TPL.003.089

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TMSIS Dataguide

Medicaid.gov

Version:

COVERAGE-TYPE

Data Element

DE Number

TPL089

System DE Number

TPL.003.089

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	A code to indicate the level of coverage being provided under this policy for the insured by the TPL carrier.
Size	X(2)
FLF Start Position	212
FLF Stop Position	213
Segment Key Field Identifier	7
Coding Requirements	1. Value must be 2 characters 2. Value must be in Coverage Type List (VVL) 3. Mandatory

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

RULE ID	RULE Definition
RULE-3182	If the coverage type is populated on a TPL medicaid eligible person health insurance coverage information file, then the coverage type reported must be found in the list of valid values.
RULE-6398	If a segment is a TPL Medicaid eligible person health insurance coverage information segment from a TPL file, then the coverage type value reported must be compatible with the specified T-MSIS picture format: X(2).

Measure ID	Measure Name
TPL-1-003-2	# of MSIS IDs with a valid Coverage Type

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
TPL058	TPL.004.058	COVERAGE-TYPE	TPL00004	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	TPL.003.089	UPDATE	File segment	None	100
09/16/2024	4.0.0	TPL.003.089	ADD	N/A		Created
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|02\|Professional (Physician) Visit -- Office	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|02\|Professional (Physician) Visit-Office
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|12\|Mental health -inpatient	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|12\|Mental health-inpatient
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|13\|Psychiatric care- outpatient	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|13\|Psychiatric care-outpatient
06/20/2025	4.0.11	COVERAGE-TYPE	Update	Data Dictionary - Valid Values	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|14\|Psychiatric care- inpatient	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION COVERAGE-TYPE\|00010101\|99991231\|14\|Psychiatric care-inpatient