CLT.002.059

CLAIM-PYMT-REM-CODE-1

Data Element

DE Number

CLT059

System DE Number

CLT.002.059

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List. It is a code set used by the health care industry to convey non-financial information critical to understanding the adjudication of a health care claim for payment. It is an external code set whose use is as mandated by the Administrative Simplification provisions of the Health Insurance Portability and Accountably Act of 1996 (P.L.104-191, commonly referred to as HIPAA).
Size	X(5)
FLF Start Position	301
FLF Stop Position	305
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Claim Payment Remittance Code List (VVL) 2. Value must be 5 characters or less 3. Conditional 4. When more than one occurrence of Claim Payment Remark Code 1 through Claim Payment Remark Code 4 is populated on a claim, all values must be unique

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Claim Payment Remittance Code List

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

RULE ID	RULE Definition
RULE-6324	If a claim is a non-denied claim from an LT file, then the claim payment rem code 1 value reported must be compatible with specified T-MSIS picture format: X(5).
RULE-959	If the claim payment rem code is populated on a non-denied LT claim, then the claim payment rem code must be found in the list of valid values.
RULE-960	If more than one CLAIM-PYMT-REM-CODE is populated on a non-denied LT claim, then each of the CLAIM-PYMT-REM-CODE values must be unique.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP108	CIP.002.108	CLAIM-PYMT-REM-CODE-1	CIP00002	CLAIM-HEADER-RECORD-IP
COT044	COT.002.044	CLAIM-PYMT-REM-CODE-1	COT00002	CLAIM-HEADER-RECORD-OT
CRX035	CRX.002.035	CLAIM-PYMT-REM-CODE-1	CRX00002	CLAIM-HEADER-RECORD-RX