CIP.002.114

TOT-MEDICAID-PAID-AMT

Data Element

DE Number

CIP114

System DE Number

CIP.002.114

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	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.
Size	S9(11)V99
FLF Start Position	533
FLF Stop Position	545
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50) 3. Must have an associated Medicaid Paid Date 4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount 5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts. 6. Conditional 7. Value must be populated, when Type of Claim is in [1,A] 8. Value must not be populated or equal to "0.00" when associated Claim Status is in [26,026,87,087,542,585,654] 9. Value should not be populated, when associated Type of Claim value is in [4,D] 10. Value must be populated when the associated Type of Claim (CIP.002.100) is in [5,E] 11. Value must not be greater than Total Allowed Amount (CIP.002.113)

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

RULE ID	RULE Definition
RULE-536	If a claim is a non-denied claim from an IP file, then the total Medicaid paid amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.
RULE-7266	If a claim is a non-denied claim from an IP file that is an original claim and is a separate CHIP FFS, Medicaid or Medicaid-expansion FFS claim with a crossover indicator equal to 0 or null, then the total medicaid paid amount must be populated.
RULE-7267	If a claim is a non-denied claim from an IP file that is an original claim and is a separate CHIP FFS, Medicaid or Medicaid-expansion FFS claim with a crossover indicator equal to 1, then the total medicaid paid amount must be populated.
RULE-7278	If a claim is a non-denied claim from an IP file that is an original claim and is a Medicaid or Medicaid-expansion CHIP, Medicaid or Medicaid-expansion CHIP encounter, separate CHIP FFS or encounter claim, and the payment level indicator is for line, then the sum of the claim line medicaid paid amount is equal to the claim header total medicaid paid amount.
RULE-7282	If a claim is a non-denied claim from an IP file that is an original claim and is a Medicaid or Medicaid-expansion CHIP FFS, Medicaid or Medicaid-expansion CHIP encounter, separate CHIP FFS or encounter claim and the total medicaid paid amount is populated, then the total medicaid paid amount is less than or equal to the total allowed amount.
RULE-7435	If the non-denied claim is an IP file, and is an Medicaid-SCHIP or Separate CHIP service tracking claim, then the claim has a null value or 0.00 value for total medicaid paid amount.
RULE-7522	If the non-denied claim is an IP file, and is an original, adjustment, gross adjustment or debit adjustment Medicaid/Medicaid-expansion CHIP or Separate CHIP supplemental claim, then the claim has a non-null value and not 0.00 value for total medicaid paid amount.
RULE-7565	If an IP claim header is for a denied claim, then total medicaid paid amount has a missing or zero value.
RULE-7682	If a claim is a non-denied claim from an IP file that is an original claim and is a Medicaid or Medicaid-expansion CHIP encounter, separate CHIP encounter claim, and the payment level indicator is for line, then the sum of the claim line medicaid paid amount is equal to the claim header total medicaid paid amount.
RULE-7686	If a claim is a non-denied claim from an IP file that is an original claim and is a Medicaid or Medicaid-expansion CHIP encounter, separate CHIP encounter claim and the total medicaid paid amount is populated, then the total medicaid paid amount is less than or equal to the total allowed amount.
RULE-7790	If a claim is a non-denied claim from an IP file that is an original claim and is a Medicaid or Medicaid-expansion CHIP or Separate CHIP Fee-for-Service claim, and the payment level indicator is for line, then the sum of the claim line medicaid paid amount is equal to the claim header total medicaid paid amount.
RULE-7794	If a claim is a non-denied claim from an IP file that is an original claim and is a Medicaid or Medicaid-expansion CHIP or Separate CHIP Fee-for-Service claim and the total medicaid paid amount is populated, then the total medicaid paid amount is less than or equal to the total allowed amount.

