An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.27.0

MCR - MANAGED CARE PLAN INFORMATION

File

File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
MCR00001 FILE-HEADER-RECORD-MANAGED-CARE A record containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
MCR00002 MANAGED-CARE-MAIN A record to capture basic, generally static information about a managed care entity.
MCR00003 MANAGED-CARE-LOCATION-AND-CONTACT-INFO A record to capture addresses, phone numbers, fax numbers, and email addresses of the managed care organization.
MCR00004 MANAGED-CARE-SERVICE-AREA A record to capture the zip codes, counties, or other geographic descriptors that define the managed care entity's service area.
MCR00005 MANAGED-CARE-OPERATING-AUTHORITY A record to capture information about the operating authority, waivers and demonstrations under which a managed care entity is contracted with the state.
MCR00006 MANAGED-CARE-PLAN-POPULATION-ENROLLED A record to capture the identity of the Medicaid/CHIP eligibility groups that the managed care entity is authorized to enroll.
MCR00007 MANAGED-CARE-ACCREDITATION-ORGANIZATION A record to capture information concerning the accreditations that the managed care entity has.
Definition
New file of Managed Care Organizations (MCO) plan level participation and characteristics data.

Overview

Diagram 7: Managed Care File – Managed Care Entity Record Segment Relationships

mcr_overview

Description of Diagram 7:

Each managed care entity in T-MSIS must have a record in the T-MSIS managed care file. Each managed care record is comprised of up to eight different types of record segments. The MANAGED-CARE-MAIN (MCR00002) segment is the parent segment to six segments: MANAGED-CARE-LOCATION-AND-CONTACT-INFO (MCR00003), MANAGED-CARE-SERVICE-AREA (MCR00004), MANAGED-CARE-OPERATING-AUTHORITY (MCR00005), MANAGED-CARE-PLAN-POPULATION-ENROLLED (MCR00006), MANAGED- CARE-ACCREDITATION-ORGANIZATION (MCR00007), and NATIONAL-HEALTH-CARE-ENTITY-ID-INFO (MCR00008), all of which join to PROV-ATTRIBUTES-MAIN on the following two data elements:

1. SUBMITTING-STATE
2. STATE-PLAN-ID-NUM

In addition, the NATIONAL-HEALTH-CARE-ENTITY-ID-INFO (MCR00008) segment is a parent segment in its own right to the CHPID-SHPID-RELATIONSHIPS (MCR00009) segment, which joins to the NATIONAL-HEALTH-CARE-ENTITY-ID-INFO segment on:

1. SUBMITTING-STATE
2. STATE-PLAN-ID-NUM
3. NATIONAL-HEALTH-CARE-ENTITY-ID*
4. NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE*.

* = MCR00008.NATIONAL-HEALTH-CARE-ENTITY-ID would join to either MCR00009.CHPID or MCR00009.SHPID based on the value in MCR00008.NATIONAL-HEALTH-CARE-ENTITY-ID-TYPE.