CLT.003.188

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TMSIS Dataguide

Medicaid.gov

Version 3.38.0

ICN-ORIG

Data Element

DE Number

CLT188

System DE Number

CLT.003.188

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A unique number assigned by the state's payment system that identifies an original or adjustment claim.
Size	X(50)
FLF Start Position	42
FLF Stop Position	91
Segment Key Field Identifier	2
Coding Requirements	1. Value must be 50 characters or less 2. Value must not contain a pipe or asterisk symbols 3. Mandatory

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1204	All non-denied LT claim line records must have a corresponding parent record.
RULE-1205	If the icn orig is populated on a non-denied claim line from an LT file, then the icn orig reported must not contain any pipe or asterisk characters.
RULE-6617	If an LT claim line, the icn orig value must be specified in the T-MSIS picture format: X(50).
RULE-7188	If a claim line is from an LT file, then submitting state, original ICN, adjustment ICN, adjudication date, line adjustment indicator, original line ICN, and adjustment line ICN values reported must be unique across all LT claim lines.
RULE-7331	If a segment is an LT claim line, icn orig must be populated.
RULE-7575	All denied LT claim line records must have a corresponding claim header record.

Measure ID	Measure Name
MIS-5-006-6	% missing: ICN-ORIG (CLT00003)
MIS-24-006-6	% missing: ICN-ORIG (CLT00003)
MIS-82-005-5	% missing: ICN-ORIG (CLT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP019	CIP.002.019	ICN-ORIG	CIP00002	CLAIM-HEADER-RECORD-IP
CIP235	CIP.003.235	ICN-ORIG	CIP00003	CLAIM-LINE-RECORD-IP
CLT019	CLT.002.019	ICN-ORIG	CLT00002	CLAIM-HEADER-RECORD-LT
COT019	COT.002.019	ICN-ORIG	COT00002	CLAIM-HEADER-RECORD-OT
COT158	COT.003.158	ICN-ORIG	COT00003	CLAIM-LINE-RECORD-OT
CRX019	CRX.002.019	ICN-ORIG	CRX00002	CLAIM-HEADER-RECORD-RX
CRX112	CRX.003.112	ICN-ORIG	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/21/2023	3.13.0	CLT.003.188	UPDATE	Segment key field identifier	Not Applicable	2