CIP.002.220

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MEDICAID-AMOUNT-PAID-DSH

Data Element

DE Number

CIP220

System DE Number

CIP.002.220

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 amount included in the Total Medicaid Amount (CIP.002.114) that is attributable to a Disproportionate Share Hospital (DSH) payment, when the state makes DSH payments by claim.
Size	S9(11)V99
FLF Start Position	1355
FLF Stop Position	1367
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 3. Conditional 4. When Type of Claim is in ['4', 'D', 'X'], value must not be 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-744	If a claim is a non-denied claim from an IP file, then the Medicaid amount pad DSH value reported must be compatible with specified T-MSIS picture format: S9(11)V99.
RULE-7579	If a claim is a non-denied, Medicaid/Medicaid expansion CHIP, Separate CHIP or other service tracking claim from an IP file, then the claim header has a MEDICAID-AMOUNT-PAID-DSH value that is null or equal to '0.00'

Measure ID	Measure Name
MIS-2-031-31	% missing: MEDICAID-AMOUNT-PAID-DSH (CIP00002)
MIS-21-032-32	% missing: MEDICAID-AMOUNT-PAID-DSH (CIP00002)
MIS-79-032-32	% missing: MEDICAID-AMOUNT-PAID-DSH (CIP00002)
RULE-7579	% of service tracking claim headers where Medicaid Amount Paid DSH is non-missing and non-zero

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	CIP.002.220	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional4. When Type of Claim is in ['4', 'D', 'X'], value must not be populated