CLT.002.052

TYPE-OF-CLAIM

Data Element

DE Number

CLT052

System DE Number

CLT.002.052

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
Size	X(1)
FLF Start Position	265
FLF Stop Position	265
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Type of Claim List (VVL) 2. Value must be 1 character 3. Mandatory 4. When value equals 'Z', claim denied indicator must equal '0'

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

RULE ID	RULE Definition
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'
RULE-6939	If a claim is a non-denied claim from an LT file, then the type of claim value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-7255	If a claim is a non-denied claim from an LT file, then the type of claim value must be populated.
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-7551	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an LT file, and the beginning date of service is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.
RULE-7581	If a claim line is a non-denied, paid claim from an LT file, and the claim line type of service is equal to supplemental payments for nursing (133), then the type of claim is a Medicaid/Medicaid expansion CHIP, Separate CHIP or Other service tracking claim.
RULE-7634	All non-denied, paid LT claim header records must have a corresponding non-denied claim line record.
RULE-7771	If a claim is a non-denied claim from an LT file, and the waiver type is populated, and the claim beginning date of service is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.
RULE-951	If the type of claim is populated on a non-denied claim from an LT file, then the type of claim value reported must be in the list of valid values for type of claim.

Measure ID	Measure Name
MCR-54-005-5	# of plans with at least 100 capitations or 100 encounters, 0 enrollments
RULE-7255	% missing: TYPE-OF-CLAIM (CLT00002)
MIS-4-043-43	% missing: TYPE-OF-CLAIM (CLT00002)
MCR-27-002-2	Encounters (by Claims file type) by Plan ID (non-PCCM)
MCR-27-001-1	Encounters (by Claim File Type)
EL-8-001-1	Enrollment, capitation payments, and encounters by Plan Type
MIS-15-001-1	% missing: TYPE-OF-CLAIM (CLT00002)
MCR-55-003-3	PACE capitation ratio
MCR-55-002-2	Enhanced PCCM capitation ratio
MCR-55-001-1	Traditional PCCM capitation ratio
MCR-54-010-10	# of plans where MC plan type does not match EL plan type
MCR-54-009-9	# of plans with at least 100 enrollments, capitations, or encounters, that do not have a managed care record
ALL-18-002-2	# of claim headers with TYPE-OF-CLAIM = U, V, W, X or Y that aren’t MFP (PROGRAM-TYPE = 08)
MCR-54-004-4	# of plans with at least 100 enrollments and some capitations that have capitation ratios outside of the expected range (0.7 - 1.3)
MCR-54-003-3	# of plans with at least 100 enrollments or 100 encounters, 0 capitations
MCR-54-002-2	# of plans with at least 100 enrollments or 100 capitations, 0 encounters
MCR-54-001-1	# of plans with at least 100 enrollments, 0 capitations, 0 encounters
MCR-53-003-3	Total # of managed care encounters
MCR-53-002-2	Total # of managed care capitations
MCR-53-001-1	Total # of managed care enrollments
EXP-43-006-6	# of non-service tracking claim headers with non-missing Service Tracking Payment Amount
EXP-43-002-2	# of non-service tracking claim headers with non-missing Service Tracking Type
EL-8-002-2	Enrollment, capitation payments, capitation ratios, encounters (by claim file type) and encounter ratios (by claim file type) by plan ID with plan ID linking to MC file
ALL-23-001-1	Type of Claim values

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP100	CIP.002.100	TYPE-OF-CLAIM	CIP00002	CLAIM-HEADER-RECORD-IP
COT037	COT.002.037	TYPE-OF-CLAIM	COT00002	CLAIM-HEADER-RECORD-OT
CRX029	CRX.002.029	TYPE-OF-CLAIM	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/09/2023	3.11.0	CLT.002.052	UPDATE	Definition	A code to indicate what type of payment is covered in this claim.	A code to indicate what type of payment is covered in this claim.For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.
08/09/2023	3.11.0	CLT.002.052	UPDATE	Last update date	12/08/2022	8/9/2023
05/08/2020	2.4.0	TYPE-OF-CLAIM	UPDATE	Data Dictionary - Valid Values	Code \| Description Z \| Denied Claimes	N/A
07/15/2022	3.0.1	CLT052	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT052\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT052\|TYPE-OF-CLAIM\|A code to indicate what type of payment is covered in this claim. For sub-capitated encounters from a sub-capitated entity or sub-capitated network provider, report TYPE-OF-CLAIM = '3' for a Medicaid sub-capitated encounter record or “C” for an S-CHIP sub-capitated encounter record.