CLT.002.253

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TMSIS Dataguide

Medicaid.gov

Version:

SERVICE-FACILITY-LOCATION-STATE

Data Element

DE Number

CLT253

System DE Number

CLT.002.253

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 state code from X12 837I loop 2310E.
Size	X(2)
FLF Start Position	1501
FLF Stop Position	1502
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. Conditional

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

RULE ID	RULE Definition
RULE-8898	if a claim is a non-denied claim from a LT file, then the service facility location state value reported must be compatible with the specified T-MSIS picture format: X(2).
RULE-9078	if the service facility location state is populated on a non-denied claim header from a LT file, then the service facility location state value reported must be found in the list of valid values for 'STATE'

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP307	CIP.002.307	SERVICE-FACILITY-LOCATION-STATE	CIP00002	CLAIM-HEADER-RECORD-IP
COT245	COT.002.245	SERVICE-FACILITY-LOCATION-STATE	COT00002	CLAIM-HEADER-RECORD-OT
COT262	COT.003.262	SERVICE-FACILITY-LOCATION-STATE	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.002.253	UPDATE	File segment	None	30
09/16/2024	4.0.0	CLT.002.253	ADD	N/A		Created