COT.003.187

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

HCBS-SERVICE-CODE

Data Element

DE Number

COT187

System DE Number

COT.003.187

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 code to indicate that the service represents a long-term care home and community based service or support for an individual with chronic medical and/or mental conditions. The codes help to delineate between acute care and long-term care provided in the home and community setting (e.g. 1915(c), 1915(i), 1915(j), and 1915(k) services).
Size	X(1)
FLF Start Position	325
FLF Stop Position	325
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in HCBS Service Code List (VVL). 2. Value must be 1 character 3. If value is 1-7, then HCBS Taxonomy must be populated. 4. Conditional

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

RULE ID	RULE Definition
RULE-6495	If a claim line is a non-denied claim line from an OT file, then the HCBS service code reported must be compatible with specified T-MSIS picture format: X(11).
RULE-7134	If the HCBS service code is populated on a non-denied OT claim line, then the HCBS service code reported must be found in the list of valid values.

Measure ID	Measure Name
ALL-19-001-1	% of claim headers with HCBS-SERVICE-CODE = 4 that are missing Waiver ID
ALL-2-004-4	% of active 1915(i) MSIS IDs (STATE-PLAN-OPTION-TYPE = '02') during the reporting period with 1915(i) claim lines (HCBS-SERVICE-CODE = '1')
ALL-2-006-6	% of active 1915(j) MSIS IDs (STATE-PLAN-OPTION-TYPE = '03') during the reporting period with 1915(j) claim lines (HCBS-SERVICE-CODE = '2')
ALL-2-011-11	% of 1915(c) waiver enrollees (WAIVER-TYPE = 06 - 20 or 33) that do not have any claim headers with HCBS-SERVICE-CODE = 4
ALL-34