CLT.002.086

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TMSIS Dataguide

Medicaid.gov

Version:

MEDICAID-COV-INPATIENT-DAYS

Data Element

DE Number

CLT086

System DE Number

CLT.002.086

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 number of inpatient psychiatric days covered by Medicaid on this claim.
Size	S9(5)
FLF Start Position	404
FLF Stop Position	408
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be a positive integer 2. Value must be between 00000:99999 (inclusive) 3. Conditional 4. 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 day 5. Value must be 5 digits or less Value is required if the associated Type of Service (CLT.003.211) in [044,048,050] (inpatient mental health/psychiatric services)

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

RULE ID	RULE Definition
RULE-1011	If a non-denied LT claim has a value populated for non covered days, medicaid covered inpatient days and a value populated for beginning date of service and ending date of service, then the sum of the covered days of service is less than or equal to the number of days between the claim beginning and end dates of service, plus one day.
RULE-1013	If a claim is a non-denied claim from an LT file, then the medicaid covered inpatient days value reported must be compatible with specified T-MSIS picture format: S9(5).

Measure ID	Measure Name
MCR-5-015-2	% of claim headers with TYPE-OF-SERVICE = 44 (inpatient hospital services for individuals aged 65+ for mental diseases) without inpatient days
MIS-81-027-27	% missing: MEDICAID-COV-INPATIENT-DAYS (CLT00002)
MIS-23-027-27	% missing: MEDICAID-COV-INPATIENT-DAYS (CLT00002)
MIS-4-025-25	% missing: MEDICAID-COV-INPATIENT-DAYS (CLT00002)
MCR-7-019-7	% of claim headers with TYPE-OF-SERVICE = 50 (inpatient and residential substance abuse) without inpatient days
MCR-7-018-6	% of claim headers with TYPE-OF-SERVICE = 48 (inpatient psychiatric services for individuals under age 21) without inpatient days
MCR-7-014-2	% of claim headers with TYPE-OF-SERVICE = 44 (inpatient hospital services for individuals aged 65+ for mental diseases) without inpatient days
MCR-7-011-19	Average # of long-term care days, exclude 0
MCR-5-020-7	% of claim headers with TYPE-OF-SERVICE = 50 (inpatient and residential substance abuse) without inpatient days
MCR-5-019-6	% of claim headers with TYPE-OF-SERVICE = 48 (inpatient psychiatric services for individuals under age 21) without inpatient days
FFS-5-011-29	Average # of long-term care days, exclude 0
MCR-5-011-20	Average # of long-term care days, exclude 0
FFS-7-019-7	% of records with TYPE-OF-SERVICE = 50 (Inpatient and residential substance abuse) without IP days
FFS-7-018-6	% of records with TYPE-OF-SERVICE = 48 (Inpatient psychiatric services under 21) without IP days
FFS-7-014-2	% of records with TYPE-OF-SERVICE = 44 (Inpatient Hospital Services for Individuals age 65+ for mental diseases) without IP days
FFS-7-011-19	Average # of long-term care days, exclude 0
FFS-5-027-7	% of claim headers with TYPE-OF-SERVICE = 50 (inpatient and residential substance abuse) without inpatient days
FFS-5-025-6	% of claim headers with TYPE-OF-SERVICE = 48 (inpatient psychiatric services for individuals under age 21) without inpatient days
FFS-5-017-2	% of claim headers with TYPE-OF-SERVICE = 44 (inpatient hospital services for individuals age 65 or older for mental diseases) without inpatient days

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP136	CIP.002.136	MEDICAID-COV-INPATIENT-DAYS	CIP00002	CLAIM-HEADER-RECORD-IP

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
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)
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
09/16/2024	4.0.0	CLT.002.086	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.086	ADD	N/A		Created