Managed Care Plan Reimbursement Type Category Code

SAS Name
Managed Care Plan Reimbursement Type Category Code

Managed Care Plan Reimbursement Type Category Code — Aggregated categories based on the managed care plan reimbursement type code values (MC_PLAN_REIMBRSMT_TYPE_CD); most recent in the calendar year

Comments

The value was chosen using the last-best method for values from the monthly TAF (calendar year).

This field is derived from the MC_PLAN_REIMBRSMT_TYPE_CD using the following logic:

1 if MC_PLAN_REIMBRSMT_TYPE_CD equals “01”, “02”, “03”

2 if MC_PLAN_REIMBRSMT_TYPE_CD equals “04”

3 if MC_PLAN_REIMBRSMT_TYPE_CD equals “05”

4 if MC_PLAN_REIMBRSMT_TYPE_CD equals “06,” “08”

5 if MC_PLAN_REIMBRSMT_TYPE_CD equals “07”

Source: T-MSIS Annual Managed Care Plan TAF

Code Code value
1 Risk-based capitation
2 Non-risk capitation
3 Fee-for-service (FFS)
4 Primary care case management (PCCM)
5 Other
Null/missing Unknown/Missing