TMSIS Data Dictionary Crosswalk

TMSIS Data Dictionary Crosswalk.pdf

Transformed - Medicaid Statistical Information System (T-MSIS) (CMS-R-284)

TMSIS Data Dictionary Crosswalk

OMB: 0938-0345

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T-MSIS Data Dictionary Crosswalk
RELEASE
DATE

TICKET

DOCUMENT

DE NO

RULE

ACTION

BEFORE

1/7/2022

TMSIS-19979

Data Dictionary

ELG086

N/A

ADD

N/A

1/7/2022

TMSIS-19979

Data Dictionary

ELG086

N/A

ADD

N/A

1/7/2022

TMSIS-20169

Data Dictionary

ELG233

N/A

UPDATE

1/7/2022

TMSIS-20169

Data Dictionary

CIP025

N/A

UPDATE

1/7/2022

TMSIS-20169

Data Dictionary

CLT024

N/A

UPDATE

1/7/2022

TMSIS-20169

Data Dictionary

COT024

N/A

UPDATE

1/7/2022

TMSIS-20169

Data Dictionary

CRX024

N/A

UPDATE

1/7/2022

TMSIS-19058

Data Dictionary

ELG260

N/A

UPDATE

12/17/2021

TMSIS-19945

Data Dictionary

BILLING-PROVNUM (COT112)

N/A

UPDATE

Data Dictionary

BILLING-PROVNUM (COT112)

N/A

UPDATE

N/A

UPDATE

12/17/2021

TMSIS-19945

12/17/2021

TMSIS-19945

Data Dictionary

BILLING-PROVNUM (COT112)

12/17/2021

TMSIS-17917

Data Dictionary

PRIMARYLANGUAGECODE (ELG046)

N/A

UPDATE

|DE NO| DATA ELEMENT NAME |DEFINITION|
|ELG233|1115A-DEMONSTRATION-IND|Indicates that the claim
or encounter was covered under the authority of an 1115(A)
demonstration. 1115(A) is a Center for Medicare and Medicaid
Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|CIP025|1115A-DEMONSTRATION-IND|Indicates that the claim
or encounter was covered under the authority of an 1115(A)
demonstration. 1115(A) is a Center for Medicare and Medicaid
Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|CLT024|1115A-DEMONSTRATION-IND|Indicates that the claim
or encounter was covered under the authority of an 1115(A)
demonstration. 1115(A) is a Center for Medicare and Medicaid
Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|COT024|1115A-DEMONSTRATION-IND|Indicates that the claim
or encounter was covered under the authority of an 1115(A)
demonstration. 1115(A) is a Center for Medicare and Medicaid
Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|CRX024|1115A-DEMONSTRATION-IND|Indicates that the claim
or encounter was covered under the authority of an 1115(A)
demonstration. 1115(A) is a Center for Medicare and Medicaid
Innovation demonstration.|
|FILE SEGMENT NAME WITH RECORD ID COMPUTING|
|ELIGIBLE-IDENTIFIER-ELG00022|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY
|CODING REQUIREMENT|
|COT112|BILLING-PROV-NUM| Not Applicable |Not Applicable
|Value must be reported in Provider Identifier (PRV.005.080) with
an associated Provider Identifier Type (PRV.005.081) equal to '1'|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY
|CODING REQUIREMENT|
|COT112|BILLING-PROV-NUM| Not Applicable |Not Applicable
|Not Applicable|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY
|CODING REQUIREMENT|
|COT112|BILLING-PROV-NUM| Not Applicable |Not Applicable
|When Type of Service (COT..003.186) is in ['119', ‘120', '122']
value mustmatch Plan ID Number (COT.002.066)|
|DE NO|DEFINITION|
|ELG046|A code indicating the language the individual speaks other
than English at home.|

