Administrative Requirements for Section 6071 of the DRA (CMS-10249)

Mathematica Policy Research

OVERVIEW AND FILE LAYOUT FOR QUARTERLY MFP SERVICES FILE
(FOR FILES SUBMITTED FEBRUARY 15, 2009 OR LATER)
Overview
The MFP Services file will allow us to describe and assess the services MFP participants
receive through the MFP demonstration. Specially, these data will be used to provide the U.S.
Congress and state policymakers with answers to a range of critical research questions such as:
-

How did the addition of new services permit money to follow the person?

-

What types and volume of HCBS were provided by the demonstration, overall
and by target population?

-

How is the utilization of HCBS, overall and by type, associated with
successful transition (length of stay in the community and
reinstitutionalization)?

The MFP Services file will include one record for each home and community-based service
people receive while participating in the MFP program. States have been instructed not to
include claims for MFP-financed services in their routine MSIS files. As a result, grantees will
need to submit a separate claims file for MFP demonstration services. This requirement means
that MFP participants will generate two types of claims
1. Regular MSIS claims for acute care and institutional services (such as physician
visits, hospital discharges, and nursing home admissions)
2. MFP claims for home- and community-based services received
File Content
If possible, the development and processing of the MFP Services File should mirror what the
state does when creating the MSIS Other claims file. Each MFP Services File submitted should
include all claims records that were paid during the reporting period and for which the state
claimed funds from your MFP grant. The MFP Services File will also include correction records
when they occur for earlier paid claims.
The file layouts for the MFP Services File appear in Tables 1 and 2. Values for almost all
data elements can be found in the Medicaid Statistical Information System (MSIS) Tape
Specifications and Data Dictionary, Release 3 located at http://www.cms.gov/MSIS/. The values
for those data elements that do not appear in this reference are in the footnotes to these tables.
Managed Long-Term Care
To conduct a comprehensive evaluation of the impacts of the Money Follows the Person
program, the evaluation will need individual level data on the use and costs of institutional and
home and community based services for all MFP program participants receiving care in all types
of service systems. This includes MFP participants who transition into managed long-term care
systems, which includes the Program of All Inclusive Care for the Elderly (PACE).

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Service Records. Data that are analogous to what appears in Tables 1 and 2 are needed for
MFP participants in states that purchase long-term care services for enrollees from managed care
plans on a capitated basis, including MFP participants who are PACE enrollees. For each
service received by an MFP participant, the evaluation needs a record indicating who received
the service, when they received it, how much they received, the type of service received, and the
amount the plan paid for the service. Grantees can use the default error tolerance levels as a
guide to the data elements that are the most critical ones for the evaluation.
Some states also contract with managed care plans for institutional care and acute care
services. Institutional care and acute care are NOT covered MFP services and states and
managed care plans should report this type of service use for its MFP participants in the same
manner they always have—through MSIS. If for some reason the state is not submitting
managed care service claims data through MSIS, then it needs to do so for their MFP
participants.
Capitated Payment Records. The MFP Services File must also include the capitated
payments for which the state seeks reimbursement through MFP grant funds. The amount that
appears on the claims record should only reflect the home and community-based portion of the
capitated payment. If the capitated payment also covers acute care or institutional care or both,
then the portion of the capitated payment that covers these services should be reported as usual
through MSIS.
Submission Process
Each grantee will submit this file, along with the crosswalk described below, 45 days after
the end of each federal fiscal quarter beginning with the first quarter of paid program claims.
Quarterly files are due February 15, May 15, August 15, and November 15 of each year.
Each quarterly file will be sent by the Gentran system. Instructions for the submission of files
are posted on the MFP Technical Assistance website (http://www.mfp-tac.com).
Crosswalks to HCBS Services
To ensure Mathematica correctly classifies each MFP service claim into the correct type of
service, grantees need to submit with each MFP services file a crosswalk that provides the
information Mathematica needs to properly classify each claims record. The crosswalk is
presented in Table 3. We are requesting you submit this crosswalk each quarter, because states
are constantly revising state-specific service codes.
Please send crosswalks to
[email protected] and [email protected].

