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TMSIS Dataguide Medicaid.gov

Version:

ICN-ORIG

Data Element

DE Number

CLT188

System DE Number

CLT.003.188

File Segment Number

CLT00003

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Definition A unique number assigned by the state's payment system that identifies an original or adjustment claim.
Size X(50)
FLF Start Position 42
FLF Stop Position 91
Segment Key Field Identifier 2
Coding Requirements 1. Value must be 50 characters or less
2. Value must not contain a pipe or asterisk symbols
3. Mandatory
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP019 CIP.002.019 ICN-ORIG CIP00002 CLAIM-HEADER-RECORD-IP
CIP235 CIP.003.235 ICN-ORIG CIP00003 CLAIM-LINE-RECORD-IP
CIP325 CIP.004.325 ICN-ORIG CIP00004 CLAIM-DX-IP
CLT019 CLT.002.019 ICN-ORIG CLT00002 CLAIM-HEADER-RECORD-LT
CLT271 CLT.004.271 ICN-ORIG CLT00004 CLAIM-DX-LT
COT019 COT.002.019 ICN-ORIG COT00002 CLAIM-HEADER-RECORD-OT
COT158 COT.003.158 ICN-ORIG COT00003 CLAIM-LINE-RECORD-OT
COT277 COT.004.277 ICN-ORIG COT00004 CLAIM-DX-OT
CRX019 CRX.002.019 ICN-ORIG CRX00002 CLAIM-HEADER-RECORD-RX
CRX112 CRX.003.112 ICN-ORIG CRX00003 CLAIM-LINE-RECORD-RX
CRX199 CRX.004.199 ICN-ORIG CRX00004 CLAIM-DX-RX
FTX020 FTX.002.020 ICN-ORIG FTX00002 INDIVIDUAL-CAPITATION-PMPM
FTX067 FTX.003.067 ICN-ORIG FTX00003 INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX108 FTX.004.108 ICN-ORIG FTX00004 GROUP-INSURANCE-PREMIUM-PAYMENT
FTX152 FTX.005.152 ICN-ORIG FTX00005 COST-SHARING-OFFSET
FTX195 FTX.006.195 ICN-ORIG FTX00006 VALUE-BASED-PAYMENT
FTX239 FTX.007.239 ICN-ORIG FTX00007 STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX282 FTX.008.282 ICN-ORIG FTX00008 COST-SETTLEMENT-PAYMENT
FTX321 FTX.009.321 ICN-ORIG FTX00009 FQHC-WRAP-PAYMENT
FTX360 FTX.095.360 ICN-ORIG FTX00095 MISCELLANEOUS-PAYMENT