AFTER
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY |CODING REQUIREMENT|
|ELG086|PRIMARY-ELIGIBILITY-GROUP-IND| Not Applicable |Not Applicable |A person enrolled in
Medicaid/CHIP should always have a primary eligibility group classification for any given day of enrollment. (There
may or may not be a secondary eligibility group classification for that same day.)
It is expected that an enrollee's eligibility group assignment (ELG087 - ELIGIBILITY-GROUP) will change over
tim e as his/her situation changes. Whenever the eligibility group assignment changes (i.e., ELG087 has a different
value), a separate ELIGIBILITY-DETERMINANTS record segment must be created. In such situations, there would
be m ultiple ELIGIBILITY-DETERMINANTS record segments, each covering a different effective time span. In
such situations, the value in ELG087 would be the primary eligibility group for the effective date span of its
respective ELIGIBILITY-DETERMINANTS record segment, and the PRIMARY-ELIGIBILITY-GROUP-IND data
elem ent on each of these segments would be set to '1' (YES).|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY |CODING REQUIREMENT|
|ELG086|PRIMARY-ELIGIBILITY-GROUP-IND| Not Applicable |Not Applicable |Should a situation arise where a
Medicaid/CHIP enrollee has been assigned both a primary and one or more secondary eligibility groups, there would
be two or more ELIGIBILITY-DETERMINANTS record segments with overlapping effective time spans - one
segment containing the primary eligibility group and the other(s) for the secondary eligibility group(s). To
differentiate the primary eligibility group from the secondary group(s), only one segment should be assigned as the
primary group using PRIMARY-ELIGIBILITY-GROUP-IND = 1; the others should be assigned PRIMARYELIGIBILITY-GROUP-IND = 0.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|ELG233|1115A-DEMONSTRATION-IND|Indicates that the claim or encounter was covered under the authority of
an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|CIP025|1115A-DEMONSTRATION-IND|Indicates that the claimor encounter was covered under the authority of
an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|CLT024|1115A-DEMONSTRATION-IND|Indicates that the claim or encounter was covered under the authority of
an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|COT024|1115A-DEMONSTRATION-IND|Indicates that the claim or encounter was covered under the authority of
an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.|
|DE NO| DATA ELEMENT NAME |DEFINITION|
|CRX024|1115A-DEMONSTRATION-IND|Indicates that the claim or encounter was covered under the authority of
an 1115A demonstration. 1115A is a Center for Medicare and Medicaid Innovation demonstration.|
|FILE SEGMENT NAME WITH RECORD ID COMPUTING|
|ELIGIBLE-IDENTIFIERS-ELG00022|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY |CODING REQUIREMENT|
|COT112|BILLING-PROV-NUM| Not Applicable |Not Applicable |When Type of Service (COT.003.186) not in
('119', ‘120’, ‘122’), then value must be reported in Provider Identifier (PRV.005.080) with an associated Provider
Identifier Type (PRV.005.081) equal to '1'|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY |CODING REQUIREMENT|
|COT112|BILLING-PROV-NUM| Not Applicable |Not Applicable |When Type of Claim not in
('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.002.019) Submitting State Provider IDorWhen
Ty pe of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match (PRV.005.081) Provider
Identifier where the Provider Identifier Type = '1'|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY |CODING REQUIREMENT|
|COT112|BILLING-PROV-NUM| Not Applicable |Not Applicable |Not Applicable|
|DE NO|DEFINITION|
|ELG046|A code indicating the language that is the individuals' preferred spoken or written language.|

T-MSIS Data Dictionary Crosswalk
RELEASE
DATE

12/17/2021

12/3/2021

TICKET

TMSIS-20170

TMSIS-19666

DOCUMENT

Data Dictionary

Data Dictionary

DE NO

ADJUDICATIONDATE

RACE (ELG213)

RULE

N/A

N/A

ACTION

UPDATE

UPDATE

10/15/2021

TMSIS-19642

Data Dictionary

CLAIM-STATUSCATEGORY
(CIP103)

N/A

UPDATE

8/13/2021

TMSIS-18890

Data Dictionary

MEDICAIDPAID-AMT

N/A

UPDATE

7/23/2021

TMSIS-18131

Data Dictionary

TOT-COPAYAMT
(CIP.002.115)

