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Data Element
CLT130
CLT.002.130
Definition | A unique identification number assigned by the state to a provider or capitation plan. This data element should represent the entity billing for the service. For encounter records, if associated Type of Claim value equals 3, C, or W, then value must be the state identifier of the provider or entity (billing or reporting) to the managed care plan. |
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Size | X(30) |
FLF Start Position | 775 |
FLF Stop Position | 804 |
Segment Key Field Identifier | Not Applicable |
Coding Requirements | 1. Value must be 30 characters or less |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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DE Number | System DE Number | DE Name | File Segment Number | File Segment Name |
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CIP179 | CIP.002.179 | BILLING-PROV-NUM | CIP00002 | CLAIM-HEADER-RECORD-IP |
COT112 | COT.002.112 | BILLING-PROV-NUM | COT00002 | CLAIM-HEADER-RECORD-OT |
CRX070 | CRX.002.070 | BILLING-PROV-NUM | CRX00002 | CLAIM-HEADER-RECORD-RX |