TN 17 (08-17)
HI 00815.060 Centers for Medicare & Medicaid Services (CMS) State Buy-In Data Processing
A. Background for the State Buy-In program
We accomplish the month-to-month operation of the State Buy-in program through automated data exchange among the States, CMS, and Social Security Administration (SSA).
One basic concept in the design of the Third Party System (TPS) is the agency that makes the Medicaid eligibility determination for a beneficiary, is responsible for accreting and deleting the beneficiary to the Buy-in Program.
See Related Instructions
B. Automated exchange of data
CMS implemented the redesign of the Third Party System (TPS) in September 2003. We accomplish the operation of the State Buy-in program through an automated exchange of data among the States, CMS, and SSA.
1. Daily file processing
A primary feature of the redesigned TPS system is the opportunity for daily file processing.
A State may submit
input files at any time for TPS processing.
unlimited Part A and Part B input file per month.
files that we process in the order they are received, in the next scheduled TPS daily update run.
elect to continue to receive only the Part A and Part B monthly billing files at the end of each month, or
elect to also receive Part A and Part B reply files every business day.
2. Daily data exchange
The data exchange between CMS and SSA occurs on a daily basis.
CMS maintains records of beneficiaries who are, or were, on Buy-in within the Enrollment Database (EDB).
TPS updates the EDB daily with accretion, deletion, and change records coming in from State agencies and from SSA.
The data that CMS receives from SSA comes from the Master Beneficiary Record (MBR) and the Supplementary Security Record (SSR).
For every State the TPS creates Part A and Part B billing files based