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TMSIS Dataguide Medicaid.gov
Version 3.27.0

TOT-MEDICAID-PAID-AMT

Data Element

DE Number

CLT065

System DE Number

CLT.002.065

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

Definition

The total amount paid by Medicaid/CHIP or the managed care plan on this claim or adjustment at the claim header level, which is the sum of the amounts paid by Medicaid or the managed care plan at the detail level for the claim.

For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the total amount that the sub-capitated entity paid the provider 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 347
FLF Stop Position 359
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. Must have an associated Medicaid Paid Date
4. If Total Medicare Coinsurance Amount and Total Medicare Deductible Amount is reported it must equal Total Medicaid Paid Amount
5. When Payment Level Indicator equals '2', value must equal the sum of line level Medicaid Paid Amounts.
6. Conditional
7. Value must not be greater than Total Allowed Amount
8. Value must be populated, when Type of Claim is in [‘1’, ‘A’]
9. Value must not be populated or equal to ‘0.00’ when associated Claim Status is in ['26', '026', '87', '087', '542', '585', '654']
10. Value should not be populated, when associated Type of Claim value is in [‘4’, ‘D’] 11. Value must be less than Total Allowed Amount
11. Value must be populated when the associated Type of Claim (CLT.002.052) is in [‘5’, ‘E’]

Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP114 CIP.002.114 TOT-MEDICAID-PAID-AMT CIP00002 CLAIM-HEADER-RECORD-IP
COT050 COT.002.050 TOT-MEDICAID-PAID-AMT COT00002 CLAIM-HEADER-RECORD-OT
CRX041 CRX.002.041 TOT-MEDICAID-PAID-AMT CRX00002 CLAIM-HEADER-RECORD-RX