CIP.003.254

MEDICAID-PAID-AMT

Data Element

DE Number

CIP254

System DE Number

CIP.003.254

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00003

File Segment Name

CLAIM-LINE-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
Size	S9(11)V99
FLF Start Position	233
FLF Stop Position	245
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. Value should not be populated or equal to zero, when associated Claim Line Status is in [26,026,87,087,542,585,654]

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

RULE ID	RULE Definition
RULE-7560	If an IP claim line is for a denied claim, then the medicaid paid amount has a missing or zero value.
RULE-802	If a claim line is a non-denied claim line from an IP file, then the Medicaid paid amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name
MCR-2-017-19	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 84 (Sterilizations)
RULE-7790	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
MCR-59R-001-13	% of Plan IDs over the threshold for MCR-59P-001-13 (% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header, by Plan ID)
MCR-59P-001-13	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header, by Plan ID
MCR-59-001-1	% of claim headers where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
MCR-2-025-16	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 135 (EHR payments to provider)
MCR-2-024-15	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 132 (Supplemental payment - inpatient)
MCR-2-023-14	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 123 (Disproportionate share hospital (DSH) payments)
MCR-2-022-24	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
MCR-2-021-23	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 92 (Exceptional care – hospital residing)
MCR-2-020-22	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 91 (Skilled care – hospital residing)
MCR-2-019-21	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
MCR-2-018-20	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
FFS-49-001-13	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
MCR-2-016-18	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 60 (Emergency hospital services)
MCR-2-015-17	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 58 (Services furnished in a religious nonmedical health care institution)
MCR-2-014-13	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 1 (Inpatient hospital services, other than services in an institution for mental diseases)
FFS-49-001-1	% of claim headers where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
RULE-7560	% of denied claim lines where Medicaid Paid Amount is non-missing and non-zero
MIS-80-009-9	% missing: MEDICAID-PAID-AMT (CIP00003)
MIS-22-010-10	% missing: MEDICAID-PAID-AMT (CIP00003)
MIS-3-009-9	% missing: MEDICAID-PAID-AMT (CIP00003)
MCR-59-009-9	% of claim lines with PAYMENT-LEVEL-IND=2 (claim detail) that have Medicaid Paid Amount greater than a non-zero Allowed Amount
MCR-59-001-13	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
FFS-49-009-9	% of claim lines with PAYMENT-LEVEL-IND=2 (claim detail) that have Medicaid Paid Amount greater than a non-zero Allowed Amount

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT208	CLT.003.208	MEDICAID-PAID-AMT	CLT00003	CLAIM-LINE-RECORD-LT
COT178	COT.003.178	MEDICAID-PAID-AMT	COT00003	CLAIM-LINE-RECORD-OT
CRX125	CRX.003.125	MEDICAID-PAID-AMT	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CIP.003.254	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CIP.003.254	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. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']	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. Value should not be populated or equal to zero, when associated Claim Line Status is in [26,026,87,087,542,585,654]
09/01/2023	3.12.0	CIP.003.254	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. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']
08/09/2023	3.11.0	CIP.003.254	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/11/2020	2.4.0	CIP254, CLT208, COT178, CRX125	UPDATE	Data Dictionary	Current Coding Requirement: For claims where Medicaid payment is only available at the header level, report the entire payment amount on the MSIS record corresponding to the line item with the highest charge. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.	Proposed Coding requirement: For claims where Medicaid payment is only available at the header level, report the entire payment amount on the MSIS record corresponding to the line item with the highest charge or the 1st detail. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.
08/13/2021	3.0.0	MEDICAID-PAID-AMT	UPDATE	Data Dictionary	\|Definition\| \|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For claims where Medicaid payment is only available at the header level, report the entire payment amount on the T-MSIS record corresponding to the line item with the highest charge or the 1st detail. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.\|	\|Definition\| \|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.\|
07/15/2022	3.0.1	CIP254	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP254\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP254\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.