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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

CHECK-NUM

Data Element

DE Number

CLT057

System DE Number

CLT.002.057

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition The check or electronic funds transfer number.
Size X(15)
FLF Start Position 225
FLF Stop Position 239
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 15 characters or less
2. Value must have an associated Check Effective Date
3. Value must not contain a pipe or asterisk symbols
4. Situational
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP105 CIP.002.105 CHECK-NUM CIP00002 CLAIM-HEADER-RECORD-IP
COT042 COT.002.042 CHECK-NUM COT00002 CLAIM-HEADER-RECORD-OT
CRX033 CRX.002.033 CHECK-NUM CRX00002 CLAIM-HEADER-RECORD-RX
FTX027 FTX.002.027 CHECK-NUM FTX00002 INDIVIDUAL-CAPITATION-PMPM
FTX074 FTX.003.074 CHECK-NUM FTX00003 INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX115 FTX.004.115 CHECK-NUM FTX00004 GROUP-INSURANCE-PREMIUM-PAYMENT
FTX159 FTX.005.159 CHECK-NUM FTX00005 COST-SHARING-OFFSET
FTX202 FTX.006.202 CHECK-NUM FTX00006 VALUE-BASED-PAYMENT
FTX246 FTX.007.246 CHECK-NUM FTX00007 STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX289 FTX.008.289 CHECK-NUM FTX00008 COST-SETTLEMENT-PAYMENT
FTX328 FTX.009.328 CHECK-NUM FTX00009 FQHC-WRAP-PAYMENT
FTX367 FTX.095.367 CHECK-NUM FTX00095 MISCELLANEOUS-PAYMENT