| 09/29/2026 |
4.0.38 |
CIP.002.022 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. <a href="https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ ">Shared MSIS Instructions</a> |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 04/09/2026 |
4.0.31 |
CIP.004.332 |
UPDATE |
Medicaid valid value info |
Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes) |
Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes)Diagnosis Code List (ICD-10) |
| 04/09/2026 |
4.0.31 |
MCR.007.086 |
UPDATE |
Medicaid valid value info |
https://www.ncqa.org/programs/health-plans/health-plan-accreditation-hpa/https://www.aaahc.org/accreditation/ |
Accreditation Organization ListAccreditation Organization List 2 |
| 10/08/2026 |
4.0.38 |
CLT.002.053 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classifications List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
| 10/08/2026 |
4.0.38 |
COT.002.038 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Situational |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one pf the corresponding Type of Bill 3 Classification Lists (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Situational |
| 10/08/2026 |
4.0.38 |
CIP.002.101 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
| 03/17/2026 |
4.0.30 |
CIP.002.101 |
UPDATE |
Coding requirement |
Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
| 10/08/2026 |
4.0.38 |
FTX.002.036 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is in [05,06], then value must equal '02' 5. Conditional |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is in [05,06], then value must equal "02"5. Conditional |
| 10/08/2026 |
4.0.38 |
FTX.002.034 |
UPDATE |
Definition |
This is a qualifier that indicates what type of ID the payee ID is. For example, if the payee ID represents a provider ID, then the payee ID type will indicate that the payee ID should be interpreted as a provider ID. For PCCM financial transactions, states may use Payee ID Type “05”, “06”. |
This is a qualifier that indicates what type of ID the payee ID is. For example, if the payee ID represents a provider ID, then the payee ID type will indicate that the payee ID should be interpreted as a provider ID. For PCCM financial transactions, states may use Payee ID Type “05”, “06". |
| 10/08/2026 |
4.0.38 |
MCR.010.119 |
UPDATE |
Data element name text |
Managed Care Plan ID |
Managed Care Plan Other ID |
| 10/08/2026 |
4.0.38 |
MCR.010.119 |
UPDATE |
Definition |
A data element to capture the various IDs used to identify a managed care plan, other than the plan ID that is used to link claims, MCR, ELG, and PRV in T-MSIS. The specific type of identifier is defined in the corresponding value in the Managed Care Plan Other Identifier Type data element. |
A data element to capture other identifiers used to identify a managed care plan. The specific type of identifier is defined in the corresponding value in the Managed Care Plan Identifier Type data element.. |
| 10/08/2026 |
4.0.38 |
MCR.010.119 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must be in Managed Care Other ID 3 List3. Mandatory |
1. Value must be 30 characters or less2. If Managed Care Plan Other ID Type (MCR.010.118) equals "03", then value must be in Managed Care Other ID 03 List (VVL3. Mandatory |
| 10/08/2026 |
4.0.38 |
ELG.003.042 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Immigration Status List (VVL)3. If associated Citizenship Indicator (ELG.003.040) value equals "0", then value must be in [1,2,3]4. If associated Citizenship Indicator (ELG.003.040) value equals "1", then value must equal "8"5. Mandatory6. When value is in [1,2], then value must match a corresponding record with an ELG-IDENTIFIER-TYPE (ELG.022.261) equal to “3” |
1. Value must be 1 character2. Value must be in Immigration Status List (VVL)3. If associated Citizenship Indicator (ELG.003.040) value equals "0", then value must be in [2,3,4]4. If associated Citizenship Indicator (ELG.003.040) value equals "1" or "2", then value must equal "8"5. Mandatory |
| 04/09/2026 |
4.0.31 |
CIP.004.332 |
UPDATE |
Medicaid valid value info |
|
Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes) |
| 11/07/2025 |
4.0.21 |
FTX.003.086 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
| 02/24/2026 |
4.0.28 |
FTX.095.376 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is in [05,06], then value must equal '02'5. Conditional |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is in [05,06], then value must equal "02"5. Conditional |
| 10/23/2025 |
4.0.20 |
FTX.095.371 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This describes the type of managed care plan or care coordination model of the payer, when applicable. The valid value list is comprised of the standard managed care plan type list from the MCR and ELG files and a complementary list of care coordination models. |
| 10/23/2025 |
4.0.20 |
FTX.095.370 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is a description of what the payer ID represents when the payer ID was reported with a payer type of "Other". |
| 10/23/2025 |
4.0.20 |
FTX.095.369 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is a qualifier that indicates what type of ID the payer ID is. For example, if the payer ID represents the state Medicaid or CHIP agency, then the payer ID type will indicate that the payer ID should be interpreted as a submitting state code. |
| 10/23/2025 |
4.0.20 |
FTX.095.368 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. |
| 10/23/2025 |
4.0.20 |
FTX.095.365 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
The dollar amount being paid to the payee or recouped from the payee for a previous payment. A recoupment should be reported as a negative amount. |
| 10/23/2025 |
4.0.20 |
FTX.095.364 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
The date that the payment or recoupment was executed by the payer. |
| 10/23/2025 |
4.0.20 |
FTX.095.363 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
Indicates the type of adjustment record. |
| 10/10/2025 |
4.0.19 |
FTX.009.343 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
| 10/23/2025 |
4.0.20 |
FTX.003.086 |
UPDATE |
Necessity |
Mandatory |
Situational |
| 10/23/2025 |
4.0.20 |
FTX.003.086 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. The value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/.
MSIS-IDENTIFICATION-NUM is situational in the FTX00003 segment because some of the covered lives on a commercial individual market health insurance policy may not be eligible for Medicaid or CHIP, although at least one member of the policy must be eligible for Medicaid or CHIP.
There should be one FTX00003 segment for each person covered under the commercial individual market policy for which the premium assistance payment is being paid, regardless of whether that particular person is eligible for and enrolled in Medicaid or CHIP. |
| 10/10/2025 |
4.0.19 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated8. If Subcapitation Indicator equals "2", then value must not be populated9. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated8. If Subcapitation Indicator equals "2", then value must not be populated9. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated10. Value must be populated when Payer ID Type equals "01" |
| 11/07/2025 |
4.0.21 |
ELG.005.095 |
UPDATE |
Definition |
The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-CHANGE-REASON value '21'; (Other) '22'; (Unknown), then the state should not report the co-occurring value '21'; and/or '22'; to T-MSIS. If there are multiple co-occurring distinct values between '01'; and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01'; through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid. |
The reason for a complete loss/termination in an individual's eligibility for Medicaid and CHIP. The end date of the segment in which the value is reported must represent the date that the complete loss/termination of Medicaid and CHIP eligibility occurred. The reason for the termination represents the reason that the segment in which it was reported was closed. If for a single termination in eligibility for a single individual there are multiple distinct co-occurring values in the state's system explaining the reason for the termination, and if one of the multiple co-occurring values maps to T-MSIS ELIGIBILITY-TERMIMNATION-REASON value '21'; (Unknown) '22'; (Other), then the state should not report the co-occurring value '21'; and/or '22'; to T-MSIS. If there are multiple co-occurring distinct values between '01'; and '19', then the state should choose whichever is first in the state's system. Of the values that could logically co-occur in the range of '01'; through '19', CMS does not currently have a preference for any one value over another. Do not populate if at the time someone loses Medicaid eligibility they become eligible for and enrolled in CHIP. Also do not populate if at the time someone loses CHIP eligibility they become eligible for and enrolled in Medicaid. |
| 04/09/2026 |
4.0.31 |
ELG.003.046 |
UPDATE |
Medicaid valid value info |
|
Language Codes List |
| 04/09/2026 |
4.0.31 |
CRX.004.206 |
UPDATE |
Medicaid valid value info |
|
Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes)Diagnosis Code List (ICD-10) |
| 10/10/2025 |
4.0.19 |
COT.003.261 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Situational |
1. Value must not be more than 28 characters2. Situational |
| 10/10/2025 |
4.0.19 |
COT.003.260 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. SItuational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. SItuational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
COT.003.259 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
COT.003.255 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Situational |
1. Value must not be more than 76 characters2. Situational |
| 07/31/2025 |
4.0.15 |
COT.003.225 |
UPDATE |
De size |
S9(9)V(9) |
S9(9)V9(9) |
| 04/09/2026 |
4.0.31 |
COT.003.207 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
COT.003.202 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
COT.003.169 |
UPDATE |
Medicaid valid value info |
|
HCPCS Code ListDental Codes ListProcedure Codes |
| 04/09/2026 |
4.0.31 |
COT.003.165 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 10/10/2025 |
4.0.19 |
COT.002.244 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Situational |
1. Value must not be more than 28 characters2. Situational |
| 10/10/2025 |
4.0.19 |
COT.002.243 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
COT.002.242 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
COT.002.237 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
| 04/09/2026 |
4.0.31 |
COT.002.123 |
UPDATE |
Medicaid valid value info |
|
Place of Service Code List |
| 04/09/2026 |
4.0.31 |
COT.002.083 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.082 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.081 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.080 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.079 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.078 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.077 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.076 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.075 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.074 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
COT.002.047 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
COT.002.046 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
COT.002.045 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
COT.002.044 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
COT.002.039 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 03/17/2026 |
4.0.30 |
COT.002.038 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Situational |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Situational |
| 07/17/2025 |
4.0.14 |
FTX.095.401 |
UPDATE |
Necessity |
Conditional |
Situational |
| 10/23/2025 |
4.0.20 |
FTX.004.127 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is situational in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
| 10/23/2025 |
4.0.20 |
FTX.004.126 |
UPDATE |
Necessity |
Situational |
Mandatory |
| 10/23/2025 |
4.0.20 |
FTX.004.126 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Mandatory |
| 10/23/2025 |
4.0.20 |
FTX.003.087 |
UPDATE |
Necessity |
Situational |
Mandatory |
| 10/23/2025 |
4.0.20 |
FTX.003.087 |
UPDATE |
Definition |
Member identification number as it appears on the card issued by the TPL insurance carrier. |
The subscriber’s identification number or a dependent’s identification number as assigned by the TPL insurance carrier (i.e., the IDs that are on the insurance card issued by the TPL insurance carrier).
There should be one FTX00003 segment for each covered life on the policy for which the premium assistance payment is made, regardless of whether that specific covered life is eligible for and enrolled in Medicaid or CHIP. This data element should be populated on each of the FTX000003 segments related to the covered lives on the individual market commercial health insurance policy for the coverage period.
The insurance policy and coverage period is identified by the following data elements on the FTX.003 transaction:
o SUBMITTING-STATE (FTX.003.065)
o INSURANCE-CARRIER-ID-NUM (FTX.003.084)
o INSURANCE-PLAN-ID (FTX.003.085)
o PREMIUM-PERIOD-START-DATE (FTX.003.088)
o PREMIUM-PERIOD-END-DATE (FTX.003.089) |
| 10/23/2025 |
4.0.20 |
FTX.003.087 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Situational |
1. Value must be 20 characters or less2. Mandatory |
| 10/23/2025 |
4.0.20 |
FTX.003.085 |
UPDATE |
Necessity |
Situational |
Mandatory |
| 10/23/2025 |
4.0.20 |
FTX.003.085 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Mandatory |
| 10/10/2025 |
4.0.19 |
CRX.003.179 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Situational |
1. Value must not be more than 76 characters2. Situational |
| 07/17/2025 |
4.0.14 |
CRX.003.171 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situaitional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/31/2025 |
4.0.15 |
CRX.003.131 |
UPDATE |
De size |
S9(9)V(9) |
S9(9)V9(9) |
| 04/09/2026 |
4.0.31 |
CRX.003.119 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 07/17/2025 |
4.0.14 |
CRX.003.118 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Situaitional |
1. Value must be 12 characters or less2. Situational |
| 04/09/2026 |
4.0.31 |
CRX.002.038 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CRX.002.037 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CRX.002.036 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CRX.002.035 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CRX.002.030 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 10/10/2025 |
4.0.19 |
CLT.003.260 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Situational |
1. Value must not be more than 76 characters2. Situational |
| 07/31/2025 |
4.0.15 |
CLT.003.230 |
UPDATE |
De size |
S9(9)V(9) |
S9(9)V9(9) |
| 04/09/2026 |
4.0.31 |
CLT.003.195 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 10/10/2025 |
4.0.19 |
CLT.002.252 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Situational |
1. Value must not be more than 28 characters2. Situational |
| 10/10/2025 |
4.0.19 |
CLT.002.251 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
CLT.002.250 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
CLT.002.245 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
| 04/09/2026 |
4.0.31 |
CLT.002.101 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.100 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.099 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.098 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.097 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.096 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/14/2026 |
4.0.32 |
CLT.002.095 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.094 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.093 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.092 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CLT.002.062 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CLT.002.061 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CLT.002.060 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CLT.002.059 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CLT.002.054 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 10/10/2025 |
4.0.19 |
CIP.003.314 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Situational |
1. Value must not be more than 76 characters2. Situational |
| 07/31/2025 |
4.0.15 |
CIP.003.278 |
UPDATE |
De size |
S9(9)V(9) |
S9(9)V9(9) |
| 04/09/2026 |
4.0.31 |
CIP.003.242 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 10/10/2025 |
4.0.19 |
CIP.002.306 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Situational |
1. Value must not be more than 28 characters2. Situational |
| 10/10/2025 |
4.0.19 |
CIP.002.305 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
CIP.002.304 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Situational3. Value must not contain a pipe or asterisk symbols |
| 10/10/2025 |
4.0.19 |
CIP.002.299 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
1. Value must not be more than 60 characters2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
| 04/09/2026 |
4.0.31 |
CIP.002.149 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.148 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.147 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.146 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.145 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.144 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.143 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.142 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.141 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.140 |
UPDATE |
Medicaid valid value info |
|
Occurrence Codes |
| 04/09/2026 |
4.0.31 |
CIP.002.111 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CIP.002.110 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CIP.002.109 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CIP.002.108 |
UPDATE |
Medicaid valid value info |
|
Claim Payment Remittance Code List |
| 04/09/2026 |
4.0.31 |
CIP.002.102 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status List |
| 04/09/2026 |
4.0.31 |
CIP.002.090 |
UPDATE |
Medicaid valid value info |
|
Procedure Code ListProcedure Code List 2 |
| 04/09/2026 |
4.0.31 |
CIP.002.086 |
UPDATE |
Medicaid valid value info |
|
Procedure Code ListProcedure Code List 2 |
| 04/09/2026 |
4.0.31 |
CIP.002.082 |
UPDATE |
Medicaid valid value info |
|
Procedure Code ListProcedure Code List 2 |
| 04/09/2026 |
4.0.31 |
CIP.002.078 |
UPDATE |
Medicaid valid value info |
|
Procedure Code ListProcedure Code List 2 |
| 04/09/2026 |
4.0.31 |
CIP.002.074 |
UPDATE |
Medicaid valid value info |
|
Procedure Code ListProcedure Code List 2 |
| 07/17/2025 |
4.0.14 |
CIP.002.072 |
UPDATE |
Necessity |
Situational |
Conditional |
| 04/09/2026 |
4.0.31 |
CIP.002.070 |
UPDATE |
Medicaid valid value info |
|
Procedure Code ListProcedure Code List 2 |
| 10/23/2025 |
4.0.20 |
PRV.006.088 |
UPDATE |
Definition |
A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Guidance: Best Practice for Reporting Provider Classification Type and Provider Classification Code in the T-MSIS Provider File".
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/cms-technical-instructions-provider-classification-requirements-in-tmsis/
A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply. |
A code to identify the schema used in the Provider Classification Code field to categorize providers. See T-MSIS Guidance Document, "CMS Technical Instructions: Provider Classification Requirements in T-MSIS".
https://www.medicaid.gov/tmsis/dataguide/v4/technical-instructions/cms-technical-instructions-provider-classification-requirements-in-tmsis/
A provider may be reported with multiple active record segments with the same Provider Classification Type if different Provider Classification Code values apply. |
| 10/08/2026 |
4.0.38 |
MCR.010.118 |
UPDATE |
Data element name text |
Managed Care Plan ID Type |
Managed Care Plan Other ID Type |
| 10/08/2026 |
4.0.38 |
MCR.010.118 |
UPDATE |
Definition |
A code to identify the kind of managed care identifier that is captured in the Managed Care Identifier data element. The state should submit updates to T-MSIS whenever an identifier is retired or issued. |
A code to identify the type of managed care identifier that is captured in the Managed Care Identifier data element. The state should submit updates to T-MSIS whenever an identifier is retired or issued. |
| 10/08/2026 |
4.0.38 |
MCR.010.118 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Managed Care Plan Other ID Type List (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Managed Care Plan ID Type List (VVL)3. Mandatory |
| 04/09/2026 |
4.0.31 |
MCR.004.058 |
UPDATE |
Medicaid valid value info |
|
Managed Care Service Area Name List |
| 07/10/2025 |
4.0.13 |
FTX.095.400 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.400 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.383 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.383 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
| 10/10/2025 |
4.0.19 |
FTX.095.368 |
UPDATE |
Definition |
This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system.
The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction.
The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
| 07/10/2025 |
4.0.13 |
FTX.009.351 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.009.351 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.312 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.312 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.272 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.272 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.229 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.229 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Value Based Payment Model Type List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Value Based Payment Model Type List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.228 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.228 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.215 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.215 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date |
| 07/10/2025 |
4.0.13 |
FTX.005.186 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.186 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.143 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.143 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.128 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.128 |
UPDATE |
Coding requirement |
1. Value must be 9-digit number2. Conditional |
1. Value must be 9-digit number2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.127 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.127 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Situational3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date |
| 07/10/2025 |
4.0.13 |
FTX.003.099 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.099 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 09/25/2025 |
4.0.18 |
FTX.003.086 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.0002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
| 07/10/2025 |
4.0.13 |
FTX.002.055 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.055 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Conditional |
1. Value must be 15 characters or less2. Situational |
| 09/25/2025 |
4.0.18 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional7. If Subcapitation Indicator equals "2", then value must not be populated |
| 02/24/2026 |
4.0.28 |
FTX.002.033 |
UPDATE |
Definition |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment.
This will typically correspond to the X12 820 Premium Receiver. |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. This will typically correspond to the X12 820 Premium Receiver. For PCCM financial transactions, states may use Payee ID Type “05”, “06" and MCR Plan Type “02”. |
| 07/17/2025 |
4.0.14 |
ELG.003.269 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.269 |
UPDATE |
Coding requirement |
1. Value must be between 000 and 400 inclusively2. Conditional |
1. Value must be between 000 and 400 inclusively2. Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.044 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.044 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated |
| 07/17/2025 |
4.0.14 |
ELG.003.038 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.038 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Income Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Income Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.034 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.034 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Marital Status List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Marital Status List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.136 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.136 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. Conditional |
1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. Situational |
| 09/25/2025 |
4.0.18 |
CRX.002.041 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]9. Value must not be greater than Total Allowed Amount (CRX.002.040) |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must be populated, when Type of Claim is in [1,A]8. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]9. Value must not be greater than Total Allowed Amount (CRX.002.040) |
| 07/17/2025 |
4.0.14 |
COT.003.188 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.188 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. Conditional |
1. Value must be 5 characters or less2. Value must be in HCBS Taxonomy Code List (VVL)3. SItuational |
| 07/17/2025 |
4.0.14 |
COT.002.073 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.073 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Situational |
| 09/25/2025 |
4.0.18 |
COT.002.050 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (COT.002.049) |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (COT.002.049) |
| 04/09/2026 |
4.0.31 |
CLT.002.141 |
UPDATE |
Medicaid valid value info |
|
A valid list of Patient Status codes can be purchased at https://www.nubc.org/license |
| 07/10/2025 |
4.0.13 |
CLT.002.091 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.091 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Situational |
| 09/25/2025 |
4.0.18 |
CLT.002.065 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CLT.002.064) |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CLT.002.064) |
| 07/10/2025 |
4.0.13 |
CIP.003.261 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.261 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual) |
| 04/09/2026 |
4.0.31 |
CIP.002.199 |
UPDATE |
Medicaid valid value info |
|
A valid list of Patient Status codes can be purchased at https://www.nubc.org/license |
| 07/10/2025 |
4.0.13 |
CIP.002.139 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.139 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Healthcare Acquired Condition Indicator List (VVL)3. Situational |
| 09/25/2025 |
4.0.18 |
CIP.002.114 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts.6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CIP.002.113) |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Must have an associated Medicaid Paid Date4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount5. When Payment Level Indicator equals "2", value must equal the sum of line level Medicaid Paid Amounts6. Conditional7. Value must not be populated or equal to "0.00" when associated Claim Status is in [542,585,654]8. Value must not be greater than Total Allowed Amount (CIP.002.113) |
| 09/29/2026 |
4.0.38 |
CIP.002.022 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. <a href="https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ ">Shared MSIS Instructions</a> |
| 07/10/2025 |
4.0.13 |
FTX.095.394 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.394 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 11/07/2025 |
4.0.21 |
FTX.095.391 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 11/07/2025 |
4.0.21 |
FTX.095.391 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
| 07/10/2025 |
4.0.13 |
FTX.009.346 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.009.346 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 09/25/2025 |
4.0.18 |
FTX.009.343 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 09/25/2025 |
4.0.18 |
FTX.009.343 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional |
| 07/10/2025 |
4.0.13 |
FTX.008.307 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.307 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.267 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.267 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 11/07/2025 |
4.0.21 |
FTX.007.264 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 11/07/2025 |
4.0.21 |
FTX.007.264 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
| 07/10/2025 |
4.0.13 |
FTX.006.222 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.222 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 10/10/2025 |
4.0.19 |
FTX.006.219 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 10/10/2025 |
4.0.19 |
FTX.006.219 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS Form List (VVL)3. When MBESCBES Form equals "2", value must be in 64.21COS Form List (VVL)4. When MBESCBES Form equals "3", value must be in 21COS Form List (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS Form List (VVL)3. When MBESCBES Form equals "2", value must be in 64.21COS Form List (VVL)4. When MBESCBES Form equals "3", value must be in 21COS Form List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
| 07/10/2025 |
4.0.13 |
FTX.005.180 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.180 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 06/19/2025 |
4.0.11 |
FTX.005.177 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL) |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.004.138 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.138 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 09/25/2025 |
4.0.18 |
FTX.004.135 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
| 06/19/2025 |
4.0.11 |
FTX.004.128 |
UPDATE |
Definition |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it's possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it's possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It’s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
| 07/10/2025 |
4.0.13 |
FTX.003.094 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.094 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.049 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.049 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Situational |
| 09/25/2025 |
4.0.18 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated8. If Subcapitation Indicator equals "2", then value must not be populated9. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated |
| 06/19/2025 |
4.0.11 |
ELG.022.266 |
UPDATE |
Coding requirement |
1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. ConditionalValue must be populated when Eligible Identifier Type (ELG.022.261) equals "2"(Old MSIS Identification Number) |
1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. Conditional4. Value must be populated when Eligible Identifier Type (ELG.022.261) equals "2"(Old MSIS Identification Number) |
| 07/10/2025 |
4.0.13 |
CRX.002.069 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.069 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.264 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.264 |
UPDATE |
Coding requirement |
1. Value must not be more than 2 characters2. Value must be in Place of Service Code List (VVL)3. Conditional4. If value is populated, then Revenue Code must not be populated |
1. Value must not be more than 2 characters2. Value must be in Place of Service Code List (VVL)3. Situational4. If value is populated, then Revenue Code must not be populated |
| 07/17/2025 |
4.0.14 |
COT.002.123 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.123 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Place of Service Code List (VVL)3. Conditional4. If value is populated, then Type of Bill must not be populated |
1. Value must be 2 characters2. Value must be in Place of Service Code List (VVL)3. Situational4. If value is populated, then Type of Bill must not be populated |
| 07/17/2025 |
4.0.14 |
COT.002.111 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.111 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational |
| 06/19/2025 |
4.0.11 |
CLT.002.148 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 5 digits or less3. ConditionalValue must be populated when Type of Service (CLT.003.211) is in [009,045,046,047,059](Intermediate Care Facility for Individuals with Intellectual Disabilities) |
1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. Value must be populated when Type of Service (CLT.003.211) is in [009,045,046,047,059](Intermediate Care Facility for Individuals with Intellectual Disabilities) |
| 07/10/2025 |
4.0.13 |
CLT.002.129 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.129 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational |
| 06/19/2025 |
4.0.11 |
CLT.002.086 |
UPDATE |
Coding requirement |
1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or lessValue is required if the associated Type of Service (CLT.003.211) in [044,048,050] (inpatient mental health/psychiatric services) |
1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or less6. Value is required if the associated Type of Service (CLT.003.211) in [044,048,050] (inpatient mental health/psychiatric services) |
| 07/10/2025 |
4.0.13 |
CIP.002.178 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.178 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Situational |
| 11/20/2025 |
4.0.22 |
MCR.010.119 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbol3. Mandatory |
1. Value must be 30 characters or less2. Value must be in Managed Care Other ID 3 List3. Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.095.394 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.095.391 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.095.383 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 10/10/2025 |
4.0.19 |
FTX.095.371 |
UPDATE |
Definition |
This describes the type of managed care plan or care coordination model of the payer, when applicable. The valid value list is comprised of the standard managed care plan type list from the MCR and ELG files and a complementary list of care coordination models. |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
| 10/10/2025 |
4.0.19 |
FTX.095.370 |
UPDATE |
Definition |
This is a description of what the payer ID represents when the payer ID was reported with a payer type of "Other". |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
| 10/10/2025 |
4.0.19 |
FTX.095.369 |
UPDATE |
Definition |
This is a qualifier that indicates what type of ID the payer ID is. For example, if the payer ID represents the state Medicaid or CHIP agency, then the payer ID type will indicate that the payer ID should be interpreted as a submitting state code. |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
| 07/10/2025 |
4.0.13 |
FTX.095.367 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.367 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.366 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.366 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 10/10/2025 |
4.0.19 |
FTX.095.365 |
UPDATE |
Definition |
The dollar amount being paid to the payee or recouped from the payee for a previous payment. A recoupment should be reported as a negative amount. |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
| 10/10/2025 |
4.0.19 |
FTX.095.364 |
UPDATE |
Definition |
The date that the payment or recoupment was executed by the payer. |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
| 10/10/2025 |
4.0.19 |
FTX.095.363 |
UPDATE |
Definition |
Indicates the type of adjustment record. |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
| 06/19/2025 |
4.0.11 |
FTX.095.361 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.009.346 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.009.343 |
UPDATE |
Necessity |
Conditional |
Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.009.343 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.009.322 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.008.307 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.008.283 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.007.267 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.007.264 |
UPDATE |
Necessity |
Conditional |
Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.007.264 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.007.240 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.006.229 |
UPDATE |
Definition |
This is the type of value-based payment model to which the financial transaction applies. These values come from the �Alternative Payment Model (APM) Framework Final White Paper�, produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
This is the type of value-based payment model to which the financial transaction applies. These values come from the 'Alternative Payment Model (APM) Framework Final White Paper', produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
| 06/05/2025 |
4.0.10 |
FTX.006.222 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.006.215 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 06/05/2025 |
4.0.10 |
FTX.006.196 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.005.180 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.005.177 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL) |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL) |
| 06/05/2025 |
4.0.10 |
FTX.005.173 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 06/05/2025 |
4.0.10 |
FTX.005.153 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.004.138 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.004.135 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 06/05/2025 |
4.0.10 |
FTX.004.128 |
UPDATE |
Definition |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it�s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it's possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
| 06/05/2025 |
4.0.10 |
FTX.004.127 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
| 06/05/2025 |
4.0.10 |
FTX.004.109 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.003.094 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.003.091 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.003.086 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique 'key' value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 06/05/2025 |
4.0.10 |
FTX.003.068 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
FTX.002.049 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 06/05/2025 |
4.0.10 |
FTX.002.021 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state's payment system that identifies the adjustment claim/transaction for an original item control number. |
| 06/05/2025 |
4.0.10 |
ELG.005.276 |
UPDATE |
Definition |
A free-form text field where a state can identify the �other� authority used to extend eligibility; required when 995 is used. |
A free-form text field where a state can identify the 'Other' authority used to extend eligibility. |
| 06/19/2025 |
4.0.11 |
ELG.003.269 |
UPDATE |
Definition |
This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
| 06/05/2025 |
4.0.10 |
ELG.012.172 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory |
| 06/05/2025 |
4.0.10 |
ELG.003.038 |
UPDATE |
Definition |
A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary's income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
| 06/05/2025 |
4.0.10 |
ELG.003.034 |
UPDATE |
Definition |
A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).
Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state�s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value. |
A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).
Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state's marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value. |
| 06/05/2025 |
4.0.10 |
CRX.003.180 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 06/05/2025 |
4.0.10 |
CRX.003.136 |
UPDATE |
Definition |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as 'extended state plan' services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state's service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf |
| 06/19/2025 |
4.0.11 |
CRX.002.075 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal �1� (Individual) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal ‘1’ (Individual) |
| 06/05/2025 |
4.0.10 |
CRX.002.069 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
CRX.002.058 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines' associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 06/05/2025 |
4.0.10 |
CRX.002.032 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 06/05/2025 |
4.0.10 |
CRX.002.029 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C' or an S-CHIP sub-capitated encounter record. |
| 06/05/2025 |
4.0.10 |
COT.003.264 |
UPDATE |
Definition |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than 'B', then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
| 06/05/2025 |
4.0.10 |
COT.003.256 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 06/19/2025 |
4.0.11 |
COT.003.254 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then�value must be populated |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated |
| 06/19/2025 |
4.0.11 |
COT.003.190 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file |
| 06/05/2025 |
4.0.10 |
COT.003.188 |
UPDATE |
Definition |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as 'extended state plan' services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state's service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf |
| 06/05/2025 |
4.0.10 |
COT.002.123 |
UPDATE |
Definition |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than 'B', then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
| 06/05/2025 |
4.0.10 |
COT.002.111 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
COT.002.068 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines' associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 06/05/2025 |
4.0.10 |
COT.002.041 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 06/05/2025 |
4.0.10 |
COT.002.037 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C' or an S-CHIP sub-capitated encounter record |
| 06/05/2025 |
4.0.10 |
CLT.003.261 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 06/19/2025 |
4.0.11 |
CLT.003.213 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file |
| 06/05/2025 |
4.0.10 |
CLT.002.129 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/05/2025 |
4.0.10 |
CLT.002.082 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines' associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 06/05/2025 |
4.0.10 |
CLT.002.056 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 06/05/2025 |
4.0.10 |
CLT.002.052 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C' or an S-CHIP sub-capitated encounter record. |
| 06/05/2025 |
4.0.10 |
CIP.003.315 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 06/19/2025 |
4.0.11 |
CIP.003.261 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual) |
| 06/05/2025 |
4.0.10 |
CIP.002.178 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash "/" in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 06/19/2025 |
4.0.11 |
CIP.002.132 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 06/05/2025 |
4.0.10 |
CIP.002.104 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 06/05/2025 |
4.0.10 |
CIP.002.100 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or 'C'or an S-CHIP sub-capitated encounter record. |
| 06/05/2025 |
4.0.10 |
FTX.006.219 |
UPDATE |
Necessity |
Conditional |
Mandatory |
| 06/05/2025 |
4.0.10 |
FTX.006.219 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS Form List (VVL)3. When MBESCBES Form equals "2", value must be in 64.21COS Form List (VVL)4. When MBESCBES Form equals "3", value must be in 21COS Form List (VVL)5. Mandatory |
| 05/29/2025 |
4.0.9 |
COT.003.254 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then�value must be populated |
| 05/29/2025 |
4.0.9 |
COT.003.190 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file |
| 05/29/2025 |
4.0.9 |
CLT.003.213 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual)6. Value must exist in the NPPES NPI data file |
| 05/29/2025 |
4.0.9 |
CIP.003.261 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal �1� (Individual) |
| 05/29/2025 |
4.0.9 |
FTX.095.391 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
| 05/29/2025 |
4.0.9 |
FTX.009.343 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
| 06/19/2025 |
4.0.11 |
FTX.008.304 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL) |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL)5. Mandatory |
| 05/29/2025 |
4.0.9 |
FTX.007.264 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
| 05/07/2025 |
4.0.8 |
FTX.006.219 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL) |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. Mandatory |
| 05/29/2025 |
4.0.9 |
FTX.005.177 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL) |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL) |
| 05/29/2025 |
4.0.9 |
FTX.005.173 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 05/29/2025 |
4.0.9 |
FTX.004.135 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 05/29/2025 |
4.0.9 |
FTX.004.127 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
| 05/29/2025 |
4.0.9 |
FTX.003.091 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Mandatory |
| 05/29/2025 |
4.0.9 |
FTX.003.086 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 05/29/2025 |
4.0.9 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 10/08/2026 |
4.0.38 |
ELG.005.097 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Restricted Benefits Code List (VVL)3. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "05", then Eligibility Group (ELG.005.087) must be "24"4. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "06", then Eligibility Group (ELG.005.087) must be "26"5. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "02", then Eligibility Group (ELG.005.087) must be "23"6. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "04", then Eligibility Group (ELG.005.087) must be "25"7. (Restricted Benefits) if value equals "3", then Dual Eligible Code (ELG.005.085) cannot be "00"8. Mandatory9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is in [1,7] then Eligibility Group (ELG.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value equals "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value equals "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "01", then Eligibility Group (ELG.005.087) must be "23"15. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "03", then Eligibility Group (ELG.005.087) must be "25"16. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06] |
1. Value must be 1 character2. Value must be in Restricted Benefits Code List (VVL)3. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "05", then Eligibility Group (ELG.005.087) must be "24"4. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "06", then Eligibility Group (ELG.005.087) must be "26"5. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "02", then Eligibility Group (ELG.005.087) must be "23"6. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "04", then Eligibility Group (ELG.005.087) must be "25"7. (Restricted Benefits) if value equals "3", then Dual Eligible Code (ELG.005.085) cannot be "00"8. Mandatory9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is in [1,7] then Eligibility Group (ELG.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value equals "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value equals "2", then associated IMMIGRATION-STATUS (ELG.003.042) value must be equal to "3"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "01", then Eligibility Group (ELG.005.087) must be "23"15. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "03", then Eligibility Group (ELG.005.087) must be "25"16. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06] |
| 05/29/2025 |
4.0.9 |
CRX.003.180 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 05/29/2025 |
4.0.9 |
COT.003.256 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 05/07/2025 |
4.0.8 |
COT.003.254 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If TYPE-OF-CLAIM is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If Type of Claim is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated |
| 05/29/2025 |
4.0.9 |
CLT.003.261 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 07/10/2025 |
4.0.13 |
CLT.002.167 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.167 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 05/29/2025 |
4.0.9 |
CIP.003.315 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals �1�, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals �2�, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals �3�, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 10/10/2025 |
4.0.19 |
FTX.095.373 |
UPDATE |
Definition |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. For PCCM financial transactions, states may use Payee ID Type “05”, “06" and MCR Plan Type “02”. |
| 04/24/2025 |
4.0.7 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 06/19/2025 |
4.0.11 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional7. Value must be populated when Payer ID Type equals "01" |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
| 04/15/2025 |
4.0.6 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional7. Value must be populated when Payer ID Type equals "01" |
| 04/15/2025 |
4.0.6 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 04/15/2025 |
4.0.6 |
COT.004.281 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Mandatory |
| 04/11/2025 |
4.0.6 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
| 04/11/2025 |
4.0.6 |
FTX.002.047 |
UPDATE |
Coding requirement |
Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional 7. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
| 03/27/2025 |
4.0.5 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01" |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 04/11/2025 |
4.0.6 |
COT.004.281 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.004.146 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.146 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.102 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.102 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 03/26/2025 |
4.0.5 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01" |
| 07/17/2025 |
4.0.14 |
ELG.003.273 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.273 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be on or before Enrollment End Date (ELG.021.254) |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. Value must be on or before Enrollment End Date (ELG.021.254) |
| 07/17/2025 |
4.0.14 |
CRX.004.204 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
CRX.004.204 |
UPDATE |
Coding requirement |
1. Value must be in [01-24]2. Conditional3. Value must be 2 digits |
1. Value must be in [01-24]2. Situational3. Value must be 2 digits |
| 07/10/2025 |
4.0.13 |
CRX.003.118 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.118 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Conditional |
1. Value must be 12 characters or less2. Situaitional |
| 07/10/2025 |
4.0.13 |
CRX.002.021 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.021 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Conditional |
1. Value must be 12 characters or less2. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.289 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.289 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.288 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.288 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.287 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.287 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.271 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.271 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.255 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.255 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Conditional |
1. Value must not be more than 76 characters long2. Situational |
| 04/24/2025 |
4.0.7 |
COT.003.254 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 04/24/2025 |
4.0.7 |
COT.003.254 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional5. If TYPE-OF-CLAIM is in [1,3,A,C,U,W] and a CPT-4 code or a CDT code (begins with the letter 'D'), then value must be populated |
| 07/17/2025 |
4.0.14 |
PRV.002.031 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.031 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Sex List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Sex List (VVL)3. Situational |
| 04/15/2025 |
4.0.6 |
MCR.010.119 |
UPDATE |
Data element name |
MANAGED-CARE-PLAN-ID |
MANAGED-CARE-PLAN-OTHER-ID |
| 07/10/2025 |
4.0.13 |
FTX.095.388 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.388 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Transaction Type List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Transaction Type List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.382 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.382 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.381 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.381 |
UPDATE |
Coding requirement |
1. Value must be 100 characters or less2. Conditional |
1. Value must be 100 characters or less2. Situational |
| 10/10/2025 |
4.0.19 |
FTX.095.376 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is not [02,03], then value must not be populated5. Conditional |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is in [05,06], then value must equal '02'5. Conditional |
| 09/25/2025 |
4.0.18 |
FTX.009.345 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"5. If Payer ID Type is in [02,03,04] value must not be populated |
| 09/25/2025 |
4.0.18 |
FTX.009.344 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"7. If Payer ID Type is in [02,03,04] value must not be populated |
| 04/24/2025 |
4.0.7 |
FTX.009.343 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01" |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.009.342 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"5. If Payer ID Type is in [02,03,04] value must not be populated |
| 03/14/2025 |
4.0.4 |
FTX.008.301 |
UPDATE |
Definition |
The date representing the beginning of the cost-settlement period. For example, if the cost-settlement is for the first calendar quarter of the year, then the cost settlement begin date would be March 1 of that year. |
The date representing the beginning of the cost settlement period. For example, if the cost settlement is for the first calendar quarter of the year then the Cost Settlement Period Start Date would be January 1 of that year and the Cost Settlement Period End Date would be March 31 of that year. Likewise, if the cost settlement is for the first calendar month of the year then the Cost Settlement Period Start Date would be January 1 of that year and the Cost Settlement Period End Date would be January 31 of that year. |
| 04/24/2025 |
4.0.7 |
FTX.007.264 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01" |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
| 02/27/2025 |
4.0.3 |
FTX.007.263 |
UPDATE |
Coding requirement |
4. Value must be populated when Payer ID Type equals "01"1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 05/29/2025 |
4.0.9 |
FTX.006.229 |
UPDATE |
Definition |
This is the type of value-based payment model to which the financial transaction applies. These values come from the “Alternative Payment Model (APM) Framework Final White Paperâ€, produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
This is the type of value-based payment model to which the financial transaction applies. These values come from the �Alternative Payment Model (APM) Framework Final White Paper�, produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
| 04/24/2025 |
4.0.7 |
FTX.006.219 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01" |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL) |
| 05/29/2025 |
4.0.9 |
FTX.006.215 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 04/24/2025 |
4.0.7 |
FTX.005.173 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date |
| 04/24/2025 |
4.0.7 |
FTX.004.127 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.021.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date |
| 03/14/2025 |
4.0.4 |
FTX.004.112 |
UPDATE |
Definition |
The date that the payment or recoupment was executed by the payer. |
The date that the payment was executed by the payer. |
| 03/14/2025 |
4.0.4 |
FTX.003.071 |
UPDATE |
Definition |
The date that the payment or recoupment was executed by the payer. |
The date that the payment was executed by the payer. |
| 02/11/2026 |
4.0.27 |
FTX.002.056 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Subcaptitation Indicator List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in Subcapitation Indicator List (VVL)3. Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.002.048 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Value must be populated when Payer ID Type equals "01"4. Conditional |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Value must be populated when Payer ID Type equals "01"4. Conditional5. If Subcapitation Indicator equals "2", then value must not be populated6. When not populated, an associated MBESCBES Form Group and MBESCBES Form must not be populated |
| 03/26/2025 |
4.0.5 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional 7. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
| 03/14/2025 |
4.0.4 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
| 09/25/2025 |
4.0.18 |
FTX.002.045 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01"5. If Subcapitation Indicator equals "2", then value must not be populated |
| 11/20/2025 |
4.0.22 |
FTX.002.041 |
UPDATE |
Definition |
Managed care plan contract ID |
The contract identifier associated with the managed care plan. This data element can be populated with a proxy plan ID for traditional PCCM payments. |
| 02/24/2026 |
4.0.28 |
FTX.002.036 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is not [02,03], then value must not be populated5. Conditional |
1. Value must be 2 characters2. Value must be in Managed Care Plan Type List (VVL)3. If Payee ID Type is in [02,03], then value must be populated4. If Payee ID Type is in [05,06], then value must equal '02' 5. Conditional |
| 10/10/2025 |
4.0.19 |
ELG.005.278 |
UPDATE |
Coding requirement |
1. Value must not be more than 50 characters long2. Conditional3. If Continuous Eligibility Code is "Other", then value must be populated |
1. Value must not be more than 50 characters2. Conditional3. If Continuous Eligibility Code is "Other", then value must be populated |
| 07/17/2025 |
4.0.14 |
ELG.005.274 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.274 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be greater than the Eligibility Determinant Effective Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. Value must be greater than the Eligibility Determinant Effective Date |
| 03/14/2025 |
4.0.4 |
ELG.003.273 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be less than the Variable Demographic Element End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. Value must be on or before Enrollment End Date (ELG.021.254) |
| 07/17/2025 |
4.0.14 |
ELG.005.095 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.095 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated. |
1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Situational4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated. |
| 07/17/2025 |
4.0.14 |
CRX.004.206 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
CRX.004.206 |
UPDATE |
Coding requirement |
1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Conditional |
1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Situational |
| 07/17/2025 |
4.0.14 |
CRX.004.205 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
CRX.004.205 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Situational |
| 03/14/2025 |
4.0.4 |
CRX.004.204 |
UPDATE |
Coding requirement |
1. Value must be in [01-24]2. Conditional |
1. Value must be in [01-24]2. Conditional3. Value must be 2 digits |
| 05/29/2025 |
4.0.9 |
CRX.003.136 |
UPDATE |
Definition |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 07/10/2025 |
4.0.13 |
CRX.003.131 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.131 |
UPDATE |
Coding requirement |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.105 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.105 |
UPDATE |
Coding requirement |
1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
| 05/29/2025 |
4.0.9 |
CRX.002.075 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal ‘1’ (Individual) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal �1� (Individual) |
| 05/29/2025 |
4.0.9 |
COT.003.264 |
UPDATE |
Definition |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “Bâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
| 07/17/2025 |
4.0.14 |
COT.003.262 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.262 |
UPDATE |
Coding requirement |
1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Conditional |
1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.245 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.245 |
UPDATE |
Coding requirement |
1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Conditional |
1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Situational |
| 10/10/2025 |
4.0.19 |
COT.002.238 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Mandatory |
1. Value must not be more than 28 characters2. Mandatory |
| 05/29/2025 |
4.0.9 |
COT.003.188 |
UPDATE |
Definition |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as �extended state plan� services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state�s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 07/17/2025 |
4.0.14 |
COT.002.147 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.147 |
UPDATE |
Coding requirement |
1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
| 05/29/2025 |
4.0.9 |
COT.002.123 |
UPDATE |
Definition |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “Bâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than �B�, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
| 07/17/2025 |
4.0.14 |
COT.002.083 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.083 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.082 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.082 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.081 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.081 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.080 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.080 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.079 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.079 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.078 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.078 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.077 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.077 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.076 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.076 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.075 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.075 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.074 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.074 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.253 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.253 |
UPDATE |
Coding requirement |
1. Value must not be more than 2 characters2. Value must be in State Code List (VVL)3. Conditional |
1. Value must not be more than 2 characters2. Value must be in State Code List (VVL)3. Situational |
| 10/10/2025 |
4.0.19 |
CLT.002.246 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Mandatory |
1. Value must not be more than 28 characters2. Mandatory |
| 07/10/2025 |
4.0.13 |
CLT.002.178 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.178 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.168 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.168 |
UPDATE |
Coding requirement |
1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
| 07/10/2025 |
4.0.13 |
CLT.002.130 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.130 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CLT.002.046) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CLT.002.046) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
1. Value must be 30 characters or less2. Situational3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CLT.002.046) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CLT.002.046) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
| 07/10/2025 |
4.0.13 |
CLT.002.101 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.101 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.100 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.100 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.099 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.099 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.098 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.098 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.097 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.097 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.096 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.096 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.095 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.095 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.094 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.094 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.093 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.093 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.092 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.092 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 06/05/2025 |
4.0.10 |
CLT.002.086 |
UPDATE |
Coding requirement |
1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or less6. (inpatient mental health/psychiatric services) when associated Type of Service (CLT.003.211) in [044,048,050], this field must be populated |
1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or lessValue is required if the associated Type of Service (CLT.003.211) in [044,048,050] (inpatient mental health/psychiatric services) |
| 07/10/2025 |
4.0.13 |
CIP.002.307 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.307 |
UPDATE |
Coding requirement |
1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Conditional |
1. Value must not be more than 2 characters2. Value must be in State Code list (VVL)3. Situational |
| 10/10/2025 |
4.0.19 |
CIP.002.300 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Mandatory |
1. Value must not be more than 28 characters2. Mandatory |
| 07/10/2025 |
4.0.13 |
CIP.002.222 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.222 |
UPDATE |
Coding requirement |
1. Conditional2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
1. Situational2. Value must be an 11-character string3. Character 1 must be numeric values 1 thru 94. Character 2 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)5. Character 3 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)6. Character 4 must be numeric values 0 thru 97. Character 5 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)8. Character 6 must be alphanumeric values 0 thru 9 or A thru Z (minus S,L,O,I,B,Z)9. Character 7 must be numeric values 0 thru 910. Character 8 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)11. Character 9 must be alphabetic values A thru Z (minus S,L,O,I,B,Z)12. Character 10 must be numeric values 0 thru 913. Character 11 must be numeric values 0 thru 914. Value must not contain a pipe or asterisk symbols |
| 07/10/2025 |
4.0.13 |
CIP.002.188 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.188 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.149 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.149 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.148 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.148 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.147 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.147 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.146 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.146 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.145 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.145 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.144 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.144 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.143 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.143 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.142 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.142 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.141 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.141 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.140 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.140 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Occurrence Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.121 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.121 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational |
| 02/20/2025 |
4.0.3 |
ELG.023.289 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.290 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.288 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.287 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.286 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.285 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.284 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.283 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.291 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.282 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.002.023 |
ADD |
N/A |
|
Created |
| 02/20/2025 |
4.0.3 |
ELG.002.023 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.292 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.293 |
REMOVE |
N/A |
Removed |
|
| 02/20/2025 |
4.0.3 |
ELG.023.294 |
REMOVE |
N/A |
Removed |
|
| 05/29/2025 |
4.0.9 |
FTX.095.383 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique �key� value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 05/29/2025 |
4.0.9 |
FTX.095.361 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
FTX.009.322 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
FTX.008.283 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
FTX.007.240 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
FTX.006.196 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
FTX.005.153 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
FTX.004.109 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 04/24/2025 |
4.0.7 |
FTX.003.086 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.0002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
| 05/29/2025 |
4.0.9 |
FTX.003.068 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
FTX.002.021 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state�s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 05/29/2025 |
4.0.9 |
ELG.005.276 |
UPDATE |
Definition |
A free-form text field where a state can identify the “other†authority used to extend eligibility; required when 995 is used. |
A free-form text field where a state can identify the �other� authority used to extend eligibility; required when 995 is used. |
| 02/27/2025 |
4.0.3 |
CRX.003.136 |
UPDATE |
Definition |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 05/29/2025 |
4.0.9 |
CRX.002.032 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 05/29/2025 |
4.0.9 |
CRX.002.029 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record. |
| 02/27/2025 |
4.0.3 |
COT.003.188 |
UPDATE |
Definition |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 05/29/2025 |
4.0.9 |
COT.002.041 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 05/29/2025 |
4.0.9 |
COT.002.037 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record |
| 05/29/2025 |
4.0.9 |
CLT.002.056 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 05/29/2025 |
4.0.9 |
CLT.002.052 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record. |
| 05/29/2025 |
4.0.9 |
CIP.002.104 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = �23� to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 05/29/2025 |
4.0.9 |
CIP.002.100 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or �C� for an S-CHIP sub-capitated encounter record. |
| 03/14/2025 |
4.0.4 |
TPL.006.085 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
TPL.005.069 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
PRV.009.122 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
PRV.008.112 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
PRV.007.099 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
PRV.006.091 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
PRV.005.080 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
PRV.004.066 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
PRV.002.021 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 02/27/2025 |
4.0.3 |
MCR.010.119 |
UPDATE |
Definition |
A data element to capture the various IDs used to identify a managed care plan. The specific type of identifier is defined in the corresponding value in the Managed Care Plan Identifier Type data element. |
A data element to capture the various IDs used to identify a managed care plan, other than the plan ID that is used to link claims, MCR, ELG, and PRV in T-MSIS. The specific type of identifier is defined in the corresponding value in the Managed Care Plan Other Identifier Type data element. |
| 04/24/2025 |
4.0.7 |
FTX.095.391 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
| 01/16/2025 |
4.0.2 |
FTX.095.383 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 02/17/2026 |
4.0.28 |
FTX.095.374 |
UPDATE |
Definition |
This is a qualifier that indicates what type of ID the payee ID is. For example, if the payee ID represents a provider ID, then the payee ID type will indicate that the payee ID should be interpreted as a provider ID. |
This is a qualifier that indicates what type of ID the payee ID is. For example, if the payee ID represents a provider ID, then the payee ID type will indicate that the payee ID should be interpreted as a provider ID. For PCCM financial transactions, states may use Payee ID Type “05”, “06”. |
| 05/29/2025 |
4.0.9 |
FTX.095.369 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is a qualifier that indicates what type of ID the payer ID is. For example, if the payer ID represents the state Medicaid or CHIP agency, then the payer ID type will indicate that the payer ID should be interpreted as a submitting state code. |
| 02/27/2025 |
4.0.3 |
FTX.009.343 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.009.343 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01" |
| 01/16/2025 |
4.0.2 |
FTX.009.322 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 04/24/2025 |
4.0.7 |
FTX.008.304 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL) |
| 01/16/2025 |
4.0.2 |
FTX.008.283 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 02/27/2025 |
4.0.3 |
FTX.007.264 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.007.264 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01" |
| 01/16/2025 |
4.0.2 |
FTX.007.240 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 01/16/2025 |
4.0.2 |
FTX.006.229 |
UPDATE |
Definition |
This is the type of value-based payment model to which the financial transaction applies. These values come from the “Alternative Payment Model (APM) Framework Final White Paper”, produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
This is the type of value-based payment model to which the financial transaction applies. These values come from the “Alternative Payment Model (APM) Framework Final White Paperâ€, produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
| 02/27/2025 |
4.0.3 |
FTX.006.219 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.006.219 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. Value must be populated when Payer ID Type equals "01" |
| 01/16/2025 |
4.0.2 |
FTX.006.215 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 01/16/2025 |
4.0.2 |
FTX.006.196 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 04/24/2025 |
4.0.7 |
FTX.005.177 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL) |
| 01/16/2025 |
4.0.2 |
FTX.005.173 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 01/16/2025 |
4.0.2 |
FTX.005.153 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 04/24/2025 |
4.0.7 |
FTX.004.135 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Policy Owner Code equals "01", then value must be populated11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 05/29/2025 |
4.0.9 |
FTX.004.128 |
UPDATE |
Definition |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it’s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It’s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it�s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It�s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
| 01/16/2025 |
4.0.2 |
FTX.004.127 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
| 01/16/2025 |
4.0.2 |
FTX.004.109 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 04/24/2025 |
4.0.7 |
FTX.003.091 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Mandatory |
| 01/16/2025 |
4.0.2 |
FTX.003.086 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key†value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 01/16/2025 |
4.0.2 |
FTX.003.068 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 02/27/2025 |
4.0.3 |
FTX.002.048 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Value must be populated when Payer ID Type equals "01"4. Conditional |
| 02/27/2025 |
4.0.3 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Value must be populated when Payer ID Type equals "01"6. Conditional |
| 02/27/2025 |
4.0.3 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Subcapitation Indicator equals "1", then value must be populated12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Value must be populated when Payer ID Type equals "01"12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated13. Value must be populated when Payer ID Type equals "01"7. Value must be populated when Payer ID Type equals "01" |
| 04/24/2025 |
4.0.7 |
FTX.002.042 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date |
| 02/17/2026 |
4.0.28 |
FTX.002.034 |
UPDATE |
Definition |
This is a qualifier that indicates what type of ID the payee ID is. For example, if the payee ID represents a provider ID, then the payee ID type will indicate that the payee ID should be interpreted as a provider ID. |
This is a qualifier that indicates what type of ID the payee ID is. For example, if the payee ID represents a provider ID, then the payee ID type will indicate that the payee ID should be interpreted as a provider ID. For PCCM financial transactions, states may use Payee ID Type “05”, “06”. |
| 01/16/2025 |
4.0.2 |
FTX.002.021 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 01/16/2025 |
4.0.2 |
ELG.005.276 |
UPDATE |
Definition |
A free-form text field where a state can identify the “other” authority used to extend eligibility; required when 995 is used. |
A free-form text field where a state can identify the “other†authority used to extend eligibility; required when 995 is used. |
| 05/29/2025 |
4.0.9 |
ELG.003.269 |
UPDATE |
Definition |
This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
| 03/14/2025 |
4.0.4 |
ELG.016.217 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
ELG.012.175 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 03/14/2025 |
4.0.4 |
ELG.011.165 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 02/27/2025 |
4.0.3 |
ELG.005.095 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional4. If Eligibility Determinant End Date (ELG.005.100) is on or after End of Time Period (ELG.001.010), then value must not be populated. |
| 03/14/2025 |
4.0.4 |
ELG.003.058 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 07/17/2025 |
4.0.14 |
ELG.003.046 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.046 |
UPDATE |
Coding requirement |
1. Value must be 3 characters2. Value must be in Preferred Language Code List (VVL)3. Conditional |
1. Value must be 3 characters2. Value must be in Preferred Language Code List (VVL)3. Situational |
| 05/29/2025 |
4.0.9 |
ELG.003.038 |
UPDATE |
Definition |
A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary�s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
| 05/29/2025 |
4.0.9 |
ELG.003.034 |
UPDATE |
Definition |
A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).
Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value. |
A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).
Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state�s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value. |
| 08/29/2025 |
4.0.17 |
CRX.003.209 |
UPDATE |
Definition |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting. |
| 08/29/2025 |
4.0.17 |
CRX.003.209 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
| 04/24/2025 |
4.0.7 |
CRX.003.180 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 07/10/2025 |
4.0.13 |
CRX.002.162 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.162 |
UPDATE |
Coding requirement |
1. Value must be one digit2. Value must be in Prescription Origin Code List (VVL)3. Conditional |
1. Value must be one digit2. Value must be in Prescription Origin Code List (VVL)3. Situational |
| 01/16/2025 |
4.0.2 |
CRX.003.136 |
UPDATE |
Definition |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 07/31/2025 |
4.0.15 |
CRX.003.132 |
UPDATE |
De size |
S9(9)V(9) |
S9(9)V9(9) |
| 02/27/2025 |
4.0.3 |
CRX.003.125 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. Value should not be populated or should be equal to zero, when associated Claim Line Status is in [542,585,654] |
| 07/10/2025 |
4.0.13 |
CRX.002.068 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.068 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Situational |
| 05/29/2025 |
4.0.9 |
CRX.002.058 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 01/16/2025 |
4.0.2 |
CRX.002.032 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 01/16/2025 |
4.0.2 |
CRX.002.029 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record. |
| 08/29/2025 |
4.0.17 |
COT.003.290 |
UPDATE |
Definition |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting. |
| 08/29/2025 |
4.0.17 |
COT.003.290 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
| 03/25/2025 |
4.0.5 |
COT.004.281 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Mandatory |
| 01/16/2025 |
4.0.2 |
COT.003.264 |
UPDATE |
Definition |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “B”, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “Bâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
|
| 07/17/2025 |
4.0.14 |
COT.003.258 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.258 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 04/24/2025 |
4.0.7 |
COT.003.256 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 03/14/2025 |
4.0.4 |
COT.003.255 |
UPDATE |
Coding requirement |
|
1. Value must not be more than 76 characters long2. Conditional |
| 03/14/2025 |
4.0.4 |
COT.003.254 |
UPDATE |
Coding requirement |
|
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory |
| 07/17/2025 |
4.0.14 |
COT.002.241 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.241 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 01/16/2025 |
4.0.2 |
COT.003.188 |
UPDATE |
Definition |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan†services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 01/16/2025 |
4.0.2 |
COT.002.123 |
UPDATE |
Definition |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “B”, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “Bâ€, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled.
|
| 07/17/2025 |
4.0.14 |
COT.002.103 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.103 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.102 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.102 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.101 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.101 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.100 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.100 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.099 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.099 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.098 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.098 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.097 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.097 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.096 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.096 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.095 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.095 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.094 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.094 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.093 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.093 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.092 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.092 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4.Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4.Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.091 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.091 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.090 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.090 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.089 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.089 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.088 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.088 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.087 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.087 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.086 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.086 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.085 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.085 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/17/2025 |
4.0.14 |
COT.002.084 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.084 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 05/29/2025 |
4.0.9 |
COT.002.068 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 01/16/2025 |
4.0.2 |
COT.002.041 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 07/17/2025 |
4.0.14 |
COT.002.038 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.038 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Conditional |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Situational |
| 01/16/2025 |
4.0.2 |
COT.002.037 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record |
| 08/29/2025 |
4.0.17 |
CLT.003.282 |
UPDATE |
Definition |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting. |
| 08/29/2025 |
4.0.17 |
CLT.003.282 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
| 04/24/2025 |
4.0.7 |
CLT.003.261 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 07/10/2025 |
4.0.13 |
CLT.002.249 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.249 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 02/27/2025 |
4.0.3 |
CLT.002.178 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
| 02/27/2025 |
4.0.3 |
CLT.002.130 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CLT.002.046) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CLT.002.046) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
| 07/10/2025 |
4.0.13 |
CLT.002.121 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.121 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.120 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.120 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.119 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.119 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.118 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.118 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.117 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.117 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.116 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.116 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.115 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.115 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.114 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.114 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.113 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.113 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.112 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.112 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.111 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.111 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.110 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.110 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.109 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.109 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before theOccurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before theOccurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.108 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.108 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.107 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.107 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.106 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.106 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.105 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.105 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.104 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.104 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.103 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.103 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CLT.002.102 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.102 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 05/29/2025 |
4.0.9 |
CLT.002.082 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 01/16/2025 |
4.0.2 |
CLT.002.056 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 03/17/2026 |
4.0.30 |
CLT.002.053 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
| 01/16/2025 |
4.0.2 |
CLT.002.052 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record. |
| 08/29/2025 |
4.0.17 |
CIP.003.340 |
UPDATE |
Definition |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). States should populate these data elements for claims when Medicaid Paid Amount is 0 or less than 0. For example, these data elements are still expected to be populated on voided or replacement claims. The data elements should align with quarterly MBES/CBES reporting. |
| 08/29/2025 |
4.0.17 |
CIP.003.340 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
| 04/24/2025 |
4.0.7 |
CIP.003.315 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form Group equals “1”, value must be in 64.9COS list (VVL)3. When MBESCBES Form Group equals “2”, value must be in 64.21COS list (VVL)4. When MBESCBES Form Group equals “3”, value must be in 21COS list (VVL)5. Conditional6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $07. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 07/10/2025 |
4.0.13 |
CIP.002.303 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.303 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 02/27/2025 |
4.0.3 |
CIP.002.188 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
| 07/10/2025 |
4.0.13 |
CIP.002.169 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.169 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.168 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.168 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.167 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.167 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.166 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.166 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.165 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.165 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.164 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.164 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.163 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.163 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.162 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.162 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.161 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.161 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.160 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.160 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.159 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.159 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.158 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.158 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.157 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.157 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.156 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.156 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.155 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.155 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.153 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.153 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.151 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.151 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.150 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.150 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be on or before the Occurrence Code End Date |
| 05/29/2025 |
4.0.9 |
CIP.002.132 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines� associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 01/16/2025 |
4.0.2 |
CIP.002.104 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23†to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 03/17/2026 |
4.0.30 |
CIP.002.101 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in one of the corresponding Type of Bill 3 Classification Lists (VVL) 5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
| 01/16/2025 |
4.0.2 |
CIP.002.100 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C†for an S-CHIP sub-capitated encounter record. |
| 02/27/2025 |
4.0.3 |
CRX.004.205 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
CRX.004.205 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Conditional |
| 05/07/2025 |
4.0.8 |
CRX.004.203 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 05/07/2025 |
4.0.8 |
CRX.004.203 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be "D"4. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be "D"4. Conditional |
| 10/10/2025 |
4.0.19 |
CLT.002.244 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Mandatory3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Mandatory3. Value must not contain a pipe or asterisk symbols |
| 07/10/2025 |
4.0.13 |
CRX.003.192 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.192 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.191 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.191 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.190 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.190 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.189 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.189 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.188 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.188 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.187 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.187 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 12/19/2024 |
4.0.1 |
FTX.007.240 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 07/10/2025 |
4.0.13 |
CRX.003.186 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.186 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.185 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.185 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.184 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.184 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.183 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.183 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.182 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.182 |
UPDATE |
Coding requirement |
1. Value must not be more than 6 characters2. Value must be in Procedure Code List (VVL)3. Conditional |
1. Value must not be more than 6 characters2. Value must be in Procedure Code List (VVL)3. Situational |
| 12/19/2024 |
4.0.1 |
CRX.003.180 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 12/19/2024 |
4.0.1 |
CRX.003.209 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
| 12/19/2024 |
4.0.1 |
FTX.006.219 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
| 02/27/2025 |
4.0.3 |
FTX.006.220 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.006.220 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
| 02/27/2025 |
4.0.3 |
FTX.006.221 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.006.221 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 02/27/2025 |
4.0.3 |
FTX.006.218 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.006.218 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 12/19/2024 |
4.0.1 |
FTX.006.215 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 12/19/2024 |
4.0.1 |
FTX.006.215 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date and Performance Period End Date is less than or equal to Enrollment End Date |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Performance Period Start Date is equal to or greater than Enrollment Effective Date |
| 12/19/2024 |
4.0.1 |
FTX.006.196 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 12/19/2024 |
4.0.1 |
CRX.004.202 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory |
| 12/19/2024 |
4.0.1 |
TPL.006.085 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
FTX.005.177 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.005.173 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 12/19/2024 |
4.0.1 |
FTX.005.173 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date and Coverage Period End Date is less than or equal to Enrollment End Date |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Coverage Period Start Date is equal to or greater than Enrollment Effective Date |
| 12/19/2024 |
4.0.1 |
FTX.005.160 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must equal Submitting State (FTX.001.007)3. Mandatory |
1. Value must be 30 characters or less2. Value must equal Submitting State (FTX.005.150)3. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.005.153 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 12/19/2024 |
4.0.1 |
FTX.004.135 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Policy Owner Code equals "01", then value must be populated11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Policy Owner Code equals "01", then value must be populated11. Conditional12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 09/25/2025 |
4.0.18 |
FTX.004.136 |
UPDATE |
Necessity |
Conditional |
Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.004.136 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Policy Owner Code equals "01", then value must be populated6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.004.137 |
UPDATE |
Necessity |
Conditional |
Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.004.137 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Policy Owner Code equals "01", then value must be populated4. Conditional |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.004.134 |
UPDATE |
Necessity |
Conditional |
Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.004.134 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. If Policy Owner Code equals "01", then value must be populated4. Conditional |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory |
| 03/14/2025 |
4.0.4 |
FTX.004.133 |
UPDATE |
Definition |
The date representing the end of the period covered by the premium payment or recoupment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
The date representing the end of the period covered by the premium payment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
| 03/14/2025 |
4.0.4 |
FTX.004.132 |
UPDATE |
Definition |
The date representing the beginning of the period covered by the premium payment or recoupment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
The date representing the beginning of the period covered by the premium payment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
| 12/19/2024 |
4.0.1 |
FTX.004.128 |
UPDATE |
Definition |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it’s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It’s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
The SSN of the member of the group insurance policy. Each FTX00004 segment represents a different member of a given group insurance policy. Typically all members of the group insurance policy will have both an MSIS ID and an SSN. Under some circumstances, it’s possible that or more members of a group insurance policy do not have an MSIS ID, but do have an SSN, if they are included on the group insurance policy but not eligible for Medicaid or CHIP. It’s also possible that one or more members of a group insurance policy do not have an SSN. If a member of a group insurance policy does not have an SSN, leave this field blank. |
| 12/19/2024 |
4.0.1 |
FTX.004.127 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/
MSIS-IDENTIFICATION-NUM is conditional in the FTX00004 segment because some members of a private group policy may not be eligible for Medicaid or CHIP, though at least one member of the group policy must be eligible for Medicaid or CHIP. There should be one FTX00004 segment for each member of the group policy for which the premium assistance payment is being paid, regardless of whether the member of the group policy was eligible for and enrolled in Medicaid or CHIP. |
| 12/19/2024 |
4.0.1 |
FTX.004.127 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date and Premium Period End Date is less than or equal to Enrollment End Date |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.021.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Premium Period Start Date is equal to or greater than Enrollment Effective Date |
| 03/14/2025 |
4.0.4 |
FTX.004.119 |
UPDATE |
Definition |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment.
This will typically correspond to the X12 820 Premium Receiver. |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is receiving a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment.
This will typically correspond to the X12 820 Premium Receiver. |
| 04/09/2026 |
4.0.31 |
CLT.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 03/14/2025 |
4.0.4 |
FTX.004.116 |
UPDATE |
Definition |
This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped.
This will typically correspond to the X12 820 Premium Payer. |
This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of making a payment, as opposed to the payee who is the object of the transaction. The payer is the entity that is making a payment. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped.
This will typically correspond to the X12 820 Premium Payer. |
| 06/19/2025 |
4.0.11 |
FTX.004.113 |
UPDATE |
Definition |
The dollar amount being paid to the payee. |
The dollar amount being paid to the payee. When a single payment covers multiple people, the full Medicaid Group Insurance payment amount should be reported on the FTX00004 transaction representing the policy subscriber, regardless of whether this person is a Medicaid enrollee. The FTX00004 transactions for the other covered people under the policy should have payment amount values of zero ($0.00). |
| 12/19/2024 |
4.0.1 |
FTX.004.109 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 03/14/2025 |
4.0.4 |
CIP.004.330 |
UPDATE |
Coding requirement |
1. Value must be in [01-24]2. Mandatory |
1. Value must be in [01-24]2. Mandatory3. Value must be 2 digits |
| 07/17/2025 |
4.0.14 |
CIP.004.333 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
CIP.004.333 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Situational |
| 11/20/2025 |
4.0.22 |
CIP.004.332 |
UPDATE |
Definition |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as '21051'. |
ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as '2105'. |
| 12/19/2024 |
4.0.1 |
CIP.004.329 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [A,E,O,P]4. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.003.091 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
| 03/14/2025 |
4.0.4 |
FTX.003.089 |
UPDATE |
Definition |
The date representing the end of the period covered by the premium payment or recoupment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
The date representing the end of the period covered by the premium payment; for example, the last day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
| 03/14/2025 |
4.0.4 |
FTX.003.088 |
UPDATE |
Definition |
The date representing the beginning of the period covered by the premium payment or recoupment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
The date representing the beginning of the period covered by the premium payment; for example, the first day of the calendar month of beneficiary coverage in the insurance plan that the payment is intended to cover (whether or not the beneficiary actually receives services during that month). |
| 12/19/2024 |
4.0.1 |
FTX.003.086 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 12/19/2024 |
4.0.1 |
FTX.003.086 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date and Payment Period End Date is less than or equal to Enrollment End Date. |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
| 12/19/2024 |
4.0.1 |
CIP.003.340 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
| 12/19/2024 |
4.0.1 |
CIP.003.315 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 03/14/2025 |
4.0.4 |
FTX.003.078 |
UPDATE |
Definition |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment.
This will typically correspond to the X12 820 Premium Receiver. |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is receiving a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment.
This will typically correspond to the X12 820 Premium Receiver. |
| 03/14/2025 |
4.0.4 |
FTX.003.075 |
UPDATE |
Definition |
This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction. The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped.
This will typically correspond to the X12 820 Premium Payer. |
This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system. The payer is the subject taking the action of making a payment, as opposed to the payee who is the object of the transaction. The payer is the entity that is making a payment. The payee is the individual or entity that is receiving a payment.
This will typically correspond to the X12 820 Premium Payer. |
| 12/19/2024 |
4.0.1 |
FTX.003.068 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 04/09/2026 |
4.0.31 |
COT.004.284 |
UPDATE |
Medicaid valid value info |
|
Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes)Diagnosis Code List (ICD-10) |
| 03/14/2025 |
4.0.4 |
COT.004.282 |
UPDATE |
Coding requirement |
1. Value must be in [01-24]2. Mandatory |
1. Value must be in [01-24]2. Mandatory3. Value must be 2 digits |
| 12/19/2024 |
4.0.1 |
COT.004.281 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [D,E,O,P,R]4. Mandatory |
| 02/27/2025 |
4.0.3 |
COT.004.280 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after the associated Beginning Date of Service |
| 12/19/2024 |
4.0.1 |
PRV.005.080 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
FTX.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Subcapitation Indicator equals "01", then value must be populated12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. If Subcapitation Indicator equals "1", then value must be populated12. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 12/19/2024 |
4.0.1 |
FTX.002.047 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "01", then value must be populated6. Conditional |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. If Subcapitation Indicator equals "1", then value must be populated6. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.002.048 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional |
| 02/27/2025 |
4.0.3 |
FTX.002.045 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.002.045 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 12/19/2024 |
4.0.1 |
FTX.002.042 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date and Capitation Period End Date is less than or equal to Enrollment End Date |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.019)4. When Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Capitation Period Start Date is equal to or greater than Enrollment Effective Date |
| 12/19/2024 |
4.0.1 |
COT.003.264 |
UPDATE |
Definition |
PLACE-OF-SERVICE is a pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claims form (i.e., 837P, CMS-1500, or 837D). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “B”, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS 1450 (UB04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “B”, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
| 07/17/2025 |
4.0.14 |
COT.003.263 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.263 |
UPDATE |
Coding requirement |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational |
| 12/19/2024 |
4.0.1 |
COT.003.254 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Mandatory |
|
| 12/19/2024 |
4.0.1 |
COT.003.256 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 12/19/2024 |
4.0.1 |
COT.003.290 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
| 07/10/2025 |
4.0.13 |
CIP.002.308 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.308 |
UPDATE |
Coding requirement |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational |
| 12/19/2024 |
4.0.1 |
FTX.002.021 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 12/19/2024 |
4.0.1 |
FTX.002.020 |
UPDATE |
Necessity |
Conditional |
Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.002.020 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory |
| 10/10/2025 |
4.0.19 |
CIP.002.298 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Mandatory3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Mandatory3. Value must not contain a pipe or asterisk symbols |
| 12/19/2024 |
4.0.1 |
PRV.002.021 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.021.254 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.021.253 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
COT.003.155 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
COT.002.246 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.246 |
UPDATE |
Coding requirement |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational |
| 10/10/2025 |
4.0.19 |
COT.002.236 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Mandatory3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters2. Mandatory3. Value must not contain a pipe or asterisk symbols |
| 12/19/2024 |
4.0.1 |
FTX.095.391 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
| 09/25/2025 |
4.0.18 |
FTX.095.392 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 09/25/2025 |
4.0.18 |
FTX.095.392 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01"7. When not populated, an associated MBESCBES Form Group and MBESCBES Category of Service must not be populated |
| 09/25/2025 |
4.0.18 |
FTX.095.393 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 09/25/2025 |
4.0.18 |
FTX.095.393 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 09/25/2025 |
4.0.18 |
FTX.095.390 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 09/25/2025 |
4.0.18 |
FTX.095.390 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 04/09/2026 |
4.0.31 |
CIP.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
FTX.095.383 |
UPDATE |
Definition |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique “key” value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
| 12/19/2024 |
4.0.1 |
FTX.095.383 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When Adjustment Indicator does not equal 1, there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date and Period Period End Date is less than or equal to Enrollment End Date |
1. Value must be 20 characters or less2. Conditional3. When populated, value must match MSIS Identification Number (ELG.002.019)4. When populated and Adjustment Indicator does not equal "1", there must be a valid record of type Enrollment Time Span where the Payment Period Start Date is equal to or greater than Enrollment Effective Date |
| 04/15/2025 |
4.0.6 |
FTX.095.373 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment. |
| 12/19/2024 |
4.0.1 |
ELG.005.276 |
UPDATE |
Definition |
A free-form text field where a state can identify the “other” authority used to extend eligibility; required when 995 is used. |
A free-form text field where a state can identify the “other” authority used to extend eligibility; required when 995 is used. |
| 07/17/2025 |
4.0.14 |
ELG.005.279 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.279 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Income Standard Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Income Standard Code List (VVL)3. Situational |
| 05/29/2025 |
4.0.9 |
FTX.095.368 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is the identifier that corresponds with the payer's role in relation to the Medicaid/CHIP system.
The payer is the subject taking the action of either making a payment or taking a recoupment, as opposed to the payee who is the object of the transaction.
The payer is the entity that is either making a payment or recouping a payment from another entity or individual. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. |
| 07/17/2025 |
4.0.14 |
ELG.005.277 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.277 |
UPDATE |
Coding requirement |
1. Value must be 3 characters2. Value must be in Continuous Eligibility Code List (VVL)3. Conditional |
1. Value must be 3 characters2. Value must be in Continuous Eligibility Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.275 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.275 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Eligibility Extension Code List (VVL)3. Conditional |
1. Value must be 3 characters or less2. Value must be in Eligibility Extension Code List (VVL)3. Situational |
| 05/29/2025 |
4.0.9 |
FTX.095.365 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
The dollar amount being paid to the payee or recouped from the payee for a previous payment. A recoupment should be reported as a negative amount. |
| 05/29/2025 |
4.0.9 |
FTX.095.364 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
The date that the payment or recoupment was executed by the payer. |
| 05/29/2025 |
4.0.9 |
FTX.095.363 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
Indicates the type of adjustment record. |
| 01/16/2025 |
4.0.2 |
FTX.095.361 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 05/29/2025 |
4.0.9 |
FTX.095.360 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
A unique item control number assigned by the states payment system that identifies an original or adjustment claim/transaction. |
| 05/29/2025 |
4.0.9 |
FTX.095.358 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. |
| 04/09/2026 |
4.0.31 |
COT.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
FTX.009.343 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
| 02/27/2025 |
4.0.3 |
FTX.009.344 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.009.344 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
| 02/27/2025 |
4.0.3 |
FTX.009.345 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.009.345 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 02/27/2025 |
4.0.3 |
FTX.009.342 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.009.342 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 03/14/2025 |
4.0.4 |
FTX.009.340 |
UPDATE |
Definition |
The date representing the beginning of the FQHC wrap payment or recoupment period. For example, if the FQHC wrap payment is for the first calendar quarter of the year, then the FQHC wrap payment begin date would be March 1 of that year. |
The date representing the beginning of the FQHC wrap payment or recoupment period. For example, if the FQHC wrap payment is for the first calendar quarter of the year then the Wrap Period Start Date would be January 1 of that year and the Wrap Period End Date would be March 31 of that year. Likewise, if the FQHC wrap payment is for the first calendar month of the year then the Wrap Period Start Date would be January 1 of that year and the Wrap Period End Date would be January 31 of that year. |
| 03/14/2025 |
4.0.4 |
CLT.004.276 |
UPDATE |
Coding requirement |
1. Value must be in [01-24]2. Mandatory |
1. Value must be in [01-24]2. Mandatory3. Value must be 2 digits |
| 07/17/2025 |
4.0.14 |
CLT.004.279 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
CLT.004.279 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Diagnosis POA Flag List (VVL)3. Situational |
| 04/09/2026 |
4.0.31 |
CLT.004.278 |
UPDATE |
Medicaid valid value info |
|
Diagnosis Code List (ICD-9-CM Diagnosis and Procedure Codes)Diagnosis Code List (ICD-10) |
| 12/19/2024 |
4.0.1 |
CLT.004.275 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [A,E,O,P]4. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.009.322 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 12/19/2024 |
4.0.1 |
CLT.003.261 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Conditional11. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $012. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
| 12/19/2024 |
4.0.1 |
CLT.003.282 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount not equal to $0 |
| 12/19/2024 |
4.0.1 |
FTX.008.304 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
| 12/19/2024 |
4.0.1 |
ELG.002.027 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.002.026 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 12/19/2024 |
4.0.1 |
FTX.008.283 |
UPDATE |
Definition |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
A unique claim/transaction number assigned by the state’s payment system that identifies the adjustment claim/transaction for an original item control number. |
| 02/27/2025 |
4.0.3 |
CRX.004.206 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
CRX.004.206 |
UPDATE |
Coding requirement |
1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory |
1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Conditional |
| 02/27/2025 |
4.0.3 |
CRX.004.204 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
CRX.004.204 |
UPDATE |
Coding requirement |
1. Value must be in [01-24]2. Mandatory |
1. Value must be in [01-24]2. Conditional |
| 07/10/2025 |
4.0.13 |
CLT.002.254 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.254 |
UPDATE |
Coding requirement |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational |
| 12/19/2024 |
4.0.1 |
FTX.007.264 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21.P", value must be in 21.P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
1. Value must be 5 characters or less2. When MBESCBES Form equals "21P", value must be in 21P Form List (VVL)3. When MBESCBES Form equals "21BASE", value must be in 21BASE Form List (VVL)4. When MBESCBES Form equals "64.21U", value must be in 64.21U Form List (VVL)5. When MBESCBES Form equals "64.10BASE", value must be in 64.10BASE Form List (VVL)6. When MBESCBES Form equals "64.9P", value must be in 64.9P Form List (VVL)7. When MBESCBES Form equals "64.9A", value must be in 64.9A Form List (VVL)8. When MBESCBES Form equals "64.9BASE", value must be in 64.9BASE Form List (VVL)9. When MBESCBES Form equals "64.21UP", value must be in 64.21UP Form List (VVL)10. Mandatory |
| 02/27/2025 |
4.0.3 |
FTX.007.265 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.007.265 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Mandatory |
1. Value must be 50 characters or less2. When MBESCBES Form Group equals "1", value must be in MBESCBES Form Group 1 List (VVL)3. When MBESCBES Form Group equals "2", value must be in MBESCBES Form Group 2 List (VVL)4. When MBESCBES Form Group equals "3", value must be in MBESCBES Form Group 3 List (VVL)5. Conditional6. Value must be populated when Payer ID Type equals "01" |
| 02/27/2025 |
4.0.3 |
FTX.007.266 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.007.266 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in MBESCBES Form Group List (VVL)3. Conditional4. Value must be populated when Payer ID Type equals "01" |
| 02/27/2025 |
4.0.3 |
FTX.007.263 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 02/27/2025 |
4.0.3 |
FTX.007.263 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Mandatory |
4. Value must be populated when Payer ID Type equals "01"1. Value must be 2 characters2. Value must be in Category for Federal Reimbursement List (VVL)3. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.249 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 07/10/2025 |
4.0.13 |
CLT.002.245 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.245 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
| 01/16/2025 |
4.0.2 |
CRX.004.200 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 07/10/2025 |
4.0.13 |
CRX.003.195 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.195 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.194 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.194 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.193 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.193 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.179 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.179 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Conditional |
1. Value must not be more than 76 characters long2. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.178 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.178 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.177 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.177 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.176 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.176 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 10/10/2025 |
4.0.19 |
CRX.002.175 |
UPDATE |
Coding requirement |
1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
| 07/10/2025 |
4.0.13 |
CRX.002.173 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.173 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 01/16/2025 |
4.0.2 |
CIP.004.326 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 07/10/2025 |
4.0.13 |
CIP.003.337 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.337 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.336 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.336 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.319 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.319 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.318 |
UPDATE |
Necessity |
Conditional |
SItuational |
| 07/10/2025 |
4.0.13 |
CIP.003.318 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.317 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.317 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.314 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.314 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Conditional |
1. Value must not be more than 76 characters long2. Situational |
| 01/16/2025 |
4.0.2 |
COT.004.278 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 07/17/2025 |
4.0.14 |
COT.003.273 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.273 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.272 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.272 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 03/14/2025 |
4.0.4 |
COT.003.271 |
UPDATE |
Data element name text |
order Provider NPI Number |
Ordering Provider NPI Number |
| 07/17/2025 |
4.0.14 |
COT.003.270 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.270 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.269 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.269 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated.6. Value must not equal Referring Provider NPI Number |
1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated.6. Value must not equal Referring Provider NPI Number |
| 07/17/2025 |
4.0.14 |
COT.003.268 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.268 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.267 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.267 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
| 07/17/2025 |
4.0.14 |
COT.003.266 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.266 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.265 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.265 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.261 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.261 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Conditional |
1. Value must not be more than 28 characters long2. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.260 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.260 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. SItuational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 07/17/2025 |
4.0.14 |
COT.003.259 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.259 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
| 12/19/2024 |
4.0.1 |
COT.003.258 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 12/19/2024 |
4.0.1 |
COT.003.255 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Conditional |
|
| 07/10/2025 |
4.0.13 |
CIP.002.339 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.339 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.338 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.338 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.311 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.311 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 10/10/2025 |
4.0.19 |
CIP.002.310 |
UPDATE |
Coding requirement |
1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
| 07/10/2025 |
4.0.13 |
CIP.002.306 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.306 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Conditional |
1. Value must not be more than 28 characters long2. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.305 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.305 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 07/10/2025 |
4.0.13 |
CIP.002.304 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.304 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
| 12/19/2024 |
4.0.1 |
CIP.002.303 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 07/10/2025 |
4.0.13 |
CIP.002.299 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.299 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
| 07/10/2025 |
4.0.13 |
CIP.002.297 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.297 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.253 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.253 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.252 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.252 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.251 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.251 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated6. Value must not equal Referring Provider NPI Number |
1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File5. Value must not be populated when Referring Provider NPI Number is not populated6. Value must not equal Referring Provider NPI Number |
| 07/17/2025 |
4.0.14 |
COT.002.250 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.250 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional3. Value must not be populated when Referring Provider Number is not populated.4. Value must not equal Referring Provider Number |
1. Value must be 30 characters or less2. Situational3. Value must not be populated when Referring Provider Number is not populated.4. Value must not equal Referring Provider Number |
| 07/17/2025 |
4.0.14 |
COT.002.249 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.249 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 10/10/2025 |
4.0.19 |
COT.002.248 |
UPDATE |
Coding requirement |
1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
| 07/17/2025 |
4.0.14 |
COT.002.244 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.244 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Conditional |
1. Value must not be more than 28 characters long2. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.243 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.243 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 07/17/2025 |
4.0.14 |
COT.002.242 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.242 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
| 12/19/2024 |
4.0.1 |
COT.002.241 |
UPDATE |
Coding requirement |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1.Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.026) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 07/17/2025 |
4.0.14 |
COT.002.237 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.237 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. Value must not contain a pipe or asterisk symbols5. There must be an Address Line 1 in order to have an Address Line 2 |
| 07/17/2025 |
4.0.14 |
COT.002.235 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.235 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 12/19/2024 |
4.0.1 |
ELG.005.095 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Eligibility Change Reason List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Eligibility Termination Reason List (VVL)3. Conditional |
| 01/16/2025 |
4.0.2 |
CLT.004.272 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 07/10/2025 |
4.0.13 |
CLT.003.267 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.267 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.266 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.266 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.265 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.265 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
| 07/10/2025 |
4.0.13 |
CLT.003.264 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.264 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.263 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.263 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.260 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.260 |
UPDATE |
Coding requirement |
1. Value must not be more than 76 characters long2. Conditional |
1. Value must not be more than 76 characters long2. Situational |
| 12/19/2024 |
4.0.1 |
ELG.003.046 |
UPDATE |
Coding requirement |
1. Value must be 3 characters2. Value must be in Primary Language Code List (VVL)3. Conditional |
1. Value must be 3 characters2. Value must be in Preferred Language Code List (VVL)3. Conditional |
| 07/10/2025 |
4.0.13 |
CLT.002.259 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.259 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.258 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.258 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.257 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.257 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 10/10/2025 |
4.0.19 |
CLT.002.256 |
UPDATE |
Coding requirement |
1. Value must not be more than 50 characters long2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
1. Value must not be more than 50 characters2. Conditional3. Value must be provided when corresponding Provider Claim Form Code is "Other" |
| 07/10/2025 |
4.0.13 |
CLT.002.252 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.252 |
UPDATE |
Coding requirement |
1. Value must not be more than 28 characters long2. Conditional |
1. Value must not be more than 28 characters long2. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.251 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.251 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. Situational3. Value must not be equal to associated Address Line 14. There must be an Address Line 1 in order to have an Address Line 25. Value must not contain a pipe or asterisk symbols |
| 07/10/2025 |
4.0.13 |
CLT.002.250 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.250 |
UPDATE |
Coding requirement |
1. Value must not be more than 60 characters long2. Conditional3. Value must not contain a pipe or asterisk symbols |
1. Value must not be more than 60 characters long2. Situational3. Value must not contain a pipe or asterisk symbols |
| 04/09/2026 |
4.0.31 |
MCR.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.003.044 |
UPDATE |
Definition |
The date the five-year bar for an individual ends. Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provides that certain immigrants who enter the United States on or after August 22, 1996 are not eligible to receive federally-funded benefits, including Medicaid and the State Children's Health Insurance Program (Separate CHIP), for five years from the date they enter the country with a status as a "qualified alien." |
The date the five-year bar for an individual ends.
