CMS Technical Instruction: Populating T-MSIS Claims File Data Elements on Void/Reversal/Cancel Records

Technical Instruction History

Date	Description of Change
10/23/2020	Original technical instructions issued
06/24/2022	Technical instructions updated in correspondence with the V3.0.0 data dictionary update: The TOT-COPAY-AMT data element was deprecated. The following data elements were added: TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT, TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT, TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT, and COMBINED-BENE-COST-SHARING-PAID-AMOUNT. The following data elements were renamed: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (formerly known as BENEFICIARY-COINSURANCE-AMOUNT), TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (formerly known as BENEFICIARY-COPAYMENT-AMOUNT), TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (formerly known as BENEFICIARY-DEDUCTIBLE-AMOUNT), and BENEFICIARY-COPAYMENT-PAID-AMOUNT (formerly known as COPAY-AMT).

Date

Description of Change

10/23/2020

Original technical instructions issued

06/24/2022

Technical instructions updated in correspondence with the V3.0.0 data dictionary update:

The TOT-COPAY-AMT data element was deprecated.
The following data elements were added: TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT, TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT, TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT, and COMBINED-BENE-COST-SHARING-PAID-AMOUNT.
The following data elements were renamed: TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT (formerly known as BENEFICIARY-COINSURANCE-AMOUNT), TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT (formerly known as BENEFICIARY-COPAYMENT-AMOUNT), TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT (formerly known as BENEFICIARY-DEDUCTIBLE-AMOUNT), and BENEFICIARY-COPAYMENT-PAID-AMOUNT (formerly known as COPAY-AMT).

Brief Issue Description

Records that void/reverse/cancel previously submitted FFS claims and encounters are important to accurately identify Medicaid utilization and expenditures. How the data elements are populated on these void/reversal/cancel records are important to accurately interpret the records. The following technical instruction document addresses how data elements should be populated in T-MSIS when a void/reversal/cancel record is included on the file.

Background Discussion

Accurately reporting adjustments is necessary for identifying Medicaid and CHIP utilization and expenditures in T-MSIS. Completely and accurately populating data elements on void/reversal/cancel records allows for the records to be appropriately linked to the most recently submitted original/adjustment record^[1]. Additionally, consistent reporting across states allows for accurate interpretation of the data. This technical instruction document provides information on how to populate data elements on void/reversal/cancel records in T-MSIS. While this technical instruction document primarily addresses reporting void/reversal/cancel records for FFS claims and encounters, it also applies to capitation payments, supplemental payments or service tracking payments that are adjusted using replace and void/reversal/cancel processes.

Challenges

Some states do not currently follow the requirements for void/reversal/cancel records as specified in the T-MSIS data dictionary, particularly for reporting expenditures. States take various approaches for populating data elements in void/reversal/cancel records, leading to inconsistency in interstate comparisons, questions regarding the accuracy of the reporting, and potential inaccurate interpretations of the state’s data. Some states have raised questions about how to populate the dollar amount and quantity data elements on void/reversal/cancel records. While state Medicaid programs and MMIS may differ, it is important that states utilize uniform T-MSIS reporting methods where those opportunities exist.

CMS Technical Instruction

States should report void/reversal/cancel records consistent with T-MSIS data dictionary requirements and appropriate technical instructions documents (see Related Technical Instructions). For the purposes of these technical instructions, the data elements reported on void/reversal/cancel records are grouped into four categories based upon how the data elements are populated by the state.

Record Key data elements should be reported with values that uniquely identify the claim and link the void claim to the previously submitted original or adjustment claim or encounter. These data elements are identified in Table 1.
X-12 transaction data elements should be reported with values related to the processing of the void claim. These data elements are identified in Table 3.
Adjudicated quantity data elements should all be reported with a value of “0”. These data elements are identified in Table 4.
Carry Over data elements should be reported with values reported on the previous original or adjustment claim or encounter. These represent all data elements not identified Table 1, Table 3 or Table 4.

Record key data elements are populated with information that uniquely identifies a record and links it to all other records in a claim family^[2]. The record keys are also used to link the information reported on the claim header to the claim line record. These data elements are reported in Table 1. All void/reversal/cancel records should be reported with ADJUSTMENT-IND and LINE-ADJUSTMENT-IND values of “1”. The other primary key data elements should be populated consistent with T-MSIS Data Dictionary and appendices. The adjudication date should be populated with the date on which payment status of the claim was finally adjudicated by the state, as per the T-MSIS data dictionary. The ICN-ORIG and ICN-ADJ data elements should be populated with values that link the void to the most recently submitted original/adjustment record in the claim family.

