| CIP016 |
CIP.002.016
|
RECORD-ID |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
CIP016 Values
|
| CIP017 |
CIP.002.017
|
SUBMITTING-STATE |
A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. |
CIP017 Values
|
| CIP018 |
CIP.002.018
|
RECORD-NUMBER |
A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file. |
N/A
|
| CIP019 |
CIP.002.019
|
ICN-ORIG |
A unique number assigned by the state's payment system that identifies an original or adjustment claim. |
N/A
|
| CIP020 |
CIP.002.020
|
ICN-ADJ |
A unique claim number assigned by the state's payment system that identifies the adjustment claim for an original transaction. |
N/A
|
| CIP021 |
CIP.002.021
|
SUBMITTER-ID |
The Submitter Identification number is the value that identifies the provider/trading partner/clearing house organization to the state's claim adjudication system. |
N/A
|
| CIP022 |
CIP.002.022
|
MSIS-IDENTIFICATION-NUM |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572 |
N/A
|
| CIP023 |
CIP.002.023
|
CROSSOVER-INDICATOR |
An indicator specifying whether the claim is a crossover claim where a portion is paid by Medicare. |
CIP023 Values
|
| CIP024 |
CIP.002.024
|
TYPE-OF-HOSPITAL |
This code denotes the type of hospital on the claim (servicing facility). |
CIP024 Values
|
| CIP025 |
CIP.002.025
|
1115A-DEMONSTRATION-IND |
In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115A demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115A demonstration. |
CIP025 Values
|
| CIP026 |
CIP.002.026
|
ADJUSTMENT-IND |
Indicates the type of adjustment record. |
CIP026 Values
|
| CIP027 |
CIP.002.027
|
ADJUSTMENT-REASON-CODE |
Claim adjustment reason codes communicate why a claim was paid differently than it was billed. |
CIP027 Values
|
| CIP028 |
CIP.002.028
|
ADMISSION-TYPE |
The basic types of admission for Inpatient hospital stays and a code indicating the priority of this admission. |
CIP028 Values
|
| CIP029 |
CIP.002.029
|
DRG-DESCRIPTION |
Description of the associated state-specific DRG code. If using standard MS-DRG classification system, leave blank. |
N/A
|
| CIP030 |
CIP.002.030
|
ADMITTING-DIAGNOSIS-CODE |
The ICD-9/10-CM Diagnosis Code provided at the time of admission by the physician. Since the Admitting Diagnosis is formulated before all tests and examinations are complete, it may be stated in the form of a problem or symptom and it may differ from any of the final diagnoses
recorded in the medical record. |
CIP030 Values
|
| CIP031 |
CIP.002.031
|
ADMITTING-DIAGNOSIS-CODE-FLAG |
A flag that identifies the coding system used for the Admitting Diagnosis Code. |
CIP031 Values
|
| CIP032 |
CIP.002.032
|
DIAGNOSIS-CODE-1 |
The primary/principal ICD-9/10-CM diagnosis code as reported on the claim. |
CIP032 Values
|
| CIP033 |
CIP.002.033
|
DIAGNOSIS-CODE-FLAG-1 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP033 Values
|
| CIP034 |
CIP.002.034
|
DIAGNOSIS-POA-FLAG-1 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP034 Values
|
| CIP035 |
CIP.002.035
|
DIAGNOSIS-CODE-2 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP035 Values
|
| CIP036 |
CIP.002.036
|
DIAGNOSIS-CODE-FLAG-2 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP036 Values
|
| CIP037 |
CIP.002.037
|
DIAGNOSIS-POA-FLAG-2 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP037 Values
|
| CIP038 |
CIP.002.038
|
DIAGNOSIS-CODE-3 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP038 Values
|
| CIP039 |
CIP.002.039
|
DIAGNOSIS-CODE-FLAG-3 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP039 Values
|
| CIP040 |
CIP.002.040
|
DIAGNOSIS-POA-FLAG-3 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP040 Values
|
| CIP041 |
CIP.002.041
|
DIAGNOSIS-CODE-4 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP041 Values
|
| CIP042 |
CIP.002.042
|
DIAGNOSIS-CODE-FLAG-4 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP042 Values
|
| CIP043 |
CIP.002.043
|
DIAGNOSIS-POA-FLAG-4 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP043 Values
|
| CIP044 |
CIP.002.044
|
DIAGNOSIS-CODE-5 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP044 Values
|
| CIP045 |
CIP.002.045
|
DIAGNOSIS-CODE-FLAG-5 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP045 Values
|
| CIP046 |
CIP.002.046
|
DIAGNOSIS-POA-FLAG-5 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP046 Values
|
| CIP047 |
CIP.002.047
|
DIAGNOSIS-CODE-6 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP047 Values
|
| CIP048 |
CIP.002.048
|
DIAGNOSIS-CODE-FLAG-6 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n,
where n can be any integer greater than or equal to 1. |
CIP048 Values
|
| CIP049 |
CIP.002.049
|
DIAGNOSIS-POA-FLAG-6 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP049 Values
|
| CIP050 |
CIP.002.050
|
DIAGNOSIS-CODE-7 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP050 Values
|
| CIP051 |
CIP.002.051
|
DIAGNOSIS-CODE-FLAG-7 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP051 Values
|
| CIP052 |
CIP.002.052
|
DIAGNOSIS-POA-FLAG-7 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP052 Values
|
| CIP053 |
CIP.002.053
|
DIAGNOSIS-CODE-8 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP053 Values
|
| CIP054 |
CIP.002.054
|
DIAGNOSIS-CODE-FLAG-8 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP054 Values
|
| CIP055 |
CIP.002.055
|
DIAGNOSIS-POA-FLAG-8 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP055 Values
|
| CIP056 |
CIP.002.056
|
DIAGNOSIS-CODE-9 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP056 Values
|
| CIP057 |
CIP.002.057
|
DIAGNOSIS-CODE-FLAG-9 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP057 Values
|
| CIP058 |
CIP.002.058
|
DIAGNOSIS-POA-FLAG-9 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP058 Values
|
| CIP059 |
CIP.002.059
|
DIAGNOSIS-CODE-10 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP059 Values
|
| CIP060 |
CIP.002.060
|
DIAGNOSIS-CODE-FLAG-10 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP060 Values
|
| CIP061 |
CIP.002.061
|
DIAGNOSIS-POA-FLAG-10 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP061 Values
|
| CIP062 |
CIP.002.062
|
DIAGNOSIS-CODE-11 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP062 Values
|
| CIP063 |
CIP.002.063
|
DIAGNOSIS-CODE-FLAG-11 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP063 Values
|
| CIP064 |
CIP.002.064
|
DIAGNOSIS-POA-FLAG-11 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably
have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP064 Values
|
| CIP065 |
CIP.002.065
|
DIAGNOSIS-CODE-12 |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as "2105". |
CIP065 Values
|
| CIP066 |
CIP.002.066
|
DIAGNOSIS-CODE-FLAG-12 |
Flag used to identify if associated Diagnosis Code field is reported with ICD-9 or ICD-10 code. Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP066 Values
|
| CIP067 |
CIP.002.067
|
DIAGNOSIS-POA-FLAG-12 |
A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery.
POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines.
*States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.
Each Diagnosis Code Flag is associated with one, and only one, Diagnosis Code in a given file segment record. For example, Diagnosis Code n is associated with Diagnosis Code Flag n, where n can be any integer greater than or equal to 1. |
CIP067 Values
|
| CIP068 |
CIP.002.068
|
DIAGNOSIS-RELATED-GROUP |
A code representing the Diagnosis Related Group (DRG) that is applicable for the inpatient services being rendered. This field is required on FFS claims and encounters records in which diagnosis related groups are used to determine paid amounts. |
CIP068 Values
|
| CIP069 |
CIP.002.069
|
DIAGNOSIS-RELATED-GROUP-IND |
An indicator identifying the grouping algorithm used to assign Diagnosis Related Group (DRG) values.Values are generated by combining two types of information: Position 1-2, State/Group generating DRG: If state specific system, fill with two digit US postal code representation for state. If CMS Grouper, fill with "HG". If any other system, fill with "XX". Position 3-4, fill with the number that represents the DRG version used (01-98). For example, "HG15" would represent CMS Grouper version 15. If version is unknown, fill with "99". |
N/A
|
| CIP070 |
CIP.002.070
|
PROCEDURE-CODE-1 |
A procedure code based on ICD-9 and ICD-10 used by the state to identify the procedures performed during the hospital stay referenced by this claim. The principal procedure and related info should be recorded in Procedure Code1, Procedure Code Date-1, and Procedure Code Flag 1. The principal procedure is performed for definitive treatment rather than for diagnostic or exploratory purposes. It is closely related to either the principal diagnosis or to complications that arise during other treatments. Use Procedure Code 2 through Procedure Code 6 (and related data elements) to record secondary, tertiary, etc. procedures. |
CIP070 Values
|
| CIP072 |
CIP.002.072
|
PROCEDURE-CODE-FLAG-1 |
A flag that identifies the coding system used for an associated procedure code. |
CIP072 Values
|
| CIP073 |
CIP.002.073
|
PROCEDURE-CODE-DATE-1 |
The date upon which a reported medical procedure was performed. |
N/A
|
| CIP074 |
CIP.002.074
|
PROCEDURE-CODE-2 |
A procedure code based on ICD-9 and ICD-10 used by the state to identify the procedures performed during the hospital stay referenced by this claim. The principal procedure and related info should be recorded in Procedure Code 1, Procedure Code 1, and Procedure Code Flag 1. The principal procedure is performed for definitive treatment rather than for diagnostic or exploratory purposes. It is closely related to either the principal diagnosis or to complications that arise during other treatments. Use Procedure Code 2 through Procedure Code 6 (and related data elements) to record secondary, tertiary, etc. procedures. |
CIP074 Values
|
| CIP076 |
CIP.002.076
|
PROCEDURE-CODE-FLAG-2 |
A flag that identifies the coding system used for an associated procedure code. |
CIP076 Values
|
| CIP077 |
CIP.002.077
|
PROCEDURE-CODE-DATE-2 |
The date upon which a reported medical procedure was performed. |
N/A
|
| CIP078 |
CIP.002.078
|
PROCEDURE-CODE-3 |
A procedure code based on ICD-9 and ICD-10 used by the state to identify the procedures performed during the hospital stay referenced by this claim. The principal procedure and related info should be recorded in Procedure Code 1, Procedure Code Date 1, and Procedure Code Flag 1. The principal procedure is performed for definitive treatment rather than for diagnostic or exploratory purposes. It is closely related to either the principal diagnosis or to complications that arise during other treatments. Use Procedure Code 2 through Procedure Code 6 (and related data elements) to record secondary, tertiary, etc. procedures. |
