COT.003.221

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TMSIS Dataguide

Medicaid.gov

Version:

ADJUDICATION-DATE

Data Element

DE Number

COT221

System DE Number

COT.003.221

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-OT

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	746
FLF Stop Position	753
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 (COT.001.010) 3. Mandatory 4. Value should be on or after the associated Beginning Date of Service

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

RULE ID	RULE Definition
RULE-1610	All non-denied OT claim line records must have a corresponding parent record.
RULE-1624	If beginning date of service and adjudication date are populated on a non-denied claim line from an OT file that is not a capitated payment, premium payment, or EHR payment to provider, then the beginning date of service value reported must be before or equal to the adjudication date value reported.
RULE-1630	If ending date of service is populated on a non-denied, non-void claim line from an OT file that is not a capitated payment, premium payment or EHR payment and adjudication date is populated on the claim line, then the ending date of service value reported must be before or equal to the adjudication date value reported.
RULE-1710	If a claim line is from an OT file, then the adjudication date value reported must be a valid date of the form CCYYMMDD.
RULE-1712	If adjudication date is populated on a non-denied claim line from an OT 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-7189	If a claim line is from an OT 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 OT claim lines.
RULE-7319	#N/A
RULE-7576	All denied OT claim line records must have a corresponding claim header record.

Measure ID	Measure Name
MIS-7-001-1	% missing: ADJUDICATION-DATE (COT00003)
ALL-16-006-6	% of claim line record segments missing ADJUDICATION-DATE (COT00003)
RULE-7319	% of claim line record segments missing ADJUDICATION-DATE (COT00003)

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
CLT233	CLT.003.233	ADJUDICATION-DATE	CLT00003	CLAIM-LINE-RECORD-LT
CLT274	CLT.004.274	ADJUDICATION-DATE	CLT00004	CLAIM-DX-LT
COT035	COT.002.035	ADJUDICATION-DATE	COT00002	CLAIM-HEADER-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
02/27/2025	4.0.3	COT.003.221	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (COT.001.010)3. Mandatory4. Value should be on or after the associated Beginning Date of Service
09/16/2024	4.0.0	COT.003.221	UPDATE	File segment	None	36
09/16/2024	4.0.0	COT.003.221	ADD	N/A		Created