CIP.002.025

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

1115A-DEMONSTRATION-IND

Data Element

DE Number

CIP025

System DE Number

CIP.002.025

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	In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115A demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115A demonstration.
Size	X(1)
FLF Start Position	157
FLF Stop Position	157
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 1 character 2. Value must be in [0, 1] or not populated 3. Value must be in 1115A Demonstration Indicator List (VVL) 4. Conditional 5. When value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated

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

RULE ID	RULE Definition
RULE-338	If the 1115A demonstration indicator is populated on a non-denied claim from an IP file, then the 1115A demonstration indicator reported must be found in the list of valid values.
RULE-339	If the 1115A demonstration information segment indicates an individual does not participate in an 1115A demonstration, then the non-denied IP claim must not have a value populated for the 1115A demonstration indicator.
RULE-6956	If a claim is a non-denied claim from an IP file, then the 1115A demonstration indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-7550	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an IP file, and the admission date is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT024	CLT.002.024	1115A-DEMONSTRATION-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT024	COT.002.024	1115A-DEMONSTRATION-IND	COT00002	CLAIM-HEADER-RECORD-OT
CRX024	CRX.002.024	1115A-DEMONSTRATION-IND	CRX00002	CLAIM-HEADER-RECORD-RX
ELG233	ELG.018.233	1115A-DEMONSTRATION-IND	ELG00018	1115A-DEMONSTRATION-INFORMATION

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/01/2023	3.11.0	CIP.002.025	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Value must be 1 character5. Conditional6. When value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional5. When value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated
01/07/2022	3.0.0	CIP025	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CIP025\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|CIP025\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.\|
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP025\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP025\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated