Medicaid Statistical Information System
The Master Beneficiary Record (MBR) master file contains the data that generates Social Security benefit checks under the Social Security Administration (SSA) Old Age, Survivors, and Disability Insurance (OASDI) program. The OASDI program provides income support to individuals who have made the transition from work to retirement, who are disabled, or the survivor of a spouse or parent who was entitled to benefits. An MBR record is created whenever an individual applies for benefits. However not everyone who applies receives benefits and the MBR record will reflect the final decision about the initial claim, including denials. There are three main multiple occurrence entry fields in the MBR: The Primary Insurance History (PIH) entries, The Disability Data (DIB) entries, and The Historical Payment Data (HIST) entries. As the values of the fields change, new entries are added to the MBR account record. The Primary Insurance History (PIH) entry is part of the variable account data and records data about the Primary Insurance Amount (PIA) for this account. The Disability Data (DIB) entry is the part of the variable benefits data that applies to disability benefits for an individual. The History Payment Data (HIST) entry records the actual payments made on this account over time. As the values of the fields change new entries are added to the MBR account record. Multiple occurrences of entries can be used to track events of importance to the beneficiaries.
The primary data sources for Medicaid statistical data are the MSIS and CMS-64 reports. MSIS is the basic source of state-reported eligibility and claims data on the Medicaid population, and their characteristics, utilization, and payments. Beginning in FY 1999, as a result of legislation enacted from the Balanced Budget Act of 1997, states were required to submit individual eligibility and claims data tapes to CMS quarterly through MSIS. Prior to FY 1999, states were required to submit an annual HCFA-2082 report, designed to collect aggregated statistical data on eligibles, recipients, services, and expenditures during a federal fiscal year (October 1 through September 30), or, at state option, to submit eligibility data and claims through MSIS. The claims data reflect bills adjudicated or processed during the year, rather than services used during the year. CMS-64 is a product of the financial budget and grant system. CMS-64 is a statement of expenditures for the Medicaid program that states submit to CMS 30 days after each quarter. The report is an accounting statement of actual expenditures made by the states for which they are entitled to receive federal reimbursement under Title XIX for that quarter. The amount claimed on CMS-64 is a summary of expenditures derived from source documents such as invoices, cost reports, and eligibility records. CMS-64 shows the disposition of Medicaid grant funds for the quarter being reported and for previous years, the recoupments made or refunds received, and income earned on grant funds. The data on CMS-64 are used to reconcile the monetary advance made on the basis of states' funding estimates filed prior to the beginning of the quarter on CMS-37. As such, CMS-64 is the primary source for ma king adjustments for any identified overpayments and underpayments to the states. Also incorporated into this process are disallowance actions forwarded from other federal financial adjustments. Finally, CMS-64 provides information that forms the basis for a series of Medicaid financial reports and budget analyses. Also included are third-party liability (TPL) collections tables. TPL refers to the legal obligation of certain health care sources to pay the medical claims of Medicaid recipients before Medicaid pays these claims. Medicaid pays only after the TPL sources have met their legal obligation to pay.