CLT.003.225

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

XXI-MBESCBES-CATEGORY-OF-SERVICE

Data Element

DE Number

CLT225

System DE Number

CLT.003.225

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	A code to indicate the category of service for the paid claim. The category of service is the line item from the CMS-21 form that states use to report their expenditures and request federal financial participation.
Size	X(3)
FLF Start Position	356
FLF Stop Position	358
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in XXI MBESCBES Category of Service List (VVL) 2. Conditional 3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is "02", then a valid value is mandatory and must be reported 4. If XIX MBESCBES Category of Service is populated then value must not be populated 5. Value must be 3 characters or less

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

RULE ID	RULE Definition
RULE-1261	If the XXI MBESCBES category of service is populated on a non-denied claim line LT file, then the value reported must be in the list of valid values for XXI MBESCBES category of service.
RULE-6665	If a claim line is a non-denied claim line from an LT file, then the XXI MBESCBES category of service value reported must be compatible with specified T-MSIS picture format: X(3).
RULE-7377	If a claim is a non-denied, non-void separate CHIP fee for service or supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to '0.00' and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
RULE-7389	If a claim is a non-denied, non-void Medicaid/Medicaid-expansion CHIP or separate CHIP service tracking claim from an LT file, and the service tracking payment amount is a non-null value and cms 64 category for federal reimbursement is equal to '02', then the claim line must have a value populated for XXI MBESCBES category of service.
RULE-7534	If a claim is a non-denied, non-void Medicaid fee for service, Medicaid CHIP supplemental, Separate CHIP fee for service or Separate CHIP supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and does not equal zero, and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service has a null value.
RULE-7638	If a claim is a non-denied, non-void Medicaid fee for service or Medicaid CHIP supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and non-zero, and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
RULE-7938	If a claim is a non-denied, Medicaid or Medicaid M-CHIP fee for service or Separate CHIP fee for service claim from an LT file, and the total medicaid paid amount is a non-null value and does not equal zero, and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service must not be populated.
RULE-7950	If a claim is a non-denied, separate CHIP fee for service claim from an LT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to zero and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
RULE-7954	If a claim is a non-denied, non-void Medicaid or M-CHIP fee for service claim from an LT file, and the total medicaid paid amount is a non-null value and greater than zero, and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
RULE-7958	If a claim is a non-denied, Medicaid or M-CHIP supplemental or Separate CHIP supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and does not equal zero, and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service must not be populated.
RULE-7966	If a claim is a non-denied, separate CHIP supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to 0.00 and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
RULE-7970	If a claim is a non-denied, non-void Medicaid or M-CHIP supplemental claim from an LT file, and the total medicaid paid amount is a non-null value and greater than zero, and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.

Measure ID	Measure Name
ALL-20-002-2	% of claim lines with both XIX and XXI MBESCBES Category of Service
MIS-50-001-1	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
MIS-74-001-1	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
RULE-7377	% of claim lines on non-zero paid claims with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)
RULE-7534	% of claim lines with both XIX and XXI MBESCBES Category of Service
RULE-7389	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (CLT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP271	CIP.003.271	XXI-MBESCBES-CATEGORY-OF-SERVICE	CIP00003	CLAIM-LINE-RECORD-IP
COT212	COT.003.212	XXI-MBESCBES-CATEGORY-OF-SERVICE	COT00003	CLAIM-LINE-RECORD-OT
CRX151	CRX.003.151	XXI-MBESCBES-CATEGORY-OF-SERVICE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CLT.003.225	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is "02", then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
08/28/2023	3.12.0	CLT.003.225	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '2', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
03/19/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	UPDATE	Data Dictionary - Valid Values	\|Data Element\|Effective Date\|End Date\|Value\|Name\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|48\|Balance\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|49\|Less: Collections\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|50\|Total\|	N/A
12/17/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	add values to XXI-MBESCBES-CATEGORY-OF-SERVICE.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|2A\|Inpatient Hospital Services - DSH\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|3A\|Inpatient Mental Health - DSH\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|3B\|Certified Community Behavior Health Clinic Payments\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A2\|Drug Rebate - State\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A3\|MCO - National Agreement\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A4\|MCO - State Sidebar Agreement\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A5\|Increased ACA OFFSET - Fee for Service - 100%\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A6\|Increased ACA OFFSET - MCO - 100%\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|21A\|Home and Community-Based Services - Regular Payment (WAIVER)\|
12/03/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|20210311\|99991231\|26\|ARP Section 9821 COVID Vaccine/Vaccine Administration\|