV-ID values in PRV00002 and in all other segments. Table 3 shows the PRV00005 segments only; all other segments and data elements should be reported as usual.
As Table 3 illustrates, in the reporting period prior to the introduction of the new provider IDs, the state reports the old provider ID values in the SUBMITTING-STATE-PROV-ID and in the PROV-IDENTIFIER columns.
Table 3. PRV00005 Segments in Reporting Period Prior to ID Change Introduced - All Provider IDs Changed During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | SUBMITTING-STATE-PROV-ID | PROV-LOCATION-ID | PROV-IDENTIFIER-TYPE | PROV-IDENTIFIER-ISSUING-ENTITY-ID | PROV-IDENTIFIER-EFF-DATE | PROV-IDENTIFIER-END-DATE | PROV-IDENTIFIER | STATE-NOTATION |
| PRV00005 | XX | 101 | P101-OLD | PL01 | 1 | <State>[1] | 1/1/2016 | 12/31/9999 | P101-OLD | |
| PRV00005 | XX | 102 | P101-OLD | PL01 | 2 | NPI | 1/1/2016 | 12/31/9999 | NPI-100001 | |
| PRV00005 | XX | 103 | P102-OLD | PL01 | 1 | <State>[1] | 1/1/2018 | 12/31/9999 | P102-OLD | |
| PRV00005 | XX | 104 | P102-OLD | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 |
3. In the reporting period that the new provider IDs are introduced, states report the old and new provider ID crosswalk in their PRV submission
The state reports the new provider ID in the SUBMITTING-STATE-PROV-ID column illustrated in Table 4, and appropriately identifies the reported state and NPIs reported in the PROV-IDENTIFIER column by reporting a valid PROV-IDENTIFIER-TYPE value of ‘1’ and ‘2’, respectively (see rows with RECORD-NUMBER ‘201’, ‘202’ ‘204’, and ‘205’). The state also reports the crosswalk between the old and new provider IDs (see rows with RECORD-NUMBER ‘203’ and ‘206’). Here, the state reports a valid value ‘9’ in the PROV-IDENTIFIER-TYPE column to indicate the crosswalk and reports the new provider ID value in the SUBMITTING-STATE-PROV-ID column and the old provider ID value in the PROV-IDENTIFIER column.
Table 4. PRV00005 Segments in Reporting Period ID Change Introduced – All Provider IDs Change During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | SUBMITTING-STATE-PROV-ID | PROV-LOCATION-ID | PROV-IDENTIFIER-TYPE | PROV-IDENTIFIER-ISSUING-ENTITY-ID | PROV-IDENTIFIER-EFF-DATE | PROV-IDENTIFIER-END-DATE | PROV-IDENTIFIER | STATE-NOTATION |
| PRV00005 | XX | 201 | P201-NEW | PL01 | 1 | <State>[2] | 1/1/2016 | 12/31/9999 | P201-NEW | |
| PRV00005 | XX | 202 | P201-NEW | PL01 | 2 | NPI | 1/1/2016 | 12/31/9999 | NPI-100001 | |
| PRV00005 | XX | 203 | P201-NEW | PL01 | 9 | <State>[2] | 1/1/2016 | 12/31/9999 | P101-OLD | |
| PRV00005 | XX | 204 | P202-NEW | PL01 | 1 | <State>[2] | 1/1/2018 | 12/31/9999 | P202-NEW | |
| PRV00005 | XX | 205 | P202-NEW | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 | |
| PRV00005 | XX | 206 | P202-NEW | PL01 | 9 | <State>[2] | 1/1/2018 | 12/31/9999 | P102-OLD |
The state also ensures old provider IDs reported as an old PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segment have reported effective dates (PROV-INDENTIFIER-EFF-DATE) and end dates (PROV-INDENTIFIER-END-DATE) within the earliest effective date (PROV-ATTRIBUTES-EFF-DATE) and the latest end date (PROV-ATTRIBUTES-END-DATE) reported in the corresponding PROV-ATTRIBUTES-MAIN-PRV00002 parent segment(s) of the new SUBMITTING-STATE-PROV-ID.
4. State chooses a PRV file submission method
The state submits the PRV file using the TFFR submission method in the reporting period when the new provider IDs are introduced (in this example, June 2022). In the PRV submission, the state reports all record segments with new SUBMITTING-STATE-PROV-ID. In the PROV-IDENTIFIERS-PRV00005 segment the state reports the old SUBMITTING-STATE-PROV-ID value as a PROV-IDENTIFIER value.
