CLT.004.273

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:

ADJUSTMENT-IND

Data Element

DE Number

CLT273

System DE Number

CLT.004.273

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Indicates the type of adjustment record.
Size	X(1)
FLF Start Position	122
FLF Stop Position	122
Segment Key Field Identifier	4
Coding Requirements	1. Value must be 1 character 2. Value must be in Adjustment Indicator List (VVL) 3. Value must be in [0,1,4] 4. Mandatory 5. If value equals "0", then associated Adjustment ICN must not be populated 6. Value must equal "1", when associated Claim Status equals "686" 7. Value must match the adjustment indicator in the header (CLT.002.025)

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

RULE ID	RULE Definition
RULE-8919	If a claim is a non-denied claim from an LT file, then the adjustment indicator value reported must be compatible with the specified T-MSIS picture format: X(1).
RULE-9100	If the adjustment indicator is populated on the Claim Diagnosis IP segment from a CLT file, then the adjustment indicator reported must be found in the list of valid values for 'ADJUSTMENT-IND'
RULE-9187	if the CLAIM-DX-LT segment is populated from a CLT file, then the ADJUSTMENT-IND must be populated

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP026	CIP.002.026	ADJUSTMENT-IND	CIP00002	CLAIM-HEADER-RECORD-IP
CIP327	CIP.004.327	ADJUSTMENT-IND	CIP00004	CLAIM-DX-IP
CLT025	CLT.002.025	ADJUSTMENT-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT025	COT.002.025	ADJUSTMENT-IND	COT00002	CLAIM-HEADER-RECORD-OT
COT279	COT.004.279	ADJUSTMENT-IND	COT00004	CLAIM-DX-OT
CRX025	CRX.002.025	ADJUSTMENT-IND	CRX00002	CLAIM-HEADER-RECORD-RX
CRX201	CRX.004.201	ADJUSTMENT-IND	CRX00004	CLAIM-DX-RX
FTX023	FTX.002.023	ADJUSTMENT-IND	FTX00002	INDIVIDUAL-CAPITATION-PMPM
FTX070	FTX.003.070	ADJUSTMENT-IND	FTX00003	INDIVIDUAL-HEALTH-INSURANCE-PREMIUM-PAYMENT
FTX111	FTX.004.111	ADJUSTMENT-IND	FTX00004	GROUP-INSURANCE-PREMIUM-PAYMENT
FTX155	FTX.005.155	ADJUSTMENT-IND	FTX00005	COST-SHARING-OFFSET
FTX198	FTX.006.198	ADJUSTMENT-IND	FTX00006	VALUE-BASED-PAYMENT
FTX242	FTX.007.242	ADJUSTMENT-IND	FTX00007	STATE-DIRECTED-PAYMENT-SEPARATE-PAYMENT-TERM
FTX285	FTX.008.285	ADJUSTMENT-IND	FTX00008	COST-SETTLEMENT-PAYMENT
FTX324	FTX.009.324	ADJUSTMENT-IND	FTX00009	FQHC-WRAP-PAYMENT
FTX363	FTX.095.363	ADJUSTMENT-IND	FTX00095	MISCELLANEOUS-PAYMENT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CLT.004.273	UPDATE	File segment	None	32
09/16/2024	4.0.0	CLT.004.273	ADD	N/A		Created