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Table 1. Proposed File Layout for Header Record in the Quarterly Money Follows the Person (MFP)
Services File
Field Name
a

File-Name
File-Status-Indicator
Filler
State-Abbreviation
Date-File-Created
Start-of-Time-Period
End-of-Time-Period
SSN-Indicator
Filler

Record Type

Type of Field

Length

Header
Header
Header
Header
Header
Header
Header
Header
Header

Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Numeric
Numeric
Numeric
Numeric
Alphanumeric

8
1
2
2
8
8
8
1
242

Source:

Medicaid Statistical Information System (MSIS) Tape Specifications and Data Dictionary,
Release 3.

Note:

The first data record of each MFP Services file will be a header record, which will contain file
identification information required for accurate validation of the file. This table summarizes the
fields in the header file record in the order in which fields will be processed. Every header
record field must contain valid data.

a

MFP File-Name = guid.NONE.MFP.Q.Gxx.CLAIMMFP.z

guid = the Gentran user identification number of the person(s) with rights to submit these files
xx = the state’s two letter abbreviation (for example, MO = Missouri).
z = either a T for a test file or a P for a non-test file (production file).
Use all capital letters in the file names as indicated above.
Grantees may submit test files before submitting final files for the evaluation. For test files replace the z
with a T. For files you wish MPR to use in its work replace the z with a P.

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Table 2. File Layout for the Quarterly Money Follows the Person (MFP) Services File
Type of Field

Field Length

Default Error Tolerancea

MSIS-Identification-Number
Adjustment-Indicator
Type-of-Service
Type-of-Claim
Date-of-Payment-Adjudication
Amount-Paid
Beginning-Date-of-Service
Ending-Date-of-Service

Alphanumeric
Numeric
Numeric
Numeric
Numeric
Signed Numeric
Numeric
Numeric

20
1
2
1
8
8
8
8

0.1%
2.0%
0.1%
2.0%
2.0%
0.1%
2.0%
2.0%

Provider-ID-Number-Billing
Amount-Charged
Other-Third-Party-Payment
Program-Type
Plan-ID-Number
Quantity-of-Service
Medicare-Deductible-Payment
Medicare-Coinsurance-Payment

Alphanumeric
Signed Numeric
Signed Numeric
Numeric
Alphanumeric
Signed Numeric
Signed Numeric
Signed Numeric

12
8
6
1
12
5
5
5

5.0%
100.0%
100.0%
2.0%
2.0%
2.0%
100.0%
100.0%

Diagnosis-Code-1b
Diagnosis-Code-2b
Place-of-Service
Specialty-Code
Service-Codeb
Service-Code-Flag
Service-Code-Mod
UB-92-Revenue-Code

Alphanumeric
Alphanumeric
Numeric
Alphanumeric
Alphanumeric
Numeric
Alphanumeric
Numeric

8
8
2
4
8
2
2
4

100.0%
100.0%
5.0%
100.0%
5.0%
5.0%
5.0%
100.0%

Provider-ID-Number-Servicing
National-Provider-IDc
Provider-Taxonomyc
Internal-Control-Number-Origc
Line-Number-Origc
Internal-Control-Number-Adjc
Line-Number-Adjc
Type-of-FMAP-Paidd
Filler

Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Alphanumeric

12
12
12
21
3
21
3
1
47

5.0%
5.0%
5.0%
5.0%
5.0%
5.0%
5.0%
2.0%

Field Name

Source:

Medicaid Statistical Information System (MSIS) Tape Specifications and Data Dictionary,
Release 3.

