CLT.003.185

SUBMITTING-STATE

Data Element

DE Number

CLT185

System DE Number

CLT.003.185

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00003

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received.
Size	X(2)
FLF Start Position	9
FLF Stop Position	10
Segment Key Field Identifier	1
Coding Requirements	1. Value must be 2 characters 2. Value must be in State Code List (VVL) 3. Mandatory 4. Value must be the same as Submitting State (CLT.001.007)

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

RULE ID	RULE Definition
RULE-1197	If the submitting state is populated on a non-denied claim line from an LT file, then the submitting state reported must be found in the list of valid values.
RULE-1198	If submitting state is populated on a claim line LT segment, then the submitting state reported on the claim line LT segment must match the submitting state on the LT file header.
RULE-1204	All non-denied LT claim line records must have a corresponding parent record.
RULE-1246	If the servicing provider number is populated on a non-denied claim from the LT file, then either the servicing provider number value reported must be equal to a provider identifier value reported with a provider identifier type value for state-assigned Medicaid provider identifiers on a provider identifiers segment from a PRV file where the effective and end dates of the provider identifiers segment overlap with the beginning date of service and (if populated) ending date of service on the claim line OR the servicing provider number value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the beginning date of service and (if populated) ending date of service on the claim line.
RULE-6381	If an LT claim line, the submitting state value must be specified in the T-MSIS picture format: X(2).
RULE-7188	If a claim line is from an LT file, then submitting state, original ICN, adjustment ICN, adjudication date, line adjustment indicator, original line ICN, and adjustment line ICN values reported must be unique across all LT claim lines.
RULE-7575	All denied LT claim line records must have a corresponding claim header record.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP007	CIP.001.007	SUBMITTING-STATE	CIP00001	FILE-HEADER-RECORD-IP
CIP017	CIP.002.017	SUBMITTING-STATE	CIP00002	CLAIM-HEADER-RECORD-IP
CIP232	CIP.003.232	SUBMITTING-STATE	CIP00003	CLAIM-LINE-RECORD-IP
CIP323	CIP.004.323	SUBMITTING-STATE	CIP00004	CLAIM-DX-IP
CLT007	CLT.001.007	SUBMITTING-STATE	CLT00001	FILE-HEADER-RECORD-LT
CLT017	CLT.002.017	SUBMITTING-STATE	CLT00002	CLAIM-HEADER-RECORD-LT
CLT269	CLT.004.269	SUBMITTING-STATE	CLT00004	CLAIM-DX-LT
COT007	COT.001.007	SUBMITTING-STATE	COT00001	FILE-HEADER-RECORD-OT
COT017	COT.002.017	SUBMITTING-STATE	COT00002	CLAIM-HEADER-RECORD-OT
COT155	COT.003.155	SUBMITTING-STATE	COT00003	CLAIM-LINE-RECORD-OT
COT275	COT.004.275	SUBMITTING-STATE	COT00004	CLAIM-DX-OT
CRX007	CRX.001.007	SUBMITTING-STATE	CRX00001	FILE-HEADER-RECORD-RX
CRX017	CRX.002.017	SUBMITTING-STATE	CRX00002	CLAIM-HEADER-RECORD-RX
CRX109	CRX.003.109	SUBMITTING-STATE	CRX00003	CLAIM-LINE-RECORD-RX
CRX197	CRX.004.197	SUBMITTING-STATE	CRX00004	CLAIM-DX-RX
ELG007	ELG.001.007	SUBMITTING-STATE	ELG00001	FILE-HEADER-RECORD-ELIGIBILITY
ELG017	ELG.002.017	SUBMITTING-STATE	ELG00002	PRIMARY-DEMOGRAPHICS-ELIGIBILITY
ELG031	ELG.003.031	SUBMITTING-STATE	ELG00003	VARIABLE-DEMOGRAPHICS-ELIGIBILITY
ELG062	ELG.004.062	SUBMITTING-STATE	ELG00004	ELIGIBLE-CONTACT-INFORMATION
ELG080	ELG.005.080	SUBMITTING-STATE	ELG00005	ELIGIBILITY-DETERMINANTS
ELG104	ELG.006.104	SUBMITTING-STATE	ELG00006	HEALTH-HOME-SPA-PARTICIPATION-INFORMATION
ELG115	ELG.007.115	SUBMITTING-STATE	ELG00007	HEALTH-HOME-SPA-PROVIDERS
