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Data Element
CLT189
CLT.003.189
Definition | A unique claim number assigned by the state's payment system that identifies the adjustment claim for an original transaction. |
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Size | X(50) |
FLF Start Position | 92 |
FLF Stop Position | 141 |
Segment Key Field Identifier | 3 |
Coding Requirements | 1. Value must be 50 characters or less 2. Value must not contain a pipe or asterisk symbols 3. If associated Adjustment Indicator value is "0", then value must not be populated 4. Conditional 5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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DE Number | System DE Number | DE Name | File Segment Number | File Segment Name |
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CIP020 | CIP.002.020 | ICN-ADJ | CIP00002 | CLAIM-HEADER-RECORD-IP |
CIP236 | CIP.003.236 | ICN-ADJ | CIP00003 | CLAIM-LINE-RECORD-IP |
CLT020 | CLT.002.020 | ICN-ADJ | CLT00002 | CLAIM-HEADER-RECORD-LT |
COT020 | COT.002.020 | ICN-ADJ | COT00002 | CLAIM-HEADER-RECORD-OT |
COT159 | COT.003.159 | ICN-ADJ | COT00003 | CLAIM-LINE-RECORD-OT |
CRX020 | CRX.002.020 | ICN-ADJ | CRX00002 | CLAIM-HEADER-RECORD-RX |
CRX113 | CRX.003.113 | ICN-ADJ | CRX00003 | CLAIM-LINE-RECORD-RX |