COT.002.024

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TMSIS Dataguide

Medicaid.gov

Version:

1115A-DEMONSTRATION-IND

Data Element

DE Number

COT024

System DE Number

COT.002.024

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	In the claims files this data element indicates whether the claim or encounter was covered under the authority of an 1115A demonstration. In the Eligibility file, this data element indicates whether the individual participates in an 1115A demonstration.
Size	X(1)
FLF Start Position	155
FLF Stop Position	155
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 1 character 2. Value must be in 1115A Demonstration Indicator List (VVL) 3. Conditional 4. When value equals "0", is invalid or not populated, then the associated 1115A Demonstration Indicator (ELG.018.233) must equal "0", is invalid or not populated

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

RULE ID	RULE Definition
RULE-1339	If the 1115A demonstration indicator is populated on a non-denied claim from an OT file, then the 1115A demonstration indicator reported must be found in the list of valid values.
RULE-1340	If the 1115A demonstration information ELG file indicates an individual does not participate in an 1115A demonstration, then the 1115A demonstration indicator on a non-denied OT claim must not be populated.
RULE-6694	If a claim line is a non-denied claim line from an OT file, then the 1115A demonstration indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-7552	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an OT file, and the beginning date of service is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP025	CIP.002.025	1115A-DEMONSTRATION-IND	CIP00002	CLAIM-HEADER-RECORD-IP
CLT024	CLT.002.024	1115A-DEMONSTRATION-IND	CLT00002	CLAIM-HEADER-RECORD-LT
CRX024	CRX.002.024	1115A-DEMONSTRATION-IND	CRX00002	CLAIM-HEADER-RECORD-RX
ELG233	ELG.018.233	1115A-DEMONSTRATION-IND	ELG00018	1115A-DEMONSTRATION-INFORMATION

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	COT.002.024	UPDATE	File segment	None	35
09/16/2024	4.0.0	COT.002.024	ADD	N/A		Created