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TMSIS Dataguide Medicaid.gov
Version 3.27.0

PLAN-ID-NUMBER

Data Element

DE Number

CLT080

System DE Number

CLT.002.080

File Segment Number

CLT00002

File Segment Name

CLAIM-HEADER-RECORD-LT

Last updated

No Updates

Definition

A unique number assigned by the state which represents a distinct comprehensive managed care plan, prepaid health plan, primary care case management program, a program for all-inclusive care for the elderly entity, or other approved plans.

Size X(12)
FLF Start Position 439
FLF Stop Position 450
Segment Key Field Identifier Not Applicable
Coding Requirements

1. Value must be 12 characters or less
2. Value must not contain a pipe or asterisk symbols
3. Conditional
4. Value must match Managed Care Plan ID (ELG.014.192)
5. Value must match State Plan ID Number (MCR.002.019)
6. Value should not be populated when Type of Claim is not equal to '3', 'C' or 'W'
7. When Type of Claim in (3, C, W, 2, B, V) value must have a managed care enrollment (ELG.014) for the beneficiary where the Beginning DOS (CLT.002.048) occurs between the managed care plan enrollment eff/end dates (ELG.014.197/198)
8. When Type of Claim in (3, C, W, 2, B, V) value must have a managed care main record (MCR.002) for the plan where the Beginning DOS (CLT.002.048) occurs between the managed care contract eff/end dates (MCR.002.020/021)

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
CIP130 CIP.002.130 PLAN-ID-NUMBER CIP00002 CLAIM-HEADER-RECORD-IP
COT066 COT.002.066 PLAN-ID-NUMBER COT00002 CLAIM-HEADER-RECORD-OT
CRX056 CRX.002.056 PLAN-ID-NUMBER CRX00002 CLAIM-HEADER-RECORD-RX