N/A

UPDATE

BEFORE

AFTER

|DE No|Data Element Name|Definition|
|CIP098|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|CLT050|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|COT035|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|CRX027|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|CIP286|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|CLT233|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|COT221|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|CRX157|ADJUDICATION-DATE|The date on which the payment
status of the claim was finally adjudicated by the state.|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY
|CODING REQUIREMENT|
|ELG213|RACE| Not Applicable |Not Applicable |A code indicating
the individual's race either in accordance with requirements of
Section 4302 of the Affordable Care Act classifications Race Code
clarifications: If state has beneficiaries coded in their database as
"Asian" with no additional detail, then code them in T-MSIS as
"Asian Unknown" (valid value "011"). DO NOT USE "Other
Asian," "Unspecified" or "Unknown." If state has beneficiaries
coded in their database as "Native Hawaiian or Other Pacific
Islander" with no additional detail, then code them in T-MSIS as
"Native Hawaiian and Other Pacific Islander Unknown"(valid value
"016"). DO NOT USE "Native Hawaiian," "Other Pacific Islander,"
"Unspecified" or "Unknown."NOTE 1: The "Other Asian"category
in T-MSIS (valid value "010") should be used in situations in which
an individual's specific Asian subgroup is not available in the code
set provided (e.g., Malaysian, Burmese).NOTE 2: The
"Unspecified" category in T-MSIS (valid value "017") should be
used with an individual who explicitly did not provide information
or refused to answer a question|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY
|CODING REQUIREMENT|
|CIP103 |CLAIM-STATUS-CATEGORY| Not Applicable |Not
Applicable |(Denied Claim) if associated Type of Claim equals Z or
associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value
must be "F2"|
|CLT055 |CLAIM-STATUS-CATEGORY| Not Applicable |Not
Applicable |(Denied Claim) if associated Type of Claim equals Z or
associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value
must be "F2"|
|COT040 |CLAIM-STATUS-CATEGORY| Not Applicable |Not
Applicable |(Denied Claim) if associated Type of Claim equals Z or
associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value
must be "F2"|
|CRX031 |CLAIM-STATUS-CATEGORY| Not Applicable |Not
Applicable |(Denied Claim) if associated Type of Claim equals Z or
associated Claim Status is in [ 26, 87, 542, 858, 654 ], then value
must be "F2"|
|Definition|
|The amount paid by Medicaid/CHIP agency or the managed care
plan on this claim or adjustment at the claim detail level. For claims
where Medicaid payment is only available at the header level, report
the entire payment amount on the T-MSIS record corresponding to
the line item with the highest charge or the 1st detail. Zero fill
Medicaid Amount Paid on all other MSIS records created from the
original claim.|
"If associated Crossover Indicator value is '0' (not a crossover
claim), then value should not be populated."
AND
"(Medicare Enrolled) if associated Dual Eligible Code
(ELG.005.085) value is in ["01", "02", "03", "04", "05", "06", "08",
"09", or "10"], then value is mandatory and must be provided"

|DE No|Data Element Name|Definition|
|CIP098|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.|
|CLT050|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.|
|COT035|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.|
|CRX027|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.|
|CIP286|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.|
|CLT233|ADJUDICATION-DATE|TThe 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.|
|COT221|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.|
|CRX157|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.|
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY |CODING REQUIREMENT|
|ELG213|RACE| Not Applicable |Not Applicable |A code indicating the individual's race in accordance with
requirements of Section 4302 of the Affordable Care Act classifications Race Code clarifications: If state has
beneficiaries coded in their database as "Asian" with no additional detail, then code them in T-MSIS as "Asian
Unknown" (valid value "011"). DO NOT USE "Other Asian," "Unspecified" or "Unknown." If state has
beneficiaries coded in their database as "Native Hawaiian or Other Pacific Islander" with no additional detail, then
code them in T-MSIS as "Native Hawaiian and Other Pacific Islander Unknown" (valid value "016"). DO NOT USE
"Native Hawaiian,""Other Pacific Islander," "Unspecified" or "Unknown." If state has beneficiaries coded in their
database as “Other” with no additional detail or in a category that is not available in the code set provided, then code
them in T-MSIS as “Other” (valid value “018”), but only use “Other” if the use of “Other Asian” or “Other Pacific
Islander” are not appropriate. DO NOT USE “Unspecified” or “Unknown”. The “Other” valid value was added to TMSIS to better align T-MSIS with the single-streamlined application and to accommodate some atypical states,
despite the requirements of Section 4302 of the ACA.NOTE 1: The "Other Asian" category in T-MSIS (valid value
"010") should be used in situations in which an individual's specific Asian subgroup is not available in the code set
provided (e.g., Malaysian, Burmese).NOTE 2: The "Unspecified" category in T-MSIS (valid value "017") should be
used with an individual who explicitly did not provide information or refused to answer a question.|