5. Federal System maintains the records with the old and new SUBMITTING-STATE-PROV-ID values.
Using an active flag and archive flag illustrated in Table 5, the Federal System will maintain the records for the old and new SUBMITTING-STATE-PROV-ID values. The Federal System will flag the record for the old SUBMITTING-STATE-PROV-ID value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to TRUE. The Federal System will flag the record for the new SUBMITTING-STATE-PROV-ID value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to FALSE. Once the record for the new SUBMITTING-STATE-PROV-ID is active, the state no longer needs to report the record for the old SUBMITTING-STATE-PROV-ID. The Federal System will use this information to link data associated with the old and new provider IDs for the purposes of analysis, reporting, and monitoring.
Table 5. Federal System Maintains Records with Old and New SUBMITTING-STATE-PROV-ID Values
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | SUBMITTING-STATE-PROV-ID | PROV-LOCATION-ID | PROV-IDENTIFIER-TYPE | PROV-IDENTIFIER-ISSUING-ENTITY-ID | PROV-IDENTIFIER-EFF-DATE | PROV-IDENTIFIER-END-DATE | PROV-IDENTIFIER | STATE-NOTATION | ACTIVE-FLAG | ARCHIVE-FLAG |
| PRV00005 | XX | 101 | P101-OLD | PL01 | 1 | <State>[3] | 1/1/2016 | 12/31/9999 | P101-OLD | TRUE | TRUE | |
| PRV00005 | XX | 102 | P101-OLD | PL01 | 2 | NPI | 1/1/2016 | 12/31/9999 | NPI-100001 | TRUE | TRUE | |
| PRV00005 | XX | 201 | P201-NEW | PL01 | 1 | <State>[3] | 1/1/2016 | 12/31/9999 | P201-NEW | TRUE | FALSE | |
| PRV00005 | XX | 202 | P201-NEW | PL01 | 2 | NPI | 1/1/2016 | 12/31/9999 | NPI-100001 | TRUE | FALSE | |
| PRV00005 | XX | 203 | P201-NEW | PL01 | 9 | <State>[3] | 1/1/2016 | 12/31/9999 | P101-OLD | TRUE | FALSE | |
| PRV00005 | XX | 103 | P102-OLD | PL01 | 1 | <State>[3] | 1/1/2018 | 12/31/9999 | P102-OLD | TRUE | TRUE | |
| PRV00005 | XX | 104 | P102-OLD | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 | TRUE | TRUE | |
| PRV00005 | XX | 204 | P202-NEW | PL01 | 1 | <State>[3] | 1/1/2018 | 12/31/9999 | P202-NEW | TRUE | FALSE | |
| PRV00005 | XX | 205 | P202-NEW | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 | TRUE | FALSE | |
| PRV00005 | XX | 206 | P202-NEW | PL01 | 9 | <State>[3] | 1/1/2018 | 12/31/9999 | P102-OLD | TRUE | FALSE |
Example 2: Subset of Provider IDs Change During Large System Enhancement
A state decides to assign new provider IDs during an LSE to a subset of providers that have been reported to T-MSIS since MSIS/T-MSIS cutover. The state intends to report to T-MSIS the new provider IDs starting in the Jun-2022 reporting period.
1. State communicates to CMS in advance
Using the CMS provided template, the state notifies CMS of the intended provider ID change (i.e., changes to reported SUBMITTING-STATE-PROV-ID values) for a subset of providers. This notice should be communicated to CMS as soon as the state is certain of its plans to change the IDs.
Table 6 illustrates the information that the state submitted, using the CMS template, to notify CMS of the upcoming change in provider IDs. This includes the reporting state, the data element that will be updated, the reporting period that the new IDs will be reported to T-MSIS, and for whom the new IDs are being assigned.
Table 6. State Notifies CMS - Subset Provider IDs Change During LSE
| State | Entity ID Type Submitting State Provider ID/ MSIS-ID |
Data Element Name | Entity ID Change Effective Reporting Period (YYYYMM) | Assigning new IDs to All the Providers/Beneficiaries that states had submitted since MSIS/T-MSIS Cutover Period or Subset of all the Providers/Beneficiaries | State Comments |
| XX | Submitting State Provider ID | SUBMITTING-STATE-PROV-ID | 202206 | Subset of Providers |
2. In the reporting period prior to introducing the new provider IDs, states report the old SUBMITTING-STATE-PROV ID values in all segments of their PRV submission
In the reporting period prior to the introduction of the provider ID change, May 2022 in this example, the state reports the old SUBMITTING-STATE-PROV-ID values in PRV00002 and in all other segments. Table 7 shows the PRV00005 segments only; all other segments and data elements should be reported as usual.
As Table 7 illustrates, in the reporting period prior to the introduction of the new provider IDs, the state reports the old provider ID values in the SUBMITTING-STATE-PROV-ID and in the PROV-IDENTIFIER columns.