Section 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) provides that certain immigrants who enter the United States on or after August 22, 1996 are not eligible to receive federally-funded benefits, including Medicaid and the State Children's
Health Insurance Program (Separate CHIP), for five years from the date they enter the country with a status as a "qualified noncitizen." |
| 07/17/2025 |
4.0.14 |
COT.003.208 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.208 |
UPDATE |
Coding requirement |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational |
| 10/08/2024 |
4.0.0 |
ELG.003.044 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated |
| 10/01/2024 |
4.0.0 |
ELG.003.044 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated |
1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated |
| 04/09/2026 |
4.0.31 |
TPL.006.081 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
TPL.006.079 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.006.079 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Situational |
| 07/17/2025 |
4.0.14 |
TPL.006.078 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.006.078 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational |
| 04/09/2026 |
4.0.31 |
TPL.006.073 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
TPL.005.069 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 04/09/2026 |
4.0.31 |
TPL.005.064 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
TPL.004.053 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
TPL.003.047 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.047 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.046 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.046 |
UPDATE |
Coding requirement |
1. Value must be 9-digit number2. For any individual, the value must be the same over all segment effective and end dates3. Conditional |
1. Value must be 9-digit number2. For any individual, the value must be the same over all segment effective and end dates3. Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.038 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.038 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.037 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.037 |
UPDATE |
Coding requirement |
1. Value must be 2 characters or less2. Value must be in Insurance Plan Type List (VVL)3. Conditional4. Value must have an associated Insurance Plan ID |
1. Value must be 2 characters or less2. Value must be in Insurance Plan Type List (VVL)3. Situational4. Value must have an associated Insurance Plan ID |
| 07/17/2025 |
4.0.14 |
TPL.003.036 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.036 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must not contain a pipe symbol3. Conditional |
1. Value must be 20 characters or less2. Value must not contain a pipe symbol3. Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.035 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.035 |
UPDATE |
Coding requirement |
1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Conditional |
1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.034 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.034 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.033 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.003.033 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 04/09/2026 |
4.0.31 |
TPL.003.030 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
TPL.002.023 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
TPL.002.023 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational |
| 02/27/2025 |
4.0.3 |
TPL.002.020 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Mandatory5. When value equals "1", there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID |
1. Value must be 1 character2. Value must be in TPL Health Insurance Coverage Indicator List (VVL)3. Mandatory4. When value equals "1", there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID |
| 04/09/2026 |
4.0.31 |
TPL.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 05/07/2025 |
4.0.8 |
TPL.001.088 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 04/09/2026 |
4.0.31 |
TPL.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
TPL.001.003 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Subcaptitation Indicator List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in Submission Transaction Type List (VVL)3. Mandatory |
| 04/09/2026 |
4.0.31 |
PRV.010.126 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
PRV.009.122 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 04/09/2026 |
4.0.31 |
PRV.009.116 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
PRV.008.112 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 04/09/2026 |
4.0.31 |
PRV.008.107 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
PRV.007.099 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 04/09/2026 |
4.0.31 |
PRV.007.095 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
PRV.006.091 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
PRV.006.089 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. If associated Provider Classification Type equals "1", value must be in Provider Taxonomy List (VVL)3. If associated Provider Classification Type equals "2", value must be in Provider Specialty List (VVL)4. If associated Provider Classification Type equals "3", value must be in Provider Type Code List (VVL)5. If associated Provider Classification Type equals "4", value must be in Provider Authorized Category of Service Code List (VVL)6. Mandatory |
1. Value must be 20 characters or less2. If associated Provider Classification Type equals "1", value must be in Provider Taxonomy List (VVL)3. If associated Provider Classification Type equals "2", value must be in Provider Specialty List (VVL)4. If associated Provider Classification Type equals "3", value must be in Provider Type Code List (VVL)5. If associated Provider Classification Type equals "4", value must be in Provider Classification Code Type 4 List (VVL)6. Mandatory |
| 04/09/2026 |
4.0.31 |
PRV.006.085 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
PRV.005.073 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
PRV.004.066 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 04/09/2026 |
4.0.31 |
PRV.004.061 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
PRV.003.051 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
PRV.003.049 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.003.049 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Situational |
| 07/17/2025 |
4.0.14 |
PRV.003.048 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.003.048 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational |
| 04/09/2026 |
4.0.31 |
PRV.003.040 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
PRV.002.035 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.035 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated End of Time Period (PRV.001.010)5. There can only be one value on all records when the value is populated6. When populated, the difference between value and Date of Birth (PRV.002.034) must be 18 years or greater |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated End of Time Period (PRV.001.010)5. There can only be one value on all records when the value is populated6. When populated, the difference between value and Date of Birth (PRV.002.034) must be 18 years or greater |
| 07/17/2025 |
4.0.14 |
PRV.002.034 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.034 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated End of Time Period (PRV.001.010)3. Conditional4. The difference between current value and Start of Time Period (PRV.001.009) must be between 18 and 85 years |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated End of Time Period (PRV.001.010)3. Situational4. The difference between current value and Start of Time Period (PRV.001.009) must be between 18 and 85 years |
| 02/20/2025 |
4.0.3 |
PRV.002.031 |
UPDATE |
Definition |
Either individual's biological sex or their self-identified sex. |
The individual's biological sex assigned at birth. |
| 07/17/2025 |
4.0.14 |
PRV.002.030 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.030 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.029 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.029 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.028 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.028 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 12/19/2024 |
4.0.1 |
PRV.002.026 |
UPDATE |
Coding requirement |
1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (individual) if value equals "03", then Provider First Name (PRV.002.028) must be populated5. (Individual) NPPES Entity Type Code associate with this NPI must equal "1" (Individual)6. (individual) if value equals "03", then Provider Last Name (PRV.002.030) must be populated7. (individual) if value equals "03", then Provider Sex (PRV.002.031) must be populated8. (individual) if value equals "03", then Provider Date of Birth (PRV.002.034) must be populated9. (Organization) If value equals "01" or "02", then Provider Date of Death (PRV.002.035) must not be populated10. (Organization) If value does not equal "03", then Provider Middle Initial (PRV.002.029) must not be populated11. (Organization) NPPES Entity Type Code associate with this NPI must equal "2" (Organization) |
1. Value must be in Facility Group Individual Code List (VVL)2. Value must be 2 characters3. Mandatory4. (Individual) if value equals "03", then Provider First Name (PRV.002.028) must be populated5. (Individual) NPPES Entity Type Code associated with a Provider NPI reported in (PRV.005.081) must equal "1" (Individual)6. (Individual) if value equals "03", then Provider Last Name (PRV.002.030) must be populated7. (Individual) if value equals "03", then Provider Sex (PRV.002.031) must be populated8. (Individual) if value equals "03", then Provider Date of Birth (PRV.002.034) must be populated9. (Organization) If value equals "01" or "02", then Provider Date of Death (PRV.002.035) must not be populated10. (Organization) If value does not equal "03", then Provider Middle Initial (PRV.002.029) must not be populated11. (Organization) NPPES Entity Type Code associated with a Provider NPI reported in (PRV.005.081) must equal "2" (Organization) |
| 07/17/2025 |
4.0.14 |
PRV.002.024 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.024 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional |
1. Value must be 60 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.022 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
PRV.002.022 |
UPDATE |
Coding requirement |
1. Value must be 100 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional |
1. Value must be 100 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational |
| 04/09/2026 |
4.0.31 |
PRV.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 05/07/2025 |
4.0.8 |
PRV.001.138 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 04/09/2026 |
4.0.31 |
PRV.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
PRV.001.003 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Subcaptitation Indicator List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in Submission Transaction Type List (VVL)3. Mandatory |
| 10/01/2024 |
4.0.0 |
MCR.006.078 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20]5. Value of the CC component must be in [18,19, 20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 12/19/2024 |
4.0.1 |
MCR.006.077 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Managed Care Plan Pop List (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Eligibility Group List (VVL)3. Mandatory |
| 04/09/2026 |
4.0.31 |
MCR.006.074 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
MCR.005.064 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
MCR.004.055 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
MCR.003.051 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
MCR.003.051 |
UPDATE |
Coding requirement |
1. Value must be 10-digit number2. Conditional |
1. Value must be 10-digit number2. Situational |
| 04/09/2026 |
4.0.31 |
MCR.003.048 |
UPDATE |
Medicaid valid value info |
|
US County Code List |
| 04/09/2026 |
4.0.31 |
MCR.003.046 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
MCR.003.044 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
MCR.003.044 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. SItuational |
| 07/10/2025 |
4.0.13 |
MCR.003.043 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
MCR.003.043 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational |
| 04/09/2026 |
4.0.31 |
MCR.003.035 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 04/09/2026 |
4.0.31 |
MCR.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 05/07/2025 |
4.0.8 |
MCR.001.112 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 10/08/2024 |
4.0.0 |
MCR.001.007 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in State Code List (VVL)4. Value must be the same for all records3. Mandatory |
1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same for all records |
| 12/19/2024 |
4.0.1 |
MCR.001.003 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Subcaptitation Indicator List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in Submission Transaction Type List (VVL)3. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.095.404 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.404 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.401 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Conditional |
1. Value must be 50 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.095.400 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 08/29/2025 |
4.0.17 |
FTX.095.397 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.095.395 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.095.395 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational |
| 05/29/2025 |
4.0.9 |
FTX.095.394 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 04/15/2025 |
4.0.6 |
FTX.095.389 |
UPDATE |
Coding requirement |
1. Value must be 100 characters or less2. Value must be populated when Payee Identifier Type equals "95"3. Conditional |
1. Value must be 100 characters or less2. Value must be populated when Transaction Type equals "95"3. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.095.374 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.095.358)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 05/29/2025 |
4.0.9 |
FTX.095.372 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is a description of what type of managed care plan or care coordination model the payer ID was reported with a PAYER-MCR-PLAN-OR-OTHER-TYPE of "Other". |
| 05/29/2025 |
4.0.9 |
FTX.095.371 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This describes the type of managed care plan or care coordination model of the payer, when applicable. The valid value list is comprised of the standard managed care plan type list from the MCR and ELG files and a complementary list of care coordination models. |
| 05/29/2025 |
4.0.9 |
FTX.095.370 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
This is a description of what the payer ID represents when the payer ID was reported with a payer type of "Other". |
| 12/19/2024 |
4.0.1 |
FTX.095.369 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.095.358)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
| 05/29/2025 |
4.0.9 |
FTX.095.367 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
The check or electronic funds transfer number. |
| 05/29/2025 |
4.0.9 |
FTX.095.366 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
The date a check is issued to the payee. In the case of electronic funds transfer, it is the date the transfer is made. |
| 05/29/2025 |
4.0.9 |
FTX.095.359 |
UPDATE |
Definition |
The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). |
A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file. |
| 07/10/2025 |
4.0.13 |
FTX.009.354 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.009.354 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.009.351 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered |
| 08/29/2025 |
4.0.17 |
FTX.009.349 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.009.347 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.009.347 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational |
| 05/29/2025 |
4.0.9 |
FTX.009.346 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.009.333 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.009.319)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.009.330 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.009.319)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
| 07/10/2025 |
4.0.13 |
FTX.009.328 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.009.328 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.009.327 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.009.327 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 07/10/2025 |
4.0.13 |
FTX.008.315 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.315 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.008.312 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 08/29/2025 |
4.0.17 |
FTX.008.310 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.008.308 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.308 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational |
| 05/29/2025 |
4.0.9 |
FTX.008.307 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.008.294 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.008.280)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.008.291 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.008.280)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
| 07/10/2025 |
4.0.13 |
FTX.008.289 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.289 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.288 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.008.288 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 07/10/2025 |
4.0.13 |
FTX.007.276 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.276 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.273 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.273 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Conditional |
1. Value must be 50 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.007.272 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 08/29/2025 |
4.0.17 |
FTX.007.270 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.007.268 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.268 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational |
| 05/29/2025 |
4.0.9 |
FTX.007.267 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.007.251 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.007.237)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.007.248 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.007.237)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
| 07/10/2025 |
4.0.13 |
FTX.007.246 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.246 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.245 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.007.245 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 07/10/2025 |
4.0.13 |
FTX.006.233 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.233 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.230 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.230 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Conditional |
1. Value must be 50 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.006.229 |
UPDATE |
Definition |
This is the type of value-based payment model to which the financial transaction applies. These values come from the “Alternative Payment Model (APM) Framework Final White Paper”, produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
This is the type of value-based payment model to which the financial transaction applies. These values come from the “Alternative Payment Model (APM) Framework Final White Paper”, produced by the Healthcare Learning and Action Network.
https://hcp-lan.org/work products/apm-whitepaper.pdf |
| 12/19/2024 |
4.0.1 |
FTX.006.228 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 08/29/2025 |
4.0.17 |
FTX.006.225 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.006.223 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.223 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational |
| 05/29/2025 |
4.0.9 |
FTX.006.222 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.006.207 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.006.193)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.006.204 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.006.193)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
| 07/10/2025 |
4.0.13 |
FTX.006.202 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.202 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.201 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.006.201 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 07/10/2025 |
4.0.13 |
FTX.005.189 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.189 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.005.186 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 07/10/2025 |
4.0.13 |
FTX.005.184 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.184 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Offset Transaction Type List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Offset Transaction Type List (VVL)3. Situational |
| 08/29/2025 |
4.0.17 |
FTX.005.183 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. Mandatory |
| 07/10/2025 |
4.0.13 |
FTX.005.181 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.181 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Situational |
| 05/29/2025 |
4.0.9 |
FTX.005.180 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 07/10/2025 |
4.0.13 |
FTX.005.172 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.172 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational |
| 12/19/2024 |
4.0.1 |
FTX.005.164 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.005.150)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.005.161 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.005.150) |
| 07/10/2025 |
4.0.13 |
FTX.005.159 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.159 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.158 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.005.158 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 03/14/2025 |
4.0.4 |
FTX.004.146 |
UPDATE |
Definition |
This represents any notes from the state's ledger/accounting system associated with the payment/recoupment. |
This represents any notes from the state's ledger/accounting system associated with the payment. |
| 12/19/2024 |
4.0.1 |
FTX.004.143 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 07/10/2025 |
4.0.13 |
FTX.004.139 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.139 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Situational |
| 05/29/2025 |
4.0.9 |
FTX.004.138 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 07/10/2025 |
4.0.13 |
FTX.004.131 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.131 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Policy Owner Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.130 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.130 |
UPDATE |
Coding requirement |
1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Conditional |
1. Value must be 16 characters or less2. Value must not contain a pipe symbol3. Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.129 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.129 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional |
1. Value must be 20 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.126 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.126 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational |
| 03/14/2025 |
4.0.4 |
FTX.004.122 |
UPDATE |
Definition |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment.
This will typically belong to the entity identified as the X12 820 Premium Receiver. |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is receiving a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment.
This will typically belong to the entity identified as the X12 820 Premium Receiver. |
| 12/19/2024 |
4.0.1 |
FTX.004.120 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.004.106)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.004.117 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.004.106) |
| 07/10/2025 |
4.0.13 |
FTX.004.115 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.115 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.114 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.004.114 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 03/14/2025 |
4.0.4 |
FTX.003.102 |
UPDATE |
Definition |
This represents any notes from the state's ledger/accounting system associated with the payment/recoupment. |
This represents any notes from the state's ledger/accounting system associated with the payment. |
| 12/19/2024 |
4.0.1 |
FTX.003.099 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 07/10/2025 |
4.0.13 |
FTX.003.095 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.095 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Situational |
| 05/29/2025 |
4.0.9 |
FTX.003.094 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 07/10/2025 |
4.0.13 |
FTX.003.087 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.087 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional |
1. Value must be 20 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.085 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.085 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbol2. Value must be 20 characters or less3. Situational |
| 03/14/2025 |
4.0.4 |
FTX.003.081 |
UPDATE |
Definition |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is either receiving a payment or having a previous payment recouped. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of either making a payment or taking a recoupment.
This will typically belong to the entity identified as the X12 820 Premium Receiver. |
This is the identifier that corresponds with the payee's role in relation to the Medicaid/CHIP system. The payee is the individual or entity that is a payment. The payee is the object of the transaction, as opposed to the payer who is the subject taking the action of making a payment.
This will typically belong to the entity identified as the X12 820 Premium Receiver. |
| 12/19/2024 |
4.0.1 |
FTX.003.079 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.003.065)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.003.076 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.003.065) |
| 07/10/2025 |
4.0.13 |
FTX.003.074 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.074 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.073 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.003.073 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 07/10/2025 |
4.0.13 |
FTX.002.061 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.061 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Conditional |
1. Value must be 500 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.002.059 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Expenditure Authority Type List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional |
1. Value must be 2 characters2. Value must be in Expenditure Authority Type List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional |
| 07/10/2025 |
4.0.13 |
FTX.002.058 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.058 |
UPDATE |
Coding requirement |
1. Value must be 100 characters or less2. Conditional |
1. Value must be 100 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
FTX.002.057 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. If Subcapitation Indicator equals "01", then value must be populated3. Conditional |
1. Value must be 50 characters or less2. If Subcapitation Indicator equals "1", then value must be populated3. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.002.055 |
UPDATE |
Definition |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions. The system will not permit reuse of a previously used SPA ID for a package that has been formally submitted; xxxx = an Situational entry for specific SPA types |
State plan amendment (SPA) ID number using the following format: SS-YY-NNNN-xxxx where:
SS = State (use the two character postal abbreviation for your state);
YY = Calendar Year (last two characters of the calendar year of the state plan amendment);
NNNN = SPA number (a four character number beginning with 0001) States should track their submissions to assign sequential numbers to their submissions.
xxxx = Optional, 1 to 4 characters alpha/numeric modifier (Suffix)
States should use the specific SPA that covered the services rendered. |
| 12/19/2024 |
4.0.1 |
FTX.002.052 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional |
1. Value must be 2 characters2. Value must be in Funding Source Nonfederal Share List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.002.051 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Funding Code List (VVL)3. If Subcapitation Indicator equals "01", then value must be populated4. Conditional |
1. Value must be 1 character2. Value must be in Funding Code List (VVL)3. If Subcapitation Indicator equals "1", then value must be populated4. Conditional |
| 07/10/2025 |
4.0.13 |
FTX.002.050 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.050 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must have a corresponding value in Waiver ID4. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period5. Situational |
| 05/29/2025 |
4.0.9 |
FTX.002.049 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Conditional |
| 12/19/2024 |
4.0.1 |
FTX.002.041 |
UPDATE |
Coding requirement |
1. Value must be 100 characters or less2. Conditional3. If Subcapitation Indicator equals "01", then value must be populated |
1. Value must be 100 characters or less2. Conditional3. If Subcapitation Indicator equals "1", then value must be populated |
| 12/19/2024 |
4.0.1 |
FTX.002.034 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.001.007)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
1. Value must be 2 characters2. Value must be in Payee Identifier Type List (VVL)3. If value equals "01", then Payee Identifier must equal Submitting State (FTX.002.018)4. If value equals "02", then Payee Identifier must equal State Plan Identification Number (MCR.002.019)5. If value in [04,05], then Payee Identifier must equal Submitting State Provider Identifier (PRV.002.019)6. If value equals "06", then Payee Identifier must equal Provider Identifier (PRV.005.081) where Provider Identifier Type (PRV.005.077) equals "2"7. If value equals "07", then Payee Identifier must equal Insurance Carrier Identification Number (TPL.006.075)8. If value equals "08", then Payee Identifier must equal MSIS Identification Number (ELG.002.019)9. Mandatory |
| 12/19/2024 |
4.0.1 |
FTX.002.029 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.001.007)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
1. Value must be 2 characters2. Value must be in Payer ID Type List (VVL)3. Mandatory4. When value equals "01" then Payer ID must equal Submitting State (FTX.002.018)5. When value equals "02" then Payer ID must equal State Plan Identification Number (MCR.002.019)6. When value equals "04" then Payer ID must equal must equal Submitting State Provider Identifier (PRV.002.019) |
| 07/10/2025 |
4.0.13 |
FTX.002.027 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.027 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. When populated, value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.026 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
FTX.002.026 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional4. Value of the CC component must be equal to "20" |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational4. Value of the CC component must be equal to "20" |
| 03/14/2025 |
4.0.4 |
FTX.002.017 |
UPDATE |
Coding requirement |
1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "FTX00002"11. Conditional |
1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "FTX00002" |
| 05/07/2025 |
4.0.8 |
FTX.001.014 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 06/05/2025 |
4.0.10 |
ELG.022.266 |
UPDATE |
Coding requirement |
1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. Conditional4. (Old MSIS Identification Number) value must be populated when Eligible Identifier Type (ELG.022.261) equals "2" |
1. Value must be 10 characters or less2. Value must be in Reason for Change List (VVL)3. ConditionalValue must be populated when Eligible Identifier Type (ELG.022.261) equals "2"(Old MSIS Identification Number) |
| 12/19/2024 |
4.0.1 |
ELG.022.264 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.022.263 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 10/08/2026 |
4.0.38 |
ELG.022.262 |
UPDATE |
Definition |
This data element is reserved for future use. |
A code to identify the organization that sponsors the identification or identifies the Immigration Identifier Number document. |
| 10/08/2026 |
4.0.38 |
ELG.022.262 |
UPDATE |
Coding requirement |
1. Value must be 18 characters or less2. Situational |
1. Value must be 18 characters or less2. Conditional3. If Eligible Identifier Type (ELG.022.261) equals "3" then value must be in Eligible Identifier Issuing Entity ID 3 List (VVL) |
| 10/08/2026 |
4.0.38 |
ELG.022.261 |
UPDATE |
Definition |
A code to identify the kind of eligible identifier that is captured in the Eligible Identifier data element. |
A code to identify the type of eligible identifier that is captured in the Eligible Identifier data element. |
| 04/09/2026 |
4.0.31 |
ELG.022.258 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 05/07/2025 |
4.0.8 |
ELG.021.252 |
UPDATE |
Coding requirement |
1. Value must be in Enrollment Type List (VVL)2. Value must be 1 character3. If value equals "1", then associated CHIP Code (ELG.003.054) value must be in [1, 2]4. If value equals "2", then associated CHIP Code (ELG.003.054) value must be "3"5. A person enrolled in Medicaid/CHIP must 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.)6. Mandatory |
1. Value must be in Enrollment Type List (VVL)2. Value must be 1 character3. If value equals "1", then associated CHIP Code (ELG.003.054) value must be in [1, 2]4. If value equals "2", then associated CHIP Code (ELG.003.054) value must be "3"5. Mandatory |
| 04/09/2026 |
4.0.31 |
ELG.021.249 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.020.244 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.020.243 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.020.239 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.018.235 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.018.234 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 07/17/2025 |
4.0.14 |
ELG.018.233 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.018.233 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational |
| 04/09/2026 |
4.0.31 |
ELG.018.230 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.017.226 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.017.225 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.017.221 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.016.217 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.016.216 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 07/17/2025 |
4.0.14 |
ELG.016.215 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.016.215 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in American Indian Alaskan Native Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in American Indian Alaskan Native Indicator List (VVL)3. Situational |
| 04/09/2026 |
4.0.31 |
ELG.016.210 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.015.206 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.015.205 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 10/08/2024 |
4.0.0 |
ELG.015.202 |
UPDATE |
Coding requirement |
2. Value must be unique within record segment over all records associated with a given Record ID1. Value must be 11 digits or less3. Mandatory |
1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory |
| 04/09/2026 |
4.0.31 |
ELG.015.201 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 10/08/2024 |
4.0.0 |
ELG.015.200 |
UPDATE |
Coding requirement |
1. Mandatory4. Value must equal "ELG00015"2. Value must be 8 characters3. Value must be in Record ID List (VVL) |
1. Mandatory2. Value must be 8 characters3. Value must be in Record ID List (VVL)4. Value must equal "ELG00015" |
| 12/19/2024 |
4.0.1 |
ELG.014.197 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.014.196 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.014.189 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.013.185 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.013.184 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.013.179 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.012.175 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.012.174 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 12/19/2024 |
4.0.1 |
ELG.012.173 |
UPDATE |
Segment key field identifier |
Not Applicable |
4 |
| 05/29/2025 |
4.0.9 |
ELG.012.172 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Waiver Type value must be in [02-20,32,33]6. Value must have a corresponding value in Waiver Type (ELG.012.173)7. Mandatory |
| 04/09/2026 |
4.0.31 |
ELG.012.169 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.011.165 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.011.164 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.011.160 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.010.156 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.010.155 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 07/17/2025 |
4.0.14 |
ELG.010.154 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.010.154 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in MFP Reinstitutionalized Reason List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in MFP Reinstitutionalized Reason List (VVL)3. Situational |
| 04/09/2026 |
4.0.31 |
ELG.010.147 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
ELG.009.270 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.009.270 |
UPDATE |
Coding requirement |
1. Value must be 3 characters2. Conditional3. Value must be in Type of Service List (VVL) |
1. Value must be 3 characters2. Situational3. Value must be in Type of Service List (VVL) |
| 12/19/2024 |
4.0.1 |
ELG.009.143 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.009.142 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.009.137 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.008.133 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.008.132 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.008.127 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.007.122 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.007.121 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.007.115 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.006.110 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.006.109 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 04/09/2026 |
4.0.31 |
ELG.006.104 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.005.100 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.005.099 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 07/17/2025 |
4.0.14 |
ELG.005.098 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.098 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in TANF Cash Code List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in TANF Cash Code List (VVL)3. Situational |
| 04/24/2025 |
4.0.7 |
ELG.005.097 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Restricted Benefits Code List (VVL)3. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "05", then Eligibility Group (ELG.005.087) must be "24"4. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "06", then Eligibility Group (ELG.005.087) must be "26"5. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "02", then Eligibility Group (ELG.005.087) must be "23"6. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "04", then Eligibility Group (ELG.005.087) must be "25"7. (Restricted Benefits) if value equals "3", then Dual Eligible Code (ELG.005.085) cannot be "00"8. Mandatory9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is in [1,7] then Eligibility Group (EGL.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value equals "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value equals "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "01", then Eligibility Group (ELG.005.087) must be "23"15. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "03", then Eligibility Group (ELG.005.087) must be "25"16. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06] |
1. Value must be 1 character2. Value must be in Restricted Benefits Code List (VVL)3. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "05", then Eligibility Group (ELG.005.087) must be "24"4. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "06", then Eligibility Group (ELG.005.087) must be "26"5. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "02", then Eligibility Group (ELG.005.087) must be "23"6. (Restricted Benefits) if value equals "1" and Dual Eligible Code (ELG.005.085) value equals "04", then Eligibility Group (ELG.005.087) must be "25"7. (Restricted Benefits) if value equals "3", then Dual Eligible Code (ELG.005.085) cannot be "00"8. Mandatory9. If value is "6" then Eligibility Group(ELG.DE.087) must be in [35,70]10. If value is in [1,7] then Eligibility Group (ELG.DE.087) must be in [72,73,74,75] and State Plan Option Type (ELG.DE.163) must equal "06"11. (Restricted Pregnancy-Related) if value equals "4", then associated Sex (ELG.002.023) value must be "F"12. (Non-Citizen) if value equals "2", then associated Citizenship Indicator (ELG.003.040) value must not be equal to "1"13. If value is "D", there must be a corresponding MFP enrollment segment (ELG00010) with Effective and End dates that are within the timespan of this segment14. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "01", then Eligibility Group (ELG.005.087) must be "23"15. (Restricted Benefits) if value equals "3" and Dual Eligible Code (ELG.005.085) value equals "03", then Eligibility Group (ELG.005.087) must be "25"16. (Restricted Benefits) if value is "G", then Dual Eligible Code (ELG.005.085) must be in [01,03,06] |
| 07/17/2025 |
4.0.14 |
ELG.005.094 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.094 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Conception to Birth Indicator List (VVL)3. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"4. If the value is equal to "1", then any associated claims must indicate the Program Type equals "14" (State Plan CHIP)5. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)6. Conditional |
1. Value must be 1 character2. Value must be in Conception to Birth Indicator List (VVL)3. If the value is equal to "1", then the Eligibility Group (ELG.005.087) must equal "64"4. If the value is equal to "1", then any associated claims must indicate the Program Type equals "14" (State Plan CHIP)5. If the value is equal to "1", then CHIP Code (ELG.003.054) must equal "3" (Individual was not Medicaid Expansion CHIP eligible, but was included in a separate title XXI CHIP Program)6. Situational |
| 06/19/2025 |
4.0.11 |
ELG.005.091 |
UPDATE |
Coding requirement |
1. Value must be 3 characters2. Value must be in SSI State Supplement Status Code List (VVL)3. (individual not receiving Federal SSI) If value is "001" or "002", then SSI Status (ELG.005.092) must be "001" or "002"4. (Individual not receiving Federal SSI)If value is "001" or "002", then SSI Indicator (ELG.005.090) must be "1"5. Value must not be populated or must be "000" when SSI Status (ELG.005.092) is not populated or is "000"6. Conditional |
1. Value must be 3 characters2. Value must be in SSI State Supplement Status Code List (VVL)3. If value is "001" or "002" (individual not receiving Federal SSI), then SSI Status (ELG.005.092) must be "001" or "002"4. If value is "001" or "002" (Individual not receiving Federal SSI), then SSI Indicator (ELG.005.090) must be "1"5. Value must not be populated or must be "000" when SSI Status (ELG.005.092) is not populated or is "000"6. Conditional |
| 07/17/2025 |
4.0.14 |
ELG.005.089 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.005.089 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in SSDI Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in SSDI Indicator List (VVL)3. Situational |
| 04/09/2026 |
4.0.31 |
ELG.005.080 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.004.076 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.004.075 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 07/17/2025 |
4.0.14 |
ELG.004.074 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.004.074 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbol2. Value must be 100 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbol2. Value must be 100 characters or less3. Situational |
| 12/19/2024 |
4.0.1 |
ELG.004.073 |
UPDATE |
Coding requirement |
1. Value must be 10-digit number2. Conditional |
1. Value must be 10-digit number2. Conditional3. If Eligible Address Type (ELG.004.065) equals "01", then value is mandatory and must be provided |
| 04/09/2026 |
4.0.31 |
ELG.004.072 |
UPDATE |
Medicaid valid value info |
|
US County Code List |
| 04/09/2026 |
4.0.31 |
ELG.004.070 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
ELG.004.068 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.004.068 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 2 value(s)3. If Address Line 2 is not populated, then value should not be populated4. Value must not contain a pipe or asterisk symbols5. Situational |
| 07/17/2025 |
4.0.14 |
ELG.004.067 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.004.067 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational |
| 12/19/2024 |
4.0.1 |
ELG.004.065 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Eligible Address Type List (VVL)3. Mandatory |
1. Value must be 2 characters2. Value must be in Eligible Address Type List (VVL)3. Mandatory4. When value equals "01" (Primary), Eligible State(ELG.004.070) must equal Submitting State (ELG.001.007) |
| 04/09/2026 |
4.0.31 |
ELG.004.062 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 12/19/2024 |
4.0.1 |
ELG.003.269 |
UPDATE |
Definition |
This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
This data element provides the beneficiary's or their household's income as a percentage of the federal poverty level. Used to assign the beneficiary to the eligibility group that covered their Medicaid or CHIP benefits. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
| 12/19/2024 |
4.0.1 |
ELG.003.058 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be greater than or equal to associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [18,19,20,99] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or after the associated Segment Effective Date value3. Mandatory4. Value of the CC component must be in [19,20,99] |
| 12/19/2024 |
4.0.1 |
ELG.003.057 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be before or the same as the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before the associated Segment End Date value3. Mandatory4. Value of the CC component must be in [18,19,20] |
| 02/27/2025 |
4.0.3 |
ELG.003.051 |
UPDATE |
Definition |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
| 06/19/2025 |
4.0.11 |
ELG.003.050 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value is "00", then value must not be populated.5. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value for either HICN or MBI is mandatory and must be provided |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.Value for either HICN or MBI is mandatory and must be provided if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled) |
| 07/17/2025 |
4.0.14 |
ELG.003.049 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.049 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Pregnancy Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Pregnancy Indicator List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.045 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.045 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Primary Language English Proficiency Code List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Primary Language English Proficiency Code List (VVL)3. Situational |
| 10/01/2024 |
4.0.0 |
ELG.003.044 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated2. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If Immigration Status (ELG.003.042) equals "8" (U.S. Citizen), then value should not be populated |
| 07/17/2025 |
4.0.14 |
ELG.003.043 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.003.043 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Immigration Verification Flag List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Immigration Verification Flag List (VVL)3. Situational |
| 11/20/2025 |
4.0.22 |
ELG.003.042 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Immigration Status List (VVL)3. If associated Citizenship Indicator (ELG.003.040) value equals "0", then value must be in [1,2,3]4. If associated Citizenship Indicator (ELG.003.040) value equals "1", then value must equal "8"5. Mandatory |
1. Value must be 1 character2. Value must be in Immigration Status List (VVL)3. If associated Citizenship Indicator (ELG.003.040) value equals "0", then value must be in [1,2,3]4. If associated Citizenship Indicator (ELG.003.040) value equals "1", then value must equal "8"5. Mandatory6. When value is in [1,2], then value must match a corresponding record with an ELG-IDENTIFIER-TYPE (ELG.022.261) equal to “3” |
| 10/08/2026 |
4.0.38 |
ELG.003.040 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in [0,1,2]3. Value must be in Citizenship Indicator List (VVL)4. If value equals "0", then associated Immigration Status (ELG.003.042) value must be in [1,2,3]5. If value is coded as "1", then associated Immigration Status (ELG.003.042) value must equal "8"6. Mandatory |
1. Value must be 1 character2. Value must be in Citizenship Indicator List (VVL)3. If value equals "0", then associated Immigration Status (ELG.003.042) value must be in [2,3,4]4. If value equals "1" or "2", then associated Immigration Status (ELG.003.042) value must equal "8"5. Mandatory |
| 10/08/2026 |
4.0.38 |
ELG.003.039 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Veteran Indicator List (VVL)3. Conditional4. Value must be populated when Immigration Status (ELG.003.042) is in [1,2,3] |
1. Value must be 1 character2. Value must be in Veteran Indicator List (VVL)3. Conditional4. Value must be populated when Immigration Status (ELG.003.042) is in [2,3,4] |
| 12/19/2024 |
4.0.1 |
ELG.003.038 |
UPDATE |
Definition |
A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
A code indicating the federal poverty level range in which the family income falls. If the beneficiary's income was assessed using multiple methodologies (MAGI and Non-MAGI), report the income that applies to their primary eligibility group.
A beneficiary’s income is applicable unless it is not required by the eligibility group for which they were determined eligible. For example, the eligibility groups for children with adoption assistance, foster care, or guardianship care under title IV-E and optional eligibility for individuals needing treatment for breast or cervical cancer do not have a Medicaid income test. Additionally, for individuals receiving SSI, states with section 1634 agreements with the Social Security Administration (SSA) and states that use SSI financial methodologies for Medicaid determinations do not conduct separate Medicaid financial eligibility for this group. |
| 12/19/2024 |
4.0.1 |
ELG.003.034 |
UPDATE |
Definition |
A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).
Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value. |
A code to classify eligible individual's marital/domestic-relationship status. This element should be reported by the state when the information is material to eligibility (i.e., institutionalization).
Because there is no specific statutory or regulatory basis for defining marital status codes, they are being defined in a way that is as flexible for states and data users as possible. States can report at whatever level of granularity is available to them in their system and a data user can choose to use them as-is or roll the values up in broader categories depending on whichever approach best meets their needs. CMS periodically reviews the values reported to MARITAL-STATUS-OTHER-EXPLANATION to determine if states are appropriately using it only when there is no existing MARITAL-STATUS value that reflects the state’s marital status description for an individual AND to determine whether it is necessary to add additional T-MSIS MARITAL-STATUS values to reflect commonly used state martial status descriptions for which there is no existing T-MSIS MARITAL-STATUS value. |
| 04/09/2026 |
4.0.31 |
ELG.003.031 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
ELG.002.025 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.002.025 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Conditional3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated Date File Created (ELG.001.008) value5. There must never be more than one Date of Death value reported across Primary Demographic segments that have the same MSIS Identification number6. When populated, Procedure Code Dates on a claim must be less than or equal to this value7. When populated, Admission Date on a claim must be less than or equal to this value8. When populated, Discharge Date on a claim must be less than or equal to this value9. When populated, Ending Date of Service on a claim must be less than or equal to this value10. When populated, value must be less than or equal to Enrollment End Date (ELG.021.254)11. When populated, value minus Date of Birth (ELG.002.024) is less than or equal to 125 years |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Situational3. If populated, value must be on or after individual's Date of Birth4. Value must be less than or equal to associated Date File Created (ELG.001.008) value5. There must never be more than one Date of Death value reported across Primary Demographic segments that have the same MSIS Identification number6. When populated, Procedure Code Dates on a claim must be less than or equal to this value7. When populated, Admission Date on a claim must be less than or equal to this value8. When populated, Discharge Date on a claim must be less than or equal to this value9. When populated, Ending Date of Service on a claim must be less than or equal to this value10. When populated, value must be less than or equal to Enrollment End Date (ELG.021.254)11. When populated, value minus Date of Birth (ELG.002.024) is less than or equal to 125 years |
| 07/17/2025 |
4.0.14 |
ELG.002.022 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
ELG.002.022 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational |
| 04/09/2026 |
4.0.31 |
ELG.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 05/07/2025 |
4.0.8 |
ELG.001.247 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 04/09/2026 |
4.0.31 |
ELG.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
CRX.003.171 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.171 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situaitional |
| 07/10/2025 |
4.0.13 |
CRX.003.170 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.170 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.169 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.169 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.168 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.168 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.167 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.167 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.159 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.159 |
UPDATE |
Coding requirement |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 12/19/2024 |
4.0.1 |
CRX.003.157 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory |
| 07/10/2025 |
4.0.13 |
CRX.003.152 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.152 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.146 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.146 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Rebate Eligible Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Rebate Eligible Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.145 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.145 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Compound Dosage Form List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Compound Dosage Form List (VVL)3. Situational |
| 04/09/2026 |
4.0.31 |
CRX.003.143 |
UPDATE |
Medicaid valid value info |
|
For background and context, see https://www.ncpdp.org/ |
| 12/19/2024 |
4.0.1 |
CRX.003.136 |
UPDATE |
Definition |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 07/10/2025 |
4.0.13 |
CRX.003.135 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.135 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Conditional |
1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Situational |
| 12/19/2024 |
4.0.1 |
CRX.003.132 |
UPDATE |
Definition |
The quantity of a drug that is dispensed for a prescription as reported by National Drug Code on the claim line. For use with CLAIMRX claims/encounters. For CLAIMOT claims/encounters, use the Service Quantity Actual field. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field.
|
The quantity of a drug that is dispensed for a prescription as reported ny National Drug Code on the claim line. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field. |
| 07/10/2025 |
4.0.13 |
CRX.003.129 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.129 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1" |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1" |
| 07/10/2025 |
4.0.13 |
CRX.003.128 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.128 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated (or must be 99998)4. Value must not be populated if Medicare Deductible Amount is not populated5. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated (or must be 99998)4. Value must not be populated if Medicare Deductible Amount is not populated5. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.127 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.127 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional4. Value should not be populated if associated Crossover Indicator value equals "0" (not a crossover claim)5. If value is greater than "0", then Crossover Indicator must be "1" |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational4. Value should not be populated if associated Crossover Indicator value equals "0" (not a crossover claim)5. If value is greater than "0", then Crossover Indicator must be "1" |
| 12/19/2024 |
4.0.1 |
CRX.003.125 |
UPDATE |
Definition |
The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.
For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. |
The amount paid to the provider by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.
For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. |
| 07/10/2025 |
4.0.13 |
CRX.003.124 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.124 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.123 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.123 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.119 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.003.119 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
| 03/14/2025 |
4.0.4 |
CRX.003.118 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 03/14/2025 |
4.0.4 |
CRX.003.118 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Mandatory |
1. Value must be 12 characters or less2. Conditional |
| 04/09/2026 |
4.0.31 |
CRX.003.109 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
CRX.002.166 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.166 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.165 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.165 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.164 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.164 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.163 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.163 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 12/10/2024 |
4.0.1 |
CRX.002.162 |
UPDATE |
Medicaid valid value info |
|
For background and context, see https://www.ncpdp.org/ |
| 07/10/2025 |
4.0.13 |
CRX.002.160 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.160 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equals "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Conditional |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equals "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Situational |
| 02/27/2025 |
4.0.3 |
CRX.002.105 |
UPDATE |
Definition |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
| 07/10/2025 |
4.0.13 |
CRX.002.104 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.104 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 02/27/2025 |
4.0.3 |
CRX.002.102 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in [3,C,W], then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. NPPES Entity Type Code associate with this NPI must equal "1" (Individual) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type (PRV.005.007) equal to '2'3. When Type of Claim not in [3,C,W], then value must match Provider Identifier (PRV.005.081)4. Mandatory5. Value must exist in the NPPES NPI data file6. NPPES Entity Type Code associated with this NPI must equal "1" (Individual) |
| 07/10/2025 |
4.0.13 |
CRX.002.099 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.099 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.096 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.096 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.093 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.093 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.092 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.092 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.090 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.090 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.089 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.089 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.088 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.088 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.087 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.087 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.086 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.086 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Compound Drug Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Compound Drug Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.082 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.082 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational |
| 06/19/2025 |
4.0.11 |
CRX.002.079 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (CRX.002.023) equals "1" and Medicare Beneficiary Identifier (CRX.002.105) is not populated |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (CRX.002.023) equals "1" and Medicare Beneficiary Identifier (CRX.002.105) is not populated |
| 02/27/2025 |
4.0.3 |
CRX.002.075 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Mandatory4. Value must exist in the NPPES NPI data file5. NPPES Entity Type Code associated with this NPI must equal ‘1’ (Individual) |
| 07/10/2025 |
4.0.13 |
CRX.002.073 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.073 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.072 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.072 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.071 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.071 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 12/19/2024 |
4.0.1 |
CRX.002.070 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. When Type of Claim is in [1,3,A,C], then value must be populated6. When Type of Claim in [1,3,A,C] then associated Provider Medicaid Enrollment Status Code (PRV.007.100) must be in [01,02,03,04,05,06] (active)7. Prescription Fill Date (CRX.002.085) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Prescription Fill Date (CRX.002.085) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
| 05/29/2025 |
4.0.9 |
CRX.002.069 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 12/19/2024 |
4.0.1 |
CRX.002.068 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Conditional6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,33] when associated Program Type equals "07" |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CRX.002.069)5. Conditional |
| 07/10/2025 |
4.0.13 |
CRX.002.067 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.067 |
UPDATE |
Coding requirement |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.065 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.065 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.064 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.064 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.063 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.063 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.062 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.062 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.061 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.061 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational |
| 12/19/2024 |
4.0.1 |
CRX.002.058 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 04/24/2025 |
4.0.7 |
CRX.002.054 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional |
| 07/10/2025 |
4.0.13 |
CRX.002.052 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.052 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.048 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.048 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.047 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.047 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.045 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.045 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.044 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.044 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
| 06/19/2025 |
4.0.11 |
CRX.002.043 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
| 12/19/2024 |
4.0.1 |
CRX.002.041 |
UPDATE |
Definition |
The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.
For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. |
The total amount paid to the provider by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid to the provider by Medicaid or the managed care plan at the detail level for the claim.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider for the service. Report a null value in this field if the provider is a sub-capitated network provider.
For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. |
| 07/10/2025 |
4.0.13 |
CRX.002.038 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.038 |
UPDATE |
Coding requirement |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated |
| 07/10/2025 |
4.0.13 |
CRX.002.037 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.037 |
UPDATE |
Coding requirement |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CRX.002.036) is not populated |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CRX.002.036) is not populated |
| 07/10/2025 |
4.0.13 |
CRX.002.036 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.036 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CRX.002.035) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CRX.002.035) is not populated |
| 07/10/2025 |
4.0.13 |
CRX.002.035 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.035 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
| 07/10/2025 |
4.0.13 |
CRX.002.034 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.034 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.033 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.033 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 12/19/2024 |
4.0.1 |
CRX.002.032 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 04/09/2026 |
4.0.31 |
CRX.002.031 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status Category List |
| 07/10/2025 |
4.0.13 |
CRX.002.030 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.030 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
| 12/19/2024 |
4.0.1 |
CRX.002.029 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
| 12/19/2024 |
4.0.1 |
CRX.002.027 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory |
| 04/09/2026 |
4.0.31 |
CRX.002.026 |
UPDATE |
Medicaid valid value info |
|
Adjustment Reason Code List |
| 07/10/2025 |
4.0.13 |
CRX.002.024 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CRX.002.024 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
| 05/07/2025 |
4.0.8 |
CRX.002.022 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. The Prescription Fill Date (CRX.002.085) on the claim must fall between Enrollment Timespan Effective Date (ELG.021.253) and Enrollment Timespan End Date (ELG.021.253) |
1. Value must be 20 characters or less2. Mandatory3. The Prescription Fill Date (CRX.002.085) on the claim must fall between Enrollment Timespan Effective Date (ELG.021.253) and Enrollment Timespan End Date (ELG.021.253)4. Value must not contain Ampersand symbol |
| 03/14/2025 |
4.0.4 |
CRX.002.021 |
UPDATE |
Necessity |
Mandatory |
Conditional |
| 03/14/2025 |
4.0.4 |
CRX.002.021 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Mandatory |
1. Value must be 12 characters or less2. Conditional |
| 01/16/2025 |
4.0.2 |
CRX.002.020 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 04/09/2026 |
4.0.31 |
CRX.002.017 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 05/07/2025 |
4.0.8 |
CRX.001.155 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 04/09/2026 |
4.0.31 |
CRX.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/17/2025 |
4.0.14 |
COT.003.225 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.225 |
UPDATE |
Coding requirement |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.224 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.224 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.223 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.223 |
UPDATE |
Coding requirement |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 02/27/2025 |
4.0.3 |
COT.003.221 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after the associated Beginning Date of Service |
| 07/17/2025 |
4.0.14 |
COT.003.219 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.219 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.218 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.218 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.227 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.227 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.217 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.217 |
UPDATE |
Coding requirement |
1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Conditional |
1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.213 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.213 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 10/08/2024 |
4.0.0 |
COT.003.208 |
UPDATE |
Coding requirement |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)3. Conditional2. Value must be in ZIP Code List (VVL) |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional |
| 07/17/2025 |
4.0.14 |
COT.003.207 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.207 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.206 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.206 |
UPDATE |
Coding requirement |
1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.205 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.205 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. SItuational |
| 07/17/2025 |
4.0.14 |
COT.003.204 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.204 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.203 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.203 |
UPDATE |
Coding requirement |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Conditional |
1. Value may only be 5 digits (0-9) (Example: 91320) or 9 digits (0-9) (Example: 913200011)2. Value must be in ZIP Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.202 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.202 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.201 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.201 |
UPDATE |
Coding requirement |
1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 28 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.200 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.200 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 1 or Address Line 3 value(s)3. There must be an Address Line 1 in order to have an Address Line 24. Value must not contain a pipe or asterisk symbols5. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.199 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.199 |
UPDATE |
Coding requirement |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 60 characters or less2. Value must not be equal to associated Address Line 2 or Address Line 3 value(s)3. Value must not contain a pipe or asterisk symbols4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.198 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.198 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Tooth Surface Code List (VVL)3. Conditional4. When populated, associated type of service value must be in [013,029,035] |
1. Value must be 1 character2. Value must be in Tooth Surface Code List (VVL)3. Situational4. When populated, associated type of service value must be in [013,029,035] |
| 07/17/2025 |
4.0.14 |
COT.003.197 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.197 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Tooth Quad Code List (VVL)3. Conditional4. When populated, associated type of service value must be in [013,029,035] |
1. Value must be 2 characters2. Value must be in Tooth Quad Code List (VVL)3. Situational4. When populated, associated type of service value must be in [013,029,035] |
| 07/17/2025 |
4.0.14 |
COT.003.195 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.195 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Tooth Designation System List (VVL)3. Value must not contain a pipe symbol4. Conditional |
1. Value must be 2 characters2. Value must be in Tooth Designation System List (VVL)3. Value must not contain a pipe symbol4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.193 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.193 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.192 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.192 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.191 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.191 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational |
| 05/07/2025 |
4.0.8 |
COT.003.190 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (COT.002.037) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file |
| 12/19/2024 |
4.0.1 |
COT.003.188 |
UPDATE |
Definition |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
"A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as “extended state plan” services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state’s service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf" |
| 07/17/2025 |
4.0.14 |
COT.003.187 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.187 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Conditional |
1. Value must be 1 character2. Value must be in HCBS Service Code List (VVL)3. If value is in [1-7], then HCBS Taxonomy must be populated4. Situational |
| 12/19/2024 |
4.0.1 |
COT.003.186 |
UPDATE |
Coding requirement |
1. Value must be 3 characters.2. Mandatory3. Value must be in Type of Service OT List (VVL)4. When value is not in [025,085], Sex (ELG.002.023) equals "M" |
1. Value must be 3 characters.2. Mandatory3. Value must be in Type of Service OT List (VVL) |
| 07/17/2025 |
4.0.14 |
COT.003.184 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.184 |
UPDATE |
Coding requirement |
1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Conditional |
1. Value may include up to 8 digits to the left of the decimal point, and 3 digits to the right e.g. 12345678.9992. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.182 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.182 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1" |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1" |
| 07/17/2025 |
4.0.14 |
COT.003.177 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.177 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.176 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.176 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.172 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.172 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Mod List (VVL)3. Must be associated with a Procedure Code4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.171 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.171 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. When populated, there must be a corresponding Procedure Code4. Conditional |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. When populated, there must be a corresponding Procedure Code4. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.170 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.170 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational |
| 07/17/2025 |
4.0.14 |
COT.003.169 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.169 |
UPDATE |
Coding requirement |
1. Value must be 8 characters or less2. Value must be in Procedure Code List (VVL)3. When populated, there must be a corresponding Procedure Code Flag4. If associated Procedure Code Flag value indicates an CPT-4 encoding "01", then value must be a valid CPT-4 procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. If associated Procedure Code Flag List (VVL) value indicates an HCPCS encoding "06", then value must be a valid HCPCS code7. Conditional |
1. Value must be 8 characters or less2. Value must be in Procedure Code List (VVL)3. When populated, there must be a corresponding Procedure Code Flag4. If associated Procedure Code Flag value indicates an CPT-4 encoding "01", then value must be a valid CPT-4 procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. If associated Procedure Code Flag List (VVL) value indicates an HCPCS encoding "06", then value must be a valid HCPCS code7. Situational |
| 04/09/2026 |
4.0.31 |
COT.003.168 |
UPDATE |
Medicaid valid value info |
|
Revenue Code List |
| 07/17/2025 |
4.0.14 |
COT.003.165 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.003.165 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
| 07/17/2025 |
4.0.14 |
COT.002.233 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.233 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.232 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.232 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.231 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.231 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.230 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.230 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 02/27/2025 |
4.0.3 |
COT.002.147 |
UPDATE |
Definition |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
| 07/17/2025 |
4.0.14 |
COT.002.146 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.146 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.141 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.141 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.138 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.138 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.135 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.135 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.134 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.134 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.133 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.133 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.132 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.132 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.131 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.131 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.130 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.130 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.128 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.128 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.127 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.127 |
UPDATE |
Coding requirement |
1. Value must be between 0.00 and 99999.992. Conditional3. Value must be expressed as a number with 2-digit precision (e.g. 100.50) |
1. Value must be between 0.00 and 99999.992. Situational3. Value must be expressed as a number with 2-digit precision (e.g. 100.50) |
| 12/19/2024 |
4.0.1 |
COT.002.123 |
UPDATE |
Definition |
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. |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than “B”, then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
| 06/19/2025 |
4.0.11 |
COT.002.122 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (COT.002.023) equals "1" and Medicare Beneficiary Identifier (COT.002.147) is not populated |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (COT.002.023) equals "1" and Medicare Beneficiary Identifier (COT.002.147) is not populated |
| 07/17/2025 |
4.0.14 |
COT.002.118 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.118 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
| 07/17/2025 |
4.0.14 |
COT.002.117 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.117 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.116 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.116 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.115 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.115 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.114 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.114 |
UPDATE |
Coding requirement |
1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Conditional4. If associated Type of Service value is in [119,120,121,122], then value should not be populated |
1. Value must be in Provider Taxonomy List (VVL)2. Value must be 12 characters or less3. Situational4. If associated Type of Service value is in [119,120,121,122], then value should not be populated |
| 07/17/2025 |
4.0.14 |
COT.002.113 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.113 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 07/17/2025 |
4.0.14 |
COT.002.112 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.112 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080).7. Value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'. |
1. Value must be 30 characters or less2. Situational3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Must have an enrollment where the Ending Date of Service (COT.003.167) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080).7. Value must be reported in Provider Identifier (PRV.005.080) with an associated Provider Identifier Type (PRV.005.081) equal to '1'. |
| 05/29/2025 |
4.0.9 |
COT.002.111 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 07/17/2025 |
4.0.14 |
COT.002.110 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.110 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Conditional6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,33] when associated Program Type equals "07" |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. When populated, Waiver ID (COT.002.111) must be populated5. Situational6. Value must be in [06,07,08,09,10,11,12,13,14,15,16,17,18,19,20,33] when associated Program Type equals "07" |
| 07/17/2025 |
4.0.14 |
COT.002.109 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.109 |
UPDATE |
Coding requirement |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.107 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.107 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.106 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.106 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.105 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.105 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.104 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.104 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational |
| 12/19/2024 |
4.0.1 |
COT.002.103 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.102 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.101 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.100 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.099 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.098 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.097 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.096 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.095 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.094 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.093 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.092 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4.Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.091 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.090 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.089 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.088 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.087 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.086 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.085 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
COT.002.084 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 02/27/2025 |
4.0.3 |
COT.002.083 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.082 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.081 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.080 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.079 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.078 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.077 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.076 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.075 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
COT.002.074 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 07/17/2025 |
4.0.14 |
COT.002.072 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.072 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational |
| 12/19/2024 |
4.0.1 |
COT.002.068 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 12/19/2024 |
4.0.1 |
COT.002.066 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (COT.002.033) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (COT.002.037) occurs between the managed care contract eff/end dates (MCR.002.020/021) |
1. Value must be 12 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional4. Value must match Managed Care Plan ID (ELG.014.192)5. Value must match State Plan ID Number (MCR.002.019)6. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (COT.002.033) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)7. When Type of Claim (COT.002.037) in [3,C,W] value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (COT.002.033) occurs between the managed care contract eff/end dates (MCR.002.020/021) |
| 07/17/2025 |
4.0.14 |
COT.002.064 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.064 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Conditional |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Situational |
| 04/24/2025 |
4.0.7 |
COT.002.063 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional |
| 07/17/2025 |
4.0.14 |
COT.002.061 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.061 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.057 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.057 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.056 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.056 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.054 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.054 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.053 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.053 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
| 06/19/2025 |
4.0.11 |
COT.002.052 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
| 07/17/2025 |
4.0.14 |
COT.002.047 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.047 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (COT.002.046) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (COT.002.046) is not populated |
| 07/17/2025 |
4.0.14 |
COT.002.046 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.046 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.045) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.045) is not populated |
| 07/17/2025 |
4.0.14 |
COT.002.045 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.045 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (COT.002.044) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (COT.002.044) is not populated |
| 07/17/2025 |
4.0.14 |
COT.002.044 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.044 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
| 07/17/2025 |
4.0.14 |
COT.002.043 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.043 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational |
| 07/17/2025 |
4.0.14 |
COT.002.042 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.042 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 12/19/2024 |
4.0.1 |
COT.002.041 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 04/09/2026 |
4.0.31 |
COT.002.040 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status Category List |
| 07/17/2025 |
4.0.14 |
COT.002.039 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.039 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
| 12/19/2024 |
4.0.1 |
COT.002.038 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. Value must be in Type of Bill List (VVL)3. First character must be a "0"4. Conditional |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Conditional |
| 12/19/2024 |
4.0.1 |
COT.002.037 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record |
| 02/27/2025 |
4.0.3 |
COT.002.035 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after the associated Beginning Date of Service |
| 04/09/2026 |
4.0.31 |
COT.002.026 |
UPDATE |
Medicaid valid value info |
|
Adjustment Reason Code List |
| 07/17/2025 |
4.0.14 |
COT.002.024 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/17/2025 |
4.0.14 |
COT.002.024 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
| 05/07/2025 |
4.0.8 |
COT.002.022 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254) |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Beginning Date of Service (COT.002.033) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)4. Value must not contain Ampersand symbol |
| 01/16/2025 |
4.0.2 |
COT.002.020 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 05/07/2025 |
4.0.8 |
COT.001.216 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 04/09/2026 |
4.0.31 |
COT.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
CLT.003.235 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.235 |
UPDATE |
Coding requirement |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.230 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.230 |
UPDATE |
Coding requirement |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.229 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.229 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.228 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.228 |
UPDATE |
Coding requirement |
1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Conditional |
1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.216 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.216 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.215 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.215 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL).3. Situational |
| 05/07/2025 |
4.0.8 |
CLT.003.213 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. Value must exist in the NPPES NPI data file |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Conditional4. If Type of Claim (CLT.002.052) not in [3,C,W], then value must match Provider Identifier (PRV.005.081)5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual)6. Value must exist in the NPPES NPI data file |
| 07/10/2025 |
4.0.13 |
CLT.003.210 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.210 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.207 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.207 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.206 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.206 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.203 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.203 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Conditional |
1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Situational |
| 04/09/2026 |
4.0.31 |
CLT.003.198 |
UPDATE |
Medicaid valid value info |
|
Revenue Code List |
| 07/10/2025 |
4.0.13 |
CLT.003.195 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.003.195 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
| 04/09/2026 |
4.0.31 |
CLT.003.185 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
CLT.002.242 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.242 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.241 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.241 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.240 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.240 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.239 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.239 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.179 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.179 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1" |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1" |
| 12/19/2024 |
4.0.1 |
CLT.002.178 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional |
| 07/10/2025 |
4.0.13 |
CLT.002.177 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.177 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.176 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.176 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.175 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.175 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.174 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.174 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
| 02/27/2025 |
4.0.3 |
CLT.002.168 |
UPDATE |
Definition |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
| 04/24/2025 |
4.0.7 |
CLT.002.167 |
UPDATE |
Coding requirement |
1. Value must be 12 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional |
| 07/10/2025 |
4.0.13 |
CLT.002.164 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.164 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.161 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.161 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.158 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.158 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.157 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.157 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.156 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.156 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.155 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.155 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.154 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.154 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.153 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.153 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.151 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.151 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.150 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.150 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Situational |
| 06/05/2025 |
4.0.10 |
CLT.002.149 |
UPDATE |
Coding requirement |
1. Value must be 5 digits or less2. Value must be numeric3. Conditional4. When populated, value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one day5. (nursing facility) value is required when the Type of Service in [009,045,047,059]6. When populated, if value is greater than zero, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal "003" (Nursing Facility) for the same month as the beginning and ending date of service |
1. Value must be 5 digits or less2. Value must be numeric3. Conditional4. When populated, value must be less than or equal to the number of days between (ending date of service minus beginning date of service) plus one dayValue is required when the Type of Service in [009,045,047,059] (nursing facility)6. When populated, if value is greater than zero, then Level of Care Status (ELG.005.088) for the associated MSIS Identification Number (CLT.002.022) must equal "003" (Nursing Facility) for the same month as the beginning and ending date of service |
| 06/05/2025 |
4.0.10 |
CLT.002.148 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must be 5 digits or less3. Conditional4. (Intermediate Care Facility for Individuals with Intellectual Disabilities) value is required when Type of Service (CLT.003.211) in [009,045,046,047,059] |
1. Value must be numeric2. Value must be 5 digits or less3. ConditionalValue must be populated when Type of Service (CLT.003.211) is in [009,045,046,047,059](Intermediate Care Facility for Individuals with Intellectual Disabilities) |
| 07/10/2025 |
4.0.13 |
CLT.002.145 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.145 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 06/19/2025 |
4.0.11 |
CLT.002.140 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (CLT.002.023) equals "1" and Medicare Beneficiary Identifier (CLT.002.168) is not populated |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (CLT.002.023) equals "1" and Medicare Beneficiary Identifier (CLT.002.168) is not populated |
| 07/10/2025 |
4.0.13 |
CLT.002.136 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.136 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.135 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.135 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.134 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.134 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.133 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.133 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.132 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.132 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.131 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.131 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 12/19/2024 |
4.0.1 |
CLT.002.130 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080)7. Ending Date of Service (CLT.002.049) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or8. Ending Date of Service (CLT.002.049) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
| 05/29/2025 |
4.0.9 |
CLT.002.129 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 07/10/2025 |
4.0.13 |
CLT.002.128 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.128 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CLT.002.129)5. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CLT.002.129)5. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.127 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.127 |
UPDATE |
Coding requirement |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.125 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.125 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.124 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.124 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.123 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.123 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.122 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.122 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational |
| 12/19/2024 |
4.0.1 |
CLT.002.121 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.120 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.119 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.118 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.117 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.116 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.115 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.114 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.113 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.112 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CLT.002.111 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.110 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.109 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before theOccurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.108 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.107 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.106 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.105 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.104 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.103 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CLT.002.102 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 02/27/2025 |
4.0.3 |
CLT.002.101 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.100 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.099 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.098 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.097 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.096 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.095 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.094 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.093 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CLT.002.092 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 07/10/2025 |
4.0.13 |
CLT.002.090 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.090 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational |
| 02/27/2025 |
4.0.3 |
CLT.002.086 |
UPDATE |
Coding requirement |
1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. Value must be less than or equal to double the number of days between Admission Date (CLT.002.044) and Discharge Date (CLT.002.046) plus one day5. Value must be 5 digits or less6. (inpatient mental health/psychiatric services) when associated Type of Service (CLT.003.211) in [044,048,050], this field must be populated |
1. Value must be a positive integer2. Value must be between 00000:99999 (inclusive)3. Conditional4. The sum of the value provided here plus the Non Covered Days (CLT.002.084) must be less than or equal to the number of days between Beginning Date of Service (CLT.002.048) and Ending Date of Service (CLT.002.049) plus one day5. Value must be 5 digits or less6. (inpatient mental health/psychiatric services) when associated Type of Service (CLT.003.211) in [044,048,050], this field must be populated |
| 07/10/2025 |
4.0.13 |
CLT.002.085 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.085 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.084 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.084 |
UPDATE |
Coding requirement |
1. Value must be 5 digits or less2. Conditional |
1. Value must be 5 digits or less2. Situational |
| 12/19/2024 |
4.0.1 |
CLT.002.082 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 07/10/2025 |
4.0.13 |
CLT.002.078 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.078 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Conditional |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equals "1"6. Situational |
| 04/24/2025 |
4.0.7 |
CLT.002.077 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional |
| 07/10/2025 |
4.0.13 |
CLT.002.075 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.075 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.071 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.071 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.070 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.070 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.069 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.069 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.068 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.068 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
| 06/19/2025 |
4.0.11 |
CLT.002.067 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
| 07/10/2025 |
4.0.13 |
CLT.002.062 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.062 |
UPDATE |
Coding requirement |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CLT.002.061) is not populated |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CLT.002.061) is not populated |
| 07/10/2025 |
4.0.13 |
CLT.002.061 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.061 |
UPDATE |
Coding requirement |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.060) is not populated |
1. Value must be in Claim Payment Remittance Code List (VVL)2. Value must be 5 characters or less3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CLT.002.060) is not populated |
| 07/10/2025 |
4.0.13 |
CLT.002.060 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.060 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CLT.002.059) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3.Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CLT.002.059) is not populated |
| 07/10/2025 |
4.0.13 |
CLT.002.059 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.059 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
| 07/10/2025 |
4.0.13 |
CLT.002.058 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.058 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.057 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.057 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 12/19/2024 |
4.0.1 |
CLT.002.056 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 04/09/2026 |
4.0.31 |
CLT.002.055 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status Category List |
| 07/10/2025 |
4.0.13 |
CLT.002.054 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.054 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
| 12/19/2024 |
4.0.1 |
CLT.002.053 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. Value must be in Type of Bill List (VVL)3. First character must be a "0"4. Mandatory |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
| 12/19/2024 |
4.0.1 |
CLT.002.052 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
| 02/27/2025 |
4.0.3 |
CLT.002.050 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CLT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
| 07/10/2025 |
4.0.13 |
CLT.002.047 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.047 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional4. When populated, Discharge Date (CLT.002.046) must be populated |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational4. When populated, Discharge Date (CLT.002.046) must be populated |
| 07/10/2025 |
4.0.13 |
CLT.002.046 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.046 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated Adjudication Date value.3. Value must be greater than or equal to associated Admission Date value.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Conditional7. When populated, Discharge Hour (CLT.002.047) must be populated |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be less than or equal to associated Adjudication Date value.3. Value must be greater than or equal to associated Admission Date value.4. Value must be greater than or equal to associated eligible Date of Birth value.5. Value must be less than or equal to associated eligible Date of Death value.6. Situational7. When populated, Discharge Hour (CLT.002.047) must be populated |
| 07/10/2025 |
4.0.13 |
CLT.002.045 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.045 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational |
| 04/09/2026 |
4.0.31 |
CLT.002.026 |
UPDATE |
Medicaid valid value info |
|
Adjustment Reason Code List |
| 12/19/2024 |
4.0.1 |
CLT.002.025 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (CIP.002.026) |
1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686" |
| 07/10/2025 |
4.0.13 |
CLT.002.024 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CLT.002.024 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
| 05/07/2025 |
4.0.8 |
CLT.002.022 |
UPDATE |
Coding requirement |
1. Mandatory2. Value must be 20 characters or less.3. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date |
1. Mandatory2. Value must be 20 characters or less.3. The Beginning Date of Service on the claim must fall between (ELG.021.253) enrollment effective and (ELG.021.253) end date4. Value must not contain Ampersand symbol |
| 01/16/2025 |
4.0.2 |
CLT.002.020 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 05/07/2025 |
4.0.8 |
CLT.001.227 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 04/09/2026 |
4.0.31 |
CLT.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
CIP.003.288 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.288 |
UPDATE |
Coding requirement |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 18 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 02/27/2025 |
4.0.3 |
CIP.003.286 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
| 07/10/2025 |
4.0.13 |
CIP.003.285 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.285 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in NDC Unit of Measure List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.284 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.284 |
UPDATE |
Coding requirement |
1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Conditional |
1. Value must be 12 digits or less2. Value must be a valid National Drug Code3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.278 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.278 |
UPDATE |
Coding requirement |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Conditional |
1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.1234567892. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.272 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.272 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.264 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.264 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.263 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.263 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational |
| 05/07/2025 |
4.0.8 |
CIP.003.261 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. NPPES Entity Type Code associate with this NPI must equal ‘1’ (Individual) |
| 12/19/2024 |
4.0.1 |
CIP.003.257 |
UPDATE |
Coding requirement |
1. Value must be 3 characters2. Mandatory3. Value must be in Type of Service IP List (VVL)4. If Sex (ELG.002.023) equals "M", then value must not equal "086" |
1. Value must be 3 characters2. Mandatory3. Value must be in Type of Service IP List (VVL) |
| 07/10/2025 |
4.0.13 |
CIP.003.256 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.256 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Billing Unit List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.250 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.250 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Conditional |
1. Value must be numeric2. Value may include up to 6 digits to the left of the decimal point, and 3 digits to the right, e.g. 123456.7893. Situational |
| 04/09/2026 |
4.0.31 |
CIP.003.245 |
UPDATE |
Medicaid valid value info |
|
Revenue Code List |
| 07/10/2025 |
4.0.13 |
CIP.003.242 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.003.242 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be"F2" |
| 04/09/2026 |
4.0.31 |
CIP.003.240 |
UPDATE |
Medicaid valid value info |
|
Link to Line Adjustment Reason Code List |
| 04/09/2026 |
4.0.31 |
CIP.003.232 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 07/10/2025 |
4.0.13 |
CIP.002.295 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.295 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.294 |
UPDATE |
Necessity |
Conditional |
SItuational |
| 07/10/2025 |
4.0.13 |
CIP.002.294 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.293 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.293 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.292 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.292 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.228 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.228 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Conditional5. If value is populated, Crossover Indicator must be equal to "1" |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0", then the value must not be populated4. Situational5. If value is populated, Crossover Indicator must be equal to "1" |
| 07/10/2025 |
4.0.13 |
CIP.002.223 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.223 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational |
| 02/27/2025 |
4.0.3 |
CIP.002.222 |
UPDATE |
Definition |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identify theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
The Medicare Beneficiary Identifier (MBI) is a randomly generated identifier used to identify all Medicare beneficiaries. It replaced the previously-used SSN-based Medicare HIC Number (HICN). To prevent identity theft, among other reasons, HICN gradually were retired and replaced by the MBI over the course of 2018 and 2019. Starting in 2020, the MBI became the primary identifier for Medicare beneficiaries. |
| 07/10/2025 |
4.0.13 |
CIP.002.221 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.221 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier, where Provider Identifier Type (PRV.005.077) equals "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.220 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.220 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.217 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.217 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Third Party Coinsurance Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.214 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.214 |
UPDATE |
Coding requirement |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional |
1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.211 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.211 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Deductible Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.210 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.210 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.209 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.209 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Copayment Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.208 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.208 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.207 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.207 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated Beneficiary Coinsurance Amount3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.206 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.206 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.204 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.204 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Border State Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.203 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.203 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Split Claim Indicator List (VVL)3. Situational |
| 06/19/2025 |
4.0.11 |
CIP.002.196 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. (Not Dual Eligible) if Dual Eligible Code (ELG.DE.085) value equals "00", then value must not be populated5. Value must be populated when Crossover Indicator (CIP.002.023) equals "1" and Medicare Beneficiary Identifier (CIP.002.222) is not populated |
1. Value must be 12 characters or less2. Conditional3. Value must not contain a pipe or asterisk symbols4. If Dual Eligible Code (ELG.DE.085) value is "00" (Not Dual Eligible), then value must not be populated.5. Value must be populated when Crossover Indicator (CIP.002.023) equals "1" and Medicare Beneficiary Identifier (CIP.002.222) is not populated |
| 07/10/2025 |
4.0.13 |
CIP.002.195 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.195 |
UPDATE |
Coding requirement |
1. Value may include up to 3 digits to the left of the decimal point, and 5 digits to the right e.g. 123.456782. Conditional3. When populated value must be zero or greater |
1. Value may include up to 3 digits to the left of the decimal point, and 5 digits to the right e.g. 123.456782. Situational3. When populated value must be zero or greater |
| 07/10/2025 |
4.0.13 |
CIP.002.194 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.194 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be populated when Outlier Code (CIP.002.197) is in [01,02,10]4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.190 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.190 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.189 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.189 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 12/19/2024 |
4.0.1 |
CIP.002.188 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Type Code List (VVL)3. Conditional |
| 07/10/2025 |
4.0.13 |
CIP.002.187 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.187 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.186 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.186 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.185 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.185 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional |
1. Value must be 30 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.184 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.184 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Conditional3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
1. Value must be 10 digits2. Situational3. Value must have an associated Provider Identifier Type equal to "2"4. Value must exist in the NPPES NPI File |
| 07/10/2025 |
4.0.13 |
CIP.002.183 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.183 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Specialty List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.182 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.182 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Provider Type Code List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.181 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.181 |
UPDATE |
Coding requirement |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Conditional |
1. Value must be 12 characters or less2. Value must be in Provider Taxonomy List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.180 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.180 |
UPDATE |
Coding requirement |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Conditional5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
1. Value must be 10 digits2. Value must have an associated Provider Identifier Type equal to "2"3. Value must exist in the NPPES NPI data file4. Situational5. When populated, value must match Provider Identifier (PRV.005.081) and Facility Group Individual Code (PRV.002.028) must equal "01"6. NPPES Entity Type Code associated with this NPI must equal "2" (Organization) |
| 07/10/2025 |
4.0.13 |
CIP.002.179 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.179 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Conditional3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
1. Value must be 30 characters or less2. Situational3. When Type of Claim not in [3,C,W] then value may match (PRV.002.019) Submitting State Provider ID or4. When Type of Claim not in [3,C,W] then value may match (PRV.005.081) Provider Identifier where the Provider Identifier Type (PRV.005.077) equals "1"5. Discharge Date (CIP.002.096) may be between Provider Attributes Effective Date (PRV.002.020) and Provider Attributes End Date (PRV.002.021) or6. Discharge Date (CIP.002.096) may be between Provider Identifier Effective Date (PRV.005.079) and Provider Identifier End Date (PRV.005.080) |
| 05/29/2025 |
4.0.9 |
CIP.002.178 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash “/” in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
1. Value must be 20 characters or less2. Value must be associated with a populated Waiver Type3. (1115 demonstration) If value begins with "11-W-" or "21-W-", the associated Claim Waiver Type value must be 01 or in [21-30]4. (1115 demonstration) If value begins with"11-W-" or "21-W-", then the value must include slash �/� in the 11th position followed by the last digit of the CMS Region [0-9] in the 12th position5. (1915(b) or 1915(c) waivers) If value begins with the two-letter state abbreviation followed by a period (.), the associated Claim Waiver Type value must be in [02-20,32,33]6. Conditional |
| 07/10/2025 |
4.0.13 |
CIP.002.177 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.177 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CIP.002.178)5. Conditional |
1. Value must be 2 characters2. Value must be in Waiver Type List (VVL)3. Value must match Eligible Waiver Type (ELG.012.173) for the enrollee for the same time period (by date of service)4. Value must have a corresponding value in Waiver ID (CIP.002.178)5. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.176 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.176 |
UPDATE |
Coding requirement |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Conditional |
1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. If there is an associated Health Home Entity Name value, then value must be "1"4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.174 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.174 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 1 character2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.173 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.173 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.172 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.172 |
UPDATE |
Coding requirement |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Conditional |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.171 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.171 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Conditional |
1. Value must be 20 characters or less2. Value must not contain a pipe or asterisk symbol3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.170 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.170 |
UPDATE |
Coding requirement |
1. Value must not be greater than 6 digits to the left of the decimal and have no more than 3 digits to the right of the decimal (i.e. 999999.999)2. Conditional |
1. Value must not be greater than 6 digits to the left of the decimal and have no more than 3 digits to the right of the decimal (i.e. 999999.999)2. Situational |
| 12/19/2024 |
4.0.1 |
CIP.002.169 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.168 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.167 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.166 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.165 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.164 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.163 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.162 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.161 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.160 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Must be greater than or equal to Occurrence Code Effective Date4. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Occurrence Code3. Value must be on or after the Occurrence Code Effective Date4. Conditional |
| 12/19/2024 |
4.0.1 |
CIP.002.159 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CIP.002.158 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CIP.002.157 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CIP.002.156 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CIP.002.155 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.154 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.154 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be less than or equal to Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CIP.002.153 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 07/10/2025 |
4.0.13 |
CIP.002.152 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.152 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Situational4. Value must be less than or equal to Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CIP.002.151 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 12/19/2024 |
4.0.1 |
CIP.002.150 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be less than or equal to Occurrence Code End Date |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. When populated, value must have an associated populated Occurrence Code3. Conditional4. Value must be on or before the Occurrence Code End Date |
| 02/27/2025 |
4.0.3 |
CIP.002.149 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.148 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.147 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.146 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.145 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.144 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.143 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.142 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.141 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 02/27/2025 |
4.0.3 |
CIP.002.140 |
UPDATE |
Definition |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
A code to describe specific event(s) relating to this billing period covered by the claim. (These are Form Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans. |
| 07/10/2025 |
4.0.13 |
CIP.002.138 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.138 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Forced Claim Indicator List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.135 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.135 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.134 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.134 |
UPDATE |
Coding requirement |
1. Value must be 5 digits or less2. Conditional |
1. Value must be 5 digits or less2. Situational |
| 12/19/2024 |
4.0.1 |
CIP.002.132 |
UPDATE |
Definition |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
The field denotes whether the payment amount was determined at the claim header or line/detail level. For claims where payment is NOT determined at the individual line level (PAYMENT-LEVEL-IND = 1), the claim lines’ associated allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts are left blank and the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amount is reported at the header level only. For claims where payment/allowed amount is determined at the individual lines and when applicable, cost-sharing and/or coordination of benefits were deducted from one or more specific line-level payment/allowed amounts (PAYMENT-LEVEL-IND = 2), the allowed (ALLOWED-AMT) and paid (MEDICAID-PAID-AMT) amounts on the associated claim lines should sum to the total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts reported on the claim header.
For claims where payment/allowed amount is determined at the individual lines but then cost sharing or coordination of benefits was deducted from the total paid/allowed amount at the header only (PAYMENT-LEVEL-IND = 3), then the line-level paid amount (MEDICAID-PAID-AMT) would be blank and line-level allowed (ALLOWED-AMT) and header level total allowed (TOT-ALLOWED-AMT) and total paid (TOT-MEDICAID-PAID-AMT) amounts must all be populated but the line level allowed amounts are not expected to sum exactly to the header level total allowed.
For example, if a claim for an office visit and a procedure is assigned a separate line-level allowed amount for each line, but then at the header level a copay is deducted from the header-level total allowed and/or total paid amounts, then the sum of line-level allowed amounts may not be equal to the header-level total allowed amounts or correspond directly to the total paid amount. If the state cannot distinguish between the scenarios for value 1 and value 3, then value 1 can be used for all claims with only header-level total allowed/paid amounts. |
| 07/10/2025 |
4.0.13 |
CIP.002.128 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.128 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Conditional |
1. Value must be 1 character2. Value must be in Medicare Combined Deductible Indicator List (VVL)3. If value equals "1", then Total Medicare Coinsurance amount must not be populated4. If value equals "0", then Crossover Indicator must equal "0"5. If value equals "1", then Crossover Indicator must equal "1"6. Situational |
| 04/24/2025 |
4.0.7 |
CIP.002.127 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is in [3,C,W], then value must be populated4. Conditional |
1. Value must be 2 characters2. Value must be in Funding Source Non-Federal Share List (VVL)3. If Type of Claim is not in [3,C,W], then value must be populated4. Conditional |
| 07/10/2025 |
4.0.13 |
CIP.002.125 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.125 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Conditional |
1. Value must be 1 character2. Value must be in Fixed Payment Indicator List (VVL)3. Situational |
| 02/27/2025 |
4.0.3 |
CIP.002.121 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Value must be in [0,1] or not populated4. Conditional |
1. Value must be 1 character2. Value must be in Other Insurance Indicator List (VVL)3. Conditional |
| 07/10/2025 |
4.0.13 |
CIP.002.119 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.119 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.118 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.118 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must be less than associated Total Billed Amount - (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.117 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.117 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Conditional5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated.4. Situational5. If associated Medicare Combined Deductible Indicator equals "1", then value must not be populated6. When populated, value must be less than or equal to Total Billed Amount |
| 06/19/2025 |
4.0.11 |
CIP.002.116 |
UPDATE |
Coding requirement |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. (Medicare Enrolled) if associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10], then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Crossover Indicator value equals "0" (not a crossover claim), then value should not be populated4. If associated Dual Eligible Code (ELG.005.085) value is in [01,02,03,04,05,06,08,09,10] (Medicare Enrolled), then value is mandatory and must be provided5. Conditional6. When populated, value must be less than or equal to Total Billed Amount |
| 07/10/2025 |
4.0.13 |
CIP.002.111 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.111 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 3 (CIP.002.110) is not populated |
| 07/10/2025 |
4.0.13 |
CIP.002.110 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.110 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CIP.002.109) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 2 (CIP.002.109) is not populated |
| 07/10/2025 |
4.0.13 |
CIP.002.109 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.109 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CIP.002.108) is not populated |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique5. Value must not be populated when Remittance Advice Remark Code 1 (CIP.002.108) is not populated |
| 07/10/2025 |
4.0.13 |
CIP.002.108 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.108 |
UPDATE |
Coding requirement |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Conditional4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
1. Value must be 5 characters or less2. Value must be in Claim Payment Remittance Code List (VVL)3. Situational4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique |
| 07/10/2025 |
4.0.13 |
CIP.002.106 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.106 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Must have an associated Check Number3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.105 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.105 |
UPDATE |
Coding requirement |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Conditional |
1. Value must be 15 characters or less2. Value must have an associated Check Effective Date3. Value must not contain a pipe or asterisk symbols4. Situational |
| 12/19/2024 |
4.0.1 |
CIP.002.104 |
UPDATE |
Definition |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
The field denotes the claims payment system from which the claim was extracted.
For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.
For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.
For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee. |
| 04/09/2026 |
4.0.31 |
CIP.002.103 |
UPDATE |
Medicaid valid value info |
|
Link to Claim Status Category List |
| 07/10/2025 |
4.0.13 |
CIP.002.102 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.102 |
UPDATE |
Coding requirement |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Conditional4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
1. Value must be 3 characters or less2. Value must be in Claim Status List (VVL)3. Situational4. If value in [542,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2" |
| 12/19/2024 |
4.0.1 |
CIP.002.101 |
UPDATE |
Coding requirement |
1. Value must be 4 characters2. Value must be in Type of Bill List (VVL)3. First character must be a "0"4. Mandatory |
1. Value must be 4 characters2. First character value must be a "0"3. Second character value must be in Type of Bill 2 Facility Type List (VVL)4. Third character value must be in Type of Bill 3 Classification Clinics List (VVL)5. Fourth character value must be in Type of Bill 4 Frequency List (VVL)6. Mandatory |
| 12/19/2024 |
4.0.1 |
CIP.002.100 |
UPDATE |
Definition |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = "3" for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record. |
| 07/10/2025 |
4.0.13 |
CIP.002.097 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.097 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional4. When populated, Discharge Date (CIP.002.096) must be populated |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational4. When populated, Discharge Date (CIP.002.096) must be populated |
| 07/10/2025 |
4.0.13 |
CIP.002.095 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.095 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Conditional |
1. Value must be 2 characters2. Value must be in Hour List (VVL)3. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.093 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.093 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.092 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.092 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code |
| 07/10/2025 |
4.0.13 |
CIP.002.090 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.090 |
UPDATE |
Coding requirement |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.089 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.089 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.088 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.088 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code |
| 07/10/2025 |
4.0.13 |
CIP.002.086 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.086 |
UPDATE |
Coding requirement |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.085 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.085 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.084 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.084 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code |
| 07/10/2025 |
4.0.13 |
CIP.002.082 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.082 |
UPDATE |
Coding requirement |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.081 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.081 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.080 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.080 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code |
| 07/10/2025 |
4.0.13 |
CIP.002.078 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.078 |
UPDATE |
Coding requirement |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.077 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.077 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.076 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.076 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Conditional4. When populated, there must be a corresponding Procedure Code |
1. Value must be 2 characters2. Value must be in Procedure Code Flag List (VVL)3. Situational4. When populated, there must be a corresponding Procedure Code |
| 07/10/2025 |
4.0.13 |
CIP.002.074 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.074 |
UPDATE |
Coding requirement |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.073 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.073 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Conditional |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value must be on or before associated Discharge Date value3. Value must be provided with an associated Procedure Code value4. Value must be on or after associated Beginning Date of Service value5. Value must be on or before associated Eligible Date of Death value6. Value must be not be populated when associated Procedure Code is not populated7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.072 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.070 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.070 |
UPDATE |
Coding requirement |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Conditional |
1. Value must be 8 characters or less2. When populated, there must be a corresponding Procedure Code Flag3. If associated Procedure Code Flag value indicates an ICD-9-CM encoding "02", then value must be a valid ICD-9-CM procedure code4. If associated Procedure Code Flag value indicates an ICD-10-CM encoding "07", then value must be a valid ICD-10-CM procedure code5. If associated Procedure Code Flag value indicates an "Other" encoding "10-87", then State must provide T-MSIS system with State-specific procedure code list, and value must be a valid State-specific procedure code6. Value must be in Procedure Code List (VVL)7. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.068 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.068 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Conditional |
1. Value must be 4 characters or less2. Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.029 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.029 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Conditional |
1. Value must be 20 characters or less2. Situational |
| 04/09/2026 |
4.0.31 |
CIP.002.027 |
UPDATE |
Medicaid valid value info |
|
Adjustment Reason Code List |
| 07/10/2025 |
4.0.13 |
CIP.002.025 |
UPDATE |
Necessity |
Conditional |
Situational |
| 07/10/2025 |
4.0.13 |
CIP.002.025 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Conditional4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
1. Value must be 1 character2. Value must be in 1115A Demonstration Indicator List (VVL)3. Situational4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated |
| 05/07/2025 |
4.0.8 |
CIP.002.022 |
UPDATE |
Coding requirement |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254) |
1. Value must be 20 characters or less2. Mandatory3. Value must match MSIS Identification Number (ELG.021.251) and the Admission Date (CIP.002.094) must be between Enrollment Effective Date (ELG.021.253) and Enrollment End Date (ELG.021.254)4. Value must not contain Ampersand symbol |
| 01/16/2025 |
4.0.2 |
CIP.002.020 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value is in [4,1], then value must be populated |
| 05/07/2025 |
4.0.8 |
CIP.001.275 |
UPDATE |
Coding requirement |
1. Value must be 4 characters or less2. Value must between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
1. Value must be 4 characters or less2. Value must be between 1 and 99993. Value must be equal to the largest of any prior values for the same reporting period and file type, plus 1 (i.e. incremented by 1)4. Value must not contain a pipe symbol5. Mandatory |
| 04/09/2026 |
4.0.31 |
CIP.001.007 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 09/16/2024 |
4.0.0 |
TPL.006.086 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.086 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.091 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.091 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.090 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.090 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.085 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.085 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.084 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.084 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.083 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.083 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.082 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.082 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.081 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.081 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.080 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.080 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.079 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.079 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.078 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.078 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.077 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.077 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.076 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.076 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.075 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.075 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.074 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.074 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.073 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.073 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.006.072 |
UPDATE |
File segment |
None |
103 |
| 09/16/2024 |
4.0.0 |
TPL.006.072 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.070 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.070 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.069 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.069 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.068 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.068 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.067 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.067 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.066 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.066 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.065 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.065 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.064 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.064 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.005.063 |
UPDATE |
File segment |
None |
102 |
| 09/16/2024 |
4.0.0 |
TPL.005.063 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.061 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.061 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.060 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.060 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.059 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.059 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.058 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.058 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.057 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.057 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.056 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.056 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.055 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.055 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.054 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.054 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.053 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.053 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.004.052 |
UPDATE |
File segment |
None |
101 |
| 09/16/2024 |
4.0.0 |
TPL.004.052 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.050 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.050 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.089 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.089 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.049 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.049 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.048 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.048 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.047 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.047 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.046 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.046 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.045 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.045 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.044 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.044 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.038 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.038 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.037 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.037 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.036 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.036 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.035 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.035 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.034 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.034 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.033 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.033 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.032 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.032 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.031 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.031 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.030 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.030 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.003.029 |
UPDATE |
File segment |
None |
100 |
| 09/16/2024 |
4.0.0 |
TPL.003.029 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
TPL.002.027 |
UPDATE |
File segment |
None |
99 |
| 09/16/2024 |
4.0.0 |
TPL.002.027 |
ADD |
N/A |
|
Created |
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PRV.007.097 |
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4.0.0 |
PRV.007.096 |
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4.0.0 |
PRV.006.092 |
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4.0.0 |
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PRV.006.090 |
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92 |
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4.0.0 |
PRV.006.089 |
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4.0.0 |
PRV.006.088 |
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PRV.006.086 |
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4.0.0 |
PRV.006.085 |
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4.0.0 |
PRV.006.084 |
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PRV.006.084 |
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4.0.0 |
PRV.005.082 |
UPDATE |
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PRV.005.082 |
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4.0.0 |
PRV.005.081 |
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4.0.0 |
PRV.005.081 |
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4.0.0 |
PRV.005.080 |
UPDATE |
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PRV.005.080 |
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4.0.0 |
PRV.005.079 |
UPDATE |
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91 |
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4.0.0 |
PRV.005.079 |
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4.0.0 |
PRV.005.078 |
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91 |
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PRV.005.078 |
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4.0.0 |
PRV.005.077 |
UPDATE |
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91 |
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4.0.0 |
PRV.005.077 |
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4.0.0 |
PRV.005.076 |
UPDATE |
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91 |
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4.0.0 |
PRV.005.076 |
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4.0.0 |
PRV.005.075 |
UPDATE |
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91 |
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4.0.0 |
PRV.005.075 |
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4.0.0 |
PRV.005.074 |
UPDATE |
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91 |
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4.0.0 |
PRV.005.074 |
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4.0.0 |
PRV.005.073 |
UPDATE |
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91 |
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4.0.0 |
PRV.005.073 |
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| 09/16/2024 |
4.0.0 |
PRV.005.072 |
UPDATE |
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91 |
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4.0.0 |
PRV.005.072 |
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| 09/16/2024 |
4.0.0 |
PRV.004.070 |
UPDATE |
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90 |
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4.0.0 |
PRV.004.070 |
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| 09/16/2024 |
4.0.0 |
PRV.004.069 |
UPDATE |
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90 |
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4.0.0 |
PRV.004.069 |
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| 09/16/2024 |
4.0.0 |
PRV.004.068 |
UPDATE |
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90 |
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4.0.0 |
PRV.004.068 |
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| 09/16/2024 |
4.0.0 |
PRV.004.067 |
UPDATE |
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90 |
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4.0.0 |
PRV.004.067 |
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| 09/16/2024 |
4.0.0 |
PRV.004.066 |
UPDATE |
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90 |
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4.0.0 |
PRV.004.066 |
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| 09/16/2024 |
4.0.0 |
PRV.004.065 |
UPDATE |
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90 |
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4.0.0 |
PRV.004.065 |
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| 09/16/2024 |
4.0.0 |
PRV.004.064 |
UPDATE |
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90 |
| 09/16/2024 |
4.0.0 |
PRV.004.064 |
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| 09/16/2024 |
4.0.0 |
PRV.004.063 |
UPDATE |
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90 |
| 09/16/2024 |
4.0.0 |
PRV.004.063 |
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N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.004.062 |
UPDATE |
File segment |
None |
90 |
| 09/16/2024 |
4.0.0 |
PRV.004.062 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.004.061 |
UPDATE |
File segment |
None |
90 |
| 09/16/2024 |
4.0.0 |
PRV.004.061 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.004.060 |
UPDATE |
File segment |
None |
90 |
| 09/16/2024 |
4.0.0 |
PRV.004.060 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.058 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.058 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.057 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.057 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.056 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.056 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.055 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.055 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.054 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.054 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.053 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.053 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.052 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.052 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.051 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.051 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.050 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.050 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.049 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.049 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.048 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.048 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.047 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.047 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.046 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.046 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.045 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.045 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.044 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.044 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.043 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.043 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.042 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.042 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.041 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.041 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.040 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.040 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.003.039 |
UPDATE |
File segment |
None |
89 |
| 09/16/2024 |
4.0.0 |
PRV.003.039 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.037 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.037 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.140 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.140 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.036 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.036 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.035 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.035 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.034 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.034 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.033 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.033 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.032 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.032 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.031 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.031 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.030 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.030 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.029 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.029 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.028 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.028 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.027 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.027 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.026 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.026 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.025 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.025 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.024 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.024 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.023 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.023 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.022 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.022 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.021 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.021 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.020 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.020 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.019 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.019 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.018 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.018 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.017 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.017 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.002.016 |
UPDATE |
File segment |
None |
88 |
| 09/16/2024 |
4.0.0 |
PRV.002.016 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.014 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.014 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.138 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.138 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.139 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.139 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.013 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.013 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.011 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.011 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.010 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.010 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.009 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.009 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.008 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.008 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.007 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.007 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.006 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.006 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.005 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.005 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.004 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.004 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.003 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.003 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.002 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.002 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
PRV.001.001 |
UPDATE |
File segment |
None |
87 |
| 09/16/2024 |
4.0.0 |
PRV.001.001 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.010.122 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.122 |
ADD |
N/A |
|
Created |
| 12/19/2024 |
4.0.1 |
MCR.010.121 |
UPDATE |
Definition |
The date when organization's accreditation ends. |
The last calendar day on which all of the other data elements in the same segment were effective.
