CLAIM-DX-IP

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TMSIS Dataguide

Medicaid.gov

Version:

CLAIM-DX-IP

File Segment

File Segment Number

CIP00004

File Name

CIP - CLAIM INPATIENT

Last updated

Data Elements Reference

DE Number	System DE Number	Data Element	Definition	Valid Values
CIP322	CIP.004.322	RECORD-ID	The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.).	CIP322 Values
CIP323	CIP.004.323	SUBMITTING-STATE	A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received.	CIP323 Values
CIP324	CIP.004.324	RECORD-NUMBER	A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file.	N/A
CIP325	CIP.004.325	ICN-ORIG	A unique number assigned by the state's payment system that identifies an original or adjustment claim.	N/A
CIP326	CIP.004.326	ICN-ADJ	A unique claim number assigned by the state's payment system that identifies the adjustment claim for an original transaction.	N/A
CIP327	CIP.004.327	ADJUSTMENT-IND	Indicates the type of adjustment record.	CIP327 Values
CIP328	CIP.004.328	ADJUDICATION-DATE	The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.	N/A
CIP329	CIP.004.329	DIAGNOSIS-TYPE	Indicates the context of the diagnosis code from the provider's claim (i.e., an 837I claim can have one principal diagnosis code, one admitting diagnosis code, up to 12 external cause of injury diagnosis codes, and up to 24 other diagnosis codes; a UB-04 claim can have one principal diagnosis code, one admitting diagnosis code, and up to 17 other diagnosis codes). The type of diagnosis code (e.g., principal, admitting, external cause of injury, or other) is captured here. The order in which the diagnosis code was reported is captured in the Diagnosis Sequence Number.	CIP329 Values
CIP330	CIP.004.330	DIAGNOSIS-SEQUENCE-NUMBER	The order in which the diagnosis occurred on the provider's claim for a given type of diagnosis code (e.g., an 837I claim can have up to 12 external cause of injury diagnosis codes and up to 24 other diagnosis codes).	N/A
CIP331	CIP.004.331	DIAGNOSIS-CODE-FLAG	Flag used to identify wither the associated Diagnosis Code value is a ICD-9 or ICD-10 code.	CIP331 Values
CIP332	CIP.004.332	DIAGNOSIS-CODE	ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as '21051'.	CIP332 Values
CIP333	CIP.004.333	DIAGNOSIS-POA-FLAG	A code to identify conditions that are present at the time the order for inpatient admission occurs; conditions that develop during an outpatient encounter, including emergency department, observation, or outpatient surgery. POA indicator is used to identify certain preventable conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a Diagnosis Related Group (DRG)* that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence-based guidelines. *States that do not use the grouper methodology may use CMS-approved methodology that is prospective in nature.	CIP333 Values
CIP334	CIP.004.334	STATE-NOTATION	A free text field for the submitting state to enter whatever information it chooses.	N/A

Definition: A record segment to capture data about the diagnosis code(s) associated with a claim.
File Segment Length: 2400

Published Date	Data Guide Version	File Segment	Action	Field	Before	After
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim. -test	A record segment to capture data about the diagnosis code(s) associated with a claim.
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim.	A record segment to capture data about the diagnosis code(s) associated with a claim. -test
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim. -test	A record segment to capture data about the diagnosis code(s) associated with a claim.
04/02/2025	4.0.6	CLAIM-DX-IP	UPDATE	Record segment definition	A record segment to capture data about the diagnosis code(s) associated with a claim.	A record segment to capture data about the diagnosis code(s) associated with a claim. -test
09/16/2024	4.0.0	CLAIM-DX-IP	ADD	N/A		Created