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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

LINE-ADJUSTMENT-REASON-CODE

Data Element

DE Number

CLT193

System DE Number

CLT.003.193

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 Claim adjustment reason codes communicate why a service line was paid differently than it was billed.
Size X(3)
FLF Start Position 149
FLF Stop Position 151
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 3 characters or less
2. Value must be in Line Adjustment Reason Code List (VVL)
3. Conditional
4. Value must be populated when the total paid amount is different from the total billed amount
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
CIP240 CIP.003.240 LINE-ADJUSTMENT-REASON-CODE CIP00003 CLAIM-LINE-RECORD-IP
COT163 COT.003.163 LINE-ADJUSTMENT-REASON-CODE COT00003 CLAIM-LINE-RECORD-OT
CRX117 CRX.003.117 LINE-ADJUSTMENT-REASON-CODE CRX00003 CLAIM-LINE-RECORD-RX