CLT.002.247

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TMSIS Dataguide

Medicaid.gov

Version:

BILLING-PROV-STATE

Data Element

DE Number

CLT247

System DE Number

CLT.002.247

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 state code from X12 837I loop 2010AA.
Size	X(2)
FLF Start Position	1332
FLF Stop Position	1333
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must not be more than 2 characters 2. Value must be in State Code 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-8892	if a claim is a non-denied claim from a LT file, then the billing provider state value reported must be compatible with the specified T-MSIS picture format: X(2).
RULE-9081	if the billing provider state is populated on a non-denied claim header from a LT file, then the billing provider state value reported must be found in the list of valid values for 'STATE'
RULE-9177	if the CLAIM-HEADER-RECORD-LT segment is populated from a CLT file, then the BILLING-PROV-STATE must be populated for non-denied claims.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP301	CIP.002.301	BILLING-PROV-STATE	CIP00002	CLAIM-HEADER-RECORD-IP
COT239	COT.002.239	BILLING-PROV-STATE	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.002.247	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.247	ADD	N/A		Created