CIP.002.104

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

SOURCE-LOCATION

Data Element

DE Number

CIP104

System DE Number

CIP.002.104

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	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
Size	X(2)
FLF Start Position	462
FLF Stop Position	463
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Source Location List (VVL) 2. Value must be 2 characters 3. Mandatory

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

RULE ID	RULE Definition
RULE-514	If the source location is populated on a non-denied claim from an IP file, then the source location reported must be found in the list of valid values.
RULE-6193	If a claim is a non-denied claim from an IP file, then the source location value reported must be compatible with specified T-MSIS picture format: X(2).

Measure ID	Measure Name
ALL-37-001-1	Source Location

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT056	CLT.002.056	SOURCE-LOCATION	CLT00002	CLAIM-HEADER-RECORD-LT
COT041	COT.002.041	SOURCE-LOCATION	COT00002	CLAIM-HEADER-RECORD-OT
CRX032	CRX.002.032	SOURCE-LOCATION	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/09/2023	3.11.0	CIP.002.104	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
08/09/2023	3.11.0	CIP.002.104	UPDATE	Last update date	12/08/2022	8/9/2023
07/15/2022	3.0.1	CIP104	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP104\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP104\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.