|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY |CODING REQUIREMENT|
|CIP103 |CLAIM-STATUS-CATEGORY| Not Applicable |Not Applicable |(Denied Claim) if associated Type of
Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"|
|CLT055 |CLAIM-STATUS-CATEGORY| Not Applicable |Not Applicable |(Denied Claim) if associated Type of
Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"|
|COT040 |CLAIM-STATUS-CATEGORY| Not Applicable |Not Applicable |(Denied Claim) if associated Type of
Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"|
|CRX031 |CLAIM-STATUS-CATEGORY| Not Applicable |Not Applicable |(Denied Claim) if associated Type of
Claim equals Z or associated Claim Status is in [ 26, 87, 542, 585, 654 ], then value must be "F2"|

|Definition|
|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail
level.|

N/A

T-MSIS Data Dictionary Crosswalk
RELEASE
DATE

TICKET

DOCUMENT

7/23/2021

TMSIS-18805

Data Dictionary

6/11/2021

TMSIS-18376

Data Dictionary

6/11/2021

TMSIS-18366

Data Dictionary

5/21/2021

TMSIS-18271

Data Dictionary

5/21/2021

TMSIS-18271

Data Dictionary

4/9/2021

TMSIS-17553

12/4/2020

DE NO
TOT-BILLEDAMT
(CIP.002.112)
ELG.016.214
TOT-BILLEDAMT
BILLING-PROVNUM
(COT.002.112)

RULE

ACTION

N/A

UPDATE

N/A

ADD

N/A

UPDATE

N/A

UPDATE

BILLING-PROVNUM
(COT.002.112)

N/A

UPDATE

Data Dictionary

CHIP-CODE
(ELG054)

N/A

UPDATE

TMSIS-8499

Data Dictionary

COT172-0001

N/A

UPDATE

12/4/2020

TMSIS-8499

Data Dictionary

COT218-0004

N/A

UPDATE

12/4/2020

TMSIS-8499

Data Dictionary

COT219-0004

N/A

UPDATE

12/4/2020

TMSIS-8499

Data Dictionary

COT227-0001

N/A

UPDATE

N/A

N/A

12/4/2020

TMSIS-14300

Data Dictionary

12/4/2020

TMSIS-16398

Data Dictionary

OCCURRENCECODE-01 to
OCCURRENCECODE-10
CIP177-0003,
CLT128-0003,
COT110-0003,
and CRX0680004

BEFORE
“If associated Type of Claim value is 2, 4, 5, B, D, or E, then value
should not be populated"

AFTER
N/A

N/A
"If associated Type of Claim value is 2, 4, 5, B, D, or E, then value
should not be populated"

If associated Race (ELG.016.213) value is not in [ "010", "015" ], then value must be null.

