CIP.002.213

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

COPAY-WAIVED-IND

Data Element

DE Number

CIP213

System DE Number

CIP.002.213

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 signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.
Size	X(1)
FLF Start Position	1262
FLF Stop Position	1262
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Copay Waived Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0,1] or not populated 4. Situational

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

RULE ID	RULE Definition
RULE-7068	If a claim is a non-denied claim from an IP file, then the copay waived indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-736	If the copay waived indicator is populated on a non-denied claim from an IP file, then the copay waived indicator value reported must be in the list of valid values.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT160	CLT.002.160	COPAY-WAIVED-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT137	COT.002.137	COPAY-WAIVED-IND	COT00002	CLAIM-HEADER-RECORD-OT
CRX095	CRX.002.095	COPAY-WAIVED-IND	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CIP.002.213	UPDATE	Coding requirement	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Situational	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. Situational
08/28/2023	3.12.0	CIP.002.213	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CIP.002.213	UPDATE	Coding requirement	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Optional	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Situational
06/24/2022	3.0.0	CIP213	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP213\|COPAY-WAIVED-IND\|An indicator signifying that the copay was waived by the provider.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CIP213\|COPAY-WAIVED-IND\|An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.