CLT.002.077

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

FUNDING-SOURCE-NONFEDERAL-SHARE

Data Element

DE Number

CLT077

System DE Number

CLT.002.077

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	A code to indicate the type of non-federal share used by the state to finance its expenditure to the provider. In the event of two sources, states are to report the portion which represents the largest proportion not funded by the Federal government.
Size	X(2)
FLF Start Position	434
FLF Stop Position	435
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Funding Source Non-Federal Share List (VVL) 2. Value must be 2 characters 3. Value must be populated if TYPE-OF-CLAIM is not in [3,C,W,6] 4. Conditional

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

RULE ID	RULE Definition
RULE-7033	If a claim line is a non-denied claim line from an LT file, then the funding source non federal share value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-996	If the funding source non-federal share is populated on a non-denied claim from an LT file, then the funding source non-federal share value reported must be in the list of valid values.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP127	CIP.002.127	FUNDING-SOURCE-NONFEDERAL-SHARE	CIP00002	CLAIM-HEADER-RECORD-IP
COT063	COT.002.063	FUNDING-SOURCE-NONFEDERAL-SHARE	COT00002	CLAIM-HEADER-RECORD-OT
CRX054	CRX.002.054	FUNDING-SOURCE-NONFEDERAL-SHARE	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CLT.002.077	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM is not in [3,C,W,6]4. Conditional
06/02/2023	3.8.0	CLT.002.077	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Value must be populated if TYPE-OF-CLAIM <> ‘3', ‘C’, ‘W’, or '6’4. Conditional
06/01/2023	3.8.0	CLT.002.077	UPDATE	Coding requirement	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Conditional	1. Value must be in Funding Source Non-Federal Share List (VVL)2. Value must be 2 characters3. Only required if Type-of-claim is not equal to '3', 'C', 'W', '6'4. Conditional
05/13/2022	3.0.0	CIP184, CLT006, COT006, CRX006, ELG006, MCR006, PRV006, TPL006, CIP127, CLT077, COT063, CRX054, ELG111, TPL044, TPL045, CIP093, CIP088, PRV043, PRV064, PRV076, PRV129, COT191	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\|NECESSITY\| CIP184\|ADMITTING-PROV-NPI-NUM\|\| CLT006\|FILE-NAME\|\| CRX006\|FILE-NAME\|\| ELG006\|FILE-NAME\|\| MCR006\|FILE-NAME\|\| PRV006\|FILE-NAME\|\| TPL006\|FILE-NAME\|\| CIP127\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| CLT077\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| COT063\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| CRX054\|FUNDING-SOURCE-NONFEDERAL-SHARE\|\| ELG111\|HEALTH-HOME-ENTITY-EFF-DATE\|\| TPL044\|POLICY-OWNER-FIRST-NAME\|\| TPL045\|POLICY-OWNER-LAST-NAME\|\| CIP093\|PROCEDURE-CODE-DATE-6\|\| CIP088\|PROCEDURE-CODE-FLAG-5\|\| PRV043\|PROV-LOCATION-ID\|\| PRV064\|PROV-LOCATION-ID\|\| PRV076\|PROV-LOCATION-ID\|\| PRV129\|PROV-LOCATION-ID\|\| COT191\|SERVICING-PROV-TAXONOMY\|\|	DE NO\| DATA ELEMENT NAME\|NECESSITY\| CIP184\|ADMITTING-PROV-NPI-NUM\|Conditional\| CLT006\|FILE-NAME\|Mandatory\| CRX006\|FILE-NAME\|Mandatory\| ELG006\|FILE-NAME\|Mandatory\| MCR006\|FILE-NAME\|Mandatory\| PRV006\|FILE-NAME\|Mandatory\| TPL006\|FILE-NAME\|Mandatory\| CIP127\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| CLT077\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| COT063\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| CRX054\|FUNDING-SOURCE-NONFEDERAL-SHARE\|Conditional\| ELG111\|HEALTH-HOME-ENTITY-EFF-DATE\|Mandatory\| TPL044\|POLICY-OWNER-FIRST-NAME\|Mandatory\| TPL045\|POLICY-OWNER-LAST-NAME\|Mandatory\| CIP093\|PROCEDURE-CODE-DATE-6\|Conditional\| CIP088\|PROCEDURE-CODE-FLAG-5\|Conditional\| PRV043\|PROV-LOCATION-ID\|Mandatory\| PRV064\|PROV-LOCATION-ID\|Mandatory\| PRV076\|PROV-LOCATION-ID\|Mandatory\| PRV129\|PROV-LOCATION-ID\|Mandatory\| COT191\|SERVICING-PROV-TAXONOMY\|Conditional\|