COT.002.035

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

ADJUDICATION-DATE

Data Element

DE Number

COT035

System DE Number

COT.002.035

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.
Size	9(8)
FLF Start Position	194
FLF Stop Position	201
Segment Key Field Identifier	5
Coding Requirements	1. Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e. Feb 29th only on the leap year, never April 31st or Sept 31st) 3. Value should be on or before End of Time Period value found in associated T-MSIS File Header Record 4. 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-1356	If adjudication date and beginning date of service are populated on a non-denied claim from an OT file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment, then the beginning date of service value reported must be before or equal to the adjudication date value reported.
RULE-1365	If a claim is from an OT file, then the adjudication date value reported must be a valid date of the form CCYYMMDD.
RULE-1367	If adjudication date is populated on a non-denied claim from an OT file that is not a Medicaid or Medicaid-expansion, S-CHIP, or Other Capitated Payment and end of time period is populated on the file header, then the adjudication value reported must be before or equal to the end of time period value reported.
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-7315	#N/A
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
ALL-16-005-5	% of claim header record segments missing ADJUDICATION-DATE (COT00002)
MIS-6-001-1	% missing: ADJUDICATION-DATE (COT00002)
RULE-7315	% of claim header record segments missing ADJUDICATION-DATE (COT00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP098	CIP.002.098	ADJUDICATION-DATE	CIP00002	CLAIM-HEADER-RECORD-IP
CIP286	CIP.003.286	ADJUDICATION-DATE	CIP00003	CLAIM-LINE-RECORD-IP
CLT050	CLT.002.050	ADJUDICATION-DATE	CLT00002	CLAIM-HEADER-RECORD-LT
CLT233	CLT.003.233	ADJUDICATION-DATE	CLT00003	CLAIM-LINE-RECORD-LT
COT221	COT.003.221	ADJUDICATION-DATE	COT00003	CLAIM-LINE-RECORD-OT
CRX027	CRX.002.027	ADJUDICATION-DATE	CRX00002	CLAIM-HEADER-RECORD-RX
CRX157	CRX.003.157	ADJUDICATION-DATE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
12/17/2021	3.0.0	ADJUDICATION-DATE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|CIP098\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CLT050\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|COT035\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CRX027\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CIP286\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CLT233\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|COT221\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\| \|CRX157\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state.\|	\|DE No\|Data Element Name\|Definition\| \|CIP098\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CLT050\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|COT035\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CRX027\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CIP286\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CLT233\|ADJUDICATION-DATE\|TThe date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|COT221\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\| \|CRX157\|ADJUDICATION-DATE\|The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.\|