CIP078 Values
|
| CIP080 |
CIP.002.080
|
PROCEDURE-CODE-FLAG-3 |
A flag that identifies the coding system used for an associated procedure code. |
CIP080 Values
|
| CIP081 |
CIP.002.081
|
PROCEDURE-CODE-DATE-3 |
The date upon which a reported medical procedure was performed. |
N/A
|
| CIP082 |
CIP.002.082
|
PROCEDURE-CODE-4 |
A procedure code based on ICD-9 and ICD-10 used by the state to identify the procedures performed during the hospital stay referenced by this claim. The principal procedure and related info should be recorded in Procedure Code 1, Procedure Code Date 1, and Procedure Code Flag 1. The principal procedure is performed for definitive treatment rather than for diagnostic or exploratory purposes. It is closely related to either the principal diagnosis or to complications that arise during other treatments. Use Procedure Code 2 through Procedure Code 6 (and related data elements) to record secondary, tertiary, etc. procedures. |
CIP082 Values
|
| CIP084 |
CIP.002.084
|
PROCEDURE-CODE-FLAG-4 |
A flag that identifies the coding system used for an associated procedure code. |
CIP084 Values
|
| CIP085 |
CIP.002.085
|
PROCEDURE-CODE-DATE-4 |
The date upon which a reported medical procedure was performed. |
N/A
|
| CIP086 |
CIP.002.086
|
PROCEDURE-CODE-5 |
A procedure code based on ICD-9 and ICD-10 used by the state to identify the procedures performed during the hospital stay referenced by this claim. The principal procedure and related info should be recorded in Procedure Code 1, Procedure Code Date 1, and Procedure Code Flag 1. The principal procedure is performed for definitive treatment rather than for diagnostic or exploratory purposes. It is closely related to either the principal diagnosis or to complications that arise during other treatments. Use Procedure Code 2 through Procedure Code 6 (and related data elements) to record secondary, tertiary, etc. procedures. |
CIP086 Values
|
| CIP088 |
CIP.002.088
|
PROCEDURE-CODE-FLAG-5 |
A flag that identifies the coding system used for an associated procedure code. |
CIP088 Values
|
| CIP089 |
CIP.002.089
|
PROCEDURE-CODE-DATE-5 |
The date upon which a reported medical procedure was performed. |
N/A
|
| CIP090 |
CIP.002.090
|
PROCEDURE-CODE-6 |
A procedure code based on ICD-9 and ICD-10 used by the state to identify the procedures performed during the hospital stay referenced by this claim. The principal procedure and related info should be recorded in Procedure Code 1, Procedure Code Date 1, and Procedure Code Flag 1. The principal procedure is performed for definitive treatment rather than for diagnostic or exploratory purposes. It is closely related to either the principal diagnosis or to complications that arise during other treatments. Use Procedure Code 2 through Procedure Code 6 (and related data elements) to record secondary, tertiary, etc. procedures. |
CIP090 Values
|
| CIP092 |
CIP.002.092
|
PROCEDURE-CODE-FLAG-6 |
A flag that identifies the coding system used for an associated procedure code. |
CIP092 Values
|
| CIP093 |
CIP.002.093
|
PROCEDURE-CODE-DATE-6 |
The date upon which a reported medical procedure was performed. |
N/A
|
| CIP094 |
CIP.002.094
|
ADMISSION-DATE |
The date on which the recipient was admitted to a hospital. |
N/A
|
| CIP095 |
CIP.002.095
|
ADMISSION-HOUR |
The hour of admission to a hospital. |
CIP095 Values
|
| CIP096 |
CIP.002.096
|
DISCHARGE-DATE |
The date on which the recipient was discharged from a hospital. |
N/A
|
| CIP097 |
CIP.002.097
|
DISCHARGE-HOUR |
The hour of discharge from a hospital. |
CIP097 Values
|
| CIP098 |
CIP.002.098
|
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. |
N/A
|
| CIP099 |
CIP.002.099
|
MEDICAID-PAID-DATE |
The date Medicaid paid this claim or adjustment. For Encounter Records (Type of Claim = 3, C, W), the date the managed care organization paid the provider for the claim or adjustment. |
N/A
|
| CIP100 |
CIP.002.100
|
TYPE-OF-CLAIM |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record. |
CIP100 Values
|
| CIP101 |
CIP.002.101
|
TYPE-OF-BILL |
A data element corresponding with UB-04 form locator FL4 that classifies the claim as to the type of facility (2nd digit), type of care (3rd digit) and the billing record's sequence in the episode of care (4th digit). (Note that the 1st digit is always zero.) |
CIP101 Values
|
| CIP102 |
CIP.002.102
|
CLAIM-STATUS |
The health care claim status codes convey the status of an entire claim status codes from the 277 transaction set. Only report the claim status for the final, adjudicated claim. |
CIP102 Values
|
| CIP103 |
CIP.002.103
|
CLAIM-STATUS-CATEGORY |
The general category of the claim status (accepted, rejected, pended, finalized, additional information requested, etc.), which is then further detailed in the companion data element claim status. |
CIP103 Values
|
| CIP104 |
CIP.002.104
|
SOURCE-LOCATION |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = "22" to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = "23" to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
CIP104 Values
|
| CIP105 |
CIP.002.105
