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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

CLAIM-DX-OT

File Segment

File Segment Number

COT00004

File Name

COT - CLAIM OTHER

Last updated

Data Elements Reference
DE Number System DE Number Data Element Definition Valid Values
COT274 COT.004.274 RECORD-ID The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). COT274 Values
COT275 COT.004.275 SUBMITTING-STATE A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. COT275 Values
COT276 COT.004.276 RECORD-NUMBER A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file. N/A
COT277 COT.004.277 ICN-ORIG A unique number assigned by the state's payment system that identifies an original or adjustment claim. N/A
COT278 COT.004.278 ICN-ADJ A unique claim number assigned by the state's payment system that identifies the adjustment claim for an original transaction. N/A
COT279 COT.004.279 ADJUSTMENT-IND Indicates the type of adjustment record. COT279 Values
COT280 COT.004.280 ADJUDICATION-DATE 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. N/A
COT281 COT.004.281 DIAGNOSIS-TYPE Indicates the context of the diagnosis code from the provider's claim (i.e., an 837I claim can have one principal diagnosis code, up to 12 external cause of injury diagnosis codes, and up to 24 other diagnosis codes; a UB-04 claim can have one principal diagnosis code, one admitting diagnosis code, and up to 17 other diagnosis codes; an 837P or CMS-1500 claim can have up to 12 diagnosis codes; an 837D or ADA claim can have up to 4 diagnosis codes). The type of diagnosis code (e.g., principal, external cause of injury, or other) is captured here. The order in which the diagnosis code was reported is captured in the Diagnosis Sequence Number. COT281 Values
COT282 COT.004.282 DIAGNOSIS-SEQUENCE-NUMBER The order in which the diagnosis occurred on the provider's claim for a given type of diagnosis code (e.g., an 837P claim can have up to 12 external cause of injury diagnosis codes and up to 24 other diagnosis codes). N/A
COT283 COT.004.283 DIAGNOSIS-CODE-FLAG Flag used to identify wither the associated Diagnosis Code value is a ICD-9 or ICD-10 code. COT283 Values
COT284 COT.004.284 DIAGNOSIS-CODE ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as '2105'. COT284 Values
COT285 COT.004.285 STATE-NOTATION A free text field for the submitting state to enter whatever information it chooses. N/A
Definition
A record segment to capture data about the diagnosis code(s) associated with a claim.

File Segment Length
2100