Table 7. PRV00005 Segments in Reporting Period Prior to ID Change Introduced - Subset of Provider IDs Changed During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | SUBMITTING-STATE-PROV-ID | PROV-LOCATION-ID | PROV-IDENTIFIER-TYPE | PROV-IDENTIFIER-ISSUING-ENTITY-ID | PROV-IDENTIFIER-EFF-DATE | PROV-IDENTIFIER-END-DATE | PROV-IDENTIFIER | STATE-NOTATION |
| PRV00005 | XX | 101 | P101-OLD | PL01 | 1 | <State>[4] | 1/1/2016 | 12/31/9999 | P101-OLD | |
| PRV00005 | XX | 102 | P101-OLD | PL01 | 2 | NPI | 1/1/2016 | 12/31/9999 | NPI-100001 | |
| PRV00005 | XX | 103 | P102-OLD | PL01 | 1 | <State>[4] | 1/1/2018 | 12/31/9999 | P102-OLD | |
| PRV00005 | XX | 104 | P102-OLD | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 |
3. In the reporting period that the new provider IDs are introduced, states report the old and new provider ID crosswalk in their PRV submission
In the reporting period the ID changes are introduced, in this example June 2022, the state reports the new provider IDs and ID crosswalks for those providers assigned a new ID.
Table 8 illustrates the relevant data elements for the PROV-IDENTIFIERS-PRV00005 segment for two providers, only one of which the state has assigned a new provider ID (see rows with RECORD-NUMBER ‘204’, ‘205’, and ‘206’).
For the provider not assigned a new provider ID (see rows RECORD-NUMBER ‘101’ and ‘102’), the state reports the old (i.e., their existing) provider ID in the SUBMITTING-STATE-PROV-ID column and also in the PROV-IDENTIFIER column (see row with RECORD-NUMBER ‘101’). The state also appropriately identifies the state and NPI values reported in the PROV-IDENTIFIER column by reporting a valid value ‘1’ and ‘2’ in the PROV-IDENTIFIER-TYPE column, respectively (see rows with RECORD-NUMBER 101 and 102).
For the provider assigned a new provider ID (see rows with RECORD-NUMBER ‘204’, ‘205’, and ‘206’), the state reports the new provider ID in the SUBMITTING-STATE-PROV-ID column and the new provider ID in the PROV-IDENTIFIER column, along with a valid value of ‘1’ and ‘2’ in the PROV-IDENTIFIER-TYPE column (see rows with RECORD-NUMBER ‘204’ and ‘205’). The state also reports the crosswalk between the old and new provider ID (see row with RECORD-NUMBER ‘206’). Specifically, the state reports a valid value ‘9’ in the PROV-IDENTIFIER-TYPE column to indicate the crosswalk, and reports the new provider ID value in the SUBMITTING-STATE-PROV-ID column and reports the old provider ID value in the PROV-IDENTIFER.
Table 8. PRV00005 Segments in Reporting Period ID Change Introduced – Subset Provider IDs Change During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | SUBMITTING-STATE-PROV-ID | PROV-LOCATION-ID | PROV-IDENTIFIER-TYPE | PROV-IDENTIFIER-ISSUING-ENTITY-ID | PROV-IDENTIFIER-EFF-DATE | PROV-IDENTIFIER-END-DATE | PROV-IDENTIFIER | STATE-NOTATION |
| PRV00005 | XX | 101 | P101-OLD | PL01 | 1 | <State>[5] | 1/1/2016 | 12/31/9999 | P101-OLD | |
| PRV00005 | XX | 102 | P101-OLD | PL01 | 2 | NPI | 1/1/2016 | 12/31/9999 | NPI-100001 | |
| PRV00005 | XX | 204 | P202-NEW | PL01 | 1 | <State>[5] | 1/1/2018 | 12/31/9999 | P202-NEW | |
| PRV00005 | XX | 205 | P202-NEW | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 | |
| PRV00005 | XX | 206 | P202-NEW | PL01 | 9 | <State>[5] | 1/1/2018 | 12/31/9999 | P102-OLD |
The state also ensures old provider IDs reported as an old PROV-IDENTIFIER in the PROV-IDENTIFIERS-PRV00005 segment have reported effective dates (PROV-INDENTIFIER-EFF-DATE) and end dates (PROV-INDENTIFIER-END-DATE) within the earliest effective date (PROV-ATTRIBUTES-EFF-DATE) and the latest end date (PROV-ATTRIBUTES-END-DATE) reported in the corresponding PROV-ATTRIBUTES-MAIN-PRV00002 parent segment(s) of the new SUBMITTING-STATE-PROV-ID.
4. State chooses a PRV file submission method
The state submits the PRV file using the TFFR submission method in the reporting period when the new provider IDs are introduced (in this example, June 2022).
For the providers assigned a new ID, the state submitted PRV file reports all record segments with new SUBMITTING-STATE-PROV-ID. In the PROV-IDENTIFIERS-PRV00005 segment the state reports the old SUBMITTING-STATE-PROV-ID value as a PROV-IDENTIFIER value.
