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CMS MACBIS T-MSIS Reporting Reminder: Completeness of Claims Classifier Data Elements

Reporting Reminder History

Date Description of Change
08/05/2021 Original reporting reminder issued

Reporting reminder updated in correspondence with the V3.0.0 data dictionary update:

  • Add IHS-SERVICE-IND (CIP296, CLT243, COT234, CRX172,) data element.

Topic Description

Reporting complete claims classifier data elements is a T-MSIS Priority Item. This reporting reminder focuses on reporting claims classifier data elements: Type-of-Service, Type-of-Claim, Program-Type, CMS-64-Category-for-Federal-Reimbursement, and IHS-SERVICE-IND[1] within the Claims files in T-MSIS.

Impacted Data Elements

  • TYPE-OF-SERVICE (CIP257,CLT211,COT186, CRX134)
  • TYPE-OF-CLAIM (CIP100, CLT052, COT037, CRX029)
  • PROGRAM-TYPE (CIP129, CLT079, COT065, CRX055)
  • IHS-SERVICE-IND (CIP296, CLT243, COT234, CRX172,)[1]

Reporting Reminder

T-MSIS includes data elements that help classify the services provided or the program and/or benefit under which the claim was covered. TYPE-OF-SERVICE, TYPE-OF-CLAIM, PROGRAM-TYPE, CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT, and IHS-SERVICE-IND[1] are data elements that help classify these services. These data elements are required and are applicable to all or nearly all claims in all file types. 

CMS will report a possible data quality issue when the following occur:

  • There are more than a small percentage of claims for which TYPE-OF-SERVICE, TYPE-OF-CLAIM, or CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT is missing; or
  • The percentage of claims for which PROGRAM-TYPE equals 01 (EPSDT), 02 (Family Planning), or 04 (Federally Qualified Health Centers (FQHC)) are outside of a reasonable range.

Please refer to the T-MSIS data dictionary for specific coding requirements for each data element.

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

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