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

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 23, 2020

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

Guidance History

Date Description of Change
10/23/2020 Original guidance issued

Brief Issue Description

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 guidance addresses how data elements should be populated in T-MSIS when a void/reversal/cancel record is included on the file.

Background Discussion

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 guidance provides information on how to populate data elements on void/reversal/cancel records in T-MSIS. While this guidance 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.

Challenges

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.

CMS Guidance

States should report void/reversal/cancel records consistent with T-MSIS data dictionary requirements and appropriate guidance documents (see Related Guidance). For the purposes of this guidance, 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 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 is populated accurately. The record in the claim family with the most recent ADJUDICATION-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 P.01.

Table 1 – Record Key Data Elements
Data Element Name Data Element Number
Claim Header Detail IP LT OT RX
SUBMITTING-STATE CIP017 CLT017 COT017 CRX017
ICN-ORIG CIP019 CLT019 COT019 CRX019
ICN-ADJ CIP020 CLT020 COT020 CRX020
ADJUSTMENT-IND CIP026 CLT025 COT025 CRX025
ADJUDICATION-DATE CIP098 CLT050 COT035 CRX027
Claim Line Detail IP LT OT RX
SUBMITTING-STATE CIP232 CLT185 COT155 CRX109
ICN-ORIG CIP235 CLT188 COT158 CRX112
ICN-ADJ CIP236 CLT189 COT159 CRX113
LINE-ADJUSTMENT-IND CIP239 CLT192 COT162 CRX116
ADJUDICATION-DATE CIP286 CLT233 COT221 CRX157
Table 2 – Using record keys to link void claims to prior submissions
Row Number SUBMITTING-STATE ICN-ORIG ICN-ADJ ADJUSTMENT-IND ADJUDICATION-DATE TOT-BILLED-AMT
Original ICN Method
1 XX 0897100 0 12/4/2019 $1000
2 XX 0897100 0897101 4 1/18/2020 $100
3 XX 0897100 0897102 1 3/7/2020 $100
Daisy Chain ICN Method
4 XX 1235674 0 12/4/2019 $1000
5 XX 1235674 7654987 4 1/18/2020 $100
6 XX 7654987 0129384 1 3/7/2020 $100

“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
Data Element Name Data Element Number
Claim Header Detail IP LT OT RX
ADJUSTMENT-REASON-CODE CIP027 CLT026 COT026 CRX026
CLAIM-STATUS CIP102 CLT054 COT039 CRX030
CLAIM-STATUS-CATEGORY CIP103 CLT055 COT040 CRX031
CLAIM-PYMT-REM-CODE-1 CIP108 CLT059 COT044 CRX035
CLAIM-PYMT-REM-CODE-2 CIP109 CLT060 COT045 CRX036
CLAIM-PYMT-REM-CODE-3 CIP110 CLT061 COT046 CRX037
CLAIM-PYMT-REM-CODE-4 CIP111 CLT062 COT047 CRX038
Claim Line Detail IP LT OT RX
LINE-ADJUSTMENT-REASON-CODE CIP240 CLT193 COT163 CRX117
CLAIM-LINE-STATUS CIP242 CLT195 COT165 CRX119

“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
Data Element Name Data Element Number
Claim Header Detail IP LT OT RX
TOT-ALLOWED-AMT CIP113 CLT064 COT049 CRX040
TOT-MEDICAID-PAID-AMT CIP114 CLT065 COT050 CRX041
TOT-COPAY-AMT CIP115 CLT066 COT051 CRX042
TOT-MEDICARE-DEDUCTIBLE-AMT CIP116 CLT067 COT052 CRX043
TOT-MEDICARE-COINS-AMT CIP117 CLT068 COT053 CRX044
NON-COV-DAYS CIP134 CLT084
NON-COV-CHARGES CIP135 CLT085
MEDICAID-COV-INPATIENT-DAYS CIP136 CLT086
ICF-IID-DAYS CLT147
NURSING-FACILITY-DAYS CLT149
LTC-RCP-LIAB-AMT CLT145
MEDICAID-AMOUNT-PAID-DSH CIP220
DRG-OUTLIER-AMT CIP194
SERVICE-TRACKING-PAYMENT-AMT CIP124 CLT074 COT060 CRX051
BENEFICIARY-COINSURANCE-AMOUNT CIP206 CLT153 COT130 CRX087
BENEFICIARY-COPAYMENT-AMOUNT CIP208 CLT155 COT132 CRX089
BENEFICIARY-DEDUCTIBLE-AMOUNT CIP210 CLT157 COT134 CRX092
Claim Line Detail IP LT OT RX
ALLOWED-AMT CIP252 CLT205 COT175 CRX122
MEDICAID-PAID-AMT CIP254 CLT208 COT178 CRX125
MEDICARE-DEDUCTIBLE-AMT CRX127
MEDICARE-COINS-AMT CRX128
OT-RX-CLAIM-QUANTITY-ALLOWED COT184 CRX184
IP-LT-QUANTITY-OF-SERVICE-ALLOWED CIP250 CLT203
MEDICAID-FFS-EQUIVALENT-AMT CIP255 CLT209 COT179 CRX122

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.

Related Guidance

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

[1] In T-MSIS, voids, reversals, and cancels are identified when ADJUSTMENT-IND and LINE-ADJUSTMENT-IND are reported with a value of “1”.

[2] A claim family is comprised of the original FFS claim or encounter and each subsequent adjustment and, void/cancel/reversal of that original FFS claim or encounter.

[3] If two records in the same claim family are submitted with the same ADJUDICATION-DATE on the same T-MSIS claim file submission using the original ICN method, then a tiebreaker methodology will select the adjustment/replace record over the void/reversal/cancel record. Two void/reversal/cancel records will generate an error under this scenario.

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.