CIP.003.239

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

LINE-ADJUSTMENT-IND

Data Element

DE Number

CIP239

System DE Number

CIP.003.239

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to indicate the type of adjustment record claim/encounter represents at claim detail level.
Size	X(1)
FLF Start Position	148
FLF Stop Position	148
Segment Key Field Identifier	6
Coding Requirements	1. Value must be in Line Adjustment Indicator List (VVL) 2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4] 3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6] 4. Value must be 1 character 5. Conditional 6. If associated Line Adjustment Number is populated, then value must 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-6219	If a claim line is a non-denied claim line from an IP file, then the line adjustment indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-7187	If a claim line is from an IP file, then submitting state, original ICN, adjustment ICN, adjudication date, line adjustment indicator, original line ICN, and adjustment line ICN values reported must be unique across all IP claim lines.
RULE-7468	If a segment is an IP claim line, line adjustment indicator must be populated.
RULE-7545	If a segment is an IP claim line, and claim line status is equal to '686' (void claim), then the line adjustment indicator must be equal to '1' (void).
RULE-7574	All denied IP claim line records must have a corresponding claim header record.
RULE-7652	If a segment is an IP claim header, and the type of claim is an encounter, then the line adjustment indicator must be populated.
RULE-7671	If the type of claim is an encounter and line adjustment indicator is populated on a claim line from an IP file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-768	All non-denied IP claim line records must have a corresponding parent record.
RULE-774	If the line adjustment indicator is populated on a claim line from an IP file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-7848	If a segment is an IP claim line, and the type of claim is a fee for service, the line adjustment indicator must be populated.
RULE-7856	If a segment is an IP claim line, and the type of claim is a supplemental, the line adjustment indicator must be populated.
RULE-7864	If a segment is an IP claim line, and the type of claim is a service tracking, the line adjustment indicator must be populated.
RULE-7872	If the type of claim is a fee-for-service and line adjustment indicator is populated on a claim line from an IP file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-7880	If the type of claim is a supplemental and line adjustment indicator is populated on a claim line from an IP file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-7888	If the type of claim is a service tracking and line adjustment indicator is populated on a claim line from an IP file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.

Measure ID	Measure Name
FFS-26-010-10	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
FFS-31-001-1	Line Adjustment Indicator values
FFS-39-001-1	Line Adjustment Indicator values
MCR-32-002-2	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
MCR-32-012-12	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
MCR-38-001-1	Line Adjustment Indicator values
MCR-47-001-1	Line Adjustment Indicator values
RULE-7468	% of claim lines with a missing Line Adjustment Indicator
RULE-774	% of claim lines with an invalid Line Adjustment Indicator (LINE-ADJUSTMENT-IND is 2, 3, 9, other invalid value)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT192	CLT.003.192	LINE-ADJUSTMENT-IND	CLT00003	CLAIM-LINE-RECORD-LT
COT162	COT.003.162	LINE-ADJUSTMENT-IND	COT00003	CLAIM-LINE-RECORD-OT
CRX116	CRX.003.116	LINE-ADJUSTMENT-IND	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CIP.003.239	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
09/21/2023	3.13.0	CIP.003.239	UPDATE	Segment key field identifier	Not Applicable	6
08/07/2023	3.11.0	CIP.003.239	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Original Claim/Encounter	Original Claim/Encounter/Payment - Indicates that this is the first (and, when applicable, only) fully adjudicated transaction in a claim family (one or more claims with the related ICN-ORIG and/or ICN-ADJ and typically the same MSIS ID and provider ID(s) also).
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Void of a prior submission	Void/Reversal/Cancel of a prior submission Use this code to convey that the purpose of the transaction is to void/reverse/cancel a previously paid/approved claim/encounter/payment where the claim/encounter/payment is not being replaced by a new paid/approved version of the claim/encounter/payment. Typically, this would be the last claim/encounter/payment that would ever be associated with a given claim family. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being voided. CMS expects a void transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being voided/reversed/cancelled.
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Debit Adjustment (positive supplemental)	Replacement/Resubmission of a previously paid/approved claim/encounter/payment - Use when the purpose of the transaction is to replace a previously paid/approved claim/encounter/payment with a new paid/approved version of the claim/encounter/payment. These records must have the same ICN-ORIG or ICN-ADJ as the claim/encounter being replaced. CMS expects a replacement transaction to also have the same MSIS ID and provider ID(s) as the claim/encounter/payment being replaced/resubmitted.
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Credit Gross Adjustment	Credit Gross Adjustment - Use this code to indicate an aggregate provider-level recoupment of payments (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as negative numbers. If a credit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a credit gross adjustment are not related to any other gross adjustments (credit or debit) then the credit gross adjustment will always be treated as a distinct financial transaction.
03/01/2024	3.20.0	LINE-ADJUSTMENT-IND CIP239	Update	Data Dictionary - Valid Values	Debit Gross Adjustment	Debit Gross Adjustment - Use this code to indicate an aggregate provider-level payment to a provider (e.g., not attributable to a single beneficiary). Amounts on these claims should be expressed as positive numbers. If a debit gross adjustment is reported with an ICN that is related to an ICN(s) of another gross adjustment (credit or debit) then CMS will interpret this to mean that the credit gross adjustment with the more recent adjudication date should completely replace the preceding related gross adjustment. If the ICNs of a debit gross adjustment are not related to any other gross adjustments (credit or debit) then the debit gross adjustment will always be treated as a distinct financial transaction.
10/02/2020	2.4.0	LINE-NUM-ADJ LINE-ADJUSTMENT-IND	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Coding Requirement\|CR No\| \|CIP238\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number. \|Not Applicable\| \|CIP239\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CIP239-0002\| \|CLT191\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|CLT191-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CLT192-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|If there is a line adjustment reason, then there must be a line adjustment indicator.\|CLT192-0003 \|COT161\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|COT161-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|COT162-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|If there is a line adjustment reason, then there must be a line adjustment indicator.\|COT162-003\| \|CRX115\|LINE-NUM-ADJ\|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|CRX115-002\| \|CRX116\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CRX116-002\|	\|DE No\|Data Element Name\|Coding Requirement\|CR No\| \|CIP238\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|Not Applicable\| \|CIP239\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CIP239-0002\| \|CLT191\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|CLT191-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CLT192-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CLT192-0003 \|COT161\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|COT161-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|Not Applicable.\|COT162-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|Not Applicable.\|COT162-003\| \|CRX115\|LINE-NUM-ADJ\|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|CRX115-002\| \|CRX116\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CRX116-002\|