Value m ust be reported in Provider Identifier (PRV.005.080) with
an associated Provider Identifier Type (PRV.005.081) equal to '1'
When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X")
then value may match (PRV.002.019) Submitting State Provider ID
or
When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X")
then value may match (PRV.005.081) Provider Identifier where the
Provider Identifier Type = '1'
CHIP-CODE (ELG054) v2.3 Definition:
A code used to distinguish among Medicaid, Medicaid Expansion,
and Separate CHIP populations
diagnosis code fields should be left blank (i.e., submitted as "pipe
pipe" with nothing in between (||) on PSV files and space-filled on
FLF files
If no corresponding procedure (PROCDURE-CODE-2 through
PROCDURE-CODE-6) was performed, leave blank or space-fill.
If no corresponding procedure (PROCDURE-CODE-2 through
PROCDURE-CODE-6) was performed, leave blank or space-fill.
If no corresponding procedure (PROCDURE-CODE-2 through
PROCDURE-CODE-6) was performed, leave blank or space-fill.

N/A

UPDATE

OCCURRENCE-CODE-01 to OCCURRENCE-CODE-10
http://www.cms.gov/Regulations-andGuidance/Guidance/Transmittals/downloads/R1104cp.pdf

OCCURRENCE-CODE-01 to OCCURRENCE-CODE-10
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1795A3.pdf

UPDATE

coding requirements say: "An ineligible individual cannot have a
category for federal reimbursement for Medicaid or CHIP (CMS-64CATEGORY-FOR-FEDERAL-REIMBURSEMENT <> 01,02)"

N/A

12/4/2020

TMSIS-16397

Data Dictionary

CMS-64CATEGORYFOR-FEDERALREIMBURSEME
NT (CIP269-0002,
CLT219-0002,
COT210-0002,
CRX149-0002)

12/4/2020

TMSIS-15910

Data Dictionary

TOT-BILLEDAMT

N/A

UPDATE

12/4/2020

TMSIS-15836

Data Dictionary

HCPCS-RATE
(COT220)

N/A

UPDATE

N/A

UPDATE

CIP269-0002 : If an individual is not eligible for S-CHIP, then any
associated claims records should not have reimbursed with federal
funding under Title XXI.
CLT219-0002: If an individual is not eligible for S-CHIP, then any
associated claims records should not have reimbursed with federal
funding under Title XXI.
COT210-0002: If an individual is not eligible for S-CHIP, then any
associated claims records should not have reimbursed with federal
funding under Title XXI.
CRX149-0002: If an individual is not eligible for S-CHIP, then any
associated claims records should not have reimbursed with federal
funding under Title XXI.
|DE NO| DATA ELEMENT NAME| DEFINITION| NECESSITY
|CODING REQUIREMENT|
|CIP112 |TOT-BILLED-AMT| Not Applicable |Not Applicable |If
TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must =
"00000000".|
|CLT063 |TOT-BILLED-AMT| Not Applicable |Not Applicable |If
TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must =
"00000000".|
|COT048 |TOT-BILLED-AMT| Not Applicable |Not Applicable |If
TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must =
"00000000".|
|CRX039 |TOT-BILLED-AMT| Not Applicable |Not Applicable |If
TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must =
"00000000".|
|Definition|Necessity|Coding Requirement|
|For outpatient hospital facility claims, HCPCS/CPT is captured
here. This data element is expected to capture data from HIPAA
837I claim loop 2400 SV202 or UB-04 FL 44 (only if the value
represents a HCPCS/CPT). If HCPCS-RATE is populated then
PROCEDURE-CODE should not be populated.|Conditional|Value
m ust be equal to a valid value.|

N/A

N/A

A code used to distinguish among Medicaid, Medicaid Expansion CHIP, and Separate CHIP populations
All UNUSED PROCEDURE-CODE-MOD or PROCEDURE-CODE-MOD-1 through PROCEDURE-CODE-MOD4 fields should be left blank (i.e., submitted as "pipe pipe" with nothing in between (||) on PSV files and space-filled
on FLF files
If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-4) was performed, leave blank
or space-fill.
If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-4) was performed, leave blank
or space-fill.
If no corresponding procedure (PROCDURE-CODE-2 through PROCDURE-CODE-4) was performed, leave blank
or space-fill.

