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TMSIS Dataguide Medicaid.gov
Version 3.28.0

CMS Reporting Reminder

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 Reminder

  • 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.