| MCR016 |
MCR.002.016
|
RECORD-ID |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a
given row of data should be interpreted depending on which segment type the Record ID represents. Each type of
segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify
the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g.,
00001, 00002, 00003, etc.). |
MCR016 Values
|
| MCR017 |
MCR.002.017
|
SUBMITTING-STATE |
A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. |
MCR017 Values
|
| MCR018 |
MCR.002.018
|
RECORD-NUMBER |
A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file. |
N/A
|
| MCR019 |
MCR.002.019
|
STATE-PLAN-ID-NUM |
The ID number a state issues to a managed care entity |
N/A
|
| MCR020 |
MCR.002.020
|
MANAGED-CARE-CONTRACT-EFF-DATE |
The start date of the managed care contract period with the state. |
N/A
|
| MCR021 |
MCR.002.021
|
MANAGED-CARE-CONTRACT-END-DATE |
The expiration date of the managed care contract period with the state. |
N/A
|
| MCR022 |
MCR.002.022
|
MANAGED-CARE-NAME |
The name of the managed care entity under contract with the State Medicaid Agency. The name
should be as it appears on the contract. |
N/A
|
| MCR023 |
MCR.002.023
|
MANAGED-CARE-PROGRAM |
The state program through which a managed care plan is approved to operate. |
MCR023 Values
|
| MCR024 |
MCR.002.024
|
MANAGED-CARE-PLAN-TYPE |
The type of managed care plan that corresponds to the State Plan Identification Number. The value reported in this data element should match the Managed Care Plan Type value reported on the Eligible file for the corresponding managed care plan number.
Assign plan type value "15" for plans that primarily cover non-emergency medical transportation (NEMT).
See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Non-Emergency Medical Transportation (NEMT) Prepaid Ambulatory Health Plans (PAHPs) in the T-MSIS Managed Care File"
https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47540
See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Managed Care Plan Type in the T-MSIS Managed Care File"
https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47564 |
MCR024 Values
|
| MCR025 |
MCR.002.025
|
REIMBURSEMENT-ARRANGEMENT |
A code indicating the how the managed care entity is reimbursed. |
MCR025 Values
|
| MCR026 |
MCR.002.026
|
MANAGED-CARE-PROFIT-STATUS |
A code denoting the profit status of managed care entity. |
MCR026 Values
|
| MCR027 |
MCR.002.027
|
CORE-BASED-STATISTICAL-AREA-CODE |
A code signifying whether the Managed Care Organization's (MCO) service area falls into one or more metropolitan or micropolitan statistical areas. Whenever a service area straddles two types of areas (e.g., metropolitan & micropolitan, metropolitan & non-CBSA area) classify the
service area based on the denser classification. Metropolitan and micropolitan statistical areas (metro and micro areas) are geographic entities defined by the U.S. Office of Management and Budget (OMB). The term "Core Based Statistical Area" (CBSA) is a collective term for both
metro and micro areas. A metro area contains a core urban area of 50,000 or more population, and a micro area contains an urban core of at least 10,000 (but less than 50,000) population. Each metro or micro area consists of one or more counties and includes the counties
containing the core urban area, as well as any adjacent counties that have a high degree of social and economic integration (as measured by commuting to work) with the urban core.
The U.S. Office of Management and Budget (OMB) defines metropolitan or micropolitan statistical areas based on published standards. The standards for defining the areas are reviewed and revised once every ten years, prior to each decennial census. Between censuses, the
definitions are updated annually to reflect the most recent Census Bureau population estimates. The current definitions are as of December 2009.
See the hyperlink below for further information.
http://www.whitehouse.gov/sites/default/files/omb/assets/bulletins/b10-02.pdf |
MCR027 Values
|
| MCR028 |
MCR.002.028
|
PERCENT-BUSINESS |
The percentage of the managed care entity's total revenue that is derived from contracts with Medicare (Part C and D) in the state and State Medicaid agency contract(s) prior calendar year. Include Medicaid and Medicare in calculation of percentage of business in public programs for IRS health insurer tax exemption as required in ACA. |
N/A
|
| MCR029 |
MCR.002.029
|
MANAGED-CARE-SERVICE-AREA |
Identifies the geographic unit under which the managed care entity is under contract to provide services. The value reported in Managed Care Service Area should represent the geographical unit of the values reported in the Managed Care Service Area Name.
See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Managed Care Service Area in the Managed Care File"
https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47542 |
MCR029 Values
|
| MCR030 |
MCR.002.030
|
MANAGED-CARE-MAIN-REC-EFF-DATE |
The first calendar day on which all of the other data elements in the same segment were effective. |
N/A
|
| MCR031 |
MCR.002.031
|
MANAGED-CARE-MAIN-REC-END-DATE |
The last calendar day on which all of the other data elements in the same segment were effective. |
N/A
|
| MCR032 |
MCR.002.032
|
STATE-NOTATION |
A free text field for the submitting state to enter whatever information it chooses. |
N/A
|
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