Indicator of a Claim for a Person

SAS Name

A flag to indicate that the claim is for a person and not a service tracking claim or a non-person claim.


This indicator distinguishes between claims for services for a person, versus claims that fit any of four scenarios: 1) missing MSIS_ID, 2) ampersand-leading MSIS_ID (&MSIS_ID), 3) service tracking claim, and/or 4) missing claim type code

Following are some scenarios that describe in more detail claims where the PRSN_CLM_IND is 0:

• Although CMS requires states to include an MSIS_ID on every claim, there are rare instances where this ID may be null/missing for data quality reasons.

• Some states pay an insurance premium for a family rather than an individual. The state may include an ampersand (&) in front of an MSIS_ID in these types of claims to indicate a multiple-person premium assistance payment.

• Some states submit data files that include “service tracking claims” that are lump-sum payments to providers or plans (e.g., for drug rebates or disproportionate share hospital payments). You can identify these service tracking claims when the variable called CLM_TYPE_CD=4, D, or X.

Source: CCW (derived)

Code Code value
0 Not a claim for a person; one (or more) of four non-person scenarios listed in COMMENT
1 Yes, claim has a normal MSIS_ID and it is not a service tracking claim