|
CHECK-NUM |
The check or electronic funds transfer number. |
N/A
|
| CIP106 |
CIP.002.106
|
CHECK-EFF-DATE |
The date a check is issued to the payee. In the case of electronic funds transfer, it is the date the transfer is made. |
N/A
|
| CIP108 |
CIP.002.108
|
CLAIM-PYMT-REM-CODE-1 |
Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List. It is a code set used by the health care industry to convey non-financial information critical to understanding the adjudication of a health care claim for payment. It is an external code set whose use is as mandated by the Administrative Simplification provisions of the Health Insurance Portability and Accountably Act of 1996 (P.L.104-191, commonly referred to as HIPAA). |
CIP108 Values
|
| CIP109 |
CIP.002.109
|
CLAIM-PYMT-REM-CODE-2 |
Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List. It is a code set used by the health care industry to convey non-financial information critical to understanding the adjudication of a health care claim for payment. It is an external code set whose use is as mandated by the Administrative Simplification provisions of the Health Insurance Portability and Accountably Act of 1996 (P.L.104-191, commonly referred to as HIPAA). |
CIP109 Values
|
| CIP110 |
CIP.002.110
|
CLAIM-PYMT-REM-CODE-3 |
Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List. It is a code set used by the health care industry to convey non-financial information critical to understanding the adjudication of a health care claim for payment. It is an external code set whose use is as mandated by the Administrative Simplification provisions of the Health Insurance Portability and Accountably Act of 1996 (P.L.104-191, commonly referred to as HIPAA). |
CIP110 Values
|
| CIP111 |
CIP.002.111
|
CLAIM-PYMT-REM-CODE-4 |
Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List. It is a code set used by the health care industry to convey non-financial information critical to understanding the adjudication of a health care claim for payment. It is an external code set whose use is as mandated by the Administrative Simplification provisions of the Health Insurance Portability and Accountably Act of 1996 (P.L.104-191, commonly referred to as HIPAA). |
CIP111 Values
|
| CIP112 |
CIP.002.112
|
TOT-BILLED-AMT |
The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. 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. |
N/A
|
| CIP113 |
CIP.002.113
|
TOT-ALLOWED-AMT |
The claim header level maximum amount determined by the payer as being "allowable" under the provisions of the contract prior to the determination of actual payment. On FFS claims the Allowed Amount is determined by the state"s MMIS. On managed care encounters the Allowed Amount is determined by the managed care organization.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity allowed for the service. 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. |
N/A
|
| CIP114 |
CIP.002.114
|
TOT-MEDICAID-PAID-AMT |
The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. 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. |
N/A
|
| CIP116 |
CIP.002.116
|
TOT-MEDICARE-DEDUCTIBLE-AMT |
The amount paid by Medicaid/CHIP, on this claim at the claim header level, toward the beneficiary's Medicare deductible. If the Medicare deductible amount can be identified separately from Medicare coinsurance payments, code that amount in this field. If the Medicare coinsurance and deductible payments cannot be separated, fill this field with the combined payment amount, code Medicare Combined Indicator a "1" and leave Total Medicare Coinsurance Amount unpopulated. |
N/A
|
| CIP117 |
CIP.002.117
|
TOT-MEDICARE-COINS-AMT |
The total amount paid by the Medicaid/CHIP agency or a managed care plan towards the portion of the Medicare allowed charges that Medicare applied to coinsurance. |
N/A
|
| CIP118 |
CIP.002.118
|
TOT-TPL-AMT |
Third-party liability refers to the legal obligation of third parties, i.e., certain individuals, entities, or programs, to pay all or part of the expenditures for medical assistance furnished under a state plan. This is the total amount denoted at the claim header level paid by the third party. |
N/A
|
| CIP119 |
CIP.002.119
|
TOT-OTHER-INSURANCE-AMT |
The amount paid by insurance other than Medicare or Medicaid on this claim. |
N/A
|
| CIP121 |
CIP.002.121
|
OTHER-INSURANCE-IND |
The field denotes whether the insured party is covered under an other insurance plan other than Medicare or Medicaid. |
CIP121 Values
|
| CIP122 |
CIP.002.122
|
OTHER-TPL-COLLECTION |
This data element indicates that the claim is for a beneficiary for whom other third party resource development and collection activities are in progress, when the liability is not another health insurance plan for which the eligible is a beneficiary. |
CIP122 Values
|
| CIP123 |
CIP.002.123
|
SERVICE-TRACKING-TYPE |
A code to categorize service tracking claims. A "service tracking claim" is used to report lump sum payments that cannot be attributed to a single enrollee. |
CIP123 Values
|
| CIP124 |
CIP.002.124
|
SERVICE-TRACKING-PAYMENT-AMT |
On service tracking claims, the payment amount is the lump sum that cannot be attributed to any one beneficiary paid to the provider. |
N/A
|
| CIP125 |
CIP.002.125
|
FIXED-PAYMENT-IND |