For the providers that were not assigned a new ID, the state submitted PRV file reported all record segments with the old (i.e., their existing) SUBMITTING-STATE-PROV-ID.
5. Federal System maintains the records with the old and new SUBMITTING-STATE-PROV- ID values.
Since only a subset of provider IDs were changed, there will be two approaches to maintaining the mix of changed and unchanged IDs.
Using an active flag and archive flag for the old SUBMITTING-STATE-PROV-ID that was not changed, the record for the old SUBMITTING-STATE-PROV-ID will remain active, as long as the state continues to maintain it. This is illustrated in Table 9.
For the old and new SUBMITTING-STATE-PROV-ID values that have a crosswalk, the Federal System will maintain the records for the old and new SUBMITTING-STATE-PROV-ID values. The Federal System will flag the record for the old SUBMITTING-STATE-PROV-ID value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to TRUE. The Federal System will flag the record for the new SUBMITTING-STATE-PROV-ID value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to FALSE. Once the record for the new SUBMITTING-STATE-PROV-ID is active, the state no longer needs to report the record for the old SUBMITTING-STATE-PROV-ID. The Federal System will use this information to link data associated with the old and new provider IDs for the purposes of analysis, reporting, and monitoring.
Table 9. Federal System Maintains Records with Old and New SUBMITTING-STATE-PROV-ID Values
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | SUBMITTING-STATE-PROV-ID | PROV-LOCATION-ID | PROV-IDENTIFIER-TYPE | PROV-IDENTIFIER-ISSUING-ENTITY-ID | PROV-IDENTIFIER-EFF-DATE | PROV-IDENTIFIER-END-DATE | PROV-IDENTIFIER | STATE-NOTATION | ACTIVE-FLAG | ARCHIVE-FLAG |
| PRV00005 | XX | 101 | P101-OLD | PL01 | 1 | <State>[6] | 1/1/2016 | 12/31/9999 | P101-OLD | TRUE | FALSE | |
| PRV00005 | XX | 102 | P101-OLD | PL01 | 2 | NPI | 1/1/2016 | 12/31/9999 | NPI-100001 | TRUE | FALSE | |
| PRV00005 | XX | 103 | P102-OLD | PL01 | 1 | <State>[6] | 1/1/2018 | 12/31/9999 | P102-OLD | TRUE | TRUE | |
| PRV00005 | XX | 104 | P102-OLD | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 | TRUE | TRUE | |
| PRV00005 | XX | 204 | P202-NEW | PL01 | 1 | <State>[6] | 1/1/2018 | 12/31/9999 | P202-NEW | TRUE | FALSE | |
| PRV00005 | XX | 205 | P202-NEW | PL01 | 2 | NPI | 1/1/2018 | 12/31/9999 | NPI-100002 | TRUE | FALSE | |
| PRV00005 | XX | 206 | P202-NEW | PL01 | 9 | <State>[6] | 1/1/2018 | 12/31/9999 | P102-OLD | TRUE | FALSE |
Example 3: All Beneficiary IDs Change During Large System Enhancement
A state decides to assign new MSIS IDs during an LSE to all beneficiaries that have been reported to T-MSIS since MSIS/T-MSIS cutover. The state intends to report to T-MSIS the new MSIS IDs starting in the Jun-2022 reporting period.
1. State communicates to CMS in advance
Using the CMS provided template, the state notifies CMS of the intended MSIS ID change (i.e., changes to reported MSIS-IDENTIFICATION-NUM values) for all beneficiaries. This notice should be communicated to CMS as soon as the state is certain of its plans to change the IDs.
Table 10 illustrates the information that the state submitted, using the CMS template, to notify CMS of the upcoming change in MSIS IDs. This includes the reporting state, the data element that will be updated, the reporting period that the new IDs will be reported to T-MSIS, and for whom the new IDs are being assigned.
Table 10. State Notifies CMS - All MSIS IDs Change During LSE
| State | Entity ID Type Submitting State Provider ID/ MSIS-ID |
Data Element Name | Entity ID Change Effective Reporting Period (YYYYMM) | Assigning new IDs to All the Providers/Beneficiaries that states had submitted since MSIS/T-MSIS Cutover Period or Subset of all the Providers/Beneficiaries | State Comments |
| XX | MSIS-ID | MSIS-IDENTIFICATION-NUM | 202206 | All Beneficiaries |
2. In the reporting period prior to introducing the new MSIS IDs, states report the old MSIS-IDENTIFICATION-NUM values in all segments of their ELG submission
In the reporting period prior to the introduction of the MSIS ID change, May 2022 in this example, the state reports the old MSIS-IDENTIFICATION-NUM values in the ELIGIBLE-IDENTIFIER-ELG00022 (ELG00022) segment and in all other segments. Table 11 shows the ELG00022 segment only; all other segments and data elements should be reported as usual.
