CMS Technical Instruction: Populating T-MSIS Claims File Data Elements on Void/Reversal/Cancel Records

Records that void/reverse/cancel previously submitted FFS claims and encounters are important to accurately identify Medicaid utilization and expenditures. How the data elements are populated on these void/reversal/cancel records are important to accurately interpret the records. The following technical instruction document addresses how data elements should be populated in T-MSIS when a void/reversal/cancel record is included on the file.

Accurately reporting adjustments is necessary for identifying Medicaid and CHIP utilization and expenditures in T-MSIS. Completely and accurately populating data elements on void/reversal/cancel records allows for the records to be appropriately linked to the most recently submitted original/adjustment record^[1]. Additionally, consistent reporting across states allows for accurate interpretation of the data. This technical instruction document provides information on how to populate data elements on void/reversal/cancel records in T-MSIS. While this technical instruction document primarily addresses reporting void/reversal/cancel records for FFS claims and encounters, it also applies to capitation payments, supplemental payments or service tracking payments that are adjusted using replace and void/reversal/cancel processes. 

Some states do not currently follow the requirements for void/reversal/cancel records as specified in the T-MSIS data dictionary, particularly for reporting expenditures. States take various approaches for populating data elements in void/reversal/cancel records, leading to inconsistency in interstate comparisons, questions regarding the accuracy of the reporting, and potential inaccurate interpretations of the state’s data. Some states have raised questions about how to populate the dollar amount and quantity data elements on void/reversal/cancel records. While state Medicaid programs and MMIS may differ, it is important that states utilize uniform T-MSIS reporting methods where those opportunities exist.

States should report void/reversal/cancel records consistent with T-MSIS data dictionary requirements and appropriate technical instructions documents (see Related Technical Instructions). For the purposes of these technical instructions, the data elements reported on void/reversal/cancel records are grouped into four categories based upon how the data elements are populated by the state.

• Record Key data elements should be reported with values that uniquely identify the claim and link the void claim to the previously submitted original or adjustment claim or encounter. These data elements are identified in Table 1.
• X-12 transaction data elements should be reported with values related to the processing of the void claim. These data elements are identified in Table 3.
• Adjudicated quantity data elements should all be reported with a value of “0”. These data elements are identified in Table 4.
• Carry Over data elements should be reported with values reported on the previous original or adjustment claim or encounter. These represent all data elements not identified Table 1, Table 3 or Table 4.

Record key data elements are populated with information that uniquely identifies a record and links it to all other records in a claim family.^[2] The record keys are also used to link the information reported on the claim header to the claim line record. These data elements are reported in Table 1. All void/reversal/cancel records should be reported with ADJUSTMENT-IND and LINE-ADJUSTMENT-IND values of “1”. The other primary key data elements should be populated consistent with T-MSIS Data Dictionary and appendices. The adjudication date, payment date, or recoupment date should be populated with the date on which payment status of the claim was finally adjudicated by the state, as per the T-MSIS data dictionary. The ICN-ORIG and ICN-ADJ data elements should be populated with values that link the void to the most recently submitted original/adjustment record in the claim family.

Table 2 provides examples of void claims linked to previous records using both the original ICN approach (rows 1 – 3) as well as the daisy chain ICN approach (rows 4 to 6). Both examples represent a claim family where the original claim is first followed by an adjustment that corrects the value reported in the TOT-BILLED-AMT and then followed by a void/reversal/cancel record. In addition to states ensuring that the ICN-ORIG and ICN-ADJ are correctly populated, states using the original ICN approach should ensure that the ADJUDICATION-DATE on claims and PAYMENT-OR-RECOUPMENT-DATE^[b] and/or PAYMENT-DATE^[b] on financial transactions is populated accurately. The record in the claim family with the most recent ADJUDICATION-DATE, PAYMENT-OR-RECOUPMENT-DATE or PAYMENT-DATE will be identified as the most recent submission of the claim.^[3] For additional information on using the original ICN approach or daisy chain ICN approach to linking claim families, please refer to T-MSIS Data Dictionary Appendix Submitting Adjustment Claims to T-MSIS.

Table 1 – Record Key Data Elements

Table 1b – Record Key Data Elements in the Financial Transactions File (FTX)

Table 2 – Using record keys to link void claims to prior submissions

“X-12 transaction” data elements are populated with information on how the void/reversal/cancel record was processed. These data elements are identified in table 3 below. If the X-12 transaction values are not applicable to the void/reversal/cancel claim or encounter, then the data element should be reported with a null value. For example, if a void only has one Remittance Advice Remark Code (RARC), then the CLAIM-PYMT-REM-CODE-2 through CLAIM-PYMT-REM-CODE-4 would be populated with a null value.

Table 3 – X-12 Transaction Data Elements

“Adjudicated quantity” data elements are populated with values that are derived through the adjudication of the FFS claim or encounter. All “adjudicated quantity” data elements should be populated with a value of “0” on a void record. The specific data elements that should be reported with a value of “0” on void/reversal/cancel records are identified in Table 4. These are values that would include the allowed amounts, the payment amounts, and the quantities of service allowed. These data elements should be populated with “0” because the void/reversal/cancel in T-MSIS is supposed to represent the final net liability for the services on the FFS claim or encounter. The adjudicated dollar amounts and quantities on the FFS claim or encounter should not reflect the marginal change in dollar amounts or quantities before and after the void/reversal/cancel occurred. Reporting positive or negative values in these fields raises question regarding how the void/reversal/cancel records should be interpreted and whether the ADJUSTMENT-IND value is accurate.

Table 4 - Adjudicated Quantity Data Elements (Claims Files)

Table 4b - Adjudicated Quantity Data Elements (FTX File)

All other data elements should be populated with the values from the most recent parent record that is being voided/reversed/cancelled. An example of this is presented in Table 2 in rows 2 and 3. The TOT-BILLED-AMT reported on the void record in row 3 is the same value that is reported in the TOT-BILLED-AMT reported on the adjustment record in row 2.

Additional technical instruction documents are listed below that are related to submissions of void records. This is not a list of all claims related technical instructions, but rather those that would help further understand the technical instructions above.

All other data elements should be populated with the values from the most recent parent record that is being voided/reversed/cancelled. An example of this is presented in Table 2 in rows 2 and 3. The TOT-BILLED-AMT reported on the void record in row 3 is the same value that is reported in the TOT-BILLED-AMT reported on the adjustment record in row 2.