CIP269: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must
be in ['2', '3']
CLT219: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must
be in ['2', '3']
COT210: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must
be in ['2', '3']
CRX149: I(federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054)
must be in ['2', '3']

N/A

|Definition|Necessity|Coding Requirement|
|Not to be populated|Not Applicable|Do not populate|

T-MSIS Data Dictionary Crosswalk
RELEASE
DATE

TICKET

DOCUMENT

DE NO

RULE

ACTION

11/13/2020

TMSIS-15263

Data Dictionary

ELG156-0003

N/A

UPDATE

0/2/2020

TMSIS-15098

Data Dictionary

LINE-NUM-ADJ
LINEADJUSTMENTIND

N/A

UPDATE

9/11/2020

TMSIS-14978

Data Dictionary

N/A

UPDATE

7/31/2020

TMSIS-12208

Data Dictionary

N/A

UPDATE

7/31/2020

TMSIS-13590

Data Dictionary

N/A

UPDATE

7/10/2020

TMSIS-13748

Data Dictionary

N/A

UPDATE

CIP254,

7/10/2020

TMSIS-13633

Data Dictionary

CLT208, COT178,
CRX125
DTL-METRICDEC-QTY
(CRX144)
MEDICAIDPAID-AMT
(CRX125)
VETERAN-IND
(ELG039)

PAYMENTLEVEL-IND
(CIP132, CLT082,
COT068,
CRX058)

N/A

UPDATE

BEFORE

AFTER

If a complete, valid end date is not available or is unknown, leave
N/A
blank, or space-fill".
|DE No|Data Element Name|Coding Requirement|CR No|
|CIP238|LINE-NUM-ADJ|This field should be left blank or spacefilled if the ADJUSTMENT-INDICATOR = 0.
Otherwise, if there is a line adjustment indicator, then there should
be a line adjustment number. |Not Applicable|
|CIP239|LINE-ADJUSTMENT-IND|If there is a line adjustment
number, then there must be a line-adjustment indicator.|CIP2390002|
|CLT191|LINE-NUM-ADJ|This field should be left blank or spacefilled if the ADJUSTMENT-INDICATOR = 0.
|DE No|Data Element Name|Coding Requirement|CR No|
Otherwise, if there is a line adjustment indicator, then there should
|CIP238|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR =
be a line adjustment number.|CLT191-0002|
0.|Not Applicable|
|CLT192|LINE-ADJUSTMENT-IND|If there is a line adjustment
|CIP239|LINE-ADJUSTMENT-IND|Not Applicable.|CIP239-0002|
number, then there must be a line-adjustment indicator.|CLT192|CLT191|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR =
0002|
0.|CLT191-0002|
|CLT192|LINE-ADJUSTMENT-IND|If there is a line adjustment
|CLT192|LINE-ADJUSTMENT-IND|Not Applicable.|CLT192-0002|
reason, then there must be a line adjustment indicator.|CLT192-0003 |CLT192|LINE-ADJUSTMENT-IND|Not Applicable.|CLT192-0003
|COT161|LINE-NUM-ADJ|This field should be left blank or space- |COT161|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR =
filled if the ADJUSTMENT-INDICATOR = 0.
0.|COT161-0002|
Otherwise, if there is a line adjustment indicator, then there should
|COT162|LINE-ADJUSTMENT-IND|Not Applicable.|COT162-0002|
be a line adjustment number.|COT161-0002|
|COT162|LINE-ADJUSTMENT-IND|Not Applicable.|COT162-003|
|COT162|LINE-ADJUSTMENT-IND|If there is a line adjustment
|CRX115|LINE-NUM-ADJ|This field should be 8-filled, left blank or space-filled if the ADJUSTMENTnumber, then there must be a line-adjustment indicator.|COT162INDICATOR = 0.|CRX115-002|
0002|
|CRX116|LINE-ADJUSTMENT-IND|Not Applicable.|CRX116-002|
|COT162|LINE-ADJUSTMENT-IND|If there is a line adjustment
reason, then there must be a line adjustment indicator.|COT162-003|
|CRX115|LINE-NUM-ADJ|This field should be 8-filled, left blank
or space-filled if the ADJUSTMENT-INDICATOR = 0.
Otherwise, if there is a line adjustment indicator, then there should
be a line adjustment number.|CRX115-002|
|CRX116|LINE-ADJUSTMENT-IND|If there is a line adjustment
number, then there must be a line-adjustment indicator.|CRX116002|
Current Coding Requirement:
For claim s where Medicaid payment is only available at the header Proposed Coding requirement:
level, report the entire payment amount on the MSIS record
For claim s where Medicaid payment is only available at the header level, report the entire payment amount on the
corresponding to the line item with the highest charge. Zero fill
MSIS record corresponding to the line item with the highest charge or the 1st detail. Zero fill Medicaid Amount Paid
Medicaid Amount Paid on all other MSIS records created from the
on all other MSIS records created from the original claim.
original claim.
|Data Element Name|Coding Requirement|
|Data Element Name|Coding Requirement|
|DTL-METRIC-DEC-QTY|Must be numeric. Only populate on compound drug claims. Should pass through the
|DTL-METRIC-DEC-QTY|Must be numeric|
“Com pound Ingredient Quantity” from the NCPDP claims form, field 448-ED.|
CRX125-0004 - If TYPE‐OF‐CLAIM = 3, C, W
CRX125-0004 - If TYPE‐OF‐CLAIM = 3, C, W
(encounter record) this field should be populated with the amount
(encounter record) this field should be populated with the amount that the managed care plan paid to the provider.
that the managed care plan paid to the provider.
|Definition|Necessity|Coding Requirement|
|Definition|Necessity|Coding Requirement|
A flag indicating if a non-citizen is exempt from the 5-year bar on benefits because they are a veteran or an active
|A flag indicating if the individual served in the active military,
member of the military, naval or air service|Conditional|this field should only be populated for beneficiaries who
naval or air service|Required|Value must be equal to a valid value.|
have a non-citizen IMMIGRATION-STATUS (i.e., IMMIGRATION-STATUS = “1”, “2”, or “3”).|