Measure ID	Measure Name
EXP-2-010-13	Total paid for TYPE-OF-SERVICE = 123 (Disproportionate share hospital (DSH) payments)
EXP-5-002-12	Total paid for TYPE-OF-SERVICE = 58 (Services furnished in a religious nonmedical health care institution)
EXP-5-001-10	Total paid for TYPE-OF-SERVICE = 1 (Inpatient hospital services, other than services in an institution for mental diseases)
EXP-2-019-11	Average paid per record for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
EXP-2-018-10	Average paid per record for TYPE-OF-SERVICE = 92 (Exceptional care – hospital residing)
EXP-2-017-9	Average paid per record for TYPE-OF-SERVICE = 91 (Skilled care – hospital residing)
EXP-2-016-8	Average paid per record for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
EXP-2-015-7	Average paid per record for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
EXP-2-014-6	Average paid per record for TYPE-OF-SERVICE = 84 (Sterilizations)
EXP-2-013-5	Average paid per record for TYPE-OF-SERVICE = 60 (Emergency hospital services)
EXP-2-012-4	Average paid per record for TYPE-OF-SERVICE = 58 (Services furnished in a religious nonmedical health care institution)
EXP-2-011-3	Average paid per record for TYPE-OF-SERVICE = 1 (Inpatient hospital services, other than services in an institution for mental diseases)
EXP-5-003-13	Total paid for TYPE-OF-SERVICE = 60 (Emergency hospital services)
EXP-2-009-21	Total paid for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
EXP-2-008-20	Total paid for TYPE-OF-SERVICE = 92 (Exceptional care – hospital residing)
EXP-2-007-19	Total paid for TYPE-OF-SERVICE = 91 (Skilled care – hospital residing)
EXP-2-006-18	Total paid for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
EXP-2-005-17	Total paid for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
EXP-2-004-16	Total paid for TYPE-OF-SERVICE = 84 (Sterilizations)
EXP-2-003-15	Total paid for TYPE-OF-SERVICE = 60 (Emergency hospital services)
EXP-2-002-14	Total paid for TYPE-OF-SERVICE = 58 (Services furnished in a religious nonmedical health care institution)
EXP-2-001-12	Total paid for TYPE-OF-SERVICE = 1 (Inpatient hospital services, other than services in an institution for mental diseases)
EXP-1-022-13	Average paid per record for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
EXP-1-021-12	Average paid per record for TYPE-OF-SERVICE = 92 (Exceptional care – hospital residing)
EXP-5-015-5	Average paid per record for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
RULE-7790	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
MCR-59R-001-13	% of Plan IDs over the threshold for MCR-59P-001-13 (% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header, by Plan ID)
EXP-29R-001-1	% of Plan IDs over the threshold for EXP-29P-001-1 (% of claim headers with Total Medicaid Paid Amount = $0 or missing, by Plan ID)
MCR-59P-001-13	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header, by Plan ID
EXP-29P-001-1	% of claim headers with Total Medicaid Paid Amount = $0 or missing, by Plan ID
MCR-59-001-1	% of claim headers where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
FFS-49-001-1	% of claim headers where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
EXP-5-019-9	Average paid per record for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
EXP-5-018-8	Average paid per record for TYPE-OF-SERVICE = 92 (Exceptional care – hospital residing)
EXP-5-017-7	Average paid per record for TYPE-OF-SERVICE = 91 (Skilled care – hospital residing)
EXP-5-016-6	Average paid per record for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
EXP-1-020-11	Average paid per record for TYPE-OF-SERVICE = 91 (Skilled care – hospital residing)
EXP-5-014-4	Average paid per record for TYPE-OF-SERVICE = 84 (Sterilizations)
EXP-5-013-3	Average paid per record for TYPE-OF-SERVICE = 60 (Emergency hospital services)
EXP-5-012-2	Average paid per record for TYPE-OF-SERVICE = 58 (Services furnished in a religious nonmedical health care institution)
EXP-5-011-1	Average paid per record for TYPE-OF-SERVICE = 1 (Inpatient hospital services, other than services in an institution for mental diseases)
EXP-5-010-11	Total paid for TYPE-OF-SERVICE = 123 (Disproportionate share hospital (DSH) payments)
EXP-5-009-19	Total paid for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
EXP-5-008-18	Total paid for TYPE-OF-SERVICE = 92 (Exceptional care – hospital residing)
EXP-5-007-17	Total paid for TYPE-OF-SERVICE = 91 (Skilled care – hospital residing)
EXP-5-006-16	Total paid for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
EXP-5-005-15	Total paid for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
EXP-5-004-14	Total paid for TYPE-OF-SERVICE = 84 (Sterilizations)
EXP-31-001-1	% of claim headers with Total Medicaid Paid Amount = $0 or missing
MCR-59-001-13	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
FFS-49-005-5	% of claim headers that have Total Medicaid Paid Amount greater than a non-zero Total Allowed Amount
FFS-49-001-13	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
FFS-43-001-1	% of crossover claim headers where Total Medicare Deductible Amount and Total Medicare Coinsurance Amount do not sum to Total Medicaid Paid Amount
EXP-S-005-2	Sum of Total Medicaid Paid Amount
EXP-S-001-1	Sum of Total Medicaid Paid Amount
