COT.003.176

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

BENEFICIARY-COPAYMENT-PAID-AMOUNT

Data Element

DE Number

COT176

System DE Number

COT.003.176

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	The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element.
Size	S9(11)V99
FLF Start Position	235
FLF Stop Position	247
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Situational 2. Value must be between -99999999999.99 and 99999999999.99 3. Value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 4. Value must be 11 digits or less left of the decimal i.e. 9999999999 99

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

RULE ID	RULE Definition
RULE-6633	If a claim is a non-denied claim from an OT file, then the beneficiary copayment paid amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name
MIS-7-005-5	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00003)
MIS-26-006-6	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00003)
MIS-84-005-5	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (COT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CRX123	CRX.003.123	BENEFICIARY-COPAYMENT-PAID-AMOUNT	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/16/2023	3.12.0	COT.003.176	UPDATE	Coding requirement	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )4. Value must be 11 digits or less left of the decimal i.e. 9999999999 99
08/16/2023	3.12.0	COT.003.176	UPDATE	Coding requirement	1. Conditional2. Value must be 11 digits or less left of the decimal i.e. 99999999999.99	1. Situational2. Value must be between -99999999999.99 and 99999999999.993. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )
06/24/2022	3.0.0	COT176/ BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name COT176\|COPAY-AMT	DE No\|Data Element Name COT176\|BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	COT176	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION COT176\|COPAY-AMT \|Conditional\|The copayment amount paid by an enrollee for the service, which does not include the amount paid by the insurance company.	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION COT176\|BENEFICIARY-COPAYMENT-PAID-AMOUNT \|Optional\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element.