This indicator indicates that the reimbursement amount included on the claim is for a fixed payment. Fixed payments are made by the state to insurers or providers for premiums or eligible coverage, not for a particular service. For example, some states have Primary Care Case Management programs where the state pays providers a monthly patient management fee of $3.50 for each eligible participant under their care. This fee is considered a fixed payment. It is very important for states to correctly identify fixed payments. Fixed payments do not have a defined "medical record" associated with the payment; therefore, fixed payments are not subject to medical record request and medical record review. |
CIP125 Values
|
| CIP126 |
CIP.002.126
|
FUNDING-CODE |
A code to indicate the source of non-federal share funds. |
CIP126 Values
|
| CIP127 |
CIP.002.127
|
FUNDING-SOURCE-NONFEDERAL-SHARE |
A code to indicate the type of non-federal share used by the state to finance its expenditure to the provider. In the event of two sources, states are to report the portion which represents the largest proportion not funded by the Federal government. |
CIP127 Values
|
| CIP128 |
CIP.002.128
|
MEDICARE-COMB-DED-IND |
Code indicating that the amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare deductible was combined with their coinsurance amount because the amounts could not be separated. |
CIP128 Values
|
| CIP129 |
CIP.002.129
|
PROGRAM-TYPE |
A code to indicate special Medicaid program under which the service was provided. |
CIP129 Values
|
| CIP130 |
CIP.002.130
|
PLAN-ID-NUMBER |
A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans. |
N/A
|
| CIP132 |
CIP.002.132
|
PAYMENT-LEVEL-IND |
The field denotes whether the payment amount was determined at the claim header or line/detail level.
For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only.
For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
CIP132 Values
|
| CIP133 |
CIP.002.133
|
MEDICARE-REIM-TYPE |
A code to indicate the type of Medicare reimbursement. |
CIP133 Values
|
| CIP134 |
CIP.002.134
|
NON-COV-DAYS |
The number of days of inpatient care not covered by the payer for this sequence as qualified by the payer organization. The number of non-covered days does not refer to days not covered for any other service. |
N/A
|
| CIP135 |
CIP.002.135
|
NON-COV-CHARGES |
The charges for inpatient care, which are not reimbursable by the primary payer. The non-covered charges do not refer to charges not covered for any other service. |
N/A
|
| CIP136 |
CIP.002.136
|
MEDICAID-COV-INPATIENT-DAYS |
The number of days covered by Medicaid on this claim. For states that combine delivery/birth services on a single claim, include covered days for both the mother and the neonate in this field. |
N/A
|
| CIP137 |
CIP.002.137
|
CLAIM-LINE-COUNT |
The total number of lines on the claim. |
N/A
|
| CIP138 |
CIP.002.138
|
FORCED-CLAIM-IND |
Indicates if the claim was processed by forcing it through a manual override process. |
CIP138 Values
|
| CIP139 |
CIP.002.139
|
HEALTH-CARE-ACQUIRED-CONDITION-IND |
This code indicates whether the claim has a Health Care Acquired Condition. For additional coding information refer to the following site : https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/index.html?redirect=/hospitalacqcond/05_Coding.asp#TopOfPage |
CIP139 Values
|
| CIP140 |
CIP.002.140
|
OCCURRENCE-CODE-01 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP140 Values
|
| CIP141 |
CIP.002.141
|
OCCURRENCE-CODE-02 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP141 Values
|
| CIP142 |
CIP.002.142
|
OCCURRENCE-CODE-03 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP142 Values
|
| CIP143 |
CIP.002.143
|
OCCURRENCE-CODE-04 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP143 Values
|
| CIP144 |
CIP.002.144
|
OCCURRENCE-CODE-05 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP144 Values
|
| CIP145 |
CIP.002.145
|
OCCURRENCE-CODE-06 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP145 Values
|
| CIP146 |
CIP.002.146
|
OCCURRENCE-CODE-07 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP146 Values
|
| CIP147 |
CIP.002.147
|
OCCURRENCE-CODE-08 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP147 Values
|
| CIP148 |
CIP.002.148
|
OCCURRENCE-CODE-09 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP148 Values
|
| CIP149 |
CIP.002.149
|
OCCURRENCE-CODE-10 |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
CIP149 Values
|
| CIP150 |
CIP.002.150
|
OCCURRENCE-CODE-EFF-DATE-01 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP151 |
CIP.002.151
|
OCCURRENCE-CODE-EFF-DATE-02 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP152 |
CIP.002.152
|
OCCURRENCE-CODE-EFF-DATE-03 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP153 |
CIP.002.153
|
OCCURRENCE-CODE-EFF-DATE-04 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP154 |
CIP.002.154
|
OCCURRENCE-CODE-EFF-DATE-05 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP155 |
CIP.002.155
|
OCCURRENCE-CODE-EFF-DATE-06 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP156 |
CIP.002.156
|
OCCURRENCE-CODE-EFF-DATE-07 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP157 |
CIP.002.157
|
OCCURRENCE-CODE-EFF-DATE-08 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP158 |