Table 2 provides examples of void claims linked to previous records using both the original ICN approach (rows 1 – 3) as well as the daisy chain ICN approach (rows 4 to 6). Both examples represent a claim family where the original claim is first followed by an adjustment that corrects the value reported in the TOT-BILLED-AMT and then followed by a void/reversal/cancel record. In addition to states ensuring that the ICN-ORIG and ICN-ADJ are correctly populated, states using the original ICN approach should ensure that the ADJUDICATION-DATE is populated accurately. The record in the claim family with the most recent ADJUDICATION-DATE will be identified as the most recent submission of the claim^[3]. For additional information on using the original ICN approach or daisy chain ICN approach to linking claim families, please refer to T-MSIS Data Dictionary Appendix P.01.

Table 1 – Record Key Data Elements
Data Element Name	Data Element Number
Claim Header Detail	IP	LT	OT	RX
SUBMITTING-STATE	CIP017	CLT017	COT017	CRX017
ICN-ORIG	CIP019	CLT019	COT019	CRX019
ICN-ADJ	CIP020	CLT020	COT020	CRX020
ADJUSTMENT-IND	CIP026	CLT025	COT025	CRX025
ADJUDICATION-DATE	CIP098	CLT050	COT035	CRX027
Claim Line Detail	IP	LT	OT	RX
SUBMITTING-STATE	CIP232	CLT185	COT155	CRX109
ICN-ORIG	CIP235	CLT188	COT158	CRX112
ICN-ADJ	CIP236	CLT189	COT159	CRX113
LINE-ADJUSTMENT-IND	CIP239	CLT192	COT162	CRX116
ADJUDICATION-DATE	CIP286	CLT233	COT221	CRX157

Table 2 – Using record keys to link void claims to prior submissions
Row Number	SUBMITTING-STATE	ICN-ORIG	ICN-ADJ	ADJUSTMENT-IND	ADJUDICATION-DATE	TOT-BILLED-AMT
Original ICN Method
1	XX	0897100		0	12/4/2019	$1000
2	XX	0897100	0897101	4	1/18/2020	$100
3	XX	0897100	0897102	1	3/7/2020	$100
Daisy Chain ICN Method
4	XX	1235674		0	12/4/2019	$1000
5	XX	1235674	7654987	4	1/18/2020	$100
6	XX	7654987	0129384	1	3/7/2020	$100

“X-12 transaction” data elements are populated with information on how the void/reversal/cancel record was processed. These data elements are identified in table 3 below. If the X-12 transaction values are not applicable to the void/reversal/cancel claim or encounter, then the data element should be reported with a null value. For example, if a void only has one Remittance Advice Remark Code (RARC), then the CLAIM-PYMT-REM-CODE-2 through CLAIM-PYMT-REM-CODE-4 would be populated with a null value.

Table 3 – X-12 Transaction Data Elements
Data Element Name	Data Element Number
Claim Header Detail	IP	LT	OT	RX
ADJUSTMENT-REASON-CODE	CIP027	CLT026	COT026	CRX026
CLAIM-STATUS	CIP102	CLT054	COT039	CRX030
CLAIM-STATUS-CATEGORY	CIP103	CLT055	COT040	CRX031
CLAIM-PYMT-REM-CODE-1	CIP108	CLT059	COT044	CRX035
CLAIM-PYMT-REM-CODE-2	CIP109	CLT060	COT045	CRX036
CLAIM-PYMT-REM-CODE-3	CIP110	CLT061	COT046	CRX037
CLAIM-PYMT-REM-CODE-4	CIP111	CLT062	COT047	CRX038
Claim Line Detail	IP	LT	OT	RX
LINE-ADJUSTMENT-REASON-CODE	CIP240	CLT193	COT163	CRX117
CLAIM-LINE-STATUS	CIP242	CLT195	COT165	CRX119

“Adjudicated quantity” data elements are populated with values that are derived through the adjudication of the FFS claim or encounter. All “adjudicated quantity” data elements should be populated with a value of “0” on a void record. The specific data elements that should be reported with a value of “0” on void/reversal/cancel records are identified in Table 4. These are values that would include the allowed amounts, the payment amounts, and the quantities of service allowed. These data elements should be populated with “0” because the void/reversal/cancel in T-MSIS is supposed to represent the final net liability for the services on the FFS claim or encounter. The adjudicated dollar amounts and quantities on the FFS claim or encounter should not reflect the marginal change in dollar amounts or quantities before and after the void/reversal/cancel occurred. Reporting positive or negative values in these fields raises question regarding how the void/reversal/cancel records should be interpreted and whether the ADJUSTMENT-IND value is accurate.

