COT.002.138

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

HEALTH-HOME-ENTITY-NAME

Data Element

DE Number

COT138

System DE Number

COT.002.138

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 free-form text field to indicate the health home program that authorized payment for the service on the claim or to identify the health home SPA in which an individual is enrolled. The name entered should be the name that the state uses to uniquely identify the team. A "Health Home Entity" can be a designated provider (e.g., physician, clinic, behavioral health organization), a health team which links to a designated provider, or a health team (physicians, nurses, behavioral health professionals). Because an identification numbering schema has not been established, the entities' names are being used instead.
Size	X(50)
FLF Start Position	910
FLF Stop Position	959
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must not contain a pipe or asterisk symbols 2. Value must 50 characters or less 3. Conditional 4. Value must be populated when an associated Type of Service (COT.003.186) equals "138" (payment for health home services) 5. Value must be populated when an associated claim line has a XIX MBESCBES Category of Service (COT.003.211) equals "45" (health homes for substance use services)

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

RULE ID	RULE Definition
RULE-1578	If the health home entity name is populated on a non-denied claim header from an OT file, then the health home entity name reported must not contain any pipe or asterisk characters.
RULE-7071	If a claim line is a non-denied claim line from an OT file, then the health home entity name value reported must be compatible with specified T-MSIS picture format: X(50).
RULE-7296
RULE-7300

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP214	CIP.002.214	HEALTH-HOME-ENTITY-NAME	CIP00002	CLAIM-HEADER-RECORD-IP
CLT161	CLT.002.161	HEALTH-HOME-ENTITY-NAME	CLT00002	CLAIM-HEADER-RECORD-LT
CRX096	CRX.002.096	HEALTH-HOME-ENTITY-NAME	CRX00002	CLAIM-HEADER-RECORD-RX
ELG108	ELG.006.108	HEALTH-HOME-ENTITY-NAME	ELG00006	HEALTH-HOME-SPA-PARTICIPATION-INFORMATION
ELG119	ELG.007.119	HEALTH-HOME-ENTITY-NAME	ELG00007	HEALTH-HOME-SPA-PROVIDERS

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	COT.002.138	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional4. Value must be populated when an associated Type of Service (COT.003.186) equals ‘138’ (payment for health home services)5. Value must be populated when an associated claim line has a XIX MBESCBES Category of Service (COT.003.211) equals ‘45’ (health homes for substance use services)	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional4. Value must be populated when an associated Type of Service (COT.003.186) equals "138" (payment for health home services)5. Value must be populated when an associated claim line has a XIX MBESCBES Category of Service (COT.003.211) equals "45" (health homes for substance use services)
08/28/2023	3.12.0	COT.002.138	UPDATE	Coding requirement	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional	1. Value must not contain a pipe or asterisk symbols2. Value must 50 characters or less3. Conditional4. Value must be populated when an associated Type of Service (COT.003.186) equals ‘138’ (payment for health home services)5. Value must be populated when an associated claim line has a XIX MBESCBES Category of Service (COT.003.211) equals ‘45’ (health homes for substance use services)
06/24/2022	3.0.0	COT138	UPDATE	Data Dictionary	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT138\|HEALTH-HOME-ENTITY-NAME\|\| 1.Value must 50 characters or less 2.Value must not contain a pipe or asterisk symbols 3.Conditional	DE No\|Data Element Name\|Definition\| CODING REQUIREMENT\| COT138\|HEALTH-HOME-ENTITY-NAME\|\| 1.1.(IV) value must not contain a pipe or asterisk symbols 2.(S) value must 50 characters or less 3.(N) conditional