CLT.002.023

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

CROSSOVER-INDICATOR

Data Element

DE Number

CLT023

System DE Number

CLT.002.023

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	An indicator specifying whether the claim is a crossover claim where a portion is paid by Medicare.
Size	X(1)
FLF Start Position	154
FLF Stop Position	154
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Crossover Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0,1] or not populated 4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in [01,02,04,08,09,10] for the same time period (by date of service) 5. If the Type of Claim value is in [1,3,A,C], then value is mandatory and must be reported 6. Conditional

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

RULE ID	RULE Definition
RULE-6684	If a claim is a non-denied claim from an LT file, then the crossover indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-7413	If a claim in a non-denied, original or adjustment FFS or Encounter crossover claim from an LT file, and the MSIS ID is populated and the beginning date of service is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01','02', '04', '08'
RULE-885	If the crossover indicator is populated on a non-denied claim from an LT file, then the crossover indicator value reported must be in the list of valid values.
RULE-7743	If a claim in a non-denied, original or adjustment Encounter crossover claim from an LT file, and the MSIS ID is populated and the beginning date of service is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'
RULE-7982	If a claim in a non-denied, original or adjustment FFS crossover claim from an LT file, and the MSIS ID is populated and the beginning date of service is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'

Measure ID	Measure Name
ALL-10-001-1	% of claim headers that are crossover claims
ALL-7-001-1	% of claim headers that are crossover claims
FFS-S-019-4	% of total original claim headers that are crossover claims
FFS-S-022-15	% of total original claim headers that are crossover claims
MCR-8-001-9	Total # of crossover claim headers
MCR-S-022-4	% of total original claim headers that are crossover claims
MCR-S-025-15	% of total original claim headers that are crossover claims
MIS-4-011-11	% missing: CROSSOVER-INDICATOR (CLT00002)
MIS-23-012-12	% missing: CROSSOVER-INDICATOR (CLT00002)
MIS-81-012-12	% missing: CROSSOVER-INDICATOR (CLT00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP023	CIP.002.023	CROSSOVER-INDICATOR	CIP00002	CLAIM-HEADER-RECORD-IP
COT023	COT.002.023	CROSSOVER-INDICATOR	COT00002	CLAIM-HEADER-RECORD-OT
CRX023	CRX.002.023	CROSSOVER-INDICATOR	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CLT.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in [01,02,04,08,09,10] for the same time period (by date of service)5. If the Type of Claim value is in [1,3,A,C], then value is mandatory and must be reported6. Conditional
08/28/2023	3.12.0	CLT.002.023	UPDATE	Coding requirement	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. Value must be 1 character6. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.7. Conditional	1. Value must be in Crossover Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If Crossover Indicator value is "1", the associated Dual Eligible Code (ELG.005.085) value must be in "01", "02", "04", "08", "09", or "10" for the same time period (by date of service)5. If the Type of Claim value is in ["1", "3", "A", "C"], then value is mandatory and must be reported.6. Conditional