CLT.002.250

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TMSIS Dataguide

Medicaid.gov

Version:

SERVICE-FACILITY-LOCATION-ADDR-LN-1

Data Element

DE Number

CLT250

System DE Number

CLT.002.250

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	Service facility location address line 1 from X12 837I loop 2310E.
Size	X(60)
FLF Start Position	1353
FLF Stop Position	1412
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must not be more than 60 characters long 2. Conditional 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-8895	if a claim is a non-denied claim from a LT file, then the service facility location address line 1 value reported must be compatible with the specified T-MSIS picture format: X(60).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP304	CIP.002.304	SERVICE-FACILITY-LOCATION-ADDR-LN-1	CIP00002	CLAIM-HEADER-RECORD-IP
COT242	COT.002.242	SERVICE-FACILITY-LOCATION-ADDR-LN-1	COT00002	CLAIM-HEADER-RECORD-OT
COT259	COT.003.259	SERVICE-FACILITY-LOCATION-ADDR-LN-1	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.002.250	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.250	ADD	N/A		Created