CIP.002.228

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MEDICARE-PAID-AMT

Data Element

DE Number

CIP228

System DE Number

CIP.002.228

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 paid by Medicare on this claim. For claims where Medicare payment is only available at the line level, report the sum of all the line level Medicare payment amounts at the header.
Size	S9(11)V99
FLF Start Position	1402
FLF Stop Position	1414
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. If associated Crossover Indicator value is "0", then the value must not be populated. 4. Conditional 5. If value is populated, Crossover Indicator must be equal to "1"

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

RULE ID	RULE Definition
RULE-757	If a claim is a non-denied claim from an IP file, then the Medicare paid amount value reported must be compatible with specified T-MSIS picture format: S9(11)V99.
RULE-7657	If a claim is a non-denied, crossover Medicaid Encounter, original or adjustment paid claim from an IP file, then the claim must have a non-null value and not zero value for medicare paid amount or total medicare coinsurance amount or total medicare deductible amount.
RULE-7662	If a claim is a non-denied, non-crossover Medicaid Encounter, original or adjustment paid claim from an IP file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.
RULE-7774	If a claim is a non-denied, crossover Medicaid or M-CHIP or Separate CHIP Fee-for-Service, original or adjustment paid claim from an IP file, then the claim must have a non-null value and not zero value for medicare paid amount or total medicare coinsurance amount or total medicare deductible amount.
RULE-7778	If a claim is a non-denied, non-crossover Medicaid or M-CHIP or Separate CHIP Fee-for-Service, original or adjustment paid claim from an IP file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.
RULE-7836	If a claim is a non-denied, non-crossover Medicaid or M-CHIP or Separate CHIP Supplemental, original or adjustment paid claim from an IP file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.
RULE-7840	If a claim is a non-denied, non-crossover Medicaid or M-CHIP or Separate CHIP Service Tracking, original or adjustment paid claim from an IP file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.

Measure ID	Measure Name
FFS-53-001-1	% of non-crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero
FFS-54-001-1	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
MCR-63-001-1	% of non-crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero
MCR-64-001-1	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
MIS-2-033-33	% missing: MEDICARE-PAID-AMT (CIP00002)
MIS-21-035-35	% missing: MEDICARE-PAID-AMT (CIP00002)
MIS-79-035-35	% missing: MEDICARE-PAID-AMT (CIP00002)
FFS-54-001_1-5	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
MCR-64-001_1-5	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
RULE-7662	% of non-crossover encounter claims where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero
RULE-7774	% of crossover claims where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
RULE-7778	% of non-crossover claims where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT179	CLT.002.179	MEDICARE-PAID-AMT	CLT00002	CLAIM-HEADER-RECORD-LT
COT182	COT.003.182	MEDICARE-PAID-AMT	COT00003	CLAIM-LINE-RECORD-OT
CRX129	CRX.003.129	MEDICARE-PAID-AMT	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/01/2023	3.12.0	CIP.002.228	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. If associated Crossover Indicator value is "0", then the Medicare Paid Amount must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	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. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
03/11/2022	3.0.0	CIP228	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CIP228 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim or adjustment.\|	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CIP228 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the line level, report the sum of all the line level Medicare payment amounts at the header.\|