EXP-45-001-1	% of header claims with Total Medicaid Paid Amount = $0 or missing
EXP-44-001-1	% of service tracking claim headers with a non-zero Total Medicaid Paid Amount
EXP-4-002-2	% of claim headers with Total Medicaid Paid Amount = $0 or missing
EXP-4-001-1	% of claim headers with Total Medicaid Paid Amount > $2 million
EXP-32-001-1	% of claim headers with Total Medicaid Paid Amount = $0 or missing
MCR-59-005-5	% of claim headers that have Total Medicaid Paid Amount greater than a non-zero Total Allowed Amount
EXP-3-005-2	% of claim headers with Total Medicaid Paid Amount = $0 or missing
EXP-3-003-4	Average Total Medicaid Paid Amount (excludes outliers with Total Medicaid Paid Amount > $2 million)
EXP-3-002-3	% of claim headers with Total Medicaid Paid Amount > $2 million
EXP-3-001-5	Sum of Total Medicaid Paid Amount
EXP-30-001-1	% of claim headers with Total Medicaid Paid Amount = $0 or missing
EXP-29-001-1	% of claim headers with Total Medicaid Paid Amount = $0 or missing
EXP-2-020-2	% of claim headers with Total Medicaid Paid Amount = $0 or missing
EXP-2-001-1	% of claim headers with Total Medicaid Paid Amount > $2 million
EXP-1-024-2	% of claim headers with Total Medicaid Paid Amount = $0 or missing
EXP-1-013-4	Average Total Medicaid Paid Amount (excludes outliers with Total Medicaid Paid Amount > $2 million)
EXP-1-012-3	% of claim headers with Total Medicaid Paid Amount > $2 million
EXP-1-006-20	Total paid for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
EXP-1-019-10	Average paid per record for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
EXP-1-018-9	Average paid per record for TYPE-OF-SERVICE = 86 (Other Pregnancy-related Procedures)
EXP-1-017-8	Average paid per record for TYPE-OF-SERVICE = 84 (Sterilizations)
EXP-1-016-7	Average paid per record for TYPE-OF-SERVICE = 60 (Emergency hospital services)
EXP-1-015-6	Average paid per record for TYPE-OF-SERVICE = 58 (Services furnished in a religious nonmedical health care institution)
EXP-1-014-5	Average paid per record for TYPE-OF-SERVICE = 1 (Inpatient hospital services, other than services in an institution for mental diseases)
EXP-1-011-16	Total paid for TYPE-OF-SERVICE = 123 (Disproportionate share hospital (DSH) payments)
EXP-1-010-24	Total paid for TYPE-OF-SERVICE = 93 (Non-acute care – hospital residing)
EXP-1-009-23	Total paid for TYPE-OF-SERVICE = 92 (Exceptional care – hospital residing)
EXP-1-008-22	Total paid for TYPE-OF-SERVICE = 91 (Skilled care – hospital residing)
EXP-1-007-21	Total paid for TYPE-OF-SERVICE = 90 (Critical access hospital services – IP)
EXP-1-001-14	Sum of Total Medicaid Paid Amount
EXP-1-005-19	Total paid for TYPE-OF-SERVICE = 84 (Sterilizations)
EXP-1-004-18	Total paid for TYPE-OF-SERVICE = 60 (Emergency hospital services)
EXP-1-003-17	Total paid for TYPE-OF-SERVICE = 58 (Services furnished in a religious nonmedical health care institution)
EXP-1-002-15	Total paid for TYPE-OF-SERVICE = 1 (Inpatient hospital services, other than services in an institution for mental diseases)
RULE-7565	% of denied claim headers where Total Medicaid Paid Amount is non-missing and non-zero
RULE-7435	% of service tracking claim headers with a non-zero Total Medicaid Paid Amount
RULE-7522	% of header claims with Total Medicaid Paid Amount = $0 or missing
MIS-79-056-56	% missing: TOT-MEDICAID-PAID-AMT (CIP00002)
MIS-21-056-56	% missing: TOT-MEDICAID-PAID-AMT (CIP00002)
MIS-2-051-51	% missing: TOT-MEDICAID-PAID-AMT (CIP00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT065	CLT.002.065	TOT-MEDICAID-PAID-AMT	CLT00002	CLAIM-HEADER-RECORD-LT
COT050	COT.002.050	TOT-MEDICAID-PAID-AMT	COT00002	CLAIM-HEADER-RECORD-OT
CRX041	CRX.002.041	TOT-MEDICAID-PAID-AMT	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CIP.002.114	UPDATE	Definition	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.	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.
09/12/2024	3.29.0	CIP.002.114	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must be populated when the associated Type of Claim (CIP.002.100) is in [‘5’, ‘E’]11. Value must not be greater than Total Allowed Amount (CIP.002.113)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to "0.00" when associated Claim Status is in [26,026,87,087,542,585,654]9. Value should not be populated, when associated Type of Claim value is in [4,D]10. Value must be populated when the associated Type of Claim (CIP.002.100) is in [5,E]11. Value must not be greater than Total Allowed Amount (CIP.002.113)
08/28/2023	3.12.0	CIP.002.114	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be greater than Total Allowed Amount (CIP.002.113)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [‘1’, ‘A’]8. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']9. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 10. Value must be populated when the associated Type of Claim (CIP.002.100) is in [‘5’, ‘E’]11. Value must not be greater than Total Allowed Amount (CIP.002.113)
08/09/2023	3.11.0	CIP.002.114	UPDATE	Definition	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.	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.
07/15/2022	3.0.1	CIP114	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP114\|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.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CIP114\|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.