CLT.002.078

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

MEDICARE-COMB-DED-IND

Data Element

DE Number

CLT078

System DE Number

CLT.002.078

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	Code indicating that the amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare deductible was combined with their coinsurance amount because the amounts could not be separated.
Size	X(1)
FLF Start Position	436
FLF Stop Position	436
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Medicare Combined Deductible Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0, 1] or not populated 4. If value equals '1', then Total Medicare Coinsurance amount must not be populated. 5. If value equals '0', then Crossover Indicator must equals '0' 6. If value equals '1', then Crossover Indicator must equals '1' 7. 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-6389	If a claim is a non-denied claim from an LT file, then the medicare comb ded indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-997	If the medicare comb ded indicator is populated on a non-denied claim from an LT file, then the medicare comb ded indicator value reported must be in the list of valid values.
RULE-998	If a claim is a non-denied, non-crossover LT claim that is an encounter claim, then the medicare comb ded indicator must be an amount not combined with the coinsurance amount.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP128	CIP.002.128	MEDICARE-COMB-DED-IND	CIP00002	CLAIM-HEADER-RECORD-IP
COT064	COT.002.064	MEDICARE-COMB-DED-IND	COT00002	CLAIM-HEADER-RECORD-OT
CRX160	CRX.002.160	MEDICARE-COMB-DED-IND	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/01/2023	3.11.0	CLT.002.078	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Value must be 1 character5. If value equals '1', then Total Medicare Coinsurance amount must not be populated.6. If value equals '0', then Crossover Indicator must equals '0'7. If value equals '1', then Crossover Indicator must equals '1'8. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional