CIP.002.176

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

HEALTH-HOME-PROV-IND

Data Element

DE Number

CIP176

System DE Number

CIP.002.176

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	Indicates whether the claim is submitted by a provider or provider group enrolled in the Health Home care model to provide services for the beneficiary on the claim. Health home providers provide service for patients with chronic illnesses. States that do not specify an eligible individual's health home provider number, if applicable, should not report claims that indicate the claim is submitted by a provider or provider group enrolled in the health home model.
Size	X(1)
FLF Start Position	949
FLF Stop Position	949
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Health Home Provider Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0, 1] or not populated 4. If there is an associated Health Home Entity Name value, then value must be "1" 5. 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-6362	If a claim is a non-denied claim from an IP file, then the health home provider indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-679	If the health home provider ID is populated on a non-denied claim from an IP file, then the health home provider ID value reported must be in the list of valid values.
RULE-680	If a non-denied IP claim has a value populated for health home entity name, then the health home provider indicator must be equal to '1'.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT127	CLT.002.127	HEALTH-HOME-PROV-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT109	COT.002.109	HEALTH-HOME-PROV-IND	COT00002	CLAIM-HEADER-RECORD-OT
CRX067	CRX.002.067	HEALTH-HOME-PROV-IND	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	CIP.002.176	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Value must be 1 character6. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional