CIP.002.194

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TMSIS Dataguide

Medicaid.gov

Version:

DRG-OUTLIER-AMT

Data Element

DE Number

CIP194

System DE Number

CIP.002.194

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 additional payment on a claim that is associated with either a cost outlier or length of stay outlier. Outlier payments compensate hospitals paid on a fixed amount per Medicare 'diagnosis related group' discharge with extra dollars for patient stays that substantially exceed the typical requirements for patient stays in the same DRG category.
Size	S9(11)V99
FLF Start Position	993
FLF Stop Position	1005
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. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10] 4. Situational

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

RULE ID	RULE Definition
RULE-708	If a claim line is a non-denied claim line from an LT file, then the drug outlier amount value reported must be compatible with specified T-MSIS picture format: S9(11)V999.
RULE-709	If a non-denied IP claim and has an outlier value of day outlier, cost outlier or composite of cost outliers, then the DRG outlier amount must be populated.
RULE-710	If a claim is a non-denied claim from an IP file, and the outlier code is equal to '00' or '09', then the DRG outlier amount must be 0 or null.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/10/2025	4.0.13	CIP.002.194	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CIP.002.194	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. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Conditional	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. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Situational
09/16/2024	4.0.0	CIP.002.194	UPDATE	File segment	None	25
09/16/2024	4.0.0	CIP.002.194	ADD	N/A		Created