ELG127	ELG.008.127	SUBMITTING-STATE	ELG00008	HEALTH-HOME-CHRONIC-CONDITIONS
ELG137	ELG.009.137	SUBMITTING-STATE	ELG00009	LOCK-IN-INFORMATION
ELG147	ELG.010.147	SUBMITTING-STATE	ELG00010	MFP-INFORMATION
ELG160	ELG.011.160	SUBMITTING-STATE	ELG00011	STATE-PLAN-OPTION-PARTICIPATION
ELG169	ELG.012.169	SUBMITTING-STATE	ELG00012	WAIVER-PARTICIPATION
ELG179	ELG.013.179	SUBMITTING-STATE	ELG00013	LTSS-PARTICIPATION
ELG189	ELG.014.189	SUBMITTING-STATE	ELG00014	MANAGED-CARE-PARTICIPATION
ELG201	ELG.015.201	SUBMITTING-STATE	ELG00015	ETHNICITY-INFORMATION
ELG210	ELG.016.210	SUBMITTING-STATE	ELG00016	RACE-INFORMATION
ELG221	ELG.017.221	SUBMITTING-STATE	ELG00017	DISABILITY-INFORMATION
ELG230	ELG.018.230	SUBMITTING-STATE	ELG00018	1115A-DEMONSTRATION-INFORMATION
ELG239	ELG.020.239	SUBMITTING-STATE	ELG00020	HCBS-CHRONIC-CONDITIONS-NON-HEALTH-HOME
ELG249	ELG.021.249	SUBMITTING-STATE	ELG00021	ENROLLMENT-TIME-SPAN-SEGMENT
ELG258	ELG.022.258	SUBMITTING-STATE	ELG00022	ELG-IDENTIFIERS
FTX007	FTX.001.007	SUBMITTING-STATE	FTX00001	FILE-HEADER-RECORD-FTX
FTX018	FTX.002.018	SUBMITTING-STATE	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX065	FTX.003.065	SUBMITTING-STATE	FTX00003	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX106	FTX.004.106	SUBMITTING-STATE	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX150	FTX.005.150	SUBMITTING-STATE	FTX00005	COST-SHARING-OFFSET
FTX193	FTX.006.193	SUBMITTING-STATE	FTX00006	VALUE-BASED-PAYMENT
FTX237	FTX.007.237	SUBMITTING-STATE	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX280	FTX.008.280	SUBMITTING-STATE	FTX00008	COST-SETTLEMENT-PAYMENT
FTX319	FTX.009.319	SUBMITTING-STATE	FTX00009	FQHC-WRAP-PAYMENT
FTX358	FTX.095.358	SUBMITTING-STATE	FTX00095	MISCELLANEOUS-PAYMENT
MCR007	MCR.001.007	SUBMITTING-STATE	MCR00001	FILE-HEADER-RECORD-MANAGED-CARE
MCR017	MCR.002.017	SUBMITTING-STATE	MCR00002	MANAGED-CARE-MAIN
MCR035	MCR.003.035	SUBMITTING-STATE	MCR00003	MANAGED-CARE-LOCATION-AND-CONTACT-INFO
MCR055	MCR.004.055	SUBMITTING-STATE	MCR00004	MANAGED-CARE-SERVICE-AREA
MCR064	MCR.005.064	SUBMITTING-STATE	MCR00005	MANAGED-CARE-OPERATING-AUTHORITY
MCR074	MCR.006.074	SUBMITTING-STATE	MCR00006	MANAGED-CARE-PLAN-POPULATION-ENROLLED
MCR083	MCR.007.083	SUBMITTING-STATE	MCR00007	MANAGED- CARE-ACCREDITATION-ORGANIZATION
MCR115	MCR.010.115	SUBMITTING-STATE	MCR00010	MANAGED-CARE-ID
PRV007	PRV.001.007	SUBMITTING-STATE	PRV00001	FILE-HEADER-RECORD-PROVIDER
PRV017	PRV.002.017	SUBMITTING-STATE	PRV00002	PROV-ATTRIBUTES-MAIN
PRV040	PRV.003.040	SUBMITTING-STATE	PRV00003	PROV-LOCATION-AND-CONTACT-INFO
PRV061	PRV.004.061	SUBMITTING-STATE	PRV00004	PROV-LICENSING-INFO
PRV073	PRV.005.073	SUBMITTING-STATE	PRV00005	PROV-IDENTIFIERS
PRV085	PRV.006.085	SUBMITTING-STATE	PRV00006	PROV-TAXONOMY-CLASSIFICATION
PRV095	PRV.007.095	SUBMITTING-STATE	PRV00007	PROV-MEDICAID-ENROLLMENT
PRV107	PRV.008.107	SUBMITTING-STATE	PRV00008	PROV-AFFILIATED-GROUPS
PRV116	PRV.009.116	SUBMITTING-STATE	PRV00009	PROV-AFFILIATED-PROGRAMS
PRV126	PRV.010.126	SUBMITTING-STATE	PRV00010	PROV-BED-TYPE-INFO
TPL007	TPL.001.007	SUBMITTING-STATE	TPL00001	FILE-HEADER-RECORD-TPL
TPL017	TPL.002.017	SUBMITTING-STATE	TPL00002	TPL-MEDICAID-ELIGIBLE-PERSON-MAIN
TPL030	TPL.003.030	SUBMITTING-STATE	TPL00003	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO
TPL053	TPL.004.053	SUBMITTING-STATE	TPL00004	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES
TPL064	TPL.005.064	SUBMITTING-STATE	TPL00005	TPL-MEDICAID-ELIGIBLE-OTHER-THIRD-PARTY-COVERAGE-INFORMATION
TPL073	TPL.006.073	SUBMITTING-STATE	TPL00006	TPL-ENTITY-CONTACT-INFORMATION

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.003.185	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.185	ADD	N/A		Created