|
| 09/16/2024 |
4.0.0 |
MCR.010.121 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.121 |
ADD |
N/A |
|
Created |
| 12/19/2024 |
4.0.1 |
MCR.010.120 |
UPDATE |
Definition |
The date the organization achieved accreditation. |
The first calendar day on which all of the other data elements in the same segment were effective. |
| 09/16/2024 |
4.0.0 |
MCR.010.120 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.120 |
ADD |
N/A |
|
Created |
| 12/19/2024 |
4.0.1 |
MCR.010.119 |
UPDATE |
Coding requirement |
1. Value must be 30 characters2. Value must not contain a pipe or asterisk symbol3. Mandatory |
1. Value must be 30 characters or less2. Value must not contain a pipe or asterisk symbol3. Mandatory |
| 09/16/2024 |
4.0.0 |
MCR.010.119 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.119 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.010.118 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.118 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.010.117 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.117 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.010.116 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.116 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.010.115 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.115 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.010.114 |
UPDATE |
File segment |
None |
85 |
| 09/16/2024 |
4.0.0 |
MCR.010.114 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.007.089 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.089 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.007.088 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.088 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.007.087 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.087 |
ADD |
N/A |
|
Created |
| 04/09/2026 |
4.0.31 |
MCR.007.086 |
UPDATE |
Medicaid valid value info |
|
https://www.ncqa.org/programs/health-plans/health-plan-accreditation-hpa/https://www.aaahc.org/accreditation/ |
| 09/16/2024 |
4.0.0 |
MCR.007.086 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.086 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.007.085 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.085 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.007.084 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.084 |
ADD |
N/A |
|
Created |
| 04/09/2026 |
4.0.31 |
MCR.007.083 |
UPDATE |
Medicaid valid value info |
|
State Code List |
| 09/16/2024 |
4.0.0 |
MCR.007.083 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.083 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.007.082 |
UPDATE |
File segment |
None |
84 |
| 09/16/2024 |
4.0.0 |
MCR.007.082 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.080 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.080 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.079 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.079 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.078 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.078 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.077 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.077 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.076 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.076 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.075 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.075 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.074 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.074 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.006.073 |
UPDATE |
File segment |
None |
83 |
| 09/16/2024 |
4.0.0 |
MCR.006.073 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.005.071 |
UPDATE |
File segment |
None |
82 |
| 09/16/2024 |
4.0.0 |
MCR.005.071 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.005.070 |
UPDATE |
File segment |
None |
82 |
| 09/16/2024 |
4.0.0 |
MCR.005.070 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
MCR.005.069 |
UPDATE |
File segment |
None |
82 |
| 09/16/2024 |
4.0.0 |
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FTX.005.183 |
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FTX.003.096 |
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FTX.003.093 |
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FTX.003.088 |
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FTX.003.086 |
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FTX.003.086 |
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| 09/16/2024 |
4.0.0 |
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FTX.001.015 |
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FTX.001.014 |
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67 |
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FTX.001.009 |
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FTX.001.008 |
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67 |
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FTX.001.007 |
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FTX.001.006 |
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FTX.001.005 |
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FTX.001.004 |
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FTX.001.004 |
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FTX.001.003 |
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FTX.001.002 |
UPDATE |
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FTX.001.002 |
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FTX.001.001 |
UPDATE |
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67 |
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FTX.001.001 |
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4.0.0 |
ELG.023.294 |
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Created |
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4.0.0 |
ELG.023.293 |
ADD |
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4.0.0 |
ELG.023.292 |
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4.0.0 |
ELG.023.291 |
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4.0.0 |
ELG.023.290 |
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4.0.0 |
ELG.023.289 |
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4.0.0 |
ELG.023.288 |
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4.0.0 |
ELG.023.287 |
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4.0.0 |
ELG.023.286 |
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4.0.0 |
ELG.023.285 |
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4.0.0 |
ELG.023.284 |
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Created |
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4.0.0 |
ELG.023.283 |
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4.0.0 |
ELG.023.282 |
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4.0.0 |
ELG.022.267 |
UPDATE |
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64 |
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ELG.022.267 |
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ELG.022.266 |
UPDATE |
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64 |
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ELG.022.266 |
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ELG.022.265 |
UPDATE |
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64 |
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4.0.0 |
ELG.022.265 |
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ELG.022.264 |
UPDATE |
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64 |
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4.0.0 |
ELG.022.264 |
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ELG.022.263 |
UPDATE |
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64 |
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4.0.0 |
ELG.022.263 |
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4.0.0 |
ELG.022.262 |
UPDATE |
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64 |
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CRX.003.180 |
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CRX.003.181 |
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CRX.003.181 |
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CRX.003.209 |
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CRX.003.209 |
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CRX.003.179 |
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CRX.003.179 |
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4.0.0 |
CRX.003.172 |
UPDATE |
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CRX.003.172 |
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CRX.003.171 |
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CRX.003.171 |
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CRX.003.170 |
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CRX.002.066 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.065 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.065 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.064 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.064 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.063 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.063 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.062 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.062 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.061 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.061 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.060 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.060 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.059 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.059 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.058 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.058 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.056 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.056 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.055 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.055 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.054 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.054 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.053 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.053 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.052 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.052 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.049 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.049 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.048 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.048 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.047 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.047 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.045 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.045 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.044 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.044 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.043 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.043 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.041 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.041 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.040 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.040 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.039 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.039 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.038 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.038 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.037 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.037 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.036 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.036 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.035 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.035 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.034 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.034 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.033 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.033 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.032 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.032 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.031 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.031 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.030 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.030 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.029 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.029 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.028 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.028 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.027 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.027 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.026 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.026 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.025 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.025 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.024 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.024 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.023 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.023 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.022 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.022 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.021 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.021 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.020 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.020 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.019 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.019 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.018 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.018 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.017 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.017 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.002.016 |
UPDATE |
File segment |
None |
40 |
| 09/16/2024 |
4.0.0 |
CRX.002.016 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.014 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.014 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.155 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.155 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.013 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.013 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.012 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.012 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.011 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.011 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.010 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.010 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.009 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.009 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.008 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.008 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.007 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.007 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.006 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.006 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.005 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.005 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.004 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.004 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.003 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.003 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.002 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.002 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CRX.001.001 |
UPDATE |
File segment |
None |
39 |
| 09/16/2024 |
4.0.0 |
CRX.001.001 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.285 |
UPDATE |
Coding requirement |
1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
1. Value must be 500 characters or less2. Value must not contain a pipe or asterisk symbols3. Situational |
| 09/16/2024 |
4.0.0 |
COT.004.285 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.285 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.284 |
UPDATE |
Coding requirement |
1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory |
1. Value must be a minimum of 3 characters2. If associated Diagnosis Code Flag value equals "1" (ICD-9), then value must be in ICD-9 Diagnosis Code List (VVL)3. If associated Diagnosis Code Flag value equals "2" (ICD-10), then value must be in ICD-10 Diagnosis Code List (VVL)4. Value must not contain a decimal point5. Mandatory |
| 09/16/2024 |
4.0.0 |
COT.004.284 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.284 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.283 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Code Flag List (VVL)3. Mandatory |
| 09/16/2024 |
4.0.0 |
COT.004.283 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.283 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.282 |
UPDATE |
Coding requirement |
1. Value must be in [01-24]2. Mandatory1. Value must be in [01-24]2. Mandatory |
1. Value must be in [01-24]2. Mandatory |
| 09/16/2024 |
4.0.0 |
COT.004.282 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.282 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.281 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory |
1. Value must be 1 character2. Value must be in Diagnosis Type Code List (VVL)3. Value must be in [P,A,E,O]4. Mandatory |
| 09/16/2024 |
4.0.0 |
COT.004.281 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.281 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.280 |
UPDATE |
Coding requirement |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value |
| 09/16/2024 |
4.0.0 |
COT.004.280 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.280 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.279 |
UPDATE |
Coding requirement |
1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (COT.002.025)1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (COT.002.025) |
1. Value must be 1 character2. Value must be in Adjustment Indicator List (VVL)3. Value must be in [0,1,4]4. Mandatory5. If value equals "0", then associated Adjustment ICN must not be populated6. Value must equal "1", when associated Claim Status equals "686"7. Value must match the adjustment indicator in the header (COT.002.025) |
| 09/16/2024 |
4.0.0 |
COT.004.279 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.279 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.278 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. If associated Adjustment Indicator value equals "0", then value must not be populated4. Conditional5. If associated Adjustment Indicator value equals "4", then value must be populated |
| 09/16/2024 |
4.0.0 |
COT.004.278 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.278 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.277 |
UPDATE |
Coding requirement |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory |
1. Value must be 50 characters or less2. Value must not contain a pipe or asterisk symbols3. Mandatory |
| 09/16/2024 |
4.0.0 |
COT.004.277 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.277 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.276 |
UPDATE |
Coding requirement |
1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory |
1. Value must be 11 digits or less2. Value must be unique within record segment over all records associated with a given Record ID3. Mandatory |
| 09/16/2024 |
4.0.0 |
COT.004.276 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.276 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.275 |
UPDATE |
Coding requirement |
1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same as Submitting State (COT.001.007)1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same as Submitting State (COT.001.007) |
1. Value must be 2 characters2. Value must be in State Code List (VVL)3. Mandatory4. Value must be the same as Submitting State (COT.001.007) |
| 09/16/2024 |
4.0.0 |
COT.004.275 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.275 |
ADD |
N/A |
|
Created |
| 10/08/2024 |
4.0.0 |
COT.004.274 |
UPDATE |
Coding requirement |
1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "COT00004"1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "COT00004" |
1. Value must be 8 characters2. Mandatory3. Value must be in Record ID List (VVL)4. Value must equal "COT00004" |
| 09/16/2024 |
4.0.0 |
COT.004.274 |
UPDATE |
File segment |
None |
37 |
| 09/16/2024 |
4.0.0 |
COT.004.274 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.214 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.214 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.273 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.273 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.272 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.272 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.271 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.271 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.270 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.270 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.269 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.269 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.268 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.268 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.267 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.267 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.266 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.266 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.265 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.265 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.264 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.264 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.263 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.263 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.262 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.262 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.261 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.261 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.260 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.260 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.259 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.259 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.258 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.258 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.256 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.256 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.257 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.257 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.290 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.290 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.255 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.255 |
ADD |
N/A |
|
Created |
| 03/14/2025 |
4.0.4 |
COT.003.289 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must not be more than 2 digits long3. Value must be between 1 and 124. Conditional |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional |
| 09/16/2024 |
4.0.0 |
COT.003.289 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.289 |
ADD |
N/A |
|
Created |
| 03/14/2025 |
4.0.4 |
COT.003.288 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must not be more than 2 digits long3. Value must be between 1 and 124. Conditional |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional |
| 09/16/2024 |
4.0.0 |
COT.003.288 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.288 |
ADD |
N/A |
|
Created |
| 03/14/2025 |
4.0.4 |
COT.003.287 |
UPDATE |
Coding requirement |
1. Value must be numeric2. Value must not be more than 2 digits long3. Value must be between 1 and 124. Conditional |
1. Value must be numeric2. Value must be 2 digits or less3. Value must be between 1 and 124. Conditional |
| 09/16/2024 |
4.0.0 |
COT.003.287 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.287 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.254 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.254 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.234 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.234 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.225 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.225 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.224 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.224 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.223 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.223 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.222 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.222 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.221 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.221 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.219 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.219 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.218 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.218 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.227 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.227 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.217 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.217 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.213 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.213 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.210 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.210 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.208 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.208 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.207 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.207 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.206 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.206 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.205 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.205 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.204 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.204 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.203 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.203 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.202 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.202 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.201 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.201 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.200 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.200 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.199 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.199 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.198 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.198 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.197 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.197 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.196 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.196 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.195 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.195 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.194 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.194 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.193 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.193 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.192 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.192 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.191 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.191 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.190 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.190 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.189 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.189 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.188 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.188 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.187 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.187 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.186 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.186 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.184 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.184 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.183 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.183 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.182 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.182 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.179 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.179 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.178 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.178 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.177 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.177 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.176 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.176 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.175 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.175 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.174 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.174 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.172 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.172 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.171 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.171 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.170 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.170 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.169 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.169 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.168 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.168 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.167 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.167 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.166 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.166 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.165 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.165 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.164 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.164 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.163 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.163 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.162 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.162 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.161 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.161 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.160 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.160 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.159 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.159 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.158 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.158 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.157 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.157 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
COT.003.156 |
UPDATE |
File segment |
None |
36 |
| 09/16/2024 |
4.0.0 |
COT.003.156 |
ADD |
N/A |
|
Created |
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CLT.002.126 |
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| 09/16/2024 |
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CLT.002.125 |
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| 09/16/2024 |
4.0.0 |
CLT.002.047 |
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| 09/16/2024 |
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| 09/16/2024 |
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CLT.002.046 |
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| 09/16/2024 |
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| 09/16/2024 |
4.0.0 |
CLT.002.045 |
UPDATE |
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| 09/16/2024 |
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| 09/16/2024 |
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CLT.002.044 |
UPDATE |
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| 09/16/2024 |
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| 09/16/2024 |
4.0.0 |
CLT.002.026 |
UPDATE |
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| 09/16/2024 |
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| 09/16/2024 |
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| 09/16/2024 |
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| 09/16/2024 |
4.0.0 |
CLT.002.024 |
UPDATE |
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| 09/16/2024 |
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| 09/16/2024 |
4.0.0 |
CLT.002.023 |
UPDATE |
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| 09/16/2024 |
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| 09/16/2024 |
4.0.0 |
CLT.002.022 |
UPDATE |
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| 09/16/2024 |
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CLT.002.022 |
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| 09/16/2024 |
4.0.0 |
CLT.002.021 |
UPDATE |
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| 09/16/2024 |
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CLT.002.021 |
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| 09/16/2024 |
4.0.0 |
CLT.002.020 |
UPDATE |
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| 09/16/2024 |
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CLT.002.020 |
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| 09/16/2024 |
4.0.0 |
CLT.002.019 |
UPDATE |
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| 09/16/2024 |
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CLT.002.019 |
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| 09/16/2024 |
4.0.0 |
CLT.002.018 |
UPDATE |
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| 09/16/2024 |
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CLT.002.018 |
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| 09/16/2024 |
4.0.0 |
CLT.002.017 |
UPDATE |
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| 09/16/2024 |
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CLT.002.017 |
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| 09/16/2024 |
4.0.0 |
CLT.002.016 |
UPDATE |
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30 |
| 09/16/2024 |
4.0.0 |
CLT.002.016 |
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|
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| 09/16/2024 |
4.0.0 |
CLT.001.014 |
UPDATE |
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29 |
| 09/16/2024 |
4.0.0 |
CLT.001.014 |
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| 09/16/2024 |
4.0.0 |
CLT.001.227 |
UPDATE |
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29 |
| 09/16/2024 |
4.0.0 |
CLT.001.227 |
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| 09/16/2024 |
4.0.0 |
CLT.001.013 |
UPDATE |
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29 |
| 09/16/2024 |
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CLT.001.013 |
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| 09/16/2024 |
4.0.0 |
CLT.001.012 |
UPDATE |
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29 |
| 09/16/2024 |
4.0.0 |
CLT.001.012 |
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| 09/16/2024 |
4.0.0 |
CLT.001.011 |
UPDATE |
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29 |
| 09/16/2024 |
4.0.0 |
CLT.001.011 |
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|
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| 09/16/2024 |
4.0.0 |
CLT.001.010 |
UPDATE |
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29 |
| 09/16/2024 |
4.0.0 |
CLT.001.010 |
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|
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| 09/16/2024 |
4.0.0 |
CLT.001.009 |
UPDATE |
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29 |
| 09/16/2024 |
4.0.0 |
CLT.001.009 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.008 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.008 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.007 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.007 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.006 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.006 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.005 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.005 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.004 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.004 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.003 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.003 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.002 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.002 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CLT.001.001 |
UPDATE |
File segment |
None |
29 |
| 09/16/2024 |
4.0.0 |
CLT.001.001 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.334 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.334 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.333 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.333 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.332 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.332 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.331 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.331 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.330 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.330 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.329 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.329 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.328 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.328 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.327 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.327 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.326 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.326 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.325 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.325 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.324 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.324 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.323 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.323 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.004.322 |
UPDATE |
File segment |
None |
27 |
| 09/16/2024 |
4.0.0 |
CIP.004.322 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.273 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.273 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.337 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.337 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.336 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.336 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.319 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.319 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.318 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.318 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.317 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.317 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.315 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.315 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.316 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.316 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.340 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.340 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.314 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.314 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.296 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.296 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.288 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.288 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.287 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.287 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.286 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.286 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.285 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.285 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.284 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.284 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.278 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.278 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.272 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.272 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.269 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.269 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.267 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.267 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.266 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.266 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.265 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.265 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.264 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.264 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.263 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.263 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.261 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.261 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.260 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.260 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.257 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.257 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.256 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.256 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.255 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.255 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.254 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.254 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.252 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.252 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.251 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.251 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.250 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.250 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.249 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.249 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.245 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.245 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.244 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.244 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.243 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.243 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.242 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.242 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.241 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.241 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.240 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.240 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.239 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.239 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.238 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.238 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.237 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.237 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.236 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.236 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.235 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.235 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.234 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.234 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.233 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.233 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.232 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.232 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.003.231 |
UPDATE |
File segment |
None |
26 |
| 09/16/2024 |
4.0.0 |
CIP.003.231 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.229 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.229 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.339 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.339 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.338 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.338 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.311 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.311 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.310 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.310 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.309 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.309 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.308 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.308 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.307 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.307 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.306 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.306 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.305 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.305 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.304 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.304 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.303 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.303 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.302 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.302 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.301 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.301 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.300 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.300 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.299 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.299 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.298 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.298 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.297 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.297 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.295 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.295 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.294 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.294 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.293 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.293 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.292 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.292 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.291 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.291 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.290 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.290 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.289 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.289 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.228 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.228 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.223 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.223 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.222 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.222 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.221 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.221 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.220 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.220 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.219 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.219 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.218 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.218 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.217 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.217 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.216 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.216 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.214 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.214 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.213 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.213 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.212 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.212 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.211 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.211 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.210 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.210 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.209 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.209 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.208 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.208 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.207 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.207 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.206 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.206 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.204 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.204 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.203 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.203 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.202 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.202 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.199 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.199 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.198 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.198 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.197 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.197 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.196 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.196 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.195 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.195 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.194 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.194 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.190 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.190 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.189 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.189 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.188 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.188 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.187 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.187 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.186 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.186 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.185 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.185 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.184 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.184 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.183 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.183 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.182 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.182 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.181 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.181 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.180 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.180 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.179 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.179 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.178 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.178 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.177 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.177 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.176 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.176 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.175 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.175 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.174 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.174 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.173 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.173 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.172 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.172 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.171 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.171 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.170 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.170 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.169 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.169 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.168 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.168 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.167 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.167 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.166 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.166 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.165 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.165 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.164 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.164 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.163 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.163 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.162 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.162 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.161 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.161 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.160 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.160 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.159 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.159 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.158 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.158 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.157 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.157 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.156 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.156 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.155 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.155 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.154 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.154 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.153 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.153 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.152 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.152 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.151 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.151 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.150 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.150 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.149 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.149 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.148 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.148 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.147 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.147 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.146 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.146 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.145 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.145 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.144 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.144 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.143 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.143 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.142 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.142 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.141 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.141 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.140 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.140 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.139 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.139 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.138 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.138 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.137 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.137 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.136 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.136 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.135 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.135 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.134 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.134 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.133 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.133 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.132 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.132 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.130 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.130 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.129 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.129 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.128 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.128 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.127 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.127 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.126 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.126 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.125 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.125 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.122 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.122 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.121 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.121 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.119 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.119 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.118 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.118 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.117 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.117 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.116 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.116 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.114 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.114 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.113 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.113 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.112 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.112 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.111 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.111 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.110 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.110 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.109 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.109 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.108 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.108 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.106 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.106 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.105 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.105 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.104 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.104 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.103 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.103 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.102 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.102 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.101 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.101 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.100 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.100 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.099 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.099 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.098 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.098 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.097 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.097 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.096 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.096 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.095 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.095 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.094 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.094 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.093 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.093 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.092 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.092 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.090 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.090 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.089 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.089 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.088 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.088 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.086 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.086 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.085 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.085 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.084 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.084 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.082 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.082 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.081 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.081 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.080 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.080 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.078 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.078 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.077 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.077 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.076 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.076 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.074 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.074 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.073 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.073 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.072 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.072 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.070 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.070 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.069 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.069 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.068 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.068 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.029 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.029 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.028 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.028 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.027 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.027 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.026 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.026 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.025 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.025 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.024 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.024 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.023 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.023 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.022 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.022 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.021 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.021 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.020 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.020 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.019 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.019 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.018 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.018 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.017 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.017 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.002.016 |
UPDATE |
File segment |
None |
25 |
| 09/16/2024 |
4.0.0 |
CIP.002.016 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.014 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.014 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.275 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.275 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.013 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.013 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.012 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.012 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.011 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.011 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.010 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.010 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.009 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.009 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.008 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.008 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.007 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.007 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.006 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.006 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.005 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.005 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.004 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.004 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.003 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.003 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.002 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.002 |
ADD |
N/A |
|
Created |
| 09/16/2024 |
4.0.0 |
CIP.001.001 |
UPDATE |
File segment |
None |
24 |
| 09/16/2024 |
4.0.0 |
CIP.001.001 |
ADD |
N/A |
|
Created |
| 11/05/2024 |
4.0.0 |
Data Elements |
UPDATE |
Icon |
None |
25 |
| 09/04/2024 |
4.0.0 |
Data Elements |
ADD |
N/A |
|
Created |
| 09/04/2024 |
4.0.0 |
Data Elements |
REMOVE |
N/A |
Removed |
|
| 09/04/2024 |
4.0.0 |
Data Elements |
ADD |
N/A |
|
Created |
|
10/09/2026
|
4.0.38 |
TRANSACTION-TYPE (FTX.095.388)
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
WAIVER-TYPE|20261001|99991231|05|PMPM Health Home Service Payment |
|
10/09/2026
|
4.0.38 |
ELIGIBILITY-TERMINATION-REASON (ELG.005.095)
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-TERMINATION-REASON|00010101|99991231|17|Lack of verifications (e.g., unable to successfully verify citizenship status, immigration status, income, or other information from an application; if unverifiable due to non-response, document as "Failure to respond) |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-TERMINATION-REASON|00010101|20270630|17|Do not use after 06/30/2027 - Lack of verifications (e.g., unable to successfully verify citizenship status, immigration status, income, or other information from an application; if unverifiable due to non-response, document as "Failure to respond) |
|
10/09/2026
|
4.0.38 |
ELIGIBILITY-TERMINATION-REASON (ELG.005.095)
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-TERMINATION-REASON|00010101|99991231|32|Beneficiary income could not be verified (if unable to verify due to non-response, report with "failure to respond" using valid value '13') |
|
10/09/2026
|
4.0.38 |
ELIGIBILITY-TERMINATION-REASON (ELG.005.095)
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-TERMINATION-REASON|00010101|99991231|33|The individual's iImmigration status or citizenship status could not be verified - or - the individual's immigration status is verified and their status is not satisfactory for full benefits (i.e., IMMIGRATION-STATUS does not equal 2 [CHIPRA 214] or 4 [eligible noncitizen])
If unable to verify due to non-response, report with "failure to respond" using valid value '13' |
|
10/09/2026
|
4.0.38 |
ELIGIBILITY-TERMINATION-REASON (ELG.005.095)
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-TERMINATION-REASON|00010101|99991231|36|Unable to verify other information from a beneficiary's case file (if unable to verify due to non-response, report with "failure to respond" using valid value '13') |
|
10/09/2026
|
4.0.38 |
IMMIGRATION-STATUS (ELG.003.042)
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|99991231|1|Qualified alien |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|20260930|1|Qualified alien|Noncitizen beneficiaries who are qualified noncitizens. Not an applicable immigration status after 9/30/2026. |
|
10/09/2026
|
4.0.38 |
IMMIGRATION-STATUS (ELG.003.042)
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|99991231|2|Lawfully present under CHIPRA 214 |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|99991231|2|Lawfully present under CHIPRA 214|Lawfully present women or children in states that elect to cover under CHIPRA 214. |
|
10/09/2026
|
4.0.38 |
IMMIGRATION-STATUS (ELG.003.042)
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|99991231|3|Eligible only for payment for emergency services|aliens who are either not qualified for Medicaid or who are currently subject to a five year bar. |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|99991231|3|Eligible for payment for emergency Medicaid services only|Noncitizen who is not FFP-eligible, not eligible under CHIPRA 214, or who is currently subject to a five-year waiting period, seven-year limit or 40 quarters requirements in Medicaid only. |
|
10/09/2026
|
4.0.38 |
IMMIGRATION-STATUS (ELG.003.042)
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Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|20261001|99991231|4|Eligible noncitizen|FFP-eligible noncitizen: Lawful Permanent Resident, Cuban/Haitian entrant, or Compact of Free Association (COFA) Migrant.