|CR NO|Coding Requirement|
|CIP132-0002|Payment fields at either the claim header or line on
encounter records should be blank.|
|CLT082-0002|Payment fields at either the claimheader or line on
encounter records should be blank.|
|COT068-0002|Payment fields at either the claim header or line on
encounter records should be blank.|
|CRX058-0002|Payment fields at either the claim header or line on
encounter records should be blank.|

|CR NO|Coding Requirement|
|CIP132-0002|Not Applicable|
|CLT082-0002|Not Applicable|
|COT068-0002|Not Applicable|
|CRX058-0002|Not Applicable|

T-MSIS Data Dictionary Crosswalk
RELEASE
DATE

TICKET

DOCUMENT

DE NO

RULE

ACTION

BEFORE

AFTER
Code | Description
EA | Each
F2 | International Unit
GM | Grams
GR | Gram
ML | Milliliter
ME | Milligram
UN | Unit

N/A

UPDATE

Code | Description
F2 | International Unit
GR | Gram
ML | Milliliter
ME | Miligram
UN | Unit

N/A

UPDATE

The beginning date of service must occur before or be the same as
the end of time period.

The beginning date of service must occur before or be the same as the end of time period for all claims except
capitation payments and service tracking payments.

N/A

UPDATE

Date must occur before or be the same as adjudication date.

Date must occur before or be the same as adjudication date for all claims except capitation payments and service
tracking payments.

N/A

UPDATE

ENDING-DATE-OF-SERVICE must be on or before the
ADJUDICATION-DATE.

ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE for all claims except capitation
pay m ents and service tracking payments

N/A

UPDATE

Date m ust occur before or be the same as End of Time Period.

Date must occur before or be the same as End of Time Period for all claims except capitation payments and service
tracking payments.

N/A

UPDATE

Date must occur before or be the same as adjudication date.

Date m ust occur before or be the same as adjudication date for all claims except capitation payments and service
tracking payments.

N/A

UPDATE

ENDING-DATE-OF-SERVICE must be on or before the
ADJUDICATION-DATE.

