| COT154 |
COT.003.154
|
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.). |
COT154 Values
|
| COT155 |
COT.003.155
|
SUBMITTING-STATE |
A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. |
COT155 Values
|
| COT156 |
COT.003.156
|
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
|
| COT157 |
COT.003.157
|
MSIS-IDENTIFICATION-NUM |
A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual. Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number.
https://www.medicaid.gov/tmsis/dataguide/t-msis-coding-blog/reporting-shared-msis-identification-numbers-eligibility/ |
N/A
|
| COT158 |
COT.003.158
|
ICN-ORIG |
A unique number assigned by the state's payment system that identifies an original or adjustment claim. |
N/A
|
| COT159 |
COT.003.159
|
ICN-ADJ |
A unique claim number assigned by the state's payment system that identifies the adjustment claim for an original transaction. |
N/A
|
| COT160 |
COT.003.160
|
LINE-NUM-ORIG |
A unique number to identify the transaction line number that is being reported on the original claim. |
N/A
|
| COT161 |
COT.003.161
|
LINE-NUM-ADJ |
A unique number to identify the transaction line number that identifies the line number on the adjustment claim. |
N/A
|
| COT162 |
COT.003.162
|
LINE-ADJUSTMENT-IND |
A code to indicate the type of adjustment record claim/encounter represents at claim detail level. |
COT162 Values
|
| COT163 |
COT.003.163
|
LINE-ADJUSTMENT-REASON-CODE |
Claim adjustment reason codes communicate why a service line was paid differently than it was billed. |
COT163 Values
|
| COT164 |
COT.003.164
|
SUBMITTER-ID |
The Submitter Identification number is the value that identifies the provider/trading partner/clearing house organization to the state's claim adjudication system. |
N/A
|
| COT165 |
COT.003.165
|
CLAIM-LINE-STATUS |
The claim line status codes from the 277 transaction set identify the status of a specific detail claim line rather than the entire claim. Only report the claim line for the final, adjudicated claim. |
COT165 Values
|
| COT166 |
COT.003.166
|
BEGINNING-DATE-OF-SERVICE |
For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, this would be the date on which the service covered by this claim began. |
N/A
|
| COT167 |
COT.003.167
|
ENDING-DATE-OF-SERVICE |
For services received during a single encounter with a provider, the date the service covered by this claim was received. For services involving multiple encounters on different days, or periods of care extending over two or more days, the date on which the service covered by this claim ended. |
N/A
|
| COT168 |
COT.003.168
|
REVENUE-CODE |
A code which identifies a specific accommodation, ancillary service or billing calculation (as defined by UB-04 Billing Manual). Revenue Code should be passed through to T-MSIS exactly as it was billed by the provider on the provider's 837I or UB-04 claim. It is only required on Inpatient, Long-Term Care and Other Fee for Service claims and managed care encounters that have a valid Type of Bill value. It's not required on financial transactions or non-institutional claims. |
COT168 Values
|
| COT169 |
COT.003.169
|
PROCEDURE-CODE |
A field to capture the CPT or HCPCS code that describes a service or good rendered by the provider to an enrollee on the specified date of service. |
COT169 Values
|
| COT170 |
COT.003.170
|
PROCEDURE-CODE-DATE |
The date upon which a reported medical procedure was performed. |
N/A
|
| COT171 |
COT.003.171
|
PROCEDURE-CODE-FLAG |
A flag that identifies the coding system used for an associated procedure code. |
COT171 Values
|
| COT172 |
COT.003.172
|
PROCEDURE-CODE-MOD-1 |
The procedure code modifier used with an associated procedure code. For example, some states use modifiers to indicate assistance in surgery or anesthesia services. |
COT172 Values
|
| COT174 |
COT.003.174
|
BILLED-AMT |
The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.
For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. |
N/A
|
| COT175 |
COT.003.175
|
ALLOWED-AMT |
The maximum amount displayed at the claim line level as determined by the payer as being 'allowable' under the provisions of the contract prior to the determination of actual payment. On Fee for Service claims the Allowed Amount is determined by the state's MMIS (or PBM). On managed care encounters the Allowed Amount is determined by the managed care organization. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity allowed at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.
For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. |
N/A
|
| COT176 |
COT.003.176
|
BENEFICIARY-COPAYMENT-PAID-AMOUNT |
The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element. |
N/A
|
| COT177 |
COT.003.177
|
TPL-AMT |
Third-party liability refers to the legal obligation of third parties, i.e., certain individuals, entities, or programs, to pay all or part of the expenditures for medical assistance furnished under a state plan. This is the total amount denoted at the claim detail level paid by the third party. |
N/A
|
| COT178 |
COT.003.178
|
MEDICAID-PAID-AMT |
The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.
