CLT.002.063

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

TOT-BILLED-AMT

Data Element

DE Number

CLT063

System DE Number

CLT.002.063

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 total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
Size	S9(11)V99
FLF Start Position	321
FLF Stop Position	333
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50) 3. Value must equal the sum of all Billed Amount instances for the associated claim 4. Conditional 5. When associated Type of Claim in [1,3,A,C] and Source Location does not equal "23", value must be populated 6. Value should not be populated when associated Type of Claim (CLT.002.052) is in [4,D,X] 7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals "2" value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)

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

RULE ID	RULE Definition
RULE-1233	If the payment level indicator is for a claim detail level payment and the total billed amount is populated on a non-denied claim from an LT file, then the total billed amount value reported must be greater than or equal to the sum of all the revenue charge values reported on the associated claim lines.
RULE-7276	If a claim is a non-denied claim from an LT file that is an original, replacement or resubmission claim and is a Medicaid or Medicaid-expansion CHIP FFS, Medicaid or Medicaid-expansion CHIP encounter, separate CHIP FFS or encounter claim, then the total billed amount must be populated.
RULE-7680	If a claim is a non-denied claim from an LT file that is an original, replacement or resubmission claim and is a Medicaid or Medicaid-expansion CHIP encounter, separate CHIP encounter claim, then the total billed amount must be populated.
RULE-970	If a claim is a non-denied claim from an LT file, then the total billed amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.
RULE-971	If the total billed amount is populated on a non-denied service tracking claim from an LT file, then the total billed amount must be 0.
RULE-978	If the total Medicare deductible amount and total billed amount are populated and greater than zero on a non-denied claim from an LT file, then the total Medicare deductible amount value reported must be less than or equal to the total billed amount value
RULE-982	If the total Medicare coinsurance amount and total billed amount are populated and greater than zero on a non-denied claim from an LT file, then the total Medicare coinsurance amount value reported must be less than or equal to the total billed amount value
RULE-986	If the total TPL amount, total billed amount, Medicare coinsurance amount, and Medicare deductible amount are populated on a non-denied claim from an LT file, then the absolute value of the total TPL amount is less than or equal to the absolute value of (total billed amount - (Medicare coinsurance amount + Medicare deductible amount)).
RULE-7788	If a claim is a non-denied claim from an LT file that is an original, replacement or resubmission claim and is a Medicaid or Medicaid-expansion CHIP or Separate CHIP Fee-for-Service claim, then the total billed amount must be populated.

Measure ID	Measure Name
EXP-6-028-2	% of claim headers with Total Billed Amount = $0
EXP-8-003-2	% of claim headers with Total Billed Amount = $0
MIS-4-036-36	% missing: TOT-BILLED-AMT (CLT00002)
MIS-23-041-41	% missing: TOT-BILLED-AMT (CLT00002)
MIS-81-041-41	% missing: TOT-BILLED-AMT (CLT00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP112	CIP.002.112	TOT-BILLED-AMT	CIP00002	CLAIM-HEADER-RECORD-IP
COT048	COT.002.048	TOT-BILLED-AMT	COT00002	CLAIM-HEADER-RECORD-OT
CRX039	CRX.002.039	TOT-BILLED-AMT	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CLT.002.063	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CLT.002.063	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated 6. Value should not be populated when associated Type of Claim (CLT.002.052) is equal to '4', 'D' or 'X'7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [1,3,A,C] and Source Location does not equal "23", value must be populated6. Value should not be populated when associated Type of Claim (CLT.002.052) is in [4,D,X]7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals "2" value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)
08/28/2023	3.12.0	CLT.002.063	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. Value should not be populated when associated Type of Claim is in [2, 4, 5, B, D E or X]6. Value should not be populated when associated Type of Claim (CIP.002.100) is equal to '4', 'D' or 'X'7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Value must equal the sum of all Billed Amount instances for the associated claim4. Conditional5. When associated Type of Claim in [‘1’, ’3’, ’A’, ’C’], value must be populated 6. Value should not be populated when associated Type of Claim (CLT.002.052) is equal to '4', 'D' or 'X'7. (individual line item payments) when populated and Payment Level Indicator (CLT.002.082) equals = '2' value must be greater than or equal to the sum of all claim line Revenue Charges (CLT.003.204)
08/09/2023	3.11.0	CLT.002.063	UPDATE	Definition	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
12/04/2020	2.4.0	TOT-BILLED-AMT	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|CIP112 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|CLT063 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|COT048 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|CRX039 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\|	N/A
06/11/2021	3.0.0	TOT-BILLED-AMT	UPDATE	Data Dictionary	"If associated Type of Claim value is 2, 4, 5, B, D, or E, then value should not be populated"	N/A
07/23/2021	3.0.0	TOT-BILLED-AMT (CIP.002.112)	UPDATE	Data Dictionary	“If associated Type of Claim value is 2, 4, 5, B, D, or E, then value should not be populated"	N/A
07/15/2022	3.0.1	CLT063	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT063\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT063\|TOT-BILLED-AMT\|The total amount billed for this claim at the claim header level as submitted by the provider. For encounter records, when Type of Claim value is [ 3, C, or W ], then value must equal amount the provider billed to the managed care plan. Total Billed Amount is not expected on financial transactions. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the provider billed the sub-capitated entity for the service. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.