TPL.003.037

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TMSIS Dataguide

Medicaid.gov

Version:

INSURANCE-PLAN-TYPE

Data Element

DE Number

TPL037

System DE Number

TPL.003.037

File Name

TPL - THIRD-PARTY LIABILITY

File Segment Number

File Segment Name

TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Code to classify the type of insurance plan providing TPL coverage.
Size	X(2)
FLF Start Position	110
FLF Stop Position	111
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 2 characters or less 2. Value must be in Insurance Plan Type List (VVL) 3. Situational 4. Value must have an associated Insurance Plan ID

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

RULE ID	RULE Definition
RULE-3091	If the insurance plan type is populated on a TPL medicaid eligible person health insurance coverage information file, then the insurance plan type reported must be found in the list of valid values.
RULE-6959	If a segment is a TPL Medicaid eligible person health insurance coverage information segment from a TPL file, then the insurance plan type value reported must be compatible with the specified T-MSIS picture format: X(2).

Measure ID	Measure Name
TPL-1-004-3	# of MSIS IDs with a valid Insurance Plan Type

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
TPL057	TPL.004.057	INSURANCE-PLAN-TYPE	TPL00004	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/17/2025	4.0.14	TPL.003.037	UPDATE	Necessity	Conditional	Situational
07/17/2025	4.0.14	TPL.003.037	UPDATE	Coding requirement	1. Value must be 2 characters or less2. Value must be in Insurance Plan Type List (VVL)3. Conditional4. Value must have an associated Insurance Plan ID	1. Value must be 2 characters or less2. Value must be in Insurance Plan Type List (VVL)3. Situational4. Value must have an associated Insurance Plan ID
09/16/2024	4.0.0	TPL.003.037	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.037	ADD	N/A		Created