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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 Segment Number

CLT00003

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

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
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