As Table 11 illustrates, in the reporting period prior to the introduction of the new MSIS IDs, the state reports the old MSIS ID values in the MSIS-IDENTIFICATION-NUM and in the ELG-IDENTIFIER columns. (As previously described, for the purposes of these technical instructions, an “old” MSIS ID refers to the “existing” MSIS ID that predates the assignment of the new MSIS IDs.)
Table 11. ELG00022 Segments in Reporting Period Prior to ID Change Introduced - All Beneficiary IDs Changed During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION | ACTIVE-FLAG | ARCHIVE-FLAG |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[7] | 1/1/2016 | 12/31/9999 | M101-OLD | TRUE | TRUE | ||
| ELG00022 | XX | 103 | M102-OLD | 1 | <State>[7] | 1/1/2018 | 12/31/9999 | M102-OLD | TRUE | TRUE |
3. In the reporting period the new beneficiary IDs are introduced, states report the new MSIS values and the ID crosswalk in the ELIGIBLE-IDENTIFIER-ELG00022 segments
In the reporting period the ID changes are introduced, in this example June 2022, the state reports the new IDs, and reports the crosswalk of the new MSIS IDs to the old MSIS IDs. Table 12 shows the ELG00022 segments only; all other segments and data elements should be reported as usual.
In the ELG00022 segment, the state reports the new MSIS ID in the MSIS-IDENTIFICATION-NUM-ID column and appropriately reports the same value (i.e., the new MSIS ID) in the ELG-IDENTIFIER column (see rows with RECORD-NUMBER ‘201’ and ‘204’). For these two records, the state reports a valid value ‘1’ in the ELG-IDENTIFIER-TYPE column to indicate the reported MSIS-IDENTIFICATION-NUM is the most current (or new) MSIS ID for that beneficiary.
The state also reports the crosswalk between the old and new MSIS IDs in the ELG00022 segment. For the crosswalk, the state reports a valid value ‘2’ in the ELG-IDENTIFIER-TYPE column to notify the Federal System that the record crosswalks the old MSIS ID to the new MSIS ID, reporting the new MSIS ID value in the MSIS-IDENTIFICATION-NUM column and the old MSIS ID value in the ELG-IDENTIFIER column (see rows with RECORD-NUMBER ‘203’ and ‘206’).
Table 12. ELG00022 Segments in Reporting Period ID Change Introduced – All Beneficiary IDs Change During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION | ACTIVE-FLAG | ARCHIVE-FLAG |
| ELG00022 | XX | 201 | M201-NEW | 1 | <State>[8] | 1/1/2016 | 12/31/9999 | M201-NEW | TRUE | FALSE | ||
| ELG00022 | XX | 203 | M201-NEW | 2 | <State>[8] | 1/1/2016 | 12/31/9999 | M101-OLD | LSE | TRUE | FALSE | |
| ELG00022 | XX | 204 | M202-NEW | 1 | <State>[8] | 1/1/2018 | 12/31/9999 | M202-NEW | TRUE | FALSE | ||
| ELG00022 | XX | 206 | M202-NEW | 2 | <State>[8] | 1/1/2018 | 12/31/9999 | M102-OLD | LSE | TRUE | FALSE |
The state also ensures old MSIS IDs reported as an old ELG-IDENTIFIER in the ELG00022 segment have reported effective dates (ELG-INDENTIFIER-EFF-DATE) and end dates (ELG-INDENTIFIER-END-DATE) within the earliest effective date (PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE) and the latest end date (PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE) reported in the corresponding PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 parent segment(s) of the new MSIS-IDENTIFICATION-NUM.
4. State chooses a ELG file submission method
The state submits the ELG file using the TFFR submission method in the reporting period when the new MSIS IDs are introduced (in this example, June 2022). In the ELG submission, the state reports all record segments with new MSIS-IDENTIFICATION-NUM. In the ELG-IDENTIFIERS-ELG00022 segment the state reports the old MSIS-IDENTIFICATION-NUM value as an ELG-IDENTIFIER value.
5. Federal System maintains the records with the old and new MSIS-IDENTIFICATION-NUM values.
Using an active flag and archive flag, the Federal System will maintain the records for the old and new MSIS-IDENTIFICATION-NUM values as illustrated in Table 13. The Federal System will flag the record for the old MSIS-IDENTIFICATION-NUM value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to TRUE. The Federal System will flag the record for the new MSIS-IDENTIFICATION-NUM value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to FALSE. Once the record for the new MSIS-IDENTIFICATION-NUM is active, the state no longer needs to report the record for the old MSIS-IDENTIFICATION-NUM. The Federal System will use this information to link data associated with the old and new MSIS IDs for the purposes of analysis, reporting, and monitoring.
