CLT.003.207

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

OTHER-INSURANCE-AMT

Data Element

DE Number

CLT207

System DE Number

CLT.003.207

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The amount paid by insurance other than Medicare or Medicaid on this claim.
Size	S9(11)V99
FLF Start Position	246
FLF Stop Position	258
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-1238	If a claim is a non-denied claim from an LT file, then the other insurance amount value reported must be a valid dollar amount that matches the 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
CIP272	CIP.003.272	OTHER-INSURANCE-AMT	CIP00003	CLAIM-LINE-RECORD-IP
COT213	COT.003.213	OTHER-INSURANCE-AMT	COT00003	CLAIM-LINE-RECORD-OT
CRX152	CRX.003.152	OTHER-INSURANCE-AMT	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After