Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 25, 2020
CMS Guidance: Reporting Eligible Identifiers in T-MSIS
Guidance History
Date | Description of Change |
---|---|
6/3/2020 | Original guidance issued |
9/25/2020 | Language added to clarify the ELG-IDENTIFIERS-ELG00022 Segment Example1 - Reporting Medicaid Card ID of a Medicaid and CHIP beneficiary to T-MSIS |
Background and Brief Issue Description
The data captured in T-MSIS is valuable for researchers who are building and evaluating innovation models. It provides researchers with historical data on model participants, as well as control data to compare against. As researchers began to use the T-MSIS data, several shortcomings were noted. It can be difficult to link data collected independently of T-MSIS with data residing in T-MSIS for many states. A major factor causing this challenge is that some states do not use a Medicaid beneficiary’s Medicaid Card ID as their MSIS-IDENTIFICATION-NUM in T-MSIS. Beneficiary identifiers in T-MSIS (i.e., the MSIS-IDENTIFICATION-NUMs) are also subject to change.
Currently in T-MSIS, states report four types of eligible identifiers: (1) Medicare Health Insurance Claim Numbers (HICNs); (2) Medicare Beneficiary Identifiers (MBIs); (3) Social Security Numbers (SSNs); and (4) MSIS Identification Numbers (MSIS IDs). Some states do not use a beneficiary’s Medicaid Card ID as the MSIS-IDENTIFICATION-NUM on their T-MSIS submissions therefore some researchers need a dedicated field for capturing Medicaid Card ID to be able to track T-MSIS data back to its various sources. CMS is introducing a new record segment (“ELG-IDENTIFIERS-ELG00022”) in the T-MSIS Eligible file to enable linking and managing effectively of the various identifiers associated with a beneficiary over the course of his/her involvement with the Medicaid/CHIP programs.
Some uses for this new segment are:
- States will use this segment to report each Medicaid and CHIP beneficiary’s Medicaid Card ID and the active time period for the corresponding identifiers.
- States will also use this segment to report changes in a beneficiary’s MSIS Identification Number due to disenrollment/re-enrollment, record merges, large system enhancements, and transition from CHIP enrollment to Medicaid enrollment or from Medicaid enrollment to CHIP enrollment.
Eligible File New Segment – ELG-IDENTIFIERS-ELG00022
The new record segment, ELG-IDENTIFIERS (ELG00022), captures the identifiers assigned to a beneficiary by various entities.
This segment is critical for linking across data sources over time. The new ELG-IDENTIFIER-TYPE (ELG261) data element is used to identify whether the segment is reporting a beneficiary’s state-assigned Medicaid Card ID, Old MSIS Identification Number. The state should provide the appropriate ELG-IDENTIFIER-TYPE code and supply the associated ID in the ELG-IDENTIFIER data element. Table 1 below shows the layout for the ELG-IDENTIFIERS-ELG00022 segment.
DE_NO | DATA_ELEMENT_NAME | SIZE | START POSITION | STOP POSITION | STOP POSITION |
---|---|---|---|---|---|
ELG257 | RECORD-ID | X(8) | 1 | 8 | An identifier assigned to each record segment. The first 3 characters identify the subject area. The last 5 bytes are an integer with leading zeros. For example, the RECORD-ID for the PRIMARY DEMOGRAPHICS – ELIGIBILITY record segment is ELG00002. |
ELG258 | SUBMITTING-STATE | X(2) | 9 | 10 | The ANSI numeric state code for the U.S. state, territory, or the District of Columbia that has submitted the data. |
ELG259 | RECORD-NUMBER | 9(11) | 11 | 21 | 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-ID, uniquely identifies a single record within the submission file. |
ELG260 | MSIS-IDENTIFICATION-NUM | X(20) | 22 | 41 | A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual and any claims submitted to the system. |
ELG261 | ELG-IDENTIFIER-TYPE | X(1) | 42 | 42 | A code to identify the kind of eligible identifier that is captured in the ELG-IDENTIFIER data element. |