For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field. |
N/A
|
| COT179 |
COT.003.179
|
MEDICAID-FFS-EQUIVALENT-AMT |
The amount that would have been paid had the services been provided on a Fee for Service basis. |
N/A
|
| COT182 |
COT.003.182
|
MEDICARE-PAID-AMT |
The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the header level, report the entire payment amount on the T-MSIS claim line with the highest charge or the 1st non-denied line. Zero fill Medicare Paid Amount on all other claim lines. |
N/A
|
| COT183 |
COT.003.183
|
SERVICE-QUANTITY-ACTUAL |
The quantity of a service or product that is rendered for a specific date of service or billing time span as reported by revenue code or procedure code on the claim/encounter line. For use with CLAIMOT claims/encounters. For CLAIMRX claims/encounters, use the Prescription Quantity Actual field. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field. |
N/A
|
| COT184 |
COT.003.184
|
SERVICE-QUANTITY-ALLOWED |
The maximum allowable quantity of a service that may be rendered per date of service or per month. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMOT claims/encounter records, use the Revenue center -quantity Allowed field. NOTE: One prescription for 100 250 milligram tablets results in Prescription Quantity allowed=100.This field is only applicable when the service being billed can be quantified in discrete units, e.g., a number of visits or the number of units of a prescription/refill that were filled. For prescriptions/refills, use the Medicaid Drug Rebate definition of a unit, which is the smallest unit by which the drug is normally measured; e.g. tablet, capsule, milliliter, etc. For drugs not identifiable or dispensed by a normal unit, e.g. powder filled vials, use 1 as the number of units. The value in Prescription Quantity allowed must correspond with the value in Unit of measure. |
N/A
|
| COT186 |
COT.003.186
|
TYPE-OF-SERVICE |
A code to categorize the services provided to a Medicaid or CHIP enrollee. |
COT186 Values
|
| COT187 |
COT.003.187
|
HCBS-SERVICE-CODE |
A code to indicate that the service represents a long-term care home and community based service or support for an individual with chronic medical and/or mental conditions. The codes help to delineate between acute care and long-term care provided in the home and community setting (e.g. 1915(c), 1915(i), 1915(j), and 1915(k) services). |
COT187 Values
|
| COT188 |
COT.003.188
|
HCBS-TAXONOMY |
A code to classify the home and community based services listed on the claim into the HCBS taxonomy. The HCBS Taxonomic classification system was adopted by CMS in August 2012.
To acknowledge state variation, services and categories are defined based on the minimum definition necessary to establish mutually distinct categories and services. Some services are defined in part by characteristics that are NOT in that service. For example, the difference between companion services and personal care is that companion services do not include assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and toileting.
Some of the services reflected by the HCBS Taxonomy including, but not limited to personal care, case management, home health aide, and physician services, may (and in some case, must) also be covered under the Medicaid State Plan. The definitions below only define these services for purposes of Section 1915(c) Waivers and the State Plan Home and Community-Based Services benefit authorized by Section 1915(i). States interested in reflecting services as 'extended state plan' services must offer them in accordance with state plan service definitions. Consult with the CMS Division of Benefits and Coverage in those instances to ensure definition alignment.
The services and categories are arranged in order of consideration for placing a particular state service in the taxonomy. If one is not sure how to map a state's service to the taxonomy, one should first consider Case Management, then Round-the-Clock Services, then Supported Employment, etc.
Documentation of the HCBS Taxonomy from the CMS Waiver Management System can be found here: https://wms-mmdl.cms.gov/WMS/help/TaxonomyCategoryDefinitions.pdf |
COT188 Values
|
| COT189 |
COT.003.189
|
SERVICING-PROV-NUM |
A unique number to identify the provider who treated the recipient. The Servicing Provider Number should be for the individual doctor who rendered the service. If "Servicing" provider and the "Billing" provider such as a sole-practitioner are the same then use the same number in both fields. The value is conditional as its usage varies by state. |
N/A
|
| COT190 |
COT.003.190
|
SERVICING-PROV-NPI-NUM |
The NPI of the health care professional who delivers or completes a particular medical service or non-surgical procedure. The SERVICING-PROV-NPI-NUM is required when rendering provider is different than the attending provider and state or federal regulatory requirements call for a "combined claim" (i.e., a claim that includes both facility and professional components). Examples are Medicaid clinic bills or critical access hospital claims. |
N/A
|
| COT191 |
COT.003.191
|
SERVICING-PROV-TAXONOMY |
The taxonomy code for the provider who treated the recipient. |
COT191 Values
|
| COT192 |
COT.003.192
|
SERVICING-PROV-TYPE |
A code to describe the type of provider being reported. |
COT192 Values
|
| COT193 |
COT.003.193
|
SERVICING-PROV-SPECIALTY |
This code describes the area of specialty for the provider being reported. |
COT193 Values
|
| COT194 |
COT.003.194
|
OTHER-TPL-COLLECTION |
This data element indicates that the claim is for a beneficiary for whom other third party resource development and collection activities are in progress, when the liability is not another health insurance plan for which the eligible is a beneficiary. |
COT194 Values
|
| COT195 |
COT.003.195
|
TOOTH-DESIGNATION-SYSTEM |
A code to identify the tooth numbering system being used. |
COT195 Values
|
| COT196 |
COT.003.196
|
TOOTH-NUM |
The tooth number serviced based on the tooth numbering system identified in the TOOTH-DESIGNATION-SYSTEM field. |
COT196 Values
|
| COT197 |
COT.003.197
|
TOOTH-QUAD-CODE |
The area of the oral cavity is designated by a two-digit code. |
COT197 Values
|
| COT198 |
COT.003.198
|
TOOTH-SURFACE-CODE |
A code to identify the tooth's surface on which the service was performed. |
COT198 Values
|
| COT199 |
COT.003.199
|
ORIGINATION-ADDR-LN1 |
The street address of the origination point from which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims, this is only required if state has captured this information, otherwise it is conditional. |
N/A
|
| COT200 |
COT.003.200
|
ORIGINATION-ADDR-LN2 |
The second line of the street address of the destination point to which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims, this is only required if state has captured this information, otherwise it is conditional. |
N/A
|
| COT201 |
COT.003.201
|
ORIGINATION-CITY |
The name of the origination city from which a patient is transported either from home or a long term care facility to a health care provider for healthcare services or vice versa. For transportation claims, this is only required if state has captured this information, otherwise it is conditional. |
N/A
|
| COT202 |
COT.003.202
|
ORIGINATION-STATE |
The ANSI numeric code of the origination state in which a patient is transported either from home or a long term care facility to a health care provider to a health care provider for healthcare services or vice versa. |
COT202 Values
|
| COT203 |
COT.003.203
|
ORIGINATION-ZIP-CODE |
The zip code of the origination city from which a patient is transported either from home or long term care facility to a health care provider for healthcare services or vice versa. |
COT203 Values
|
| COT204 |
COT.003.204
|
DESTINATION-ADDR-LN1 |
The street address of the destination point to which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional. |
N/A
|
| COT205 |
COT.003.205
|
DESTINATION-ADDR-LN2 |
The street address of the destination point to which a patient is transported either from home or Long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional. |
N/A
|
| COT206 |
COT.003.206
|
DESTINATION-CITY |
The name of the destination city to which a patient is transported either from home or a long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional. |
N/A
|
| COT207 |
COT.003.207
|
DESTINATION-STATE |
The ANSI state numeric code for the U.S. state, Territory, or the District of Columbia code of the destination state in which a patient is transported either from home or a long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional. |
COT207 Values
|
| COT208 |
COT.003.208
|
DESTINATION-ZIP-CODE |
The zip code of the destination city to which a patient is transported either from home or long term care facility to a health care provider for healthcare services or vice versa. For transportation claims only. Required if state has captured this information, otherwise it is conditional. |
COT208 Values
|
| COT210 |
COT.003.210
|
CATEGORY-FOR-FEDERAL-REIMBURSEMENT |
A code to indicate the Federal funding source for the payment. |
COT210 Values
|
| COT213 |
COT.003.213
|
OTHER-INSURANCE-AMT |
The amount paid by insurance other than Medicare or Medicaid on this claim. |
N/A
|
| COT217 |
COT.003.217
|
NATIONAL-DRUG-CODE |
A code following the National Drug Code format indicating the drug, device, or medical supply covered by this claim. |
N/A
|
| COT227 |
COT.003.227
|
PROCEDURE-CODE-MOD-2 |
The procedure code modifier used with an associated procedure code. For example, some states use modifiers to indicate assistance in surgery or anesthesia services. |
COT227 Values
|
| COT218 |
COT.003.218
|
PROCEDURE-CODE-MOD-3 |
The procedure code modifier used with an associated procedure code. For example, some states use modifiers to indicate assistance in surgery or anesthesia services. |
COT218 Values
|
| COT219 |
COT.003.219
|
PROCEDURE-CODE-MOD-4 |
The procedure code modifier used with an associated procedure code. For example, some states use modifiers to indicate assistance in surgery or anesthesia services. |
COT219 Values
|
| COT221 |
COT.003.221
|
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
|
| COT222 |
COT.003.222
|
SELF-DIRECTION-TYPE |
A data element to identify how the beneficiary self-directed the service, i.e. hiring authority (the beneficiary has decision-making authority to recruit, hire, train and supervise the individuals who furnish his/her services), budget authority (The beneficiary has decision-making authority over how the Medicaid funds in a budget are spent), or both hiring and budget authority. |
COT222 Values
|
| COT223 |
COT.003.223
|
PRE-AUTHORIZATION-NUM |
A number, code or other value that indicates the services provided on this claim have been authorized by the payee or other service organization, or that a referral for services has been approved. (Also referred to as a Prior Authorization or Referral Number). |
N/A
|
| COT224 |
COT.003.224
|
NDC-UNIT-OF-MEASURE |
A code to indicate the basis by which the quantity of the National Drug Code is expressed. |
COT224 Values
|
| COT225 |
COT.003.225
|
NDC-QUANTITY |
This field is to capture the actual quantity of the National Drug Code being prescribed on the claim/encounter. |
N/A
|
| COT234 |
COT.003.234
|
IHS-SERVICE-IND |
To indicate Services received by Medicaid-eligible individuals who are American Indian or Alaska Native (AI/AN) through facilities of the Indian Health Service (IHS), whether operated by IHS or by Tribes. |
COT234 Values
|
| COT254 |
COT.003.254
|
DIAGNOSIS-CODE-POINTER-1 |
A pointer to the diagnosis code in the order of importance to this service. |
N/A
|
| COT287 |
COT.003.287
|
DIAGNOSIS-CODE-POINTER-2 |
A pointer to the diagnosis code in the order of importance to this service. |
N/A
|
| COT288 |
COT.003.288
|
DIAGNOSIS-CODE-POINTER-3 |
A pointer to the diagnosis code in the order of importance to this service. |
N/A
|
| COT289 |
COT.003.289
|
DIAGNOSIS-CODE-POINTER-4 |
A pointer to the diagnosis code in the order of importance to this service. |
N/A
|
| COT255 |
COT.003.255
|
UNIQUE-DEVICE-IDENTIFIER |
An unique identifier assigned to every medical device that meets the requirements of 21 CFR 801 and 830. |
N/A
|
| COT290 |
COT.003.290
|
MBESCBES-FORM-GROUP |
Indicates group of MBES/CBES forms that this payment applies to (e.g., the CMS-64.9 Base form is for Title XIX-funded Medicaid, the CMS-64.21 form is for Title XXI-funded Medicaid-expansion CHIP (M-CHIP), and the CMS-21 Base form is for Title XXI-funded separate CHIP (S-CHIP)). |
COT290 Values
|
| COT257 |
COT.003.257
|
MBESCBES-FORM |
The MBES or CBES form to which the expenditure will be mapped (e.g., CMS-64 Base, CMS-64.21U, CMS-21, etc.). This should be determined by the state's MBES/CBES reporting process. The MBES or CBES form reported here will determine what the meaning of the corresponding MBES/CBES category of service value is. |
COT257 Values
|
| COT256 |
COT.003.256
|
MBESCBES-CATEGORY-OF-SERVICE |
A code indicating the category of service for the paid claim. The category of service is the line item from the MBES/CBES expenditure form (e.g., CMS-64 Base, CMS-64.21U, CMS-21, etc.) that states use to report their expenditures and request federal financial participation. |
COT256 Values
|
| COT258 |
COT.003.258
|
SERVICE-FACILITY-LOCATION-ORG-NPI |
Service facility location organization NPI from X12 837P loop 2420C and 837D loop 2420D. |
N/A
|
| COT259 |
COT.003.259
|
SERVICE-FACILITY-LOCATION-ADDR-LN-1 |
Service facility location address line 1 from X12 837P loop 2420C and 837D loop 2420D. |
N/A
|
| COT260 |
COT.003.260
|
SERVICE-FACILITY-LOCATION-ADDR-LN-2 |
Service facility location address line 2 from X12 837P loop 2420C and 837D loop 2420D. |
