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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

COT - CLAIM OTHER

File

View Changelog
File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
COT00001 FILE-HEADER-RECORD-OT A record segment containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
COT00002 CLAIM-HEADER-RECORD-OT A record segment to capture data about another type of claim or encounter (besides IP, LT, and RX) that applies to the claim in its totality.
COT00003 CLAIM-LINE-RECORD-OT A record segment to capture data about specific goods or services rendered to a Medicaid/CHIP enrollee during an outpatient visit.
COT00004 CLAIM-DX-OT A record segment to capture data about the diagnosis code(s) associated with a claim.
Definition
Professional, Dental, Outpatient Institutional claims and encounter, capitation payments and other financial transactions.

Overview

Claim OT File – Claim Record Segment Relationships

Claim OT File – Claim Record Segment Relationships

Description

Each claim record in the T-MSIS other claims file is composed of three types of record segments: One claim header segment, one or more claim diagnosis segments, and one or more claim line segments. Each claim diagnosis segment and claim line segment joins to its corresponding claim header segment on the following five data elements:

1. SUBMITTING-STATE

2. ICN-ORIG

3. ICN-ADJ

4. ADJUDICATION-DATE

5. ADJUSTMENT-IND (joins to LINE-ADJUSTMENT-IND for claim line segments)