CLT.002.242

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

COMBINED-BENE-COST-SHARING-PAID-AMOUNT

Data Element

DE Number

CLT242

System DE Number

CLT.002.242

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	The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary.
Size	S9(11)V99
FLF Start Position	1746
FLF Stop Position	1758
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50) 3. 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-7608	If a claim is a non-denied claim from an LT file, then the combined beneficiary cost sharing paid amount value reported must be compatible with specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP295	CIP.002.295	COMBINED-BENE-COST-SHARING-PAID-AMOUNT	CIP00002	CLAIM-HEADER-RECORD-IP
COT233	COT.002.233	COMBINED-BENE-COST-SHARING-PAID-AMOUNT	COT00002	CLAIM-HEADER-RECORD-OT
CRX166	CRX.002.166	COMBINED-BENE-COST-SHARING-PAID-AMOUNT	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CLT.002.242	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. Conditional
06/24/2022	3.0.0	CLT242/ COMBINED-BENE-COST-SHARING-PAID-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CLT242\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|S9(11)V99\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002
06/24/2022	3.0.0	CLT242	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CLT242\|COMBINED-BENE-COST-SHARING-PAID-AMOUNT\|Conditional\|The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMLT\|CLAIM-HEADER-RECORD-LT-CLT00002