CLT.003.219

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TMSIS Dataguide

Medicaid.gov

Version:

CATEGORY-FOR-FEDERAL-REIMBURSEMENT

Data Element

DE Number

CLT219

System DE Number

CLT.003.219

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to indicate the Federal funding source for the payment.
Size	X(2)
FLF Start Position	335
FLF Stop Position	336
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 2 characters 2. Value must be in Category for Federal Reimbursement List (VVL) 3. (Federal Funding under Title XXI) if value equals "02", then the eligible's CHIP Code (ELG.003.054) must be in [2,3] 4. (Federal Funding under Title XIX) if value equals "01" then the eligible's CHIP Code (ELG.003.054) must be "1" 5. Conditional 6. If Type of Claim is in [1,A,U] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported

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

RULE ID	RULE Definition
RULE-1255	If the category for federal reimbursement is populated on a non-denied claim line from an LT file, then the category for federal reimbursement value reported must be in the list of valid values for category for federal reimbursement.
RULE-1256	If a claim is a non-denied claim from an LT file and the variable demographics eligibility chip code is equal to '2' or '3', then the claim line has a category of federal reimbursement equal to '02'.
RULE-6983	If a claim line is a non-denied claim line from an LT file, then the category for federal reimbursement value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-7207	If a claim is a non-denied claim from an IP file and the variable demographics eligibility chip code is equal to '1', then the claim line has a category for federal reimbursement value equal to '01'.
RULE-7263	If a claim is a non-denied claim from an LT file, that is a Medicaid or Medicaid-expansion FFS or a Separate CHIP FFS claim and is an original claim or a replacement/resubmission claim payment and total medicaid paid amt is non-null and not zero, then the claim line category for federal reimbursement must be populated.

Measure ID	Measure Name
MIS-5-003-3	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CLT00003)
MIS-24-001-1	% missing: CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CLT00003)
RULE-7263	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CLT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP269	CIP.003.269	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	CIP00003	CLAIM-LINE-RECORD-IP
COT210	COT.003.210	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	COT00003	CLAIM-LINE-RECORD-OT
CRX149	CRX.003.149	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	CRX00003	CLAIM-LINE-RECORD-RX
FTX045	FTX.002.045	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX090	FTX.003.090	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00003	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX134	FTX.004.134	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX176	FTX.005.176	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00005	COST-SHARING-OFFSET
FTX218	FTX.006.218	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00006	VALUE-BASED-PAYMENT
FTX263	FTX.007.263	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX303	FTX.008.303	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00008	COST-SETTLEMENT-PAYMENT
FTX342	FTX.009.342	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00009	FQHC-WRAP-PAYMENT
FTX390	FTX.095.390	CATEGORY-FOR-FEDERAL-REIMBURSEMENT	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.003.219	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.219	ADD	N/A		Created