CLT.002.056

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

SOURCE-LOCATION

Data Element

DE Number

CLT056

System DE Number

CLT.002.056

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	The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
Size	X(2)
FLF Start Position	276
FLF Stop Position	277
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Source Location List (VVL) 2. Value must be 2 characters 3. Mandatory

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

RULE ID	RULE Definition
RULE-6816	The format for SOURCE-LOCATION on a non-denied LT claim was expected to be submitted as X(2).
RULE-955	If the source location is populated on a non-denied claim from an LT file, then the source location value reported must be in the list of valid values for 'source location'.

Measure ID	Measure Name
ALL-38-001-1	Source Location

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP104	CIP.002.104	SOURCE-LOCATION	CIP00002	CLAIM-HEADER-RECORD-IP
COT041	COT.002.041	SOURCE-LOCATION	COT00002	CLAIM-HEADER-RECORD-OT
CRX032	CRX.002.032	SOURCE-LOCATION	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/09/2023	3.11.0	CLT.002.056	UPDATE	Definition	The field denotes the claims payment system from which the claim was extracted.	The field denotes the claims payment system from which the claim was extracted.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis.For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee.For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.
08/09/2023	3.11.0	CLT.002.056	UPDATE	Last update date	12/08/2022	8/9/2023
07/15/2022	3.0.1	CLT056	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT056\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT056\|SOURCE-LOCATION\|The field denotes the claims payment system from which the claim was extracted. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report a SOURCE-LOCATION = '22' to indicate that the sub-capitated entity paid a provider for the service to the enrollee on a FFS basis. For sub-capitated encounters from a sub-capitated network provider that were submitted to sub-capitated entity, report a SOURCE-LOCATION = '23' to indicate that the sub-capitated network provider provided the service directly to the enrollee. For sub-capitated encounters from a sub-capitated network provider, report a SOURCE-LOCATION = “23” to indicate that the sub-capitated network provider provided the service directly to the enrollee.