CIP.002.158
|
OCCURRENCE-CODE-EFF-DATE-09 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP159 |
CIP.002.159
|
OCCURRENCE-CODE-EFF-DATE-10 |
The start date of the corresponding occurrence code or occurrence span codes. |
N/A
|
| CIP160 |
CIP.002.160
|
OCCURRENCE-CODE-END-DATE-01 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP161 |
CIP.002.161
|
OCCURRENCE-CODE-END-DATE-02 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP162 |
CIP.002.162
|
OCCURRENCE-CODE-END-DATE-03 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP163 |
CIP.002.163
|
OCCURRENCE-CODE-END-DATE-04 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP164 |
CIP.002.164
|
OCCURRENCE-CODE-END-DATE-05 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP165 |
CIP.002.165
|
OCCURRENCE-CODE-END-DATE-06 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP166 |
CIP.002.166
|
OCCURRENCE-CODE-END-DATE-07 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP167 |
CIP.002.167
|
OCCURRENCE-CODE-END-DATE-08 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP168 |
CIP.002.168
|
OCCURRENCE-CODE-END-DATE-09 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP169 |
CIP.002.169
|
OCCURRENCE-CODE-END-DATE-10 |
The last date that the corresponding occurrence code or occurrence span code was applicable. If occurrence date span is a single day, value must be equal to the value of the associated Occurrence Code Effective Date. |
N/A
|
| CIP170 |
CIP.002.170
|
BIRTH-WEIGHT-GRAMS |
The weight of a newborn at time of birth in grams (applicable to newborns only). The field is required when a claim involves a child birth. |
N/A
|
| CIP171 |
CIP.002.171
|
PATIENT-CONTROL-NUM |
A patient's unique number assigned by the provider agency during claim submission, which identifies the client or the client's episode of service within the provider's system to facilitate retrieval of
individual financial and clinical records and posting of payment |
N/A
|
| CIP172 |
CIP.002.172
|
ELIGIBLE-LAST-NAME |
The last name of the individual to whom the services were provided. (The patients name should be captured as it appears on the claim record, it does not need to be the same as it appears on the eligibility file. The MSIS Identification Number will be used to associate a claim record with the appropriate eligibility data.) |
N/A
|
| CIP173 |
CIP.002.173
|
ELIGIBLE-FIRST-NAME |
The first name of the individual to whom the services were provided. (The patients name should be captured as it appears on the claim record, it does not need to be the same as it appears on the eligibility file. The MSIS Identification Number will be used to associate a claim record with the appropriate eligibility data.) |
N/A
|
| CIP174 |
CIP.002.174
|
ELIGIBLE-MIDDLE-INIT |
Individual's middle initial; middle initial component of full name (e.g. First Name, Middle Initial, Last Name). |
N/A
|
| CIP175 |
CIP.002.175
|
DATE-OF-BIRTH |
Date of birth of the individual to whom the services were provided. A patient's age should not be greater than 112 years. |
N/A
|
| CIP176 |
CIP.002.176
|
HEALTH-HOME-PROV-IND |
Indicates whether the claim is submitted by a provider or provider group enrolled in the Health Home care model to provide services for the beneficiary on the claim. Health home providers provide service for patients with chronic illnesses. States that do not specify an eligible individual's health home provider number, if applicable, should not report claims that indicate the claim is submitted by a provider or provider group enrolled in the health home model. |
CIP176 Values
|
| CIP177 |
CIP.002.177
|
WAIVER-TYPE |
A code for specifying waiver type under which the eligible individual is covered during the month and receiving services/under which claim is submitted. |
CIP177 Values
|
| CIP178 |
CIP.002.178
|
WAIVER-ID |
Field specifying the waiver or demonstration which authorized payment for a claim. These IDs must be the approved, full federal waiver ID number assigned during the state submission and CMS approval process. Waiver IDs should actually only be the "core" part of the waiver IDs, without including suffixes for renewals or amendments. |
N/A
|
| CIP179 |
CIP.002.179
|
BILLING-PROV-NUM |
A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan. |
N/A
|
| CIP180 |
CIP.002.180
|
BILLING-PROV-NPI-NUM |
The National Provider ID (NPI) of the billing entity responsible for billing a patient for healthcare services. The billing provider can also be servicing, referring, or prescribing provider. Can be admitting provider except for Long Term Care. |
N/A
|
| CIP181 |
CIP.002.181
|
BILLING-PROV-TAXONOMY |
The taxonomy code for the institution billing for the beneficiary. |
CIP181 Values
|
| CIP182 |
CIP.002.182
|
BILLING-PROV-TYPE |
A code to describe the type of provider being reported. |
CIP182 Values
|
| CIP183 |
CIP.002.183
|
BILLING-PROV-SPECIALTY |
This code describes the area of specialty for the provider being reported. |
CIP183 Values
|
| CIP184 |
CIP.002.184
|
ADMITTING-PROV-NPI-NUM |
The National Provider ID (NPI) of the doctor responsible for admitting a patient to a hospital or other inpatient health facility. |
N/A
|
| CIP185 |
CIP.002.185
|
ADMITTING-PROV-NUM |
The Medicaid ID of the doctor responsible for admitting a patient to a hospital or other inpatient health facility. |