Table 4 - Adjudicated Quantity Data Elements
Data Element Name	Data Element Number
Claim Header Detail	IP	LT	OT	RX
TOT-ALLOWED-AMT	CIP113	CLT064	COT049	CRX040
TOT-MEDICAID-PAID-AMT	CIP114	CLT065	COT050	CRX041
TOT-COPAY-AMT^[a]	CIP115	CLT066	COT051	CRX042
TOT-MEDICARE-DEDUCTIBLE-AMT	CIP116	CLT067	COT052	CRX043
TOT-MEDICARE-COINS-AMT	CIP117	CLT068	COT053	CRX044
NON-COV-DAYS	CIP134	CLT084
NON-COV-CHARGES	CIP135	CLT085
MEDICAID-COV-INPATIENT-DAYS	CIP136	CLT086
ICF-IID-DAYS		CLT147
NURSING-FACILITY-DAYS		CLT149
LTC-RCP-LIAB-AMT		CLT145
MEDICAID-AMOUNT-PAID-DSH	CIP220
DRG-OUTLIER-AMT	CIP194
SERVICE-TRACKING-PAYMENT-AMT	CIP124	CLT074	COT060	CRX051
TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT^[b]	CIP292	CLT239	COT230	CRX163
TOT-BENEFICIARY-COINSURANCE-LIABLE-AMOUNT^[b]	CIP293	CLT240	COT231	CRX164
TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT^[b]	CIP294	CLT241	COT232	CRX165
COMBINED-BENE-COST-SHARING-PAID-AMOUNT^[b]	CIP295	CLT242	COT233	CRX166
TOT-BENEFICIARY-COINSURANCE-PAID-AMOUNT^[c]	CIP206	CLT153	COT130	CRX087
TOT-BENEFICIARY-COPAYMENT-PAID-AMOUNT^[d]	CIP208	CLT155	COT132	CRX089
TOT-BENEFICIARY-DEDUCTIBLE-PAID-AMOUNT^[e]	CIP210	CLT157	COT134	CRX092
Claim Line Detail	IP	LT	OT	RX
ALLOWED-AMT	CIP252	CLT205	COT175	CRX122
BENEFICIARY-COPAYMENT-PAID-AMOUNT^[f]			COT176	CRX123
MEDICAID-PAID-AMT	CIP254	CLT208	COT178	CRX125
MEDICARE-DEDUCTIBLE-AMT				CRX127
MEDICARE-COINS-AMT				CRX128
OT-RX-CLAIM-QUANTITY-ALLOWED			COT184	CRX184
IP-LT-QUANTITY-OF-SERVICE-ALLOWED	CIP250	CLT203
MEDICAID-FFS-EQUIVALENT-AMT	CIP255	CLT209	COT179	CRX122

[a] This data element has been deprecated as of V3.0.0 of the Data Dictionary.

[b] This is a new data element as of T-MSIS Data Dictionary V3.0.0.

[c] This data element was formerly known as BENEFICIARY-COINSURANCE-AMOUNT before T-MSIS Data Dictionary V3.0.0.

[d] This data element was formerly known as BENEFICIARY-COPAYMENT-AMOUNT before T-MSIS Data Dictionary V3.0.0.

[e] This data element was formerly known as BENEFICIARY-DEDUCTIBLE-AMOUNT before T-MSIS Data Dictionary V3.0.0.

[f] This data element was formerly known as COPAY-AMT before T-MSIS Data Dictionary V3.0.0.

All other data elements should be populated with the values from the most recent parent record that is being voided/reversed/cancelled. An example of this is presented in Table 2 in rows 2 and 3. The TOT-BILLED-AMT reported on the void record in row 3 is the same value that is reported in the TOT-BILLED-AMT reported on the adjustment record in row 2.

Related Technical Instructions

Additional technical instruction documents are listed below that are related to submissions of void records. This is not a list of all claims related technical instructions, but rather those that would help further understand the technical instructions above.

[1] In T-MSIS, voids, reversals, and cancels are identified when ADJUSTMENT-IND and LINE-ADJUSTMENT-IND are reported with a value of “1”.

[2] A claim family is comprised of the original FFS claim or encounter and each subsequent adjustment and, void/cancel/reversal of that original FFS claim or encounter.

[3] If two records in the same claim family are submitted with the same ADJUDICATION-DATE on the same T-MSIS claim file submission using the original ICN method, then a tiebreaker methodology will select the adjustment/replace record over the void/reversal/cancel record. Two void/reversal/cancel records will generate an error under this scenario.