COT.002.019

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

ICN-ORIG

Data Element

DE Number

COT019

System DE Number

COT.002.019

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A unique number assigned by the state's payment system that identifies an original or adjustment claim.
Size	X(50)
FLF Start Position	22
FLF Stop Position	71
Segment Key Field Identifier	2
Coding Requirements	1. Value must be 50 characters or less 2. Value must not contain a pipe or asterisk symbols 3. Mandatory

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

RULE ID	RULE Definition
RULE-1331	If the icn orig is populated on a non-denied claim header from an OT file, then the icn orig reported must not contain any pipe or asterisk characters.
RULE-6670	If a claim is from an OT file, then the ICN origination value reported must be compatible with the specified T-MSIS picture format: X(50).
RULE-7185	If a claim header is from an OT file, then submitting state, original ICN, adjustment ICN, adjudication date, and adjustment indicator values reported must be unique across all OT claim headers.
RULE-7326	If a segment is an OT claim header, icn orig must be populated.
RULE-7433	All non-denied OT claim header records must have a corresponding claim line record.
RULE-7572	All denied OT claim header records must have a corresponding claim line record.
RULE-7635	All non-denied, paid OT claim header records must have a corresponding non-denied claim line record.

Measure ID	Measure Name
MIS-6-021-21	% missing: ICN-ORIG (COT00002)
MIS-25-021-21	% missing: ICN-ORIG (COT00002)
MIS-83-021-21	% missing: ICN-ORIG (COT00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP019	CIP.002.019	ICN-ORIG	CIP00002	CLAIM-HEADER-RECORD-IP
CIP235	CIP.003.235	ICN-ORIG	CIP00003	CLAIM-LINE-RECORD-IP
CLT019	CLT.002.019	ICN-ORIG	CLT00002	CLAIM-HEADER-RECORD-LT
CLT188	CLT.003.188	ICN-ORIG	CLT00003	CLAIM-LINE-RECORD-LT
COT158	COT.003.158	ICN-ORIG	COT00003	CLAIM-LINE-RECORD-OT
CRX019	CRX.002.019	ICN-ORIG	CRX00002	CLAIM-HEADER-RECORD-RX
CRX112	CRX.003.112	ICN-ORIG	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After