COT.002.069

MEDICARE-REIM-TYPE

Data Element

DE Number

COT069

System DE Number

COT.002.069

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	A code to indicate the type of Medicare reimbursement.
Size	X(2)
FLF Start Position	397
FLF Stop Position	398
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Medicare Reimbursement Type List (VVL) 2. Value is mandatory and must be provided, when Crossover Indicator is equal to "1" (Crossover Claim) 3. Value must be 2 characters 4. Conditional

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Valid Value Code Set	Valid Value Code	Valid Value Name	Effective Start Date	Effective End Date
MEDICARE-REIM-TYPE	01	IPPS - Acute Inpatient PPS	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	02	LTCHPPS - Long-term Care Hospital PPS	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	03	SNFPPS - Skilled Nursing Facility PPS	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	04	HHPPS - Home Health PPS	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	05	IRFPPS - Inpatient Rehabilitation Facility PPS	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	06	IPFPPS - Inpatient Psychiatric Facility PPS	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	07	OPPS - Outpatient PPS	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	08	Fee Schedules (for physicians, DME, ambulance, and clinical lab)	01/01/0001	12/31/9999
MEDICARE-REIM-TYPE	09	Part C Hierarchical Condition Category Risk Assessment (CMS-HCC RA) Capitation Payment Model	01/01/0001	12/31/9999

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RULE ID	RULE Definition
RULE-1428	If the medicare reim type is populated on a non-denied claim from an OT file, then the medicare reim type reported must be found in the list of valid values.
RULE-6820	The format for MEDICARE-REIM-TYPE on a non-denied OT claim was expected to be submitted as X(2).

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Measure ID	Measure Name
No data available in table

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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP133	CIP.002.133	MEDICARE-REIM-TYPE	CIP00002	CLAIM-HEADER-RECORD-IP
CLT083	CLT.002.083	MEDICARE-REIM-TYPE	CLT00002	CLAIM-HEADER-RECORD-LT
CRX059	CRX.002.059	MEDICARE-REIM-TYPE	CRX00002	CLAIM-HEADER-RECORD-RX