CLT.003.208

MEDICAID-PAID-AMT

Data Element

DE Number

CLT208

System DE Number

CLT.003.208

File Name

CLT - CLAIM LONG-TERM CARE

File Segment Number

CLT00003

File Segment Name

CLAIM-LINE-RECORD-LT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider 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	259
FLF Stop Position	271
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 4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']

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

RULE ID	RULE Definition
RULE-1239	If a claim line is a non-denied claim line from an LT file, then the Medicaid paid amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.
RULE-7561	If an LT claim line is for a denied claim, then the medicaid paid amount has a missing or zero value.

Measure ID	Measure Name
MCR-6-015-13	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 48 (Inpatient psychiatric services for individuals under age 21)
RULE-7791	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
MCR-59R-002-14	% of Plan IDs over the threshold for MCR-59P-002-14 (% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header, by Plan ID)
MCR-59P-002-14	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header, by Plan ID
MCR-6-026-18	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 133 (Supplemental payment - nursing)
MCR-6-025-25	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 59 (Skilled nursing facility services for individuals under age 21)
MCR-6-024-24	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 50 (Inpatient substance abuse treatment services and residential substance abuse treatment services.)
MCR-6-023-23	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 48 (Inpatient psychiatric services for individuals under age 21)
MCR-6-022-22	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 47 (Nursing facility services, other than in institutions for mental diseases)
MCR-6-021-21	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 46 (Intermediate care facility (ICF/IIDICF/IID) services)
MCR-6-020-20	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 45 (Nursing facility services for individuals age 65 or older in institutions for mental diseases)
MCR-6-019-19	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 44 (Inpatient hospital services for individuals age 65 or older in institutions for mental diseases)
MCR-6-018-17	Ratio of Average Medicaid FFS equivalent amount per Long-Term Care day to Average Amount Paid per Long-Term Care day for TYPE-OF-SERVICE = 9 (Nursing facility services; age 21 or older)
MCR-6-017-15	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 59 (Skilled nursing facility services for individuals under age 21)
MCR-6-016-14	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 50 (Inpatient substance abuse treatment services and residential substance abuse treatment services.)
FFS-49-002-14	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
MCR-6-014-12	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 47 (Nursing facility services, other than in institutions for mental diseases)
MCR-6-013-11	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 46 (Intermediate care facility (ICF/IIDICF/IID) services)
MCR-6-012-10	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 45 (Nursing facility services for individuals age 65 or older in institutions for mental diseases)
MCR-6-011-9	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 44 (Inpatient hospital services for individuals age 65 or older in institutions for mental diseases)
MCR-6-010-16	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 9 (Nursing facility services; age 21 or older)
MCR-59-002-2	% of claim headers where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
FFS-49-002-2	% of claim headers where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
RULE-7561	% of denied claim lines where Medicaid Paid Amount is non-missing and non-zero
MIS-82-009-9	% missing: MEDICAID-PAID-AMT (CLT00003)
MIS-24-001-10	% missing: MEDICAID-PAID-AMT (CLT00003)
MIS-5-011-11	% missing: MEDICAID-PAID-AMT (CLT00003)
MCR-59-010-10	% of claim lines with PAYMENT-LEVEL-IND=2 (claim detail) that have Medicaid Paid Amount greater than a non-zero Allowed Amount
MCR-59-002-14	% of claim headers with PAYMENT-LEVEL-IND = 2 where the sum of Medicaid Paid Amount from the lines does not equal Total Medicaid Paid Amount from the header
FFS-49-010-10	% of claim lines with PAYMENT-LEVEL-IND=2 (claim detail) that have Medicaid Paid Amount greater than a non-zero Allowed Amount

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP254	CIP.003.254	MEDICAID-PAID-AMT	CIP00003	CLAIM-LINE-RECORD-IP
COT178	COT.003.178	MEDICAID-PAID-AMT	COT00003	CLAIM-LINE-RECORD-OT
CRX125	CRX.003.125	MEDICAID-PAID-AMT	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/01/2023	3.12.0	CLT.003.208	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. Conditional4. Value should not be populated or equal to zero, when associated Claim Line Status is in ['26', '026', '87', '087', '542', '585', '654']
08/09/2023	3.11.0	CLT.003.208	UPDATE	Definition	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider 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.003.208	UPDATE	Last update date	12/08/2022	8/9/2023
09/11/2020	2.4.0	CIP254, CLT208, COT178, CRX125	UPDATE	Data Dictionary	Current Coding Requirement: For claims where Medicaid payment is only available at the header level, report the entire payment amount on the MSIS record corresponding to the line item with the highest charge. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.	Proposed Coding requirement: For claims where Medicaid payment is only available at the header level, report the entire payment amount on the MSIS record corresponding to the line item with the highest charge or the 1st detail. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.
08/13/2021	3.0.0	MEDICAID-PAID-AMT	UPDATE	Data Dictionary	\|Definition\| \|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For claims where Medicaid payment is only available at the header level, report the entire payment amount on the T-MSIS record corresponding to the line item with the highest charge or the 1st detail. Zero fill Medicaid Amount Paid on all other MSIS records created from the original claim.\|	\|Definition\| \|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.\|
07/15/2022	3.0.1	CLT208	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT208\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CLT208\|MEDICAID-PAID-AMT\|The amount paid by Medicaid/CHIP agency or the managed care plan on this claim or adjustment at the claim detail level. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the sub-capitated entity paid the provider 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.