CIP.003.255

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MEDICAID-FFS-EQUIVALENT-AMT

Data Element

DE Number

CIP255

System DE Number

CIP.003.255

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	The amount that would have been paid had the services been provided on a Fee for Service basis.
Size	S9(11)V99
FLF Start Position	246
FLF Stop Position	258
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 Type of Claim value equals '3, C, W', then value is mandatory and must be provided 4. Conditional

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

RULE ID	RULE Definition
RULE-803	If a claim is a non-denied claim from an IP file, then the medicaid FFS equivalent 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-2-014-13	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)
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-2-016-18	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 60 (Emergency hospital services)
MCR-2-017-19	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 84 (Sterilizations)
MCR-2-018-20	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
MCR-2-019-21	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
MCR-2-020-22	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 91 (Skilled 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-2-022-24	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
MCR-2-023-14	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 123 (Disproportionate share hospital (DSH) payments)
MCR-2-024-15	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 132 (Supplemental payment - inpatient)
MCR-2-025-16	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 135 (EHR payments to provider)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT209	CLT.003.209	MEDICAID-FFS-EQUIVALENT-AMT	CLT00003	CLAIM-LINE-RECORD-LT
COT179	COT.003.179	MEDICAID-FFS-EQUIVALENT-AMT	COT00003	CLAIM-LINE-RECORD-OT
CRX126	CRX.003.126	MEDICAID-FFS-EQUIVALENT-AMT	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/01/2023	3.12.0	CIP.003.255	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 Type of Claim (CE) value equals '3, C, W', then value is mandatory and must be provided4. 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. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional