ELG.018.233

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

1115A-DEMONSTRATION-IND

Data Element

DE Number

ELG233

System DE Number

ELG.018.233

File Name

File Segment Number

File Segment Name

1115A-DEMONSTRATION-INFORMATION

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Indicates that the individual participates in an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation (CMMI) demonstration.
Size	X(1)
FLF Start Position	42
FLF Stop Position	42
Segment Key Field Identifier	3
Coding Requirements	1. Value must be 1 character 2. Value must be in [0, 1] or not populated 3. Value must be in 1115A Demonstration Indicator List (VVL) 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-2474	If the 1115A demonstration indicator is populated on a 1115A demonstration information file, then the 1115A demonstration indicator reported must be found in the list of valid values.
RULE-7092	If a segment is a 1115A demonstration information segment from an ELG file, then the 1115A demonstration indicator value reported must be compatible with the specified T-MSIS picture format: X(1).
RULE-7549	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an RX file, and the prescription fill date is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.
RULE-7550	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an IP file, and the admission date is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.
RULE-7551	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an LT file, and the beginning date of service is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.
RULE-7552	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an OT file, and the beginning date of service is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.

Measure ID	Measure Name
EL-6-021-21	# of 1115A demonstration participants
MIS-1-084-84	% distinct MSIS IDs with only missing values in any active segment: 1115A-DEMONSTRATION-IND (ELG00018)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP025	CIP.002.025	1115A-DEMONSTRATION-IND	CIP00002	CLAIM-HEADER-RECORD-IP
CLT024	CLT.002.024	1115A-DEMONSTRATION-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT024	COT.002.024	1115A-DEMONSTRATION-IND	COT00002	CLAIM-HEADER-RECORD-OT
CRX024	CRX.002.024	1115A-DEMONSTRATION-IND	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/01/2023	3.11.0	ELG.018.233	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in 1115A Demonstration Indicator List (VVL)4. Conditional
01/07/2022	3.0.0	ELG233	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG233\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration.\|	\|DE NO\| DATA ELEMENT NAME \|DEFINITION\| \|ELG233\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.\|
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP025\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CIP025\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CRX024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated
06/24/2022	3.0.0	1115A-DEMONSTRATION-IND	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT024\|1115A-DEMONSTRATION-IND\|Indicates that the claim or encounter was covered under the authority of an 1115(A) demonstration. 1115(A) is a Center for Medicare and Medicaid Innovation demonstration\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, the associated 1115A Demonstration Indicator (ELG.018.223) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| CLT024\|1115A-DEMONSTRATION-IND\|In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115(A) demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115(A) demonstration.\| 1. Value must be in 1115A Demonstration Indicator List (VVL) 2.(FD1) when value equals '0', is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal '0', is invalid or not populated 3. Value must be 1 character 4. Conditional 5. Value must be in [0, 1] or not populated