ELG262 | ELG-IDENTIFIER-ISSUING-ENTITY-ID | X(18) | 43 | 60 | This data element is reserved for future use. |
ELG263 | ELG-IDENTIFIER-EFF-DATE | 9(8) | 61 | 68 | The first day of the time span during which the values in the ELG-IDENTIFIERS-ELG00022 record segment are in effect (i.e., the values accurately reflect reality as it is understood to be at the time the record is created). This date field is necessary when defining a unique row in a database table. |
ELG264 | ELG-IDENTIFIER-END-DATE | 9(8) | 69 | 76 | The last day of the time span during which the values in the ELG-IDENTIFIERS-ELG00022 record segment are in effect (i.e., the values accurately reflect reality as it is understood to be at the time the record is created). |
ELG265 | ELG-IDENTIFIER | X(20) | 77 | 96 | A data element to capture the various identifiers assigned to Medicaid and CHIP beneficiary by various entities. The specific type of identifier is shown in the corresponding value in the ELG-IDENTIFIER-TYPE data element. |
ELG266 | REASON-FOR-CHANGE | X(10) | 97 | 106 | A code to identify the reason for changing the MSIS- IDENTIFICATION-NUM of a beneficiary and only required for ELG-IDENTIFIER-TYPE '2-Old MSIS Identification Number'. For example, If MSIS- IDENTIFICATION-NUM of a beneficiary is being changed due to 'Merge with other MSIS ID' or 'Unmerge'. |
ELG267 | STATE-NOTATION | X(500) | 107 | 606 | A free text field for the submitting state to enter whatever information it chooses. |
ELG268 | FILLER | X(394) | 607 | 1000 |
Record Segments Keys
The following data elements are the record segment keys of ELG-IDENTIFIERS-ELG00022 segment
- SUBMITTING-STATE
- MSIS-IDENTIFICATION_NUM
- ELG-IDENTIFIER-TYPE
- ELG-IDENTIFIER
- ELG-IDENTIFIER-EFF-DATE
As shown in Figure 1, the ELG-IDENTIFIERS-ELG00022 segment is a child to the PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 segment and links to that segment by the required data elements SUBMITTING-STATE, MSIS-IDENTIFICATION-NUM. Each record in the ELG-IDENTIFIERS-ELG00022 segment must have corresponding records in the PRIMARY-DEMOGRAPHICS-ELIGIBILITY-ELG00002 segments that contain effective and end-date ranges that span the effective and end-date range reported in the ELG-IDENTIFIERS-ELG00022 segment.
Definitions for the Data Elements in the ELG-IDENTIFIERS-ELG00022 Segment
Critical fields that can be used to assess the validity of the ELG-IDENTIFIERS-ELG00022 segment information include ELG-IDENTIFIER-EFF-DATE (ELG263), ELG-IDENTIFIER-END-DATE (ELG264), ELG-IDENTIFIER-TYPE (ELG261), ELG-IDENTIFIER (ELG265) and REASON-FOR-CHANGE(ELG266). This section reviews these fields.
ELG-IDENTIFIER-EFF-DATE and ELG-IDENTIFIER-END-DATE
ELG-IDENTIFIER-EFF-DATE is a required field and represents the first day of the time span during which the values in all data elements in the ELG-IDENTIFIERS-ELG00022 segment are in effect. ELG-IDENTIFIER-EFF-DATE must be a valid date and populated in CCYYMMDD format.
ELG-IDENTIFIER-END-DATE represents the last day of the time span during which the values of the data elements in the ELG-IDENTIFIERS-ELG00022 segment are in effect.
ELG-IDENTIFIER-TYPE
ELG-IDENTIFIER-TYPE is a code that identifies the kind of identifier captured in the ELG-IDENTIFIER data element. For every unique combination of SUBMITTING-STATE and MSIS-IDENTIFICATION-NUM, states should provide to T-MSIS the identifiers associated with the beneficiary for ELG-IDENTIFIER-TYPE 1 always and ELG-IDENTIFIER-TYPE 2 whenever it is applicable to the beneficiary. If a beneficiary has multiple identifiers for the same ELG-IDENTIFIER-TYPE, then a separate record segment should be reported for each identifier. For example, if a beneficiary has two old MSIS Identification Numbers, then a separate record segment for each of the old MSIS Identification Numbers should be reported with an ELG-IDENTIFIER-TYPE of “2” and their respective effective and end dates. Table 2 below shows the valid values and associated descriptions.
