COT.003.161

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

LINE-NUM-ADJ

Data Element

DE Number

COT161

System DE Number

COT.003.161

File Name

COT - CLAIM OTHER

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A unique number to identify the transaction line number that identifies the line number on the adjustment claim.
Size	X(3)
FLF Start Position	145
FLF Stop Position	147
Segment Key Field Identifier	5
Coding Requirements	1. Value must be 3 characters or less 2. If associated Line Adjustment Indicator value is 0, then value must not be populated 3. If associated Line Adjustment Indicator value is 1, then value is mandatory and must be provided 4. Conditional 5. When populated, value must be one or greater

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

RULE ID	RULE Definition
RULE-1614	If an OT claim line has a value populated for line number adj, then the line number adj value must be greater than or equal to zero.
RULE-1615	If the line adjustment indicator is for an orignal claim on a non-denied claim from an OT file, then the adjustment line number must not be populated.
RULE-6196	If a claim line is a non-denied claim line from an OT file, then the line number adjustment value reported must be compatible with specified T-MSIS picture format: X(3).
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.

Measure ID	Measure Name
MIS-7-013-13	% missing: LINE-NUM-ADJ (COT00003)
MIS-26-013-13	% missing: LINE-NUM-ADJ (COT00003)
MIS-84-012-12	% missing: LINE-NUM-ADJ (COT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP238	CIP.003.238	LINE-NUM-ADJ	CIP00003	CLAIM-LINE-RECORD-IP
CLT191	CLT.003.191	LINE-NUM-ADJ	CLT00003	CLAIM-LINE-RECORD-LT
CRX115	CRX.003.115	LINE-NUM-ADJ	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
10/02/2020	2.4.0	LINE-NUM-ADJ LINE-ADJUSTMENT-IND	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Coding Requirement\|CR No\| \|CIP238\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number. \|Not Applicable\| \|CIP239\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CIP239-0002\| \|CLT191\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|CLT191-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CLT192-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|If there is a line adjustment reason, then there must be a line adjustment indicator.\|CLT192-0003 \|COT161\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|COT161-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|COT162-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|If there is a line adjustment reason, then there must be a line adjustment indicator.\|COT162-003\| \|CRX115\|LINE-NUM-ADJ\|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.\|CRX115-002\| \|CRX116\|LINE-ADJUSTMENT-IND\|If there is a line adjustment number, then there must be a line-adjustment indicator.\|CRX116-002\|	\|DE No\|Data Element Name\|Coding Requirement\|CR No\| \|CIP238\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|Not Applicable\| \|CIP239\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CIP239-0002\| \|CLT191\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|CLT191-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CLT192-0002\| \|CLT192\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CLT192-0003 \|COT161\|LINE-NUM-ADJ\|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|COT161-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|Not Applicable.\|COT162-0002\| \|COT162\|LINE-ADJUSTMENT-IND\|Not Applicable.\|COT162-003\| \|CRX115\|LINE-NUM-ADJ\|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.\|CRX115-002\| \|CRX116\|LINE-ADJUSTMENT-IND\|Not Applicable.\|CRX116-002\|