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TMSIS Dataguide Medicaid.gov

Version:

MEDICARE-COMB-DED-IND

Data Element

DE Number

CIP128

System DE Number

CIP.002.128

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

Definition Code indicating that the amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare deductible was combined with their coinsurance amount because the amounts could not be separated.
Size X(1)
FLF Start Position 491
FLF Stop Position 491
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 1 character
2. Value must be in Medicare Combined Deductible Indicator List (VVL)
3. If value equals "1", then Total Medicare Coinsurance amount must not be populated
4. If value equals "0", then Crossover Indicator must equal "0"
5. If value equals "1", then Crossover Indicator must equal "1"
6. Conditional
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
CLT078 CLT.002.078 MEDICARE-COMB-DED-IND CLT00002 CLAIM-HEADER-RECORD-LT
COT064 COT.002.064 MEDICARE-COMB-DED-IND COT00002 CLAIM-HEADER-RECORD-OT
CRX160 CRX.002.160 MEDICARE-COMB-DED-IND CRX00002 CLAIM-HEADER-RECORD-RX