Code | Identifier | Description |
---|---|---|
1 | Medicaid Card ID | The Medicaid Card ID is a state-assigned unique identifier that states should report with all Medicaid and CHIP beneficiaries. This should be the identifier that is used in the state’s Medicaid Management Information System (MMIS). The beneficiary’s Medicaid Card ID should be reported even if the Medicaid Card ID is the same as the Medicaid Identification Number used in T-MSIS. |
2 | Old MSIS Identification Number | The Old MSIS Identification Number identifier type is a value that states should report for all Medicaid and CHIP beneficiaries when their MSIS Identification Number is changed due to record merges, unmerges, large system enhancements, and transition between CHIP and Medicaid enrollment. |
REASON-FOR-CHANGE
REASON-FOR-CHANGE is a code that identifies the reason for changing the MSIS-IDENTIFICATION-NUM of a beneficiary. This is applicable for ELG-IDENTIFIER-TYPE = 2, (Old MSIS Identification Number). For example, MSIS-IDENTIFICATION-NUM of a beneficiary is being changed due to 'Merge with other MSIS ID' or 'Unmerge'. Table 3 below shows the valid values and associated descriptions.
Code | Description |
---|---|
MERGE | Merge Beneficiaries - if the state was reporting multiple Medicaid Identification Numbers for a single beneficiary and merges them under a single MSIS Identification Number. |
UNMERGE | Unmerge Beneficiaries - if the state unmerges a beneficiary from another beneficiary. For example, if a newborn child is originally reported with the mother’s MSIS Identification Number and is then assigned a different MSIS Identification Number. |
LSE | Large System Enhancement - if the state assigns a new MSIS Identification Number to any beneficiaries during large system enhancement in state MMIS. |
TCAM | Transition between CHIP and Medicaid - if the Medicaid and Separate CHIP programs use different Identifier Number schemas and beneficiaries are transferred from CHIP to Medicaid or from Medicaid to CHIP and a new MSIS Identification Number is issued. |
CMS Guidance
States should work with their eligibility determination system to ensure that they implement the following best practices when assigning identifiers to beneficiaries during enrollment.
- The ELG-IDENTIFIERS-ELG00022 data segment is being populated correctly.
- Using the external resources that are available, the state should validate beneficiary’s identifiers during the enrollment process. Table 2 above shows available data sources by ELG-IDENTIFIER-TYPE. When preparing T-MSIS files, states should determine whether the identifiers comply with the stated validation criteria. If they do not, states should coordinate with the MMIS vendor to ensure that the data are being properly captured in the source systems.
-
States should adhere to the ELG-IDENTIFIERS-ELG00022 coding requirements as stated below and in Table 4.
Coding Requirements
SEGMENT /DE_NO | DATA_ELEMENT_NAME | CODING REQUIREMENTS |
---|---|---|
ELG-IDENTIFIERS-SEG00022 | N/A | Required data elements on the ELG-IDENTIFIERS-ELG00022 segment—SUBMITTING-STATE, MSIS-IDENTFICATION-NUM, ELG-IDENTIFIER, ELG-IDENTIFIER-TYPE, ELG-IDENTIFIER-EFF-DATE, and ELG-IDENTIFIER-END-DATE. These data elements are necessary for the ELG-IDENTIFIERS-ELG00022 segment to be meaningful and useful. |
ELG-IDENTIFIERS-SEG00022 | N/A |
Table 2. above Validating Eligible Identifiers - ELG-IDENTIFIER-TYPE Validation procedures to conform with MMIS. ELG-IDENTIFIER-TYPE should be properly formatted.
|
ELG-IDENTIFIERS-SEG00022 | N/A |
For every ELG-IDENTIFIERS-ELG00022 record segment,
|
ELG-IDENTIFIERS-SEG00022 | N/A |
For every ELG-IDENTIFIERS-ELG00022 record segment, the state should provide the identifiers for ELG-IDENTIFIER-TYPE 1 and 2. Reporting ELG-IDENTIFIER-TYPE 1 is always required and ELG-IDENTIFIER-TYPE 2 is conditionally required.
|
ELG257 | RECORD-ID |
|
ELG258 | SUBMITTING-STATE |
|
ELG259 | RECORD-NUMBER |
|
ELG260 | MSIS-IDENTIFICATION-NUM |
|
ELG261 | ELG-IDENTIFIER-TYPE |
|
ELG262 | ELG-IDENTIFIER-ISSUING-ENTITY-ID | This data element is reserved for future use. |
ELG263 | ELG-IDENTIFIER-EFF-DATE |
|
ELG264 | ELG-IDENTIFIER-END-DATE |
|
ELG265 | ELG-IDENTIFIER |
|
ELG266 | REASON-FOR-CHANGE |
|
ELG267 | STATE-NOTATION |
|
ELG268 | FILLER |
|
ELG-IDENTIFIERS-ELG00022 Segment Examples
Example1: Reporting Medicaid Card ID of a Medicaid and CHIP beneficiary to T-MSIS
Regardless of whether or not a state uses the same value as both the Medicaid Card ID and the MSIS Identification number, it still must generate an ELG00022 segment that identifies the value as a Medicaid Card ID. Table 5 shows an example where the values for both the Medicaid Card ID and MSIS Identification Number are the same, while Table 6 shows an example where the values are different.
RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE |
---|---|---|---|---|---|---|---|---|---|
ELG00022 | YY | 2001 | MCID456 | 1 (Medicaid Card ID) | 01/01/2017 | 12/31/9999 | MCID456 |
RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE |
---|---|---|---|---|---|---|---|---|---|
ELG00022 | XX | 1001 | M001 | 1 (Medicaid Card ID) | 01/01/2019 | 12/31/9999 | MCID123 |
Example2: Reporting Multiple MSIS IDs of a Medicaid and CHIP beneficiary to T-MSIS when state changes MSIS ID of a beneficiary
A state has reported two beneficiaries with MSIS ID M001 and M003 in the Eligible file. Later, the state identifies that those two beneficiaries are the same person therefore they want to merge the two MSIS IDs into one record. The most recent MSIS ID is M003 and the old MSIS ID is M001. The state should report that information in the new segment as follows:
RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE |
---|---|---|---|---|---|---|---|---|---|
ELG00022 | XX | 1001 | M001 | 1 (Medicaid Card ID) | 01/01/2019 | 12/31/9999 | MCID123 | ||
ELG00022 | XX | 1002 | M003 | 1 (Medicaid Card ID) | 01/01/2019 | 12/31/9999 | MCID123 | ||
ELG00022 | XX | 1003 | M003 | 2-Old MSIS Identification Number | 01/01/2019 | 12/31/9999 | M001 | MERGE |
Example3: Reporting correct MSIS ID of a Medicaid and CHIP beneficiary to T-MSIS when state changes MSIS ID of a beneficiary.
A state has reported a beneficiary with MSIS ID M002 in the Eligible file. Later, the state identifies that they were reporting two beneficiaries’ information under the same MSIS ID (e.g., twin baby information) and then unmerged those two individuals. A new Medicaid Card ID and MSIS ID (M004) is assigned to twin baby B and the existing MSIS ID M002 will be used by twin baby A. The state should report the information in the new segment as follows:
RECORD-ID | SUBMITTING-STATE | RECORD-NUMBER | MSIS-IDENTIFICATION-NUM | ELG-IDENTIFIER-TYPE | ELG-IDENTIFIER-ISSUING-ENTITY-ID | ELG-IDENTIFIER-EFF-DATE | ELG-IDENTIFIER-END-DATE | ELG-IDENTIFIER | REASON-FOR-CHANGE |
---|---|---|---|---|---|---|---|---|---|
ELG00022 | XX | 1001 | M002 | 1 (Medicaid Card ID) | 01/01/2019 | 12/31/9999 | MCID-456 | ||
ELG00022 | XX | 1002 | M004 | 1 (Medicaid Card ID) | 01/01/2019 | 12/31/9999 | MCID-789 | ||
ELG00022 | XX | 1003 | M004 | 2-Old MSIS Identification Number | 01/01/2019 | 12/31/9999 | M002 | UNMERGE |
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