Table 13. Federal System Maintains Records with Old and New MSIS-IDENTIFICATION-NUM Values
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION | ACTIVE-FLAG | ARCHIVE-FLAG |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[9] | 1/1/2016 | 12/31/9999 | M101-OLD | TRUE | TRUE | ||
| ELG00022 | XX | 201 | M201-NEW | 1 | <State>[9] | 1/1/2016 | 12/31/9999 | M201-NEW | TRUE | FALSE | ||
| ELG00022 | XX | 203 | M201-NEW | 2 | <State>[9] | 1/1/2016 | 12/31/9999 | M101-OLD | LSE | TRUE | FALSE | |
| ELG00022 | XX | 103 | M102-OLD | 1 | <State>[9] | 1/1/2018 | 12/31/9999 | M102-OLD | TRUE | TRUE | ||
| ELG00022 | XX | 204 | M202-NEW | 1 | <State>[9] | 1/1/2018 | 12/31/9999 | M202-NEW | TRUE | FALSE | ||
| ELG00022 | XX | 206 | M202-NEW | 2 | <State>[9] | 1/1/2018 | 12/31/9999 | M102-OLD | LSE | TRUE | FALSE |
Example 4: Subset of Beneficiary IDs Change During Large System Enhancement
A state decides to assign new MSIS IDs during an LSE to a subset of beneficiaries that have been reported to T-MSIS since MSIS/T-MSIS cutover. The state intends to report to T-MSIS the new MSIS IDs starting in the Jun-2022 reporting period.
1. State communicates to CMS in advance
Using the CMS provided template, the state notifies CMS of the intended MSIS ID change (i.e., changes to MSIS-IDENTIFICATION-NUM values) for a subset of beneficiaries. This notice should be communicated to CMS as soon as the state is certain of its plans to change the IDs.
Table 14 illustrates the information that the state submitted, using the CMS template, to notify CMS of the upcoming change in MSIS IDs. This includes the reporting state, the data element that will be updated, the reporting period that the new IDs will be reported to T-MSIS, and for whom the new IDs are being assigned.
Table 14. State Notifies CMS – Subset of Beneficiary IDs Change During LSE
| State | Entity ID Type Submitting State Provider ID/ MSIS-ID |
Data Element Name | Entity ID Change Effective Reporting Period (YYYYMM) | Assigning new IDs to All the Providers/Beneficiaries that states had submitted since MSIS/T-MSIS Cutover Period or Subset of all the Providers/Beneficiaries | State Comments |
| XX | MSIS-ID | MSIS-IDENTIFICATION-NUM | 202206 | Subset of Beneficiaries |
2. In the reporting period prior to introducing the new MSIS IDs, states report the old MSIS-IDENTIFICATION-NUM values in all segments of their ELG submission
In the reporting period prior to the introduction of the MSIS ID change, May 2022 in this example, the state reports the old MSIS-IDENTIFICATION-NUM values in the ELIGIBLE-IDENTIFIER-ELG00022 (ELG00022) segment and in all other segments. Table 15 shows the ELG00022 segment only; all other segments and data elements should be reported as usual.
As Table 15 illustrates, in the reporting period prior to the introduction of the new MSIS IDs, the state reports the old MSIS ID values in the MSIS-IDENTIFICATION-NUM and in the ELG-IDENTIFIER columns. (As previously described, for the purposes of these technical instructions, an “old” MSIS ID refers to the “existing” MSIS ID that predates the assignment of the new MSIS IDs.)
Table 15. ELG00022 Segments in Reporting Period Prior to ID Change Introduced – Subset of Beneficiary IDs Changed During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[10] | 1/1/2016 | 12/31/9999 | M101-OLD | ||
| ELG00022 | XX | 102 | M102-OLD | 1 | <State>[10] | 1/1/2018 | 12/31/9999 | M102-OLD |
3. In the reporting period the new beneficiary IDs are introduced, states report the new MSIS values and the ID crosswalk in the ELIGIBLE-IDENTIFIER-ELG00022 segments
In the reporting period the ID changes are introduced, in this example June 2022, the state reports the new IDs for the subset of beneficiaries and reports the crosswalk of the new MSIS IDs to the old MSIS IDs. Table 16 shows the ELG00022 segment only; all other segments should be reported as usual.
For the beneficiary not assigned a new MSIS ID (see row with RECORD-NUMBER ‘101’), the state reports the old (i.e., their existing) MSIS ID in the MSIS-IDENTIFICATION-NUM-ID column and reports the same value in the ELG-IDENTIFIER column. The state appropriately reports a valid value ‘1’ in the ELG-IDENTIFIER-TYPE column to indicate that the ELG-IDENTIFIER value is the Medicaid Card ID (State MMIS) value.
