CIP.003.268

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide

Medicaid.gov

Version 3.27.0

BENEFIT-TYPE

Data Element

DE Number

CIP268

System DE Number

CIP.003.268

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 benefit category corresponding to the service reported on the claim or encounter record. Note: The code definitions in the valid value list originate from the Medicaid and CHIP Program Data System (MACPro) benefit type list. See Appendix H: Benefit Types
Size	X(3)
FLF Start Position	330
FLF Stop Position	332
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Benefit Type Code List (VVL) 2. Value must be 3 characters 3. Mandatory

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

RULE ID	RULE Definition
RULE-6544	If a claim line is a non-denied claim line from an IP file, then the benefit type value reported must be compatible with specified T-MSIS picture format: X(3).
RULE-822	If the benefit type is populated on a non-denied claim from an IP file, then the benefit type reported must be found in the list of valid values.

Measure ID	Measure Name
ALL-1-005-3	# of unique Benefit Type values reported for mandatory institutional-only non-Long-Term Care benefit (see DD Appendix H)
ALL-1-008-6	# of unique Benefit Type values reported for optional institutional-only non-Long-Term Care benefit (see DD Appendix H)
ALL-1-011-11	% of claim headers with Benefit Type values representing a combination ambulatory/institutional non-Long-Term Care benefit (see DD Appendix H)
ALL-1-014-14	% of claim headers with Benefit Type values representing institutional-only non-Long-Term Care benefit (see DD Appendix H)
ALL-3-001-1	% of claim headers with Benefit Type values representing institutional-only non-Long-Term Care benefit (See DD Appendix H)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT218	CLT.003.218	BENEFIT-TYPE	CLT00003	CLAIM-LINE-RECORD-LT
COT209	COT.003.209	BENEFIT-TYPE	COT00003	CLAIM-LINE-RECORD-OT
CRX148	CRX.003.148	BENEFIT-TYPE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
04/17/2020	2.4.0	BENEFIT-TYPE CIP268, CLT218, COT209, CRX148	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID \|Code \|Description\| Effective Date\| End Date\| BENEFIT-TYPE \|CIP268, CLT218, COT209, CRX148\| 107\| In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products\| 3/18/2020\| 12/31/9999\| BENEFIT-TYPE\| CIP268, CLT218, COT209, CRX148\| 108\| COVID–19 testing-related s ervices\| 3/18/2020\| 12/31/9999\|