CLT.003.204

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

REVENUE-CHARGE

Data Element

DE Number

CLT204

System DE Number

CLT.003.204

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
Size	S9(11)V99
FLF Start Position	207
FLF Stop Position	219
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. Value must be less than or equal to associated Total Billed Amount value. 4. When populated, associated claim line Revenue Charge must be populated 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-1232	If a claim is a non-denied claim from an LT file, then the revenue charge value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.
RULE-1234	If revenue code is populated on a non-denied claim line from an LT file, then revenue charge must be populated.

Measure ID	Measure Name
MIS-5-013-13	% missing: REVENUE-CHARGE (CLT00003)
MIS-24-012-12	% missing: REVENUE-CHARGE (CLT00003)
MIS-82-011-11	% missing: REVENUE-CHARGE (CLT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP251	CIP.003.251	REVENUE-CHARGE	CIP00003	CLAIM-LINE-RECORD-IP

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/15/2023	3.12.0	CLT.003.204	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. Value must be less than or equal to associated Total Billed Amount (CE) value.4. When populated, associated claim line Revenue Charge must be populated5. 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. Value must be less than or equal to associated Total Billed Amount value.4. When populated, associated claim line Revenue Charge must be populated5. Conditional
08/09/2023	3.11.0	CLT.003.204	UPDATE	Definition	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.	The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
08/09/2023	3.11.0	CLT.003.204	UPDATE	Last update date	12/08/2022	8/9/2023
07/15/2022	3.0.1	CLT204	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT204\|REVENUE-CHARGE\|The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT204\|REVENUE-CHARGE\|The total amount billed for the related Revenue Code. Total amount billed includes both covered and non-covered charges (as defined by UB-04 Billing Manual). For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed to the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.