For the beneficiary assigned a new MSIS ID (see rows RECORD-NUMBER ‘201’ and ‘202’), the state reports the new MSIS ID and the ID crosswalk. To report new MSIS ID, the state reports the new MSIS ID in the MSIS-IDENTIFICATION-NUM-ID column and reports the same value (i.e., the new MSIS ID) in the ELG-IDENTIFIER column (see row with RECORD-NUMBER ‘201’). The state appropriately reports a valid value ‘1’ in the ELG-IDENTIFIER-TYPE column to indicate that the ELG-IDENTIFIER value is the current (‘new’) Medicaid Card ID (State MMIS) value.
The state also reports the crosswalk between the old and new MSIS ID (RECORD-NUMBER 202). Specifically, the state reports a valid value ‘2’ in the ELG-IDENTIFIER-TYPE column to notify the Federal System that the record crosswalks the old MSIS ID to the new MSIS ID and reports the new MSIS ID value in the MSIS-IDENTIFICATION-NUM column and the old MSIS ID value in the ELG-IDENTIFIER column (see row with RECORD-NUMBER ‘202’).
Table 16. ELG00022 Segments in Reporting Period ID Change Introduced – Subset of Beneficiary IDs Change During LSE
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[11] | 1/1/2016 | 12/31/9999 | M101-OLD | ||
| ELG00022 | XX | 201 | M202-NEW | 1 | <State>[11] | 1/1/2018 | 12/31/9999 | M202-NEW | ||
| ELG00022 | XX | 202 | M202-NEW | 2 | <State>[11] | 1/1/2018 | 12/31/9999 | M102-OLD | LSE |
The state also ensures old MSIS IDs reported as an old ELG-IDENTIFIER in the ELG00022 segment have reported effective dates (ELG-INDENTIFIER-EFF-DATE) and end dates (ELG-INDENTIFIER-END-DATE) within the earliest effective date (PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE) and the latest end date (PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE) reported in the corresponding PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 parent segment(s) of the new MSIS-IDENTIFICATION-NUM.
4. State chooses a ELG file submission method
The state submits the ELG file using the TFFR submission method in the reporting period when the new MSIS IDs are introduced (in this example, June 2022).
For the beneficiaries assigned a new ID, the state submitted ELG file reports all record segments with new MSIS-IDENTIFICATION-NUM. In the ELG-IDENTIFIERS-ELG00022 segment the state reports the old MSIS-IDENTIFICATION-NUM value as an ELG-IDENTIFIER value.
For the beneficiaries that were not assigned a new ID, the state submitted ELG file reported all record segments with the old (i.e., the existing) MSIS-IDENTIFICATION-NUM.
5. Federal System maintains the records with the old and new MSIS-IDENTIFICATION-NUM values
Using an active flag and archive flag for the old MSIS-IDENTIFICATION-NUM that was not changed, the record for the old MSIS-IDENTIFICATION-NUM will remain active as long as the state continues to maintain it as illustrated in Table 17. For the old and new MSIS-IDENTIFICATION-NUM values that have a crosswalk, the Federal System will maintain the records for the old and new MSIS-IDENTIFICATION-NUM values. The Federal System will flag the record for the old MSIS-IDENTIFICATION-NUM value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to TRUE. The Federal System will flag the record for the new MSIS-IDENTIFICATION-NUM value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to FALSE. Once the record for the new MSIS-IDENTIFICATION-NUM is active, the state no longer needs to report the record for the old MSIS-IDENTIFICATION-NUM. The Federal System will use this information to link data associated with the old and new MSIS IDs for the purposes of analysis, reporting, and monitoring.
Table 17. Federal System Maintains Records with Old and New MSIS-IDENTIFICATION-NUM Values
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION | ACTIVE-FLAG | ARCHIVE-FLAG |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[12] | 1/1/2016 | 12/31/9999 | M101-OLD | TRUE | FALSE | ||
| ELG00022 | XX | 102 | M102-OLD | 1 | <State>[12] | 1/1/2018 | 12/31/9999 | M102-OLD | TRUE | TRUE | ||
| ELG00022 | XX | 201 | M202-NEW | 1 | <State>[12] | 1/1/2018 | 12/31/9999 | M202-NEW | TRUE | FALSE | ||
| ELG00022 | XX | 202 | M202-NEW | 2 | <State>[12] | 1/1/2018 | 12/31/9999 | M102-OLD | LSE | TRUE | FALSE |
Example 5: Beneficiary IDs Change Due to Merge Activities
On a monthly or periodic basis, a state assigns new MSIS IDs due to beneficiary Merge scenarios to a relatively small number of beneficiaries. The state intends to report to T-MSIS the new MSIS IDs starting in the Jun-2022 reporting period.
