Line Medicaid Paid Amount

Not available for managed care claims. CMS has required redaction of some payment fields for managed care claims due to the proprietary and confidential nature of this information. The managed care records are identified as those where the claim type code (CLM_TYPE_CD) = 3, C or W.

• If CLM_TYPE_CD = (1, A, U) then the amount paid by the state or their fiscal agent to a provider is found in the Line Medicaid Paid Amount (LINE_MDCD_PD_AMT) and the Total Amount Paid By Medicaid (MDCD_PD_AMT, found on the header claim) variables.

• If CLM_TYPE_CD = (2, B, V) then the amount paid by the state or their fiscal agent to a managed care plan is found in the MDCD_PD_AMT and TOT_MDCD_PD_AMT variables.

• If CLM_TYPE_CD = (5, E, Y) then the amount paid by the state or their fiscal agent to a provider or managed care plan is found in the MDCD_PD_AMT and TOT_MDCD_PD_AMT variables.

• If CLM_TYPE_CD = (3, C, W) then the amount paid by a managed care plan to a provider is found in the MDCD_PD_AMT and TOT_MDCD_PD_AMT variables. The data for some data elements that capture dollar amounts on managed care encounters, including the values reported by states in the MDCD_PD_AMT and TOT_MDCD_PD_AMT variables, are suppressed for most data users because of the proprietary nature of that information to a managed care plan’s business. Data users who do have access to those dollar amounts should avoid double-counting the amount paid by the state or their fiscal agent to managed care plans AND the amount paid by the managed care plan to providers.

SOURCE: T-MSIS Analytic File (TAF) Claims