CMS File Exchange

CMS provides state and territory Medicaid agencies with multiple data exchanges and query files to support coordination and program operations for people who are dually eligible for Medicare and Medicaid, also known as dually eligible beneficiaries.

These data exchanges and query files include:

For more information on these three files, please see the Overview of MMA, Buy-in, and TBQ Files document, including the similarities and differences among the files.

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Download Overview File

File Layouts and Technical Information

Additional information on file layouts and technical content can be found on the Data Dictionary and File Layouts page.

Data Sharing Agreements

More information about Data Sharing Agreements, as well as the IEA and accompanying DRA form, can be found on the Data Sharing Agreements page

State buy-in of Medicare Premiums

Medicaid programs help pay for Medicare premiums and, in some cases, Medicare cost-sharing, for people with disabilities and certain low-income adults over age 65. All states, Washington D.C., and some U.S. territories have entered into Part B state buy-in agreements with CMS to pay Part B premiums for those receiving Supplemental Security Income (SSI) and other cash assistance, those enrolled in the Medicare Savings Programs (MSPs), and certain other Medicaid coverage groups. Most states and territories have expanded their buy-in agreements to include the payment of Part A premiums for Qualified Medicare Beneficiaries (QMBs).

State buy-in agreements simplify the process for states and participating territories to assist low-income residents with Medicare expenses. Buy-in agreements permit states and participating territories to directly enroll eligible individuals in Medicare Part A and/or B at any time of the year, without regard for Medicare enrollment periods, and to pay premiums on their behalf, without any late enrollment penalties. For an individual who is determined eligible for Medicare by the U.S. Social Security Administration (SSA), but not enrolled, state buy-in works to enroll the individual in Medicare Part A or Part B and to direct the federal government to bill the state or participating territory for the enrollee’s premiums. For an individual who is already enrolled in Medicare, state buy-in directs the federal government to bill the state or participating territory for the beneficiary’s Medicare premiums and to stop collecting the premiums through deductions from the beneficiary’s monthly Social Security, Railroad Retirement Board (RRB), Office of Personnel Management (OPM) benefits, or through CMS direct billing.

State Buy-in File Data Exchange

State buy-in of Medicare premiums for dually eligible individuals operates through an established data exchange process between the state/territory, CMS, and SSA. The enrolled states and participating territories depend on the successful transmission of accretion, deletion, and change records to effectively update states’/territories’ roles for their MSPs. In turn, CMS will update all records through the CMS Third Party System (TPS) and return a response file to inform the state about the disposition of each record. CMS returns a rejection notification when a state’s/territory’s request fails to update through TPS processing.

Effective April 1, 2022, federal regulations at 42 CFR 423.910 require states to submit and receive State Buy-in Exchange Files on a daily basis.

Webinar: Overview of the Buy-In File Exchange.

To learn more about the Buy-In File Exchange and the benefits of daily submission for your state, watch our recent webinar (left):

To download a copy of the slides, please click on the button below.

Download Slides Here

Resources

The Buy-In Tip Sheet provides best practice and system tips about the CMS Buy-In File. This new resource also answers common questions on the Buy-In File, ranging from testing daily exchange to transaction codes and processing times.

Download Buy-In Tip Sheet

On September 8, 2020, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Manual for State Payment of Medicare Premiums (formerly called “State Buy-in Manual”). The manual updates information and instructions to states on federal policy, operations, and systems concerning the payment of Medicare Parts A and B premiums (or buy-in) for individuals dually eligible for Medicare and Medicaid.

Access Website Here

Interested in the Medicare Modernization Act (MMA) File? Please watch our recent overview webinar and view the accompanying FAQ.

Read the MMA FAQ

Since 2005, Medicaid agencies submit files to CMS to identify all people who are dually enrolled in both Medicare and Medicaid, also known as dually eligible beneficiaries, within the state. This file includes both full-benefit dually eligible individuals and partial-benefit dually eligible individuals (e.g., those who only receive Medicaid help with Medicare premiums or cost-sharing). The file that states submit is called the MMA File (after the Medicare Prescription Drug Improvement and Modernization Act of 2003) or State Phasedown File.

Under the MMA File Exchange, the state sends its MMA File to the CMS Medicare Beneficiary Database (MBD), and for each “MMA Request File” received, the CMS MBD generates and returns an “MMA Response File” for the state.

Effective April 1, 2022, federal regulations at 42 CFR 423.910 require states to submit MMA Files on a daily basis.

MMA Webinars

This webinar provides background on the MMA File, benefits of daily exchange with CMS, and lessons learned transitioning to daily/weekly exchange by Indiana and West Virginia.

This webinar is intended for all state & contractor staff interested in learning more about shifting to daily MMA file submission.

To learn more about daily submission of the MMA file and the benefits to your state, watch our recent webinar (left): Medicare Modernization Act 201.

This webinar is intended for all state & contractor staff interested in learning more about shifting to daily MMA file submission.

Resources

Overview of EDB, MMA, Buy-in and TBQ Files

This overview document focuses on the following four CMS data files to provide the similarities and differences between each:

  1. Enrollment Database (EDB) File
  2. Medicare Prescription Drug, Improvement, and Modernization Act (MMA) File Exchange
  3. Buy-in File Exchange, click the tab at the top of this page
  4. Territory Beneficiary Query (TBQ) File

This document also provides resources and the Centers of Medicare and Medicaid’s contact information. If you are looking for additional information, please be sure to contact us.

Download Overview File
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Home-and Community-Based Services Tip Sheet

This MMA tip sheet provides detail information about the Institutional Status Indicator located in the MMA file. States can use this indicator to identify which full-benefit dually eligible beneficiaries qualify for $0 Part D copayments.

Retroactive Detail Records Tip Sheet

This MMA tip sheet provides background information on retroactive detail records, examples of retroactive changes to MMA file submission, and additional resources for MMA file technical information.

cms-mmco mma

Please see an introduction to the MMA file and MMA submission procedures by visiting the CMS-MMCO MMA page. Click below to visit.

MapD state USER guide

The MAPD State User Guide provides technical instructions for submitting state data as well as the MMA Request & Response file layouts. Click below to visit.

The Territory & State Beneficiary Query (TBQ) File allows Medicaid agencies to query CMS for detailed Medicare beneficiary information. The TBQ File includes beneficiary-level demographics, Medicare Parts A, B, C, and D eligibility and enrollment, and additional entitlement data.

As part of CMS modernization of the Medicare Enrollment & Premium Payment Systems legacy applications, CMS retired the Enrollment Database (EDB) State File Exchange in June 2022. For more information on the CMS modernization efforts, the EDB State File Exchange, and an EDB-to-TBQ Crosswalk file, please see the following resources.

Additional Information

To learn more about the Frequently Asked Questions related to the MMA file, click below.

Download MMA Q&A

To learn more about the files encompassed under the Medicare-Medicaid Data Sharing Program, click below.

Download Data Sharing Overview

To learn more about the MMA, Buy-In, TBQ, and EDB exchange files offered by CMS, click below.

Download CMS Data Overview

Attention

You are leaving the SDRC Public website and are being redirected to the new SDRC Portal website, where you can submit and track data requests, ask questions, and access SDRC resources. You will need a username and password to log into the SDRC Portal. If you are Medicaid agency staff and/or associated downstream user who would like access, please contact the SDRC Support Team for more information.

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