CIP.002.023

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

CROSSOVER-INDICATOR

Data Element

DE Number

CIP023

System DE Number

CIP.002.023

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	An indicator specifying whether the claim is a crossover claim where a portion is paid by Medicare.
Size	X(1)
FLF Start Position	154
FLF Stop Position	154
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Crossover Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0, 1] or not populated 4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service) 5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported 6. Conditional

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-336	If the crossover indicator is populated on a non-denied claim from an IP file, then the crossover indicator reported must be found in the list of valid values.
RULE-7039	If a claim is a non-denied claim from an IP file, then the crossover indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-7412	If a claim in a non-denied, original or adjustment FFS or Encounter crossover claim from an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01','02', '04', '08'
RULE-7744	If a claim in a non-denied, original or adjustment Encounter crossover claimfrom an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01','02', '04', '08'
RULE-7981	If a claim in a non-denied, original or adjustment FFS crossover claim from an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'

Measure ID	Measure Name
ALL-6-001-1	% of claim headers that are crossover claims
ALL-9-001-1	% of claim headers that are crossover claims
FFS-S-017-1	% of total original claim headers that are crossover claims
FFS-S-020-12	% of total original claim headers that are crossover claims
MCR-4-001-13	Total # of crossover claim headers
MCR-S-020-1	% of total original claim headers that are crossover claims
MCR-S-023-12	% of total original claim headers that are crossover claims
MIS-2-012-12	% missing: CROSSOVER-INDICATOR (CIP00002)
MIS-21-013-13	% missing: CROSSOVER-INDICATOR (CIP00002)
MIS-79-013-13	% missing: CROSSOVER-INDICATOR (CIP00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT023	CLT.002.023	CROSSOVER-INDICATOR	CLT00002	CLAIM-HEADER-RECORD-LT
COT023	COT.002.023	CROSSOVER-INDICATOR	COT00002	CLAIM-HEADER-RECORD-OT
CRX023	CRX.002.023	CROSSOVER-INDICATOR	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	CIP.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. Value must be 1 character6. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.7. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported6. Conditional