COT.002.038

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

TYPE-OF-BILL

Data Element

DE Number

COT038

System DE Number

COT.002.038

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	A data element corresponding with UB-04 form locator FL4 that classifies the claim as to the type of facility (2nd digit), type of care (3rd digit) and the billing record's sequence in the episode of care (4th digit). (Note that the 1st digit is always zero.)
Size	X(4)
FLF Start Position	211
FLF Stop Position	214
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Type of Bill List (VVL) 2. Value must be 4 characters 3. First character must be a '0' 4. 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-1371	If type of bill is populated on a non-denied, non-void claim from an OT file, then the type of bill value reported must be in the list of valid values for type of bill.
RULE-6864	If a claim is a non-denied claim from an OT file, then the type of bill value reported must be compatible with specified T-MSIS picture format: X(4).
RULE-7351	If a non-denied claim from an OT file has the type of claim equal to '1','3','A','C', then the claim type of bill or place of service must be populated.
RULE-7353	If a non-denied claim line from an OT file has the type of claim equal to '1','3','A','C', and the revenue code is populated, then the claim type of bill must be populated.
RULE-7746	If a non-denied claim from an OT file has the type of claim Medicaid or Medicaid-expansion CHIP Managed Care Encounter or Separate CHIP Encounter, then the claim type of bill or place of service must be populated.
RULE-7748	If a non-denied claim line from an OT file has the type of claim Medicaid or Medicaid-expansion CHIP Managed Care Encounter or Separate CHIP Encounter, and the revenue code is populated, then the claim type of bill must be populated.
RULE-7812	If a non-denied claim from an OT file has the type of claim Medicaid or Medicaid-expansion CHIP Managed Care Fee-for-service or Separate CHIP Fee-for-service, then the claim type of bill or place of service must be populated.
RULE-7814	If a non-denied claim line from an OT file has the type of claim Medicaid or Medicaid-expansion CHIP Managed Care Fee-for-service or Separate CHIP Fee-for-service, and the revenue code is populated, then the claim type of bill must be populated.

Measure ID	Measure Name
ALL-15-002-2	% of claim lines with both Type of Bill and Place of Service non-missing
ALL-15-003-3	% of claim lines missing Type of Bill and Place of Service
ALL-15-004-4	% of claim lines with non-missing Type of Bill that have missing Revenue Code
ALL-15-005-5	% of claim lines with non-missing Revenue Code that have missing Type of Bill
ALL-32-001-1	Type of Bill values
FFS-52-007-7	% of claim lines where TYPE-OF-BILL does not begin with 03, 07, 08, 012, 013, 014, 022, 023, 024
MCR-62-007-7	% of claim lines where TYPE-OF-BILL does not begin with 03, 07, 08, 012, 013, 014, 022, 023, 024
MIS-6-033-33	% missing: TYPE-OF-BILL (COT00002)
RULE-1371	% of claim headers with invalid Type of Bill
MIS-25-038-38	% missing: TYPE-OF-BILL (COT00002)
MIS-83-038-38	% missing: TYPE-OF-BILL (COT00002)
RULE-7351	% of claim lines missing Type of Bill and Place of Service
RULE-7352	% of claim lines with non-missing Type of Bill that have missing Revenue Code
RULE-7353	% of claim lines with non-missing Revenue Code that have missing Type of Bill

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP101	CIP.002.101	TYPE-OF-BILL	CIP00002	CLAIM-HEADER-RECORD-IP
CLT053	CLT.002.053	TYPE-OF-BILL	CLT00002	CLAIM-HEADER-RECORD-LT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/13/2021	3.0.0	TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|1\|Rural Health Clinic (RHC)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|2\|Hospital Based or Independent Renal Dialysis Facility\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|3\|Free Standing Provider-Based Federally Qualified Health Center (FQHC)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|4\|Other Rehabilitation Facility (ORF)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|5\|Comprehensive Outpatient Rehabilitation Facility (CORF)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|6\|Community Mental Health Center (CMHC)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|20100401\|99991231\|7\|Federally Qualified Health Center (FQHC) (Effective 4/1/10)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|20120401\|99991231\|8\|Licensed Freestanding Emergency Medical Facility (Effective 4/1/12)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-CLINICS\|00010101\|99991231\|9\|OTHER\|
08/13/2021	3.0.0	TYPE-OF-BILL-2-FACILITY-TYPE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|1\|Hospital\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|2\|Skilled Nursing\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|3\|Home Health\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|4\|Religious Nonmedical (Hospital)\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|20051001\|5\|Reserved for national assignment (discontinued effective 10/1/05).\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|6\|Intermediate Care\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|7\|Clinic or Hospital Based Renal Dialysis Facility (requires special information in second digit below).\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|8\|Special facility or hospital ASC surgery (requires special information in second digit below).\| \|TYPE-OF-BILL-2-FACILITY-TYPE\|00010101\|99991231\|9\|Reserved for National Assignment\|
08/13/2021	3.0.0	TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|1\|Inpatient\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|2\|Inpatient\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|3\|Outpatient\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|4\|Other\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|5\|Intermediate Care - Level I\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|6\|Intermediate Care - Level II\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|20051001\|7\|Reserved for national assignment (discontinued effective 10/1/05).\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|8\|Swing Bed (may be used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement).\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-OTHER\|00010101\|99991231\|9\|Reserved for National Assignment\|
08/13/2021	3.0.0	TYPE-OF-BILL-4-FREQUENCY	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|0\|Nonpayment/Zero Claims\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|1\|Admit Through Discharge Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|2\|Interim-First Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|3\|Interim-Continuing Claims (Not valid for PPS Bills)\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|A\|Admission/Election Notice\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|B\|Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Termination/Revocation Notice\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|C\|Hospice Change of Provider Notice\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|D\|Hospice/Medicare Coordinated Care Demonstration/Religious Nonmedical Health Care Institution Void/Cancel\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|E\|Hospice Change of Ownership\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|F\|Beneficiary Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|G\|CWF Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|H\|CMS Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|I\|FI Adjustment Claim (Other than QIO or Provider\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|J\|Initiated Adjustment Claim-Other\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|K\|OIG Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|M\|MSP Initiated Adjustment Claim\| \|TYPE-OF-BILL-4-FREQUENCY\|00010101\|99991231\|P\|QIO Adjustment Claim\|
08/13/2021	3.0.0	TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|1\|Hospice (Nonhospital Based)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|2\|Hospice (Hospital Based)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|3\|Ambulatory Surgical Center Services to Hospital Outpatients\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|4\|Free Standing Birthing Center\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|5\|Critical Access Hospital\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|6\|Residential Facility\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|20210101\|99991231\|7\|Freestanding Non-residential Opioid Treatment Program (Effective 1/1/21)\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|8\|Reserved for National Assignment\| \|TYPE-OF-BILL-3-BILL-CLASSIFICATION-FACILITY\|00010101\|99991231\|9\|OTHER\|