N/A
|
| CIP186 |
CIP.002.186
|
ADMITTING-PROV-SPECIALTY |
This code describes the area of specialty for the provider being reported. |
CIP186 Values
|
| CIP187 |
CIP.002.187
|
ADMITTING-PROV-TAXONOMY |
Taxonomic classification (code) for a given healthcare provider, as defined by the National Uniform Claim Committee. |
CIP187 Values
|
| CIP188 |
CIP.002.188
|
ADMITTING-PROV-TYPE |
A code to describe the type of provider being reported. |
CIP188 Values
|
| CIP189 |
CIP.002.189
|
REFERRING-PROV-NUM |
A unique identification number assigned to a provider which identifies the physician or other provider who referred the patient. For physicians, this must be the individual's ID number, not a
group identification number. If the referring provider number is not available, but the physician's Drug Enforcement Agency (DEA) ID is on the State file, then the State should use the DEA
ID for this data element. |
N/A
|
| CIP190 |
CIP.002.190
|
REFERRING-PROV-NPI-NUM |
The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient. |
N/A
|
| CIP194 |
CIP.002.194
|
DRG-OUTLIER-AMT |
The additional payment on a claim that is associated with either a cost outlier or length of stay outlier. Outlier payments compensate hospitals paid on a fixed amount per Medicare "diagnosis related group" discharge with extra dollars for patient stays that substantially exceed the typical requirements for patient stays in the same DRG category. |
N/A
|
| CIP195 |
CIP.002.195
|
DRG-REL-WEIGHT |
The relative weight for the DRG on the claim. Each year CMS assigns a relative weight to each DRG. These weights indicate the relative costs for treating patients during the prior year. The national average charge for each DRG is compared to the overall average. This ratio is published annually in the Federal Register for each DRG. A DRG with a weight of 2.0000 means that charges were historically twice the average; a DRG with a weight of 0.5000 was half the average. This data element in T-MSIS is expected to capture the relative weight of the DRG in the state's system regardless of which DRG system the state uses. |
N/A
|
| CIP196 |
CIP.002.196
|
MEDICARE-HIC-NUM |
The Medicare HIC Number (HICN) is an identifier formerly used by SSA and CMS to identify all Medicare beneficiaries. For many beneficiaries, their SSN was a major component of their HICN. To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the
Medicare Beneficiary Identifier (MBI) over the course of 2018 and 2019. HICN continue to be used by Medicare for limited administrative purposes after 2019 but starting in 2020 the MBI became the primary identifier for Medicare beneficiaries. HICN consists of two components: SSN &
alpha-suffix or (for Railroad IDs) prefix and ID (not always SSN based) |
N/A
|
| CIP197 |
CIP.002.197
|
OUTLIER-CODE |
This code indicates the Type of Outlier Code or DRG Source. The field identifies two mutually exclusive conditions. The first, for PPS providers (codes 0, 1, and 2), classifies stays of exceptional cost or length (outliers). The second, for non-PPS providers (codes 6, 7, 8, and 9), denotes the source for developing the DRG. https://www.resdac.org/cms-data/variables/medpar-drgoutlier-stay-code |
CIP197 Values
|
| CIP198 |
CIP.002.198
|
OUTLIER-DAYS |
This field specifies the number of days paid as outliers under Prospective Payment System (PPS) and the days over the threshold for the DRG. |
N/A
|
| CIP199 |
CIP.002.199
|
PATIENT-STATUS |
A code indicating the patient's status as of the last day the claim covers. Values used are from UB-04. This is also referred to as patient discharge status. A valid list of codes can be purchased at https://www.nubc.org/license |
CIP199 Values
|
| CIP202 |
CIP.002.202
|
REMITTANCE-NUM |
The Remittance Advice Number is a sequential number that identifies the current Remittance Advice (RA) produced for a provider. The number is incremented by one each time a new RA is generated. The RA is the detailed explanation of the reason for the payment amount. |
N/A
|
| CIP203 |
CIP.002.203
|
SPLIT-CLAIM-IND |
An indicator that denotes that claims in excess of a pre-determined number of claim lines (threshold determined by the individual state) will be split during processing. |
CIP203 Values
|
| CIP204 |
CIP.002.204
|
BORDER-STATE-IND |
A code to indicate whether an individual received services or equipment across state borders. (The provider location is out of state, but for payment purposes the provider is treated as an in-state provider.) |
CIP204 Values
|
| CIP206 |
CIP.002.206
|
TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT |
The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their coinsurance for the covered services on the claim. Do not include coinsurance payments made by a third party/ies on behalf of the beneficiary. |
N/A
|
| CIP207 |
CIP.002.207
|
BENEFICIARY-COINSURANCE-DATE-PAID |
The date the beneficiary paid the coinsurance amount. |
N/A
|
| CIP208 |
CIP.002.208
|
TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT |
The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on the claim. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. |
N/A
|
| CIP209 |
CIP.002.209
|
BENEFICIARY-COPAYMENT-DATE-PAID |
The date the beneficiary paid the copayment amount. |
