CLT.002.060

CLAIM-PYMT-REM-CODE-2

Data Element

DE Number

CLT060

System DE Number

CLT.002.060

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	306
FLF Stop Position	310
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 5. Value must not be populated when Remittance Advice Remark Code 1 (CLT.002.059) is not populated

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-6326	If a claim is a non-denied claim from an LT file, then the claim payment rem code 2 value reported must be compatible with specified T-MSIS picture format: X(5).
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.
RULE-961	If the claim pymt rem code 2 is populated on a non-denied claim from an LT file, then the claim pymt rem code 2 value reported must be in the list of valid values for 'claim pymt rem code'.
RULE-963	If the claim pymt rem code 1 is not populated on a non-denied claim from an LT file, then claim pymt rem code 2 must not be populated.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP109	CIP.002.109	CLAIM-PYMT-REM-CODE-2	CIP00002	CLAIM-HEADER-RECORD-IP
COT045	COT.002.045	CLAIM-PYMT-REM-CODE-2	COT00002	CLAIM-HEADER-RECORD-OT
CRX036	CRX.002.036	CLAIM-PYMT-REM-CODE-2	CRX00002	CLAIM-HEADER-RECORD-RX