CLT.002.160

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

COPAY-WAIVED-IND

Data Element

DE Number

CLT160

System DE Number

CLT.002.160

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	An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.
Size	X(1)
FLF Start Position	1016
FLF Stop Position	1016
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Copay Waived Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0,1] or not populated 4. Situational

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

RULE ID	RULE Definition
RULE-1169	If the copay waiver indicator is populated on a non-denied claim from an LT file, then the copay waiver indicator reported must be found in the list of valid values.
RULE-6149	If a claim is a non-denied claim from an IP file, then the copay waived 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
CIP213	CIP.002.213	COPAY-WAIVED-IND	CIP00002	CLAIM-HEADER-RECORD-IP
COT137	COT.002.137	COPAY-WAIVED-IND	COT00002	CLAIM-HEADER-RECORD-OT
CRX095	CRX.002.095	COPAY-WAIVED-IND	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	CLT.002.160	UPDATE	Necessity	Optional	Situational
08/28/2023	3.12.0	CLT.002.160	UPDATE	Coding requirement	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Optional	1. Value must be in Copay Waived Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. Situational
06/24/2022	3.0.0	CLT160	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT160\|COPAY-WAIVED-IND\|An indicator signifying that the copay was waived by the provider.	\|DE NO\| DATA ELEMENT NAME\|DEFINITION CLT160\|COPAY-WAIVED-IND\|An indicator signifying that the copay was discounted or waived by the provider (e.g., physician or hospital). Do not use to indicate administrative-level, Medicaid State Agency or Medicaid MCO copayment waived decisions.