N/A
|
| CIP210 |
CIP.002.210
|
TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT |
The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their deductible for the covered services on the claim. Do not include deductible payments made by a third party/ies on behalf of the beneficiary. |
N/A
|
| CIP211 |
CIP.002.211
|
BENEFICIARY-DEDUCTIBLE-DATE-PAID |
The date the beneficiary paid the deductible amount. |
N/A
|
| CIP212 |
CIP.002.212
|
CLAIM-DENIED-INDICATOR |
An indicator to identify a claim that the state refused pay in its entirety. |
CIP212 Values
|
| CIP213 |
CIP.002.213
|
COPAY-WAIVED-IND |
An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions. |
CIP213 Values
|
| CIP214 |
CIP.002.214
|
HEALTH-HOME-ENTITY-NAME |
A free-form text field to indicate the health home program that authorized payment for the service on the claim or to identify the health home SPA in which an individual is enrolled. The name entered should be the name that the state uses to uniquely identify the team. A "Health Home Entity" can be a designated provider (e.g., physician, clinic, behavioral health organization), a health team which links to a designated provider, or a health team (physicians, nurses, behavioral health professionals). Because an identification numbering schema has not been established, the entities" names are being used instead. |
N/A
|
| CIP216 |
CIP.002.216
|
THIRD-PARTY-COINSURANCE-AMOUNT-PAID |
The amount of money paid by a third party on behalf of the beneficiary towards coinsurance. |
N/A
|
| CIP217 |
CIP.002.217
|
THIRD-PARTY-COINSURANCE-DATE-PAID |
The date the third party paid the coinsurance amount |
N/A
|
| CIP218 |
CIP.002.218
|
THIRD-PARTY-COPAYMENT-AMOUNT-PAID |
The amount of money paid by a third party on behalf of the beneficiary towards copayment. |
N/A
|
| CIP219 |
CIP.002.219
|
THIRD-PARTY-COPAYMENT-DATE-PAID |
The date the third party paid the copayment amount. |
N/A
|
| CIP220 |
CIP.002.220
|
MEDICAID-AMOUNT-PAID-DSH |
The amount included in the Total Medicaid Amount (CIP.002.114) that is attributable to a Disproportionate Share Hospital (DSH) payment, when the state makes DSH payments by claim. |
N/A
|
| CIP221 |
CIP.002.221
|
HEALTH-HOME-PROVIDER-NPI |
The National Provider ID (NPI) of the health home provider. |
N/A
|
| CIP222 |
CIP.002.222
|
MEDICARE-BENEFICIARY-IDENTIFIER |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI
over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
N/A
|
| CIP223 |
CIP.002.223
|
OPERATING-PROV-TAXONOMY |
Taxonomic classification (code) for a given healthcare provider, as defined by the National Uniform Claim Committee. |
CIP223 Values
|
| CIP228 |
CIP.002.228
|
MEDICARE-PAID-AMT |
The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the line level, report the sum of all the line level Medicare payment amounts at the header. |
N/A
|
| CIP229 |
CIP.002.229
|
STATE-NOTATION |
A free text field for the submitting state to enter whatever information it chooses. |
N/A
|
| CIP289 |
CIP.002.289
|
PROV-LOCATION-ID |
A code to uniquely identify the geographic location where the provider's services were performed. The Provider Location Identifier values reported on Inpatient, Long-Term Care, Other, and Pharmacy Claim Header Segments must correspond to an active Provider Location Identifier value on a Provider Location and Contact Info (PRV.003) segment. If a particular license (e.g., a physician's medical license) or provider identifier (e.g., an individual provider's NPI or SSN) is applicable to all of their servicing locations, value "000" (a string of exactly three zeros) can be used in the PRV.004 or PRV.005, respectively, to represent all locations, however that location identifier must not be attributed to claims or provider bed type info. |
N/A
|
| CIP290 |
CIP.002.290
|
BEGINNING-DATE-OF-SERVICE |
For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. For capitation premium payments, the date on which the period of coverage related to this payment began. For financial transactions reported to the OT file, populate with the first day of the time period covered by this financial transaction. |
N/A
|
| CIP291 |
CIP.002.291
|
ENDING-DATE-OF-SERVICE |
For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. For capitation premium payments, the date on which the period of coverage related to this payment ends/ended. For financial transactions reported to the OT file, populate with the last day of the time period covered by this financial transaction. |
N/A
|
| CIP292 |
CIP.002.292
|
TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT |
The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment. |
N/A
|
| CIP293 |
CIP.002.293
|
TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT |
The total coinsurance amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary coinsurance liability for covered services on the claim. Do not subtract out any payments made toward the coinsurance. |
N/A
|
| CIP294 |
CIP.002.294
|
TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT |
The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible. |
N/A
|
| CIP295 |
CIP.002.295
|
COMBINED-BENE-COST-SHARING-PAID-AMOUNT |
The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary. |
N/A
|
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