Service Tracking Claims in Medicaid T-MSIS Analytic File (TAF) Research Identifiable Files (RIF)

Purpose

Along with claims at the individual beneficiary (single enrollee/provider/visit) level, state Medicaid programs also submit service tracking claims which record lump sum payments to providers or managed care plans. These data are a new enhancement to the TAF RIF, and researchers have the option of requesting these claims along with TAF claims data. This article describes service tracking claims in TAF RIF data and considerations for researchers.

Current Version Date:
09/03/2021

State Medicaid agencies report beneficiary and provider enrollment and eligibility, utilization and claims, and expenditure data for Medicaid and Children’s Health Insurance Program (CHIP) using the Transformed Medicaid Statistical Information system (T-MSIS). Some expenditures include lump sum payments to managed care plans or providers for services used by Medicaid enrollees; these are captured as service tracking claims in T-MSIS. Service tracking claims are created in the same format as TAF RIF claims data and may be submitted by states within the T-MSIS data for all four claim types (inpatient, long term care, pharmacy, and other services).  Service tracking claims have specific T-MSIS claim type values:  CLM_TYPE_CD=4, D, or X.   In some cases, service tracking claims have a state-assigned MSIS_ID (the unique T-MSIS identifier for a beneficiary) that begins with an “&”, rather than a service tracking claim type code.   Finally, the TAF RIF classify a few other anomalous types of claim records as “non-person” claims: 

  • Claim records missing a CLM_TYPE_CD value
  • Claim records missing an MSIS_ID value
Service tracking claims are identified by a new TAF RIF variable in all four claim file types called PRSN_CLM_IND. Valid values for this new variable are:
  • 1 = Traditional beneficiary claim and not a service tracking record
  • 0 = service tracking record, &MSIS_ID, null MSIS_ID, or null CLM_TYPE_CD

A variety of service payments are represented by service tracking claims.  States may use lump sum payments to pay home and community-based service providers, non-emergency medical transportation providers and value-based payment incentives for plans and providers. Whether and how often service tracking claims will be reported for a state will depend on each state’s policies and use of lump sum payments. Researchers may be interested in tracking and/or quantifying the level of these payments by state.

Service tracking claims were not expected to include capitation payments to managed care organizations, as these should be submitted as a different record type; however, some states have reported capitated payments using the service tracking record type.  Service tracking claims will need to be combined with other claims if researchers are interested in quantifying these payments.  Researchers may also find in the TAF RIF data what appear to be traditional beneficiary claims classified as service tracking claims by the states.  As always, the quality of state-submitted Medicaid data can vary widely from state to state.

Thus, beginning with 2017 and 2018 TAF RIF Release 2, service tracking claims are available to researchers.  If requested, service tracking claims are included with the appropriate claims file and contain information in all segments of the claim (header, line, occurrence) (see Table 1).

Claims File Type (Header Level) 2017 2018
Inpatient 15,700 23,000
Long Term Care (LT) 24,900 653,400
Other Services (OT) 13,155,200 13,255,900
Pharmacy (RX) 816,300 494,100
Table 1. Number of service tracking claims file type and year
*rounded to the nearest 100

Use of service tracking claims varies by state as states vary in administering the Medicaid program.  For example, in 2017 41% of service tracking claims in the OT header file come from Minnesota.

Service tracking claims generally cannot be linked to individual Medicaid enrollees; however, presence of BENE_ID linked claims also varies by state.  Service dates are available on service tracking claims, and many claims span calendar months (e.g., January 1-January 31). Because service tracking claims account for such a variety of services and payments, the population of data elements varies.

Key information on the service tracking claims includes:

  • State
  • Provider (NPI, service tracking billing provider)
  • Waiver ID
  • Date (beginning and ending of service)
  • Payment (Medicaid paid amount, service tracking payment amount)
  • Line procedure codes

Researchers will want to consider whether it’s necessary to include service tracking claims in the data requested for their research project because the volume of these claims is large, especially in the Other Services claim file type (Table 1).  In general, service tracking claims are not useful for understanding an individual enrollee’s use of services; however, service tracking claims may be useful in understanding state expenditures for specific programs. If researchers are considering requesting service tracking claims, it will be necessary to learn more about policies in the states of interest for their research project to understand whether these claims are likely to be present.

The DQ Atlas provides more specific information on non-claim record types by state and file year and release number. The newly available service tracking claims overlap the ‘Service Tracking Claims’ and ‘Non-Program (Other) Claims’ topics (see ‘Background and Methods’ on each page for details on record inclusion and quality measure definitions).

 

For more information on service tracking claims, see:

DQ Atlas (Topic: Non-Claim Records)

TAF Technical Documentation