1. State does not need to notify CMS in advance
The state does not need to notify CMS of MSIS ID changes due to Merge cases.
2. In the reporting period prior to introducing the new MSIS IDs, states report the old MSIS-IDENTIFICATION-NUM values in all segments of their ELG submission
In the reporting period prior to the introduction of the MSIS ID change, May 2022 in this example, the state reports the old MSIS-IDENTIFICATION-NUM values in the ELIGIBLE-IDENTIFIER-ELG00022 (ELG00022) segment and in all other segments. Table 18 shows the ELG00022 segment only; all other segments and data elements should be reported as usual.
As Table 18 illustrates, in the reporting period prior to merging two MSIS IDs, each MSIS ID is reported on a separate ELG00022 segment where the ELG-IDENTIFIER is equal to the MSIS-IDENTIFICATION-NUM and the ELG-IDENTIFIER-TYPE is equal to ‘1’.
Table 18. ELG00022 Segments in Reporting Period Prior to ID Change Introduced – Beneficiary ID Changed During Merge
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[13] | 1/1/2016 | 12/31/9999 | M101-OLD | ||
| ELG00022 | XX | 102 | M102-OLD | 1 | <State>[13] | 1/1/2018 | 12/31/9999 | M102-OLD |
3. In the reporting period the new beneficiary IDs are introduced, states report the new MSIS values and the ID crosswalk in the ELIGIBLE-IDENTIFIER-ELG00022 segments
In the reporting period the IDs are merged, in this example June 2022, the state reports the crosswalk of the MSIS ID that belongs to the redundant record as the ELG-IDENTIFIER value associated with the MSIS-IDENTIFICATION-NUM value of the record the state will continue to maintain. Table 19 shows the ELG00022 segments only; all other segments and data elements should be reported as usual.
The state reports the crosswalk between the merged MSIS IDs. Specifically, the state reports a valid value ‘2’ in the ELG-IDENTIFIER-TYPE column to notify the Federal System that the segment crosswalks the MSIS ID that the state is no longer maintaining with the MSIS ID of the record that they continue to maintain (see row with RECORD-NUMBER ‘202’).
Table 19. ELG00022 Segments in Reporting Period ID Change Introduced – Beneficiary ID Changed During Merge
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[14] | 1/1/2016 | 12/31/9999 | M101-OLD | ||
| ELG00022 | XX | 202 | M101-OLD | 2 | <State>[14] | 1/1/2016 | 12/31/9999 | M102-OLD | MERGE |
The state also ensures merged MSIS IDs reported as a MERGE ELG-IDENTIFIER in the ELG00022 segment have reported effective dates (ELG-INDENTIFIER-EFF-DATE) and end dates (ELG-INDENTIFIER-END-DATE) within the earliest effective date (PRIMARY-DEMOGRAPHIC-ELEMENT-EFF-DATE) and the latest end date (PRIMARY-DEMOGRAPHIC-ELEMENT-END-DATE) reported in the corresponding PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 parent segment(s) of the MSIS-IDENTIFICATION-NUM to which the MERGE ELG-IDENTIFIER has been merged.
4. State chooses a ELG file submission method
The state submits the ELG file using their state declared method in the reporting period when the MSIS ID merge was introduced (in this example, June 2022). The state is not required to continue submitting the record for the MSIS-IDENTIFICATION-NUM that has been merged via the crosswalk.
5. Federal System maintains the records with the old and new MSIS-IDENTIFICATION-NUM values
Using an active flag and archive flag, for the merged MSIS-IDENTIFICATION-NUM values that have a crosswalk, the Federal System will maintain the records for the both MSIS-IDENTIFICATION-NUM values as illustrated in Table 20. The Federal System will flag the record for the merged MSIS-IDENTIFICATION-NUM value with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to TRUE. The Federal System will flag the record for the MSIS-IDENTIFICATION-NUM value that will continue to be maintained with the ACTIVE-FLAG equal to TRUE and the ARCHIVE-FLAG equal to FALSE. Once the records are merged, the state no longer needs to report the record for the merged MSIS-IDENTIFICATION-NUM.
Table 20. Federal System Maintains Records with Old and New MSIS-IDENTIFICATION-NUM Values
| RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE | STATE-NOTATION | ACTIVE-FLAG | ARCHIVE-FLAG |
| ELG00022 | XX | 101 | M101-OLD | 1 | <State>[15] | 1/1/2016 | 12/31/9999 | M101-OLD | TRUE | FALSE | ||
| ELG00022 | XX | 102 | M102-OLD | 1 | <State>[15] | 1/1/2018 | 12/31/9999 | M102-OLD | TRUE | TRUE | ||
| ELG00022 | XX | 202 | M101-OLD | 2 | <State>[15] | 1/1/2018 | 12/31/9999 | M102-OLD | MERGE | TRUE | FALSE |