COT.003.162

LINE-ADJUSTMENT-IND

Data Element

DE Number

COT162

System DE Number

COT.003.162

File Name

COT - CLAIM OTHER

File Segment Number

COT00003

File Segment Name

CLAIM-LINE-RECORD-OT

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to indicate the type of adjustment record claim/encounter represents at claim detail level.
Size	X(1)
FLF Start Position	148
FLF Stop Position	148
Segment Key Field Identifier	6
Coding Requirements	1. Value must be in Line Adjustment Indicator List (VVL) 2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4] 3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6] 4. Value must be 1 character 5. Conditional 6. If associated Line Adjustment Number is populated, then value must be populated

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

RULE ID	RULE Definition
RULE-7656	If a segment is an OT claim header, and the type of claim is a capitation, then the line adjustment indicator must be populated.
RULE-7890	If the type of claim is a service tracking and line adjustment indicator is populated on a claim line from an OT file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-7882	If the type of claim is a supplemental and line adjustment indicator is populated on a claim line from an OT file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-7874	If the type of claim is a fee-for-service and line adjustment indicator is populated on a claim line from an OT file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-7866	If a segment is an OT claim line, and the type of claim is a service tracking, the line adjustment indicator must be populated.
RULE-7858	If a segment is an OT claim line, and the type of claim is a supplemental, the line adjustment indicator must be populated.
RULE-7850	If a segment is an OT claim line, and the type of claim is a fee for service, the line adjustment indicator must be populated.
RULE-7676	If the type of claim is a capitation and line adjustment indicator is populated on a claim line from an OT file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-7673	If the type of claim is an encounter and line adjustment indicator is populated on a claim line from an OT file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.
RULE-1610	All non-denied OT claim line records must have a corresponding parent record.
RULE-7654	If a segment is an OT claim header, and the type of claim is an encounter, then the line adjustment indicator must be populated.
RULE-7576	All denied OT claim line records must have a corresponding claim header record.
RULE-7547	If a segment is an OT claim line, and claim line status is equal to '686' (void claim), then the line adjustment indicator must be equal to '1' (void).
RULE-7470	If a segment is an OT claim line, line adjustment indicator must be populated.
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-7019	If a claim line is a non-denied claim line from an OT file, then the line adjustment indicator value reported must be compatible with specified T-MSIS picture format: X(1).
RULE-1616	If the line adjustment indicator is populated on a claim line from an OT file, then the line adjustment indicator value reported must be in the list of valid values for line adjustment indicator.

Measure ID	Measure Name
MCR-32-017-17	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
RULE-7470	% of claim lines with a missing Line Adjustment Indicator
RULE-1616	% of claim lines with an invalid Line Adjustment Indicator (LINE-ADJUSTMENT-IND is 2, 3, 9, other invalid value)
MCR-S-017-19	% of claim lines that are original
MCR-S-013-8	% of claim lines that are original
MCR-51-001-1	Line Adjustment Indicator values
MCR-50-001-1	Line Adjustment Indicator values
MCR-41-001-1	Line Adjustment Indicator values
MCR-40-001-1	Line Adjustment Indicator values
MCR-32-018-18	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
EXP-23-002-1	Average absolute value of Medicaid Paid Amount
MCR-32-008-8	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
MCR-32-007-7	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
FFS-S-014-19	% of claim lines that are original
FFS-S-010-8	% of claim lines that are original
FFS-41-001-1	Line Adjustment Indicator values
FFS-33-001-1	Line Adjustment Indicator values
FFS-26-014-14	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
FFS-26-006-6	% of claim lines without a valid Line Adjustment Indicator (LINE-ADJ-IND is 2, 3, 9, other invalid value, or missing)
EXP-25-002-1	Average absolute value of Medicaid Paid Amount

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP239	CIP.003.239	LINE-ADJUSTMENT-IND	CIP00003	CLAIM-LINE-RECORD-IP
CLT192	CLT.003.192	LINE-ADJUSTMENT-IND	CLT00003	CLAIM-LINE-RECORD-LT
CRX116	CRX.003.116	LINE-ADJUSTMENT-IND	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	COT.003.162	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [1,3,5,A,C,E,U,W,Y], then value must be in [0,1,4]3. If associated Type of Claim value is in [4,D,X], then value must be in [5,6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
09/21/2023	3.13.0	COT.003.162	UPDATE	Segment key field identifier	Not Applicable	6
08/07/2023	3.11.0	COT.003.162	UPDATE	Coding requirement	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated	1. Value must be in Line Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is in [ 4, D, X ], then value must be in [5, 6]4. Value must be 1 character5. Conditional6. If associated Line Adjustment Number is populated, then value must be populated
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\|