COT.003.158

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

ICN-ORIG

Data Element

DE Number

COT158

System DE Number

COT.003.158

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A unique number assigned by the state's payment system that identifies an original or adjustment claim.
Size	X(50)
FLF Start Position	42
FLF Stop Position	91
Segment Key Field Identifier	2
Coding Requirements	1. Value must be 50 characters or less 2. Value must not contain a pipe or asterisk symbols 3. 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-1610	All non-denied OT claim line records must have a corresponding parent record.
RULE-1611	If the icn orig is populated on a non-denied claim line from an OT file, then the icn orig reported must not contain any pipe or asterisk characters.
RULE-7057	If an OT claim line, the icn orig value must be specified in the T-MSIS picture format: X(50).
RULE-7189	If a claim line is from an OT file, then submitting state, original ICN, adjustment ICN, adjudication date, line adjustment indicator, original line ICN, and adjustment line ICN values reported must be unique across all OT claim lines.
RULE-7330	If a segment is an OT claim line, icn orig must be populated.
RULE-7576	All denied OT claim line records must have a corresponding claim header record.

Measure ID	Measure Name
MIS-7-011-11	% missing: ICN-ORIG (COT00003)
MIS-26-012-12	% missing: ICN-ORIG (COT00003)
MIS-84-011-11	% missing: ICN-ORIG (COT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP019	CIP.002.019	ICN-ORIG	CIP00002	CLAIM-HEADER-RECORD-IP
CIP235	CIP.003.235	ICN-ORIG	CIP00003	CLAIM-LINE-RECORD-IP
CLT019	CLT.002.019	ICN-ORIG	CLT00002	CLAIM-HEADER-RECORD-LT
CLT188	CLT.003.188	ICN-ORIG	CLT00003	CLAIM-LINE-RECORD-LT
COT019	COT.002.019	ICN-ORIG	COT00002	CLAIM-HEADER-RECORD-OT
CRX019	CRX.002.019	ICN-ORIG	CRX00002	CLAIM-HEADER-RECORD-RX
CRX112	CRX.003.112	ICN-ORIG	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After