When viewing the monthly Medicaid Status file, if the MMR and the Medicaid status files display different Medicaid status, which file's data should take precedence?


Prior to final reconciliation for a payment year, the Medicaid status on the Monthly Membership Report (MMR) reflects the rolling anchor month’s status used in prospective payment, while the monthly Medicaid Status file identifies the most recent monthly Medicaid status information CMS has for the beneficiary. MAOs and other entities can also use the Medicare Advantage Prescription Drug User Interface (MARx UI) to identify a beneficiary’s most recent dual status. At final reconciliation, CMS uses the most recent information about a beneficiary’s dual status from each payment month and makes payments adjustments if the dual status is updated.

Source: User Group Webinar on April 19, 2018

Last Updated: 04/19/2018