CIP.003.286

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

ADJUDICATION-DATE

Data Element

DE Number

CIP286

System DE Number

CIP.003.286

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 date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.
Size	9(8)
FLF Start Position	895
FLF Stop Position	902
Segment Key Field Identifier	7
Coding Requirements	1. Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3. Value should be on or before End of Time Period value found in associated T-MSIS File Header Record 4. Mandatory 5. Value should be on or after associated Admission Date value

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

RULE ID	RULE Definition
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-7317	#N/A
RULE-7574	All denied IP claim line records must have a corresponding claim header record.
RULE-768	All non-denied IP claim line records must have a corresponding parent record.
RULE-783	If beginning date of service and adjudication date are populated on a non-denied claim line from an IP file that is not a capitated payment or premium payment, then the beginning date of service value reported must be before or equal to the adjudication date value reported.
RULE-789	If ending date of service and adjudication date are populated on a non-denied claim line from an IP file that is not a capitated payment or premium payment, then the ending date of service value reported must be before or equal to the adjudication date value reported.
RULE-826	If the XIX MBESCBES category of service is populated on a non-denied IP claim line, then the XIX MBESCBES category of service reported must be found in the list of valid values.
RULE-828	If the XXI MBESCBES category of service is populated on a non-denied IP claim line, then the XIX MBESCBES category of service reported must be found in the list of valid values.
RULE-838	If a claim line is from an IP file, then the adjudication date value reported must be a valid date of the form CCYYMMDD.
RULE-840	If adjudication date is populated on a non-denied claim line from an IP file that is not a capitated payment or premium payment and end of time period is populated on the file header, then the adjudication date value reported must be before or equal to the end of time period value reported.
RULE-841	If admission date is populated on a non-denied claim from an IP file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment and adjudication date is populated on a non-denied claim line that is not a capitated payment or premium payment, then the admission date value reported must be before or equal to the adjudication date value reported.

Measure ID	Measure Name
ALL-16-002-2	% of claim line record segments missing ADJUDICATION-DATE (CIP00003)
MIS-3-001-1	% missing: ADJUDICATION-DATE (CIP00003)
RULE-7317	% of claim line record segments missing ADJUDICATION-DATE (CIP00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP098	CIP.002.098	ADJUDICATION-DATE	CIP00002	CLAIM-HEADER-RECORD-IP
CLT050	CLT.002.050	ADJUDICATION-DATE	CLT00002	CLAIM-HEADER-RECORD-LT
CLT233	CLT.003.233	ADJUDICATION-DATE	CLT00003	CLAIM-LINE-RECORD-LT
COT035	COT.002.035	ADJUDICATION-DATE	COT00002	CLAIM-HEADER-RECORD-OT
COT221	COT.003.221	ADJUDICATION-DATE	COT00003	CLAIM-LINE-RECORD-OT
CRX027	CRX.002.027	ADJUDICATION-DATE	CRX00002	CLAIM-HEADER-RECORD-RX
CRX157	CRX.003.157	ADJUDICATION-DATE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
12/17/2021	3.0.0	ADJUDICATION-DATE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP098\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CLT050\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|COT035\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CRX027\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CIP286\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CLT233\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|COT221\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CRX157\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\|	\|DE No\|Data Element Name\|Definition\| \|CIP098\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CLT050\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|COT035\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CRX027\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CIP286\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CLT233\|ADJUDICATION-DATE\|TThe date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|COT221\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CRX157\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\|