Note:

This table summarizes the fields in the Quarterly MFP Services File record in the order in
which they physically occur in each record.

a

The error tolerance describes, for each field, the maximum allowable percentage of records submitted
that may have missing, unknown, or invalid codes.

b
c

The field length has been increased from 7 to 8 starting with the February 2009 file submissions.

New data elements as of the February 2009 file submissions.

d

Valid values will be 1 = Qualified HCBS; 2 = HCBS Demonstration Services; and 3 = Supplemental
Demonstration Services.

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APPENDIX
Data Dictionary for New Data Elements
for Files Submitted February 2009 and Later

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CLAIMS FILES
Data Element Name: INTERNAL-CONTROL-NUMBER-ORIG
Definition: A unique number (up to 21 alpha/numeric characters) assigned by the State’s payment system
that identifies an original claim. Field Description:
COBOL Error Example
PICTURE Tolerance Value
X(21) 5.0% “ABC000111222333444555666”
Coding Requirements:
Record the value exactly as it appears in the State system. Do not pad.
If the ADJUSTMENT-INDICATOR is ‘0’ then this field must include the ICN for the original claim. On
adjustment claims this field should show the ICN for the claim being adjusted
If Value is unknown, or the claim is a service tracking claim, fill with "999999999999999999999".
Error Condition Resulting Error Code
THE FOLLOWING EDITS WILL NOT COUNT AGAINST THE ERROR TOLERANCE
FOR GROSS ADJUSTMENT RECORDS (ADJUSTMENT INDICATOR=5)
1. Value = "999999999999999999999"..................................... ...............................................................301
2. Value is “Space Filled”..........................................................................................................................303
3. Value is 0-filled......................................................................................................................................304

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CLAIMS FILES
Data Element Name: INTERNAL-CONTROL-NUMBER-ADJ
Definition: A unique claim number (up to 21 alpha/numeric characters) assigned by the State’s payment
system that identifies the adjustment claim for an original transaction.
Field Description:
COBOL Error Example
PICTURE Tolerance Value
X(21) 5.0% “ABC111222333444555666”
Coding Requirements:
Record the value exactly as it appears in the State system. Do not pad.
This field should be 8-filled if the ADJUSTMENT-INDICATOR = 0
If Value is unknown, fill with "999999999999999999999".
Error Condition Resulting Error Code
THE FOLLOWING EDITS WILL NOT COUNT AGAINST THE ERROR TOLERANCE
FOR GROSS ADJUSTMENT RECORDS (ADJUSTMENT INDICATOR=5)
1. Value = "999999999999999999999".....................................................................................................301
2. Value is “Space Filled”..........................................................................................................................303
3. Value is 0-filled......................................................................................................................................304
4. Value = “888888888888888888888" AND ADJUSTMENT-INDICATOR IS NE 0..........................305

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CLAIMS FILES
Data Element Name: LINE-NUMBER-ORIG
Definition: A unique number to identify the transaction line number that is being reported on the original
claim.
Field Description:
COBOL Error Example
PICTURE Tolerance Value
9(3) 5.0% “001”
Coding Requirements:
Record the value exactly as it appears in the State system. Do not pad. This field should also be
completed on adjustment claims to reflect the LINE-NUMBER of the INTERNAL-CONTROLNUMBER on the claim that is being adjusted.
If Value is unknown, fill with "999”.
Error Condition Resulting Error Code
THE FOLLOWING EDITS WILL NOT COUNT AGAINST THE ERROR TOLERANCE
FOR ADJUSTMENT RECORDS (ADJUSTMENT INDICATOR=1, 2, 3, 4, OR 5)
1. Value = "999".........................................................................................................................................301
2. Value is “Space Filled”..........................................................................................................................303
3. Value is 0-filled......................................................................................................................................304
4. Value = “888" AND ADJUSTMENT-INDICATOR IS = 0.......................... ......................................305

