CLT.002.244

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TMSIS Dataguide

Medicaid.gov

Version:

BILLING-PROV-ADDR-LN-1

Data Element

DE Number

CLT244

System DE Number

CLT.002.244

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	Billing provider address line 1 from X12 837I loop 2010AA.
Size	X(60)
FLF Start Position	1184
FLF Stop Position	1243
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must not be more than 60 characters long 2. Mandatory 3. Value must not contain a pipe or asterisk symbols

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

RULE ID	RULE Definition
RULE-8889	if a claim is a non-denied claim from a LT file, then the billing provider address line 1 value reported must be compatible with the specified T-MSIS picture format: X(60).
RULE-9175	if the CLAIM-HEADER-RECORD-LT segment is populated from a CLT file, then the BILLING-PROV-ADDR-LN-1 must be populated for non-denied claims.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP298	CIP.002.298	BILLING-PROV-ADDR-LN-1	CIP00002	CLAIM-HEADER-RECORD-IP
COT236	COT.002.236	BILLING-PROV-ADDR-LN-1	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.002.244	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.244	ADD	N/A		Created