COT.002.054

TOT-TPL-AMT

Data Element

DE Number

COT054

System DE Number

COT.002.054

File Name

COT - CLAIM OTHER

File Segment Number

COT00002

File Segment Name

CLAIM-HEADER-RECORD-OT

Last updated

09/12/2024

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Third-party liability refers to the legal obligation of third parties, i.e., certain individuals, entities, or programs, to pay all or part of the expenditures for medical assistance furnished under a state plan. This is the total amount denoted at the claim header level paid by the third party.
Size	S9(11)V99
FLF Start Position	331
FLF Stop Position	343
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. Value must be less than associated Total Billed Amount- (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount) 4. Conditional

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date
No data available in table

Search:

Show entries

RULE ID	RULE Definition
RULE-1404	If a claim is a non-denied claim from an OT file, then the total TPL amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Search:

Show entries

Search:

Show entries

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP118	CIP.002.118	TOT-TPL-AMT	CIP00002	CLAIM-HEADER-RECORD-IP
CLT069	CLT.002.069	TOT-TPL-AMT	CLT00002	CLAIM-HEADER-RECORD-LT
CRX045	CRX.002.045	TOT-TPL-AMT	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	COT.002.054	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. Value must be less than associated Total Billed Amount- (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. 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. Value must be less than associated Total Billed Amount- (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional
08/15/2023	3.12.0	COT.002.054	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. Value must be less than associated Total Billed Amount (CE) - (Total Medicare Coinsurance Amount (CE) + Total Medicare Deductible Amount (CE))4. 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. Value must be less than associated Total Billed Amount- (Total Medicare Coinsurance Amount + Total Medicare Deductible Amount)4. Conditional