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CLAIMS FILES
Data Element Name: LINE-NUMBER-ADJ
Definition: A unique number to identify the transaction line number that identifies the line number on the
Adjustment ICN.
Field Description:
COBOL Error Example
PICTURE Tolerance Value
9(3) 5.0% “001”
Coding Requirements:
Record the value exactly as it appears in the State system. Do not pad.
This field should be 8-filled if the ADJUSTMENT-INDICATOR = 0.
If Value is unknown, fill with "999”.
Error Condition Resulting Error Code
THE FOLLOWING EDITS WILL NOT COUNT AGAINST THE ERROR TOLERANCE
FOR ADJUSTMENT RECORDS (ADJUSTMENT INDICATOR=1, 2, 3, 4, OR 5)
1. Value = "999".........................................................................................................................................301
2. Value is “Space Filled”..........................................................................................................................303
3. Value is 0-filled......................................................................................................................................304
4. Value = “888" AND ADJUSTMENT-INDICATOR IS NE 0..............................................................306

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CLAIMS FILES
Data Element Name: NATIONAL-PROVIDER-ID
Definition: The unique number to identify the provider who treated the recipient (as opposed to the
provider “billing” for the service).
Field Description:
COBOL Error Example
PICTURE Tolerance Value
X(12) 5.0% “01CA79300000”
Coding Requirements:
Record the value exactly as it appears in the State system. Do not 9-fill.
If legacy identifiers are available for providers, then report the legacy IDs in the Provider ID fields and
the NPI in this field. If only the legacy Provider ID is available, then 9-fill the National Provider ID and
enter the legacy IDs in the Provider ID fields.
8-fill field for premium payments (TYPE-OF-SERVICE = 20, 21, 22)
If Value is unknown, fill with "999999999999".
Error Condition Resulting Error Code
THE FOLLOWING EDITS WILL NOT COUNT AGAINST THE ERROR TOLERANCE
FOR ADJUSTMENT RECORDS (ADJUSTMENT INDICATOR=1, 2, 3, 4, OR 5)
1. Value = "999999999999".......................................................................................................................301
2. Value is “Space Filled”..........................................................................................................................303
3. Value is 0-filled......................................................................................................................................304
4. Value = “888888888888" AND TYPE-OF-SERVICE <> {20, 21, 22}...............................................305
5. Value <> “888888888888" AND TYPE-OF-SERVICE = {20, 21, 22}...............................................306
6. Value = PROVIDER-ID-NUMBER-BILLING ……...……………………………………………….529

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CLAIMS FILES
Data Element Name: PROVIDER-TAXONOMY
Definition: The taxonomy code for the provider who treated the recipient (as opposed to the provider
“billing” for the service). The provider-taxonomy code is part of the HIPAA-standard code set, and is
selected by providers as part of the National Provider Identification application.
Field Description:
COBOL Error Example
PICTURE Tolerance Value
X(12) 5.0% “01CA79300000”
Coding Requirements:
8-fill field for premium payments (TYPE-OF-SERVICE = 20, 21, 22)
If Value is unknown, fill with "999999999999".
Generally, the provider taxonomy requires 10 bytes. However, two additional bytes have been provided
for future expansion.
Error Condition Resulting Error Code
THE FOLLOWING EDITS WILL NOT COUNT AGAINST THE ERROR TOLERANCE
FOR ADJUSTMENT RECORDS (ADJUSTMENT INDICATOR=1, 2, 3, 4, OR 5)
1. Value = "999999999999".......................................................................................................................301
2. Value is “Space Filled”..........................................................................................................................303
3. Value is 0-filled......................................................................................................................................304
4. Relational Field in Error........................................................................................................................999
5. Value = “888888888888" AND TYPE-OF-SERVICE <> {20, 21, 22}...............................................305
6. Value <> “888888888888" AND TYPE-OF-SERVICE = {20, 21, 22}...............................................306
7. Value = PROVIDER-ID-NUMBER-BILLING AND TYPE-OF-SERVICE = {11,12}......................529

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