CIP.002.102

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide

Medicaid.gov

Version:

CLAIM-STATUS

Data Element

DE Number

CIP102

System DE Number

CIP.002.102

File Name

CIP - CLAIM INPATIENT

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	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.
Size	X(3)
FLF Start Position	340
FLF Stop Position	342
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 3 characters or less 2. Value must be in Claim Status List (VVL) 3. Situational 4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"

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

RULE ID	RULE Definition
RULE-512	If the claim status is populated on a non-denied claim from an IP file, then the claim status reported must be found in the list of valid values.
RULE-7008	If a claim line is a non-denied claim line from an IP file, then the claim status value reported must be compatible with specified T-MSIS picture format: X(3).
RULE-7412	If a claim in a non-denied, original or adjustment FFS or Encounter crossover claim from an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01','02', '04', '08'
RULE-7550	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an IP file, and the admission date is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.
RULE-7633	All non-denied, paid IP claim header records must have a corresponding non-denied claim line record.
RULE-7744	If a claim in a non-denied, original or adjustment Encounter crossover claimfrom an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01','02', '04', '08'
RULE-7770	If a claim is a non-denied claim from an IP file, and the waiver type is populated, and the claim admission date is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.
RULE-7981	If a claim in a non-denied, original or adjustment FFS crossover claim from an IP file, and the MSIS ID is populated and the admission date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT054	CLT.002.054	CLAIM-STATUS	CLT00002	CLAIM-HEADER-RECORD-LT
COT039	COT.002.039	CLAIM-STATUS	COT00002	CLAIM-HEADER-RECORD-OT
CRX030	CRX.002.030	CLAIM-STATUS	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/10/2025	4.0.13	CIP.002.102	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.102	UPDATE	Coding requirement	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"	1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"
09/16/2024	4.0.0	CIP.002.102	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.102	ADD	N/A		Created