ENDING-DATE-OF-SERVICE must be on or before the ADJUDICATION-DATE for all claims except capitation
pay m ents and service tracking payments

N/A

UPDATE

Date must occur before or be the same as End of Time Period.

Date must occur before or be the same as End of Time Period for all claims except capitation payments and service
tracking payments.

N/A

UPDATE

Necessity | Required

Necessity | Conditional

ELG083

N/A

UPDATE

Data Dictionary

CRX129

N/A

UPDATE

Data Dictionary

COT123

N/A

UPDATE

TMSIS-13122

Data Dictionary

COT123

N/A

UPDATE

Coding Requirement | Leave field blank for capitation or premium
pay m ents (TYPE-OF-SERVICE = 119, 120, 121, 122)

3/27/2020

TMSIS-12777

Data Dictionary

ELGIDENTIFIERS

N/A

ADD

N/A

12/13/2019

TMSIS-12296

Data Dictionary

CONCEPTIONTO-BIRTH-IND
(ELG094)

N/A

UPDATE

The CHIP-CODE must equal “3” (Individual was notMedicaidExpansion CHIP eligible, but was included in a separate title XXI
CHIP program) or “4” (Individual was both Medicaid eligible and
Separate CHIP eligible.)

5/29/2020

TMSIS12206/TMSIS13891

Data Dictionary

5/8/2020

TMSIS-11991

Data Dictionary

5/8/2020

TMSIS-11991

Data Dictionary

5/8/2020

TMSIS-11991

Data Dictionary

5/8/2020

TMSIS-11991

Data Dictionary

5/8/2020

TMSIS-11991

Data Dictionary

5/8/2020

TMSIS-11991

Data Dictionary

5/8/2020

TMSIS-11991

Data Dictionary

5/8/2020

TMSIS-12205

Data Dictionary

4/17/2020

TMSIS-13119

Data Dictionary

4/17/2020

TMSIS-13120

4/17/2020

TMSIS-13121

4/17/2020

UNIT-OFMEASURE
(CRX133)

BEGINNINGDATE-OFSERVICE
(COT033-0003)
BEGINNINGDATE-OFSERVICE
(COT033-0005)
ENDING-DATEOF-SERVICE
(COT034-0004)
ENDING-DATEOF-SERVICE
(COT034-0007)
BEGINNINGDATE-OFSERVICE
(COT166-0004)
ENDING-DATEOF-SERVICE
(COT167-0004)
ENDING-DATEOF-SERVICE
(COT167-0007)
CITIZENSHIPVERIFICATIONFLAG (ELG041)

If m ultiple MSIS-CASE-NUMs exist at the state-level, and T-MSIS
only allows one Case Number in current T-MSIS DD, please enter
the Case Number with the longest eligibility days in that particular
month.
Necessity | Required
PLACE-OF-SERVICE (COT123): A code indicating where the
service was performed. CMS 1500 values are used for this data
elem ent.

N/A
Necessity | Conditional
PLACE-OF-SERVICE (COT123): A data element corresponding with line 24b on the CMS-1500 that indicates
where the services took place. This is a pass-through data element that should not be modified or derived when
m issing unless otherwise specified.
PLACE-OF-SERVICE (COT123): “A data element corresponding with line 24b on the CMS-1500 that indicates
where the services took place. This is a pass-through data element that should not be modified or derived when
missing unless otherwise specified.”
Update Data Dictionary document for ELG-IDENTIFIERS segment
Update Data Dictionary Appendices document for ELG-IDENTIFIER-TYPE data element
Update Data Dictionary Data Validation Rule document with all rules of ELG-IDENTIFIERS segment
Update Data Dictionary Record Layout for ELG-IDENTIFIERS
Update Data Dictionary Segment Relationship doc for ELG-IDENTIFIERS
The CHIP-CODE must equal “3” (Individual was notMedicaid-Expansion CHIP eligible, butwas included in a
separate title XXI CHIP program).


File Typeapplication/pdf
File TitleTMSIS DD Crosswalk
AuthorConnie Gibson
File Modified2022-01-31
File Created2022-01-31

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