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Data Element
CLT261
CLT.003.261
Definition | A code indicating the category of service for the paid claim. The category of service is the line item from the MBES/CBES expenditure form (e.g., CMS-64 Base, CMS-64.21U, CMS-21, etc.) that states use to report their expenditures and request federal financial participation. |
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Size | X(5) |
FLF Start Position | 535 |
FLF Stop Position | 539 |
Segment Key Field Identifier | Not Applicable |
Coding Requirements | 1. Value must be 5 characters or less 2. When MBESCBES Form Group equals "1", value must be in 64.9COS list (VVL) 3. When MBESCBES Form Group equals "2", value must be in 64.21COS list (VVL) 4. When MBESCBES Form Group equals "3", value must be in 21COS list (VVL) 5. Conditional 6. If Type of Claim in [1,A,U], then value must be populated on all claim lines with a Medicaid Paid Amount greater than $0 7. When populated, an associated MBESCBES Form Group and MBESCBES Form must be populated |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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DE Number | System DE Number | DE Name | File Segment Number | File Segment Name |
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CIP315 | CIP.003.315 | MBESCBES-CATEGORY-OF-SERVICE | CIP00003 | CLAIM-LINE-RECORD-IP |
COT256 | COT.003.256 | MBESCBES-CATEGORY-OF-SERVICE | COT00003 | CLAIM-LINE-RECORD-OT |
CRX180 | CRX.003.180 | MBESCBES-CATEGORY-OF-SERVICE | CRX00003 | CLAIM-LINE-RECORD-RX |
FTX046 | FTX.002.046 | MBESCBES-CATEGORY-OF-SERVICE | FTX00002 | INDIVIDUAL-CAPITATION-PMPM |
FTX091 | FTX.003.091 | MBESCBES-CATEGORY-OF-SERVICE | FTX00003 | INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT |
FTX135 | FTX.004.135 | MBESCBES-CATEGORY-OF-SERVICE | FTX00004 | GROUP-INSURANCE-PREMIUM-PAYMENT |
FTX177 | FTX.005.177 | MBESCBES-CATEGORY-OF-SERVICE | FTX00005 | COST-SHARING-OFFSET |
FTX219 | FTX.006.219 | MBESCBES-CATEGORY-OF-SERVICE | FTX00006 | VALUE-BASED-PAYMENT |
FTX264 | FTX.007.264 | MBESCBES-CATEGORY-OF-SERVICE | FTX00007 | STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM |
FTX304 | FTX.008.304 | MBESCBES-CATEGORY-OF-SERVICE | FTX00008 | COST-SETTLEMENT-PAYMENT |
FTX343 | FTX.009.343 | MBESCBES-CATEGORY-OF-SERVICE | FTX00009 | FQHC-WRAP-PAYMENT |
FTX391 | FTX.095.391 | MBESCBES-CATEGORY-OF-SERVICE | FTX00095 | MISCELLANEOUS-PAYMENT |