Use on or after 10/1/2026. |
|
10/09/2026
|
4.0.38 |
IMMIGRATION-STATUS (ELG.003.042)
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|99991231|8|Not Applicable (U.S. citizen or U.S. national) |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
IMMIGRATION-STATUS|00010101|99991231|8|U.S. citizen or U.S. national |
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10/09/2026
|
4.0.38 |
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MANAGED-CARE-PLAN-TYPE | 00010101 | 99991231 | 03 | Enhanced PCCM Provider |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MANAGED-CARE-PLAN-TYPE | 20260101|99991231 | 03 | PCCM Entity |
|
10/09/2026
|
4.0.38 |
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Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MANAGED-CARE-PLAN-OTHER-ID-TYPE | 20260101|99991231 | 03 | Program Name Code | The code value identifying the Medicaid or CHIP managed care program under which the managed care plan operates, as specified in the MANAGED-CARE-PLAN-OTHER-ID-03 Valid Value list. |
|
10/09/2026
|
4.0.38 |
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Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AL030283|Alabama Coordinated Health Network (ACHN) |
|
10/09/2026
|
4.0.38 |
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Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AL030584|Alabama Integrated Care Network (ICN) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AL170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AZ010199|AHCCCS Complete Care (ACC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AZ010193|AHCCCS Complete Care Regional Behavioral Health Agreements (AHCCS ACC-RHBA) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AZ010149-01|Arizona Health Care Cost Containment System (AHCCCS) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AZ010195-02|Arizona Long-Term Care System Developmentally Disabled (ALTCS-DD) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AZ010195-01|Arizona Long-Term Care System Elderly and Physically Disabled (ALTCS-EPD) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AZ010187|Comprehensive Health Plan (CHP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AR020399|PCCM |
|
10/09/2026
|
4.0.38 |
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Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AR010397|CHIP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AR150299|Non-Emergency Transportation (NET) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AR170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|AR011293|Provider Led Arkansas Shared Savings Entity (PASSE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010490|AIDS Healthcare Foundation |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA140299-01|Dental Managed Care/ Los Angeles |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA140299-02|Dental Managed Care/ Sacramento |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA100299|Drug MediCal - Organized Delivery System |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010299|Medi-Cal Managed Care program (MCMC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010298-01|Regional Model |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010298-02|County Operated Health Plans Model (COHS) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010298-03|Geographic Managed Care Model (GMC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010298-04|Two-Plan Model |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010298-05|Single Plan Model |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA080293|Medi-Cal Specialty Mental Health Services (SMHS) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CA010489|SCAN (Senior Care Action Network) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO010299|Accountable Care Collaborative (ACC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO010299-01|MCOs Accountable Care Collaborative |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO010397|Child Health Plan Plus (CHP+) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO140397|Child Health Plan Plus (CHP+) Dental Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO202284|Community First Choice |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO050199|Expanding the Substance Use Disorder Continuum of Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO200592|Home and Community-Based Services Case Management |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO200584|Home and Community-Based Services Wellness Education Benefit |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CO120293|RAE Accountable Care Collaborative |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CT200292|CT Home Care Program for Elders Case Management Freedom of Choice Waiver |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CT201295|CT Housing Engagement & Support Services (CHESS) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|CT200297|EPSDT EIS Qualified Program Waiver |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DE010199|Delaware State Health Plan/Delaware State Health Plan Plus |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DE200299|Pathways to Employment |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DE170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DC010491|Child and Adolescent Supplemental Security Income Program (CASSIP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DC010489|DC Dual Choice D-SNP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DC010399|District of Columbia Healthy Families Program (DCHFP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DC151199|Non-Emergency Medical Transportation |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|DC170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL150299|NEMT |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL010139|D-SNP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL800489-02|FIDE SNP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL800489-01|HIDE SNP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL010184|Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL030183|MomCare |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL010145-01|Statewide Medicaid Managed Care - MMA |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL010397|Statewide Medicaid Managed Care Children’s Medical Services (CMS) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL010145-02|Statewide Medicaid Managed Care – Long-Term Care (LTC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|FL140199|Dental |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|GA010399|Georgia Families |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|GA010387|Georgia Families 360 |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|GA201199|NEMT |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|GA010199|Georgia Pathways to Coverage |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|GA010397|PeachCare for Kids |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|GA050183|Planning 4 Healthy Babies (P4HB) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|HI050190|Community Care Services (CCS) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|HI010199|Hawaii’s QUEST Integration |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ID020399|Healthy Connections |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ID130299|Idaho Behavioral Health Plan (IBHP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ID800289|Idaho Medicaid Plus (IMP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ID140299|Idaho Smiles |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ID800789|Medicare Medicaid Coordinated Plan (MMCP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ID150399|NEMT Broker |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL010399|FIDE-SNP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL010299|HealthChoice Illinois (HCI) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL010287|HealthChoice Illinois - YouthCare |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL010186-02|Illinois Immigrant Adult |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL010186-01|Illinois Immigrant Children |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL010284|Managed Long Term Services and Supports |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL010489|Medicare-Medicaid Alignment Initiative (MMAI) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IL170889|Programs of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN201295|Adult Mental Health and Habilitation (AMHH) and Behavioral and Primary Healthcare Coordination (BPHC) Services (AMHH/BPHC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN200595|Community Integration and Habilitation and Family Supports |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN010199|Healthy Indiana Plan (HIP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN010295|Hoosier Care Connect (HCC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN010391|Hoosier HealthWise (HHW) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN201293|Medicaid Rehabilitation Option Services (MRO) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN010595|PathWays for Aging |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IN170889|The Program of All-Inclusive Care for the Elderly, PACE |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IA140397|CHIP Hawki - Dental |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IA140199|Dental Wellness Plan |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IA010599|Health Link |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|IA170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KS010397|CHIP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KS010299|KanCare |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KS170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KY010288|Kentucky Managed Care Organization Program (KYMCO) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KY150299|KY Human Service Transportation Delivery Program (HSTD) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KY170889|Programs of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KY010287|SKY (Supporting Kentucky Youth) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|KY130185|Team KY |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|LA050599|Coordinated System of Care (CSoc) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|LA140299|Dental Benefit Program (DBP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|LA010599|Healthy Louisiana |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|LA170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ME600999|Accountable Communities |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ME150299|Maine Non-Emergency Transportation (NET) Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ME020399|MaineCare |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MD010199|HealthChoice |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MD170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA010199|Accountable Care Organization Partnership Plan (ACPP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA120199|BH/SUD PIHP (Massachusetts Behavioral Health Partnership (MBHP)) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA010198|MCO Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA600199|MCO-Administered ACO |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA800189|One Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA170889|Plan All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA030199|Primary Care Accountable Care Organization (Primary Care ACO or PCACO) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA020199|Primary Care Clinician Plan (PCC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MA010689|Senior Care Options (SCO) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MI010299|Comprehensive Health Care Program (CHCP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MI010599|Health Link |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MI140291|Healthy Kids Dental (HKD) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MI120693|Managed Specialty Services & Supports |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MI060584|MI Choice |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MI010589|MI Coordinated Health |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MI170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MN200592|Case Management Waiver |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MN010589|Minnesota Senior Care Plus (MSC+) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MN010689|Minnesota Senior Health Options (MSHO) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MN010188|MinnesotaCare |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MN010299|PMAP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MN010495|Special Needs Basic Care (SNBC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MS010399|Mississippi Coordinated Access Network (MississippiCAN) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MS010399-01|Mississippi MS SCAN/CHIP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MS010397|MississippiCHIP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MO010299|MO HealthNet Managed Care Plan |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MO201199|NEMT |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MO170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MT020349|Comprehensive Primary Care Plus (CPC+) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MT020288|Passport to Health |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MT020399|Patient-Centered Medical Home (PCMH) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MT020290|Team Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|MT030382|Tribal Health Improvement Program (T-HIP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NE010397|CHIP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NE010588|Heritage Health |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NE170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NE010199|Substance Use Disorder Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NV140299|Dental Benefits Administration Program (DBA) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NV201199|NEMT |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NV010399|Nevada Mandatory Health Maintenance Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NH010188|Granite Advantage Health Care Program (GAHCP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NH140599|MCM-Dental Services |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NH010299|Medicaid Care Management (MCM) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NJ010189|FIDE-SNP-Duals |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NJ010188|NJ Family Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NJ010194|NJ Family Care Acute Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NJ010184|NJ Family Care MLTSS |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NJ201199|Non-Emergency Medical Transportation (NEMT) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NJ170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NM010199|New Mexico Turquoise Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NM170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY010397|Children’s Health Insurance Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY800189|Fully Integrated Duals Advantage for Individuals with Intellectual & Developmental Disabilities (FIDA-IDD) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY010193|Health and Recovery Plan (HARP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY010190|Human Immunodeficiency Virus Special Needs Plan (HIV SNP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY070184|Managed Long Term Care Partial Cap (MLTC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY010189|Medicaid Advantage Plus (MAP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY010299|Mainstream Managed Care (MMC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NY170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NC010193|BH I/DD Tailored Plan |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NC010199-01|Children and Families Specialty Plan |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NC030399|Community Care of North Carolina (CCNC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NC030382|Eastern Band of Cherokee Indians (EBCI) Tribal Option |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NC120293|Medicaid Direct Behavioral Health PIHP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NC170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|NC010199|Standard Plan |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ND010288|ND Medicaid Expansion |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|ND170889|Program of All-Inclusive Care for the Elderly |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OH010589|MyCare Ohio Opt-Out Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OH800589|MyCare Ohio, Ohio's Integrated Care Delivery System (MCOP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OH010299|Ohio Medicaid Managed Care Program (MMC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OH170889|Ohio Program of All-Inclusive Care for the Elderly (Ohio PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OH050299|Ohio RISE (Resilience through Integrated Systems and Excellence) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OH201295|Recovery Management Services Under the Specialized Recovery Services (SRS) Program (1915(i) HCBS) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OH180299|Single Pharmacy Benefit Manager (SPBM) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK020190|Health Access Network (HAN) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK020192|Health Management Program (HMP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK020187|SoonerCare Choice |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK201199|SoonerRide |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK010291|SoonerSelect Children's Specialty Program (CSP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK140299|SoonerSelect Dental |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OK010287|SoonerSelect Medical |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OR200292|APD Case Management Freedom of Choice Waiver 1915(b)(4) waiver |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OR010199|Coordinated Care Organization (CCO) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OR200295|Office of Developmental Disabilities Service Selective Contracting 1915(b)(4) Waiver |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|OR170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PA050490|Adult Community Autism Program (ACAP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PA120299|Behavioral Health HealthChoices (BH-HC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PA010397|Children's Health Insurance Program (CHIP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PA010595|Community HealthChoices (CHC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PA170889|Living Independence for the Elderly (LIFE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PA151199|Medical Assistance Transportation Program (MATP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PA010299|Physical Health HealthChoices (PH-HC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PR010489|Platino: Dual-Special Needs Plan (D-SNP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|PR010499|The Vital Government Health Plan |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|RI010191|Children and Youth With Special Health Care Needs (CYSHCN) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|RI010397|CHIP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|RI010199|Medicaid Managed Care Program (Rhode Island) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|RI150399|Medical Transportation Management (MTM) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|RI800189-01|Rhode Island Medicaid Managed Care Fully Integrated Dual Special Needs Plan Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|RI170889|RI Medicaid PACE Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|RI140191|RIteSmiles Program (Rhode Island) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SC010399|Healthy Connections Choices |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SC010689|Healthy Connections Prime |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SC150399|NEMT |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SC200599|Palmetto Coordinated System of Care Waiver (PCSC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SC170889|Program For All-Inclusive Care Of The Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SC020791|South Carolina Medical Homes Network (MHN) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SD020983|Pregnancy Primary Care Case Management |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|SD020399|Primary Care Provider Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TN010391|CoverKids Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TN180188|Pharmacy Benefits Management |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TN170889|Program of All-Inclusive Care for the Elderly |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TN010199|TennCare |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TN140199|TennCare Dental |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TN050199|TennCare Select |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010397-01|CHIP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010396|CHIP Rural Service Area (CHIP RSA) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010397-02|CHIP UMCC |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX140191|Dental (Children's Medicaid Dental Services) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010189|D-SNP |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX800189|Dual Demonstration Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010199|STAR |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010487|STAR Health |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010191|STAR Kids |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX200195|STAR PLUS UMCC |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX010195|STAR+PLUS |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|TX200199|Uniform Managed Care Program (UMCC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT200299|Transportation |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT140397|UT CHIP Dental |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT010397|UT CHIP Medical |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT140299|UT Medicaid Dental |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT120293|UT Prepaid Mental Health Plan |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT010495|Utah Healthy Outcomes for Medical Excellence (HOME) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT010299|Utah Medicaid ACO |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|UT010188|Utah Medicaid Integrated Care (UMIC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|VT010199|Vermont Global Commitment to Health |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|VA010599|Cardinal Care Managed Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|VA010149|FAMIS |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|VA170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WA010186|Apple Health Expansion Emergency Managed Care for Non-Citizen Adults |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WA010487|Apple Health Integrated Foster Care (IFC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WA010299|Apple Health Integrated Managed Care (IMC) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WA120299|Behavioral Health Only Services (BHSO) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WA202295|Consumer Directed Employer (CDE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WA170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WA020382|Tribal PCCM |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WV010599|Mountain Health Promise (MHP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WV010299|Mountain Health Trust (MHT) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WV201199|Non-Emergency Medical Transportation (NEMT) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WV010397|WVCHIP (WVCHIP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WI010199|BadgerCare Plus (BCP) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WI051091|Care 4 Kids |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WI200591|Children's Long-Term Services and Supports Program |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WI050599|Family Care |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WI010799|Family Care Partnership |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WI170889|Program of All-Inclusive Care for the Elderly (PACE) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WI010395|SSI Managed Care (SSI) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WY020399|Primary Care Medical Home (PCMH) |
|
10/09/2026
|
4.0.38 |
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MCR.101.119|20261001|99991231|WY060291|Wyoming Medicaid's Care Management Entity (CME) |
|
02/27/2026
|
4.0.28 |
FTX.095.388
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TRANSACTION-TYPE|01/01/2026|12/31/9999|03|Direct reimbursement to Bene for retroactive period cost (e.g. 42 CFR 447.25) |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TRANSACTION-TYPE|01/01/2026|12/31/9999|03|Direct reimbursement to beneficiaries for retroactive period cost (e.g. 42 CFR 447.25) |
|
02/27/2026
|
4.0.28 |
FTX.095.388
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TRANSACTION-TYPE|01/01/2026|12/31/9999|04|Direct reimbursement to Bene for non-emergency transportation |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TRANSACTION-TYPE|01/01/2026|12/31/9999|04|Direct reimbursement to beneficiaries for non-emergency transportation |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21|Child Health Expenditures by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21.11|Summary Total of Receipts from Form CMS 21.11A |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.1|Summary Sheet |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.11|Summary Total of Receipts from Form CMS 64.11a |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21|Quarterly MAP Payments for CHIP Categories |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21.11A|Actual Receipts by Plan Name |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21AD|21 REMAP Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21BASE|Children's Health Expenditures By Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21C|CHIP Fiscal Year Allotment |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21L|Calculation of 10% Limit |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21LSUB|Form CMS-21L Outreach Allowance |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21NARR|Narrative Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21O|Children's Health Expenditures For the Title XXI Program Overpayment Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21OMEQC|Children's Health Expenditures For the Title XXI Program Overpayment Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21P|Child Health Expenditures by Type of Service for Title XXI Program |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21PAD|21 REMAP Waiver P |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21PERM|Child Health Expenditures by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21PWAIVER|Child Health Waivers by Type of Service for Title XXI Program |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21Summary|Summary of CMS 21 |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21T.TRACK|20% Medicaid Allowance |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|21WAIVER|Child Health Waivers by Type Of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10200K|Quarterly Expenditures for State & Local Administration - 200K |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10BASE|Quarterly Expenditures for State & Local Administration |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10I|Quarterly Expenditures for State & Local Administration |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10P|Prior Period Adjustments for Lines 7, 8, 10A, 10B |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10P200K|Prior Period Adjustments for Lines 7, 8, 10A, 10B - 200K |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10PI|Prior Period Adjustments for Lines 7, 8, 10A, 10B |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10WAIV|64.10 Waivers |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.10WAIVP|Waiver Prior Period Adjustments for Lines 7, 8, 10A, 10B |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.1108CAP|Quarterly Medicaid Statement of Expenditures For the Medical Assistance Program Summary Sheet |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.11A|Actual Receipts by Plan Name |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21P|Prior Period MAP Adjustments for CHIP Categories |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21U|Child Health Expenditures by Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21U114|Child Health Expenditures by Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21U115|Child Health Expenditures by Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21U200K|Child Health Expenditures by Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UP|Child Health Expenditures by Service - Prior Period |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UP114|Child Health Expenditures by Service - Prior Period |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UP115|Child Health Expenditures by Service - Prior Period |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UP200K|Child Health Expenditures by Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UPWAV|Child Health Expenditures by Service - Prior Period Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UPWAV114|Child Health Expenditures by Service - Prior Period Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UPWAV115|Child Health Expenditures by Service - Prior Period Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UWAIV|Child Health Expenditures by Service - Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UWAIV114|Child Health Expenditures by Service - Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21UWAIV115|Child Health Expenditures by Service - Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21WAIV|Waiver Quarterly MAP Payments for CHIP Categories |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.21WAIVP|Waiver Prior Period MAP Adjustments for CHIP Categories |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9200K|Medical Assistance Expenditures by Type of Service 200K |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9200KP|Medical Assistance Expenditures by Type of Service 200KP |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9A|Third Party Liability Collections and Cost Avoidance |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9ARPSection9817|ARP 9817 HCBS |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9BASE|Medical Assistance Expenditures by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9C1|Fraud, Waste & Abuse Recoveries From State Medicaid Program Integrity Activities |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9C1F|Fraud, Waste & Abuse Recoveries From State Medicaid Program Integrity Activities |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9C2|Recoveries From OIG State Compliant Fraud Claims Act |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9D|DSH Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9E|Medical Assistance Expenditures Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9EP|Medical Assistance Expenditures Eligibility Form for Prior Period Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9EPWAIV|Waiver for Medical Assistance Expenditures Eligibility Form for Prior Period Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9EWAIV|Waiver for Medical Assistance Expenditures Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9I|Medical Assistance Expenditures by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9I.DSHDIV.WAIV|DSH Diversion Waiver for Medical Assistance Payments by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9I.VIII|Medical Assistance Expenditures by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9O|Medicaid Overpayment Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9OARRA|Medicaid Overpayment Adjustments - ARRA Portion |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9OFWA|Fraud, Waste & Abuse Amounts Overpayments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9OMEQC|Medicaid Eligibility Quality Control Collections and Overpayment |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9OPerm|Medicaid Overpayment Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9ORAC|Medicaid Overpayment Adjustments for RAC |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9P|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9PE|Medical Assistance Expenditures PE Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9PEP|Medical Assistance Expenditures PE Eligibility Form for Prior Period Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9PEPWAIV|Waiver for Medical Assistance Expenditures PE Eligibility Form for Prior Period Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9PEWAIV|Waiver for Medical Assistance Expenditures PE Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9PI|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9PI.DSHDIV.WAIV|DSH Diversion Waiver for MAP Prior Period Adjustments for Line 7, 8, 10A, 10B |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9PI.VIII|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9QI|QI Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9R|Drug Rebate Schedule |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9SAP|Support Act Section 1003 Payment |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9T|Medical Assistance Expenditures by Type of Service Applied Against the CHIP Amount |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9TP|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B Applied Against the CHIP Amount |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9TPWAIV|Line 7, 8, 10A, 10B Waiver MAP Prior Period Adjustments Applied Against the CHIP Amount |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9TWAIV|Waivers for Medical Assistance Payments by Type of Service Applied Against the CHIP Amount |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9VIII|Medical Assistance Expenditures Newly Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9VIII.P|MAP Prior Period Adjustments for Line 7, 8, 10A, 10B Newly Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9VIII.WAIV|Waivers for Medical Assistance Expenditures Newly Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9VIII.WAIV.P|Waiver for Prior Period Adjustments for Line 7, 8, 10A, 10B Newly Eligibility Form |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9VIIIARPSection9817|ARP Section 9817 - VIII Group |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9WAIV|Waivers for Medical Assistance Payments by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9WAIV.DSH|Waivers for Medical Assistance Payments by Type of Service |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9WAIV.P|Line 7, 8, 10A, 10B Waiver MAP Prior Period Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.9WAIV.P.DSH|Line 7, 8, 10A, 10B DHS Diversion Waiver MAP Prior Period Adjustments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.ENROLL|Medicaid Enrollees |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.F|Medicaid Statement of Expenditures Summary Sheet |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.REH|Midical Assistance Expenditures by Type of Service for Rehabilitation Services |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.S9RAC|RAC Collection |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.SCH|Midical Assistance Expenditures by Type of Service for School-Based Services |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.SPV.NARR|Supplemental Payment Validation Narrative |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.SPV.PAYMENTS|Supplemental Payment Validation Payments |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|64.SPV.PROVIDERSUBMISSION|Supplemental Payment Validation Providers |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|HCBS.1915c|Midical Assistance Expenditures by Type of Service for 1915(c) HCBS Waiver |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|HCBS.1915i|Midical Assistance Expenditures by Type of Service for 1915(i) HCBS Supplemental Benefit Package |
N/A |
|
02/13/2026
|
4.0.27 |
MBESCBES-FORM
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORM|01/01/2026|12/31/9999|HCBS.1915j|Midical Assistance Expenditures by Type of Service for 1915(j) Self-Directed Personal Assistance Services State Plan Option |
N/A |
|
06/20/2025
|
4.0.11 |
NCD-UNIT-OF-MEASURE
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
NDC-UNIT-OF-MEASURE|00010101|99991231|EA|Each |
|
06/20/2025
|
4.0.11 |
NCD-UNIT-OF-MEASURE
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
NDC-UNIT-OF-MEASURE|00010101|99991231|GM|Grams |
|
06/20/2025
|
4.0.11 |
COVERAGE-TYPE
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|02|Professional (Physician) Visit -- Office |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|02|Professional (Physician) Visit-Office |
|
06/20/2025
|
4.0.11 |
COVERAGE-TYPE
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|12|Mental health -inpatient |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|12|Mental health-inpatient |
|
06/20/2025
|
4.0.11 |
COVERAGE-TYPE
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|13|Psychiatric care- outpatient |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|13|Psychiatric care-outpatient |
|
06/20/2025
|
4.0.11 |
COVERAGE-TYPE
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|14|Psychiatric care- inpatient |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
COVERAGE-TYPE|00010101|99991231|14|Psychiatric care-inpatient |
|
06/20/2025
|
4.0.11 |
ACCREDITATION-ORGANIZATION
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ACCREDITATION-ORGANIZATION|00010101|99991231|13|National committee for quality assurance-- accredited |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ACCREDITATION-ORGANIZATION|00010101|99991231|13|National committee for quality assurance - accredited |
|
06/20/2025
|
4.0.11 |
ACCREDITATION-ORGANIZATION
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ACCREDITATION-ORGANIZATION|00010101|99991231|14|National committee for quality assurance - interim |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ACCREDITATION-ORGANIZATION|00010101|99991231|14|National committee for quality assurance - interim |
|
06/20/2025
|
4.0.11 |
ACCREDITATION-ORGANIZATION
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ACCREDITATION-ORGANIZATION|00010101|99991231|15|National committee for quality assurance - denied |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ACCREDITATION-ORGANIZATION|00010101|99991231|15|National committee for quality assurance - denied |
|
06/20/2025
|
4.0.11 |
ELIGIBILITY-GROUP
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-GROUP|00010101|99991231|73|Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible for non 1905z(3) states |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-GROUP|00010101|99991231|73|Adult Group - Individuals at or below 133% FPL Age 19 through 64 - not newly eligible for non 1905z(3) states |
|
06/20/2025
|
4.0.11 |
ELIGIBILITY-GROUP
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-GROUP|00010101|99991231|75|Adult Group - Individuals at or below 133% FPL Age 19 through 64- not newly eligible non-parent/ caretaker-relative(s) in 1905z(3) states |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
ELIGIBILITY-GROUP|00010101|99991231|75|Adult Group - Individuals at or below 133% FPL Age 19 through 64 - not newly eligible non-parent/ caretaker-relative(s) in 1905z(3) states |
|
06/20/2025
|
4.0.11 |
TYPE-OF-SERVICE-OT
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TYPE-OF-SERVICE-OT|00010101|99991231|071|HCBS - Training for family members |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TYPE-OF-SERVICE-OT|00010101|99991231|071|HCBS - Training for family members |
|
06/20/2025
|
4.0.11 |
TYPE-OF-SERVICE-OT
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TYPE-OF-SERVICE-OT|00010101|99991231|072|HCBS - Minor modification to the home |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TYPE-OF-SERVICE-OT|00010101|99991231|072|HCBS - Minor modification to the home |
|
06/20/2025
|
4.0.11 |
TYPE-OF-SERVICE
|
Update |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TYPE-OF-SERVICE|00010101|99991231|146|Inpatient Psychiatric Services for beneficiaries between the ages of 22 and 64 who receive services in an institution for mental disease (IMD) |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
TYPE-OF-SERVICE|00010101|99991231|146|Inpatient Psychiatric Services for beneficiaries between the ages of 21 and 64 who receive services in an institution for mental disease (IMD). |
|
06/20/2025
|
4.0.11 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION
MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9VIII WAIVER|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Prior Period Expenditures |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9BASE|Medical Assistance Expenditures by Type of Service |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9 WAIVER|Medical Assistance Expenditures by Type of Service |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9P|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9P Waiver|Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program, Prior Period Adjustment |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9 200K|Medical Assistance Expenditures by Type of Service |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9P 200K|Medical Assistance Expenditures by Type of Service for the Medical Assistance Program Prior Period Adjustments in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9I|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PI|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9TP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9TP WAIVER|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PE|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PEP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PEPWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9PEWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9E|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EPWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9VIII|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9VIIIP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9VIIIP Waiver|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9E|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EP|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EPWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9EWAIV|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-1
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-1|00010101|99991231|CMS 64.9T|Medical Assistance Expenditures by Type of Service For the Medical Assistance Program Expenditures in This Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21U|Child Health Expenditures by Service |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21 WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21U WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Expenditure Categories |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21P|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21P WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21UP|Quarterly Medical Assistance Expenditures by Children’s Health Insurance Program expenditure categories |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-2
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-2|00010101|99991231|CMS 64.21UP WAIVER|Quarterly Medical Assistance Expenditures By Children's Health Insurance Program Prior Period Expenditures |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21BASE|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21P|Quarterly Children's Health Insurance Program |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21 WAIVER|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |
|
04/25/2025
|
4.0.7 |
MBESCBES-FORMGP-3
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION MBESCBES-FORMGP-3|00010101|99991231|CMS 21PWAIVER|Children's Health Expenditures by Type of Service For the Title XXI Program Expenditures in this Quarter |
|
03/12/2025
|
4.0.4 |
ELIGIBILITY-GROUP (ELG087)
|
Add |
Data Dictionary - Valid Values |
N/A |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ELIGIBILITY-GROUP | 20250301 | 99991231 | 77 | Other optional eligibility for reasonable classifications of children under 21 |
|
03/12/2025
|
4.0.4 |
ADDR-COUNTY (ELG072)
|
Delete |
Data Dictionary - Valid Values |
VALUE_SET_ID|EFFECTIVE_DATE|END_DATE|VALUE|NAME|DESCRIPTION ADDR-COUNTY | 01/01/0001 | 12/31/9999 | 113 | Shannon County, South Dakota | |
N/A |
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