N/A
|
| COT261 |
COT.003.261
|
SERVICE-FACILITY-LOCATION-CITY |
Service facility location address city name from X12 837P loop 2420C and 837D loop 2420D. |
N/A
|
| COT262 |
COT.003.262
|
SERVICE-FACILITY-LOCATION-STATE |
Service facility location address state code from X12 837P loop 2420C and 837D loop 2420D. |
COT262 Values
|
| COT263 |
COT.003.263
|
SERVICE-FACILITY-LOCATION-ZIP-CODE |
Service facility location address ZIP code from X12 837P loop 2420C and 837D loop 2420D. |
COT263 Values
|
| COT264 |
COT.003.264
|
PLACE-OF-SERVICE |
A pass-through data element meaning that the state should report the field in T-MSIS as reported by the provider on the claim form (i.e., 837P or 837D - Place of Service is only captured at the line level of the CMS-1500). If the claim is submitted on the 837p electronic claims form and the Facility Code Qualifier is reported with any value other than 'B', then the PLACE-OF-SERVICE value should be blank or space-filled. If the claim is submitted on the CMS-1450 (UB-04) institutional claims form, the PLACE-OF-SERVICE field should be blank or space-filled. Otherwise, if the claim is submitted with the place of service populated with any value other than the valid values listed in T-MSIS Data Guide for PLACE-OF-SERVICE values, that value should still be reported in the PLACE-OF-SERVICE data element. If the claim is submitted by a provider with the place of service fields blank, then the PLACE-OF-SERVICE on the T-MSIS OT claims file should be blank or space-filled. |
COT264 Values
|
| COT265 |
COT.003.265
|
GME-AMOUNT-PAID |
The amount included in the Medicaid Amount (COT.003.178) that is attributable to a Graduate Medical Education (GME) payment, when the state makes GME payments by claim. |
N/A
|
| COT266 |
COT.003.266
|
REFERRING-PROV-NUM |
A unique identification number assigned to a provider which identifies the physician or other provider who referred the patient. For physicians, this must be the individual's ID number, not a group identification number. If the referring provider number is not available, but the physician's Drug Enforcement Agency (DEA) ID is on the State file, then the State should use the DEA ID for this data element. This is only applicable when a provider reports a second referral at the header of their claim. |
N/A
|
| COT267 |
COT.003.267
|
REFERRING-PROV-NPI-NUM |
The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient. |
N/A
|
| COT268 |
COT.003.268
|
REFERRING-PROV-NUM-2 |
A unique identification number assigned to a provider which identifies the physician or other provider who referred the patient. For physicians, this must be the individual's ID number, not a group identification number. If the referring provider number is not available, but the physician's Drug Enforcement Agency (DEA) ID is on the State file, then the State should use the DEA ID for this data element. This is only applicable when a provider reports a second referral at the header of their claim. |
N/A
|
| COT269 |
COT.003.269
|
REFERRING-PROV-NPI-NUM-2 |
The National Provider ID (NPI) of the provider who recommended the servicing provider to the patient. This is only applicable when a provider reports a second referral at the line/detail of their claim. |
N/A
|
| COT270 |
COT.003.270
|
ORDERING-PROV-NUM |
The Medicaid provider ID of the Ordering Provider is the individual who requested the services or items being reported on this service line. Examples include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies. |
N/A
|
| COT271 |
COT.003.271
|
ORDERING-PROV-NPI-NUM |
The Medicaid provider ID of the Ordering Provider is the individual who requested the services or items being reported on this service line. Examples include, but are not limited to, provider ordering diagnostic tests and medical equipment or supplies. |
N/A
|
| COT272 |
COT.003.272
|
SDP-ALLOWED-AMT |
The component (in dollar and cents) of the allowed amount that represents the difference between what would have been the managed care plan's typical contractual allowed amount and the enhanced allowed amount for this specific claim as defined by the State's SPA, waiver, or demonstration for a State Directed Payment model per 42 CFR 438.6(c)(1)(iii). |
N/A
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| COT273 |
COT.003.273
|
SDP-PAID-AMT |
The component (in dollar and cents) of the paid amount that represents the difference between what would have been the managed care plan's typical contractual paid amount and the enhanced paid amount for this specific claim as defined by the State's SPA, waiver, or demonstration for a State Directed Payment model per 42 CFR 438.6(c)(1)(iii). |
N/A
|
| COT214 |
COT.003.214
|
STATE-NOTATION |
A free text field for the submitting state to enter whatever information it chooses. |
N/A
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