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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

FIXED-PAYMENT-IND

Data Element

DE Number

CIP125

System DE Number

CIP.002.125

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 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.
Size X(1)
FLF Start Position 486
FLF Stop Position 486
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 1 character
2. Value must be in Fixed Payment Indicator List (VVL)
3. Situational
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CLT075 CLT.002.075 FIXED-PAYMENT-IND CLT00002 CLAIM-HEADER-RECORD-LT
COT061 COT.002.061 FIXED-PAYMENT-IND COT00002 CLAIM-HEADER-RECORD-OT
CRX052 CRX.002.052 FIXED-PAYMENT-IND CRX00002 CLAIM-HEADER-RECORD-RX