MCR.002.020

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MANAGED-CARE-CONTRACT-EFF-DATE

Data Element

DE Number

MCR020

System DE Number

MCR.002.020

File Name

MCR - MANAGED CARE PLAN INFORMATION

File Segment Number

File Segment Name

MANAGED-CARE-MAIN

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The start date of the managed care contract period with the state.
Size	9(8)
FLF Start Position	34
FLF Stop Position	41
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3. Value must be before or the same as the associated Segment End Date value 4. Mandatory 5. Value of the CC component must be in ['18', '19', '20'] 6. Mandatory 7. Value must occur before Managed Care Contract End Date (MCR.002.021)

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-2382	If the managed care plan ID is populated on a managed care participation ELG file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
RULE-2384	If the managed care participation plan type is populated on a managed care participation segment and the managed care main plan type is populated on the managed care main file segment and the managed care participation managed care plan enrollment end date is greater than the states tmsis cutover date then managed care participation managed care plan type equals the managed care main managed care plan type and the effective and end dates on the managed care participation segment must fall within the effective and end dates of one or more continuous managed care main segments.
RULE-2559	If a segment is a managed care main segment from an MCR file, then the managed care contract effective date value reported must be a valid date of the form CCYYMMDD.
RULE-2561	If the managed are main segment has a value populated for managed care contract effective date and a value populated for managed care contract end date, then the contract effective date is less than or equal to the contract end date.
RULE-2990	If the affiliated program type is equal to '2' (health plan (state assigned health plan ID)) on a provider affiliated programs PRV file segment and the provider affiliated programs prov affiliated program end date is greater than the states tmsis cutover date then the effective and end dates on the provider affiliated programs segment must fall with the effective and end dates of one or more continuous mangaged care main segments.
RULE-7198	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an IP file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the admission date on the claim is within the contract effective and end dates of the managed care main segment.
RULE-7199	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an LT file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the beginning date of service on the claim is within the contract effective and end dates of the managed care main segment.
RULE-7200	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an OT file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the beginning date of service on the claim is within the contract effective and end dates on the managed care main segment.
RULE-7201	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an RX file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the prescription fill date is within the contract effective and end dates on the managed care main segment.
RULE-7702	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other capitation from an OT file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the beginning date of service on the claim is within the contract effective and end dates on the managed care main segment.

Measure ID	Measure Name
RULE-7198	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7199	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7200	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7201	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-7702	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/09/2023	3.11.0	MCR.002.020	UPDATE	Last update date	12/08/2022	8/9/2023
08/09/2023	3.11.0	MCR.002.020	UPDATE	Definition	The first calendar day on which all of the other data elements in the same segment were effective.	The start date of the managed care contract period with the state.
11/18/2022	3.0.5	MCR020	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| MCR020\|MANAGED-CARE-CONTRACT-EFF-DATE\|The first calendar day on which all of the other data elements in the same segment were effective.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| MCR020\|MANAGED-CARE-CONTRACT-EFF-DATE\|The start date of the managed care contract period with the state.