CLT.002.056

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TMSIS Dataguide

Medicaid.gov

Version:

SOURCE-LOCATION

Data Element

DE Number

CLT056

System DE Number

CLT.002.056

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

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.
Size	X(2)
FLF Start Position	223
FLF Stop Position	224
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 2 characters 2. Value must be in Source Location List (VVL) 3. Mandatory

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

RULE ID	RULE Definition
RULE-6816	The format for SOURCE-LOCATION on a non-denied LT claim was expected to be submitted as X(2).
RULE-955	If the source location is populated on a non-denied claim from an LT file, then the source location value reported must be in the list of valid values for 'source location'.

Measure ID	Measure Name
ALL-38-001-1	Source Location

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP104	CIP.002.104	SOURCE-LOCATION	CIP00002	CLAIM-HEADER-RECORD-IP
COT041	COT.002.041	SOURCE-LOCATION	COT00002	CLAIM-HEADER-RECORD-OT
CRX032	CRX.002.032	SOURCE-LOCATION	CRX00002	CLAIM-HEADER-RECORD-RX
FTX054	FTX.002.054	SOURCE-LOCATION	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX098	FTX.003.098	SOURCE-LOCATION	FTX00003	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX142	FTX.004.142	SOURCE-LOCATION	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX185	FTX.005.185	SOURCE-LOCATION	FTX00005	COST-SHARING-OFFSET
FTX227	FTX.006.227	SOURCE-LOCATION	FTX00006	VALUE-BASED-PAYMENT
FTX271	FTX.007.271	SOURCE-LOCATION	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX311	FTX.008.311	SOURCE-LOCATION	FTX00008	COST-SETTLEMENT-PAYMENT
FTX350	FTX.009.350	SOURCE-LOCATION	FTX00009	FQHC-WRAP-PAYMENT
FTX399	FTX.095.399	SOURCE-LOCATION	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
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.
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 = â€œ23â€ 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	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 = â€ś23â€ť 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 = â€œ23â€ to indicate that the sub-capitated network provider provided the service directly to the enrollee.
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 = â€ś23â€ť to indicate that the sub-capitated network provider provided the service directly to the enrollee.
09/16/2024	4.0.0	CLT.002.056	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.056	ADD	N/A		Created