CLT.002.127

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

HEALTH-HOME-PROV-IND

Data Element

DE Number

CLT127

System DE Number

CLT.002.127

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	Indicates whether the claim is submitted by a provider or provider group enrolled in the Health Home care model to provide services for the beneficiary on the claim. Health home providers provide service for patients with chronic illnesses. States that do not specify an eligible individual's health home provider number, if applicable, should not report claims that indicate the claim is submitted by a provider or provider group enrolled in the health home model.
Size	X(1)
FLF Start Position	752
FLF Stop Position	752
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Health Home Provider Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0, 1] or not populated 4. If there is an associated Health Home Entity Name value, then value must be "1" 5. 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-1117	If the health home provider indicator is populated on a non-denied claim from an LT file, then the health home provider indicator reported must be found in the list of valid values.
RULE-1118	If a non-denied LT claim has a value populated for health home entity name, then the health home provider indicator must be equal to '1'.
RULE-6746	If a claim is a non-denied claim from an LT file, then the health home provider indicator value reported must be compatible with specified T-MSIS picture format: X(1).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP176	CIP.002.176	HEALTH-HOME-PROV-IND	CIP00002	CLAIM-HEADER-RECORD-IP
COT109	COT.002.109	HEALTH-HOME-PROV-IND	COT00002	CLAIM-HEADER-RECORD-OT
CRX067	CRX.002.067	HEALTH-HOME-PROV-IND	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	CLT.002.127	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Value must be 1 character6. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional