Reporting Reminder: Capitation Payments in the T-MSIS Claim OT file

Topic Description

This reporting reminder describes how to report capitation payments in the T-MSIS Claim OT file.

Impacted Data Elements

• TYPE-OF-CLAIM (COT037)
• ENDING-DATE-OF-SERVICE (COT034, COT167)

Reporting Reminders

• All capitation payments (TYPE-OF-CLAIM = “2” or “B”) should be reported with valid date values in the ENDING-DATE-OF-SERVICE (COT034, COT167) data elements. 
  • The ENDING-DATE-OF-SERVICE (COT034, COT167) data element reported on claim header record and the claim line record should be populated with a date. 
  • For capitation payments, the value reported in the ENDING-DATE-OF-SERVICE field should reflect the date on which the period of coverage related to this payment ends/ended.