Updated research request forms and data security approval requirement effective 4/24/23
SAS Name
RCPNT_IND
CODE INDICATING IF AND HOW THE ELIGIBLE RECEIVED A MEDICAID SERVICE DURING THE CALENDAR YEAR AND WHETHER THOSE SERVICES WERE RECEIVED UNDER A FEE-FOR-SERVICE OR PRE-PAID PLAN.
| Code | Code value |
|---|---|
| 0 | THE ELIGIBLE PERSON DID NOT RECEIVE ANY SERVICES |
| 1 | THE ELIGIBLE PERSON HAD ONLY FEE-FOR-SERVICE CLAIMS (INCLUDING CLAIMS WITH $0 PAID AMOUNTS) FOR TYPES OF SERVICE = 1-19, 23-54 AND 99. |
| 2 | THE ELIGIBLE PERSON HAD ONLY PREMIUM PAYMENT CLAIMS (PRE-PAID PLAN) FOR TYPES OF SERVICE = 20-23. |
| 3 | THE ELIGIBLE PERSON HAD ONLY ENCOUNTER RECORDS (PRE-PAID PLAN) FOR TYPES OF SERVICE = 1-19, 24-54, 99. |
| 4 | THE ELIGIBLE PERSON HAD FEE-FOR-SERVICE AND PREMIUM PAYMENT CLAIMS, BUT NO ENCOUNTER RECORDS |
| 5 | THE ELIGIBLE PERSON HAD PREMIUM PAYMENT CLAIMS AND ENCOUNTER RECORDS, BUT NO FEE-F0R- SERVICE CLAIMS |
| 6 | THE ELIGIBLE PERSON HAD FEE-FOR-SERVICE CLAIMS AND ENCOUNTER RECORDS, BUT NO PREMIUM PAYMENT CLAIMS |
| 7 | THE ELIGIBLE PERSON HAD FEE-FOR-SERVICE CLAIMS, PREMIUM PAYMENT CLAIMS AND ENCOUNTER RECORDS |
| 8 | S-CHIP ENROLLMENT MONTHS WERE FOUND BUT NO MEDICAID ENROLLMENT MONTHS WERE FOUND |
| 9 | NEITHER S-CHIP ENROLLMENT MONTHS NOR MEDICAID ENROLLMENT MONTHS WERE FOUND |
USER NOTE: SEE 'TYPE OF SERVICE RECIPIENT INDICATOR' WHICH IS SIMILAR TO 'RECIPIENT INDICATOR'. THE FIELD 'TYPE OF SERVICE RECIPIENT INDICATOR' IS DIFFERENT. IT IS CREATED BY TYPE OF SERVICE, FOR EACH OF THE LISTED TYPES OF SERVICES AND IT DOES NOT INCLUDE CODE VALUES FOR PREMIUM PAYMENTS.
USER NOTE: WHEN SOMEONE HAS CLAIMS BUT NO ELIGIBILITY INFORMATION, THIS DATA ELEMENT IS 9-FILLED.
USER NOTE: MSIS FILES CONTAIN RECORDS WITH MEDICAID PAYMENT AMOUNT = $0 IF THE SERVICE WAS COVERED, BUT FULL PAYMENT WAS MADE BY ANOTHER PAYER (E.G. THIRD PARTY LIABILITY). THERE ARE ALSO INSTANCES OF CLAIMS WITH MEDICAID PAID AMOUNT < $0. IN MAX ALL NON-ENCOUNTER CLAIMS WITH MEDICAID PAYMENT AMOUNT LESS THAN OR EQUAL TO ZERO ARE DELETED. THE RECIPIENT INDICATOR IS SET TO 1 THROUGH 7 IF THE BENEFICIARY HAS AT LEAST ONE CLAIM OF ANY TYPE.
NOTE: IN MAX 2006, VALUES 8 AND 9 WERE ADDED TO THE FILE.NOTE: IN MAX 2008, A CLARIFICATION NOTE WAS ADDED ABOUT THE VALUE ASSIGNED WHEN SOMEONE HAS CLAIMS BUT NO ELIGIBILITY INFORMATION.NOTE: IN MAX 2010, USER NOTE WAS UPDATED TO CLARIFY THAT IN MAX ALL NON-ENCOUNTER CLAIMS WITH MEDICAID PAYMENT AMOUNT LESS THAN OR EQUALTO ZERO ARE DELETED.
SOURCE: CREATED USING MSIS CLAIMS FILES.