CLT.003.233

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide

Medicaid.gov

Version:

ADJUDICATION-DATE

Data Element

DE Number

CLT233

System DE Number

CLT.003.233

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	The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.
Size	9(8)
FLF Start Position	378
FLF Stop Position	385
Segment Key Field Identifier	7
Coding Requirements	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Value should be on or before End of Time Period (CLT.001.010) 3. Mandatory 4. Value should be on or after associated Admission Date value

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

RULE ID	RULE Definition
RULE-1204	All non-denied LT claim line records must have a corresponding parent record.
RULE-1220	If beginning date of service and adjudication date are populated on a non-denied claim line from an LT file that is not a capitated payment or premium payment, then the beginning date of service value reported must be before or equal to the adjudication date value reported.
RULE-1225	If ending date of service and adjudication date are populated on a non-denied claim line from an LT file that is not a capitated payment or premium payment, then the ending date of service value reported must be before or equal to the adjudication date value reported.
RULE-1270	If a claim line is from an LT file, then the adjudication date value reported must be a valid date of the form CCYYMMDD.
RULE-1272	If adjudication date is populated on a non-denied claim line from an LT file that is not a capitated payment or premium payment and end of time period is populated on the file header, then the adjudication date value reported must be before or equal to the end of time period value reported.
RULE-1273	If admission date is populated on a non-denied claim from an LT file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment or premium payment and adjudication date is populated on a non-denied claim line that is not a capitated payment or premium payment, then the admission date value reported must be before or equal to the adjudication date value reported.
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-7318	#N/A
RULE-7575	All denied LT claim line records must have a corresponding claim header record.

Measure ID	Measure Name
MIS-5-001-1	% missing: ADJUDICATION-DATE (CLT00003)
ALL-16-004-4	% of claim line record segments missing ADJUDICATION-DATE (CLT00003)
RULE-7318	% of claim line record segments missing ADJUDICATION-DATE (CLT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP098	CIP.002.098	ADJUDICATION-DATE	CIP00002	CLAIM-HEADER-RECORD-IP
CIP286	CIP.003.286	ADJUDICATION-DATE	CIP00003	CLAIM-LINE-RECORD-IP
CIP328	CIP.004.328	ADJUDICATION-DATE	CIP00004	CLAIM-DX-IP
CLT050	CLT.002.050	ADJUDICATION-DATE	CLT00002	CLAIM-HEADER-RECORD-LT
CLT274	CLT.004.274	ADJUDICATION-DATE	CLT00004	CLAIM-DX-LT
COT035	COT.002.035	ADJUDICATION-DATE	COT00002	CLAIM-HEADER-RECORD-OT
COT221	COT.003.221	ADJUDICATION-DATE	COT00003	CLAIM-LINE-RECORD-OT
COT280	COT.004.280	ADJUDICATION-DATE	COT00004	CLAIM-DX-OT
CRX027	CRX.002.027	ADJUDICATION-DATE	CRX00002	CLAIM-HEADER-RECORD-RX
CRX157	CRX.003.157	ADJUDICATION-DATE	CRX00003	CLAIM-LINE-RECORD-RX
CRX202	CRX.004.202	ADJUDICATION-DATE	CRX00004	CLAIM-DX-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.003.233	UPDATE	File segment	None	31
09/16/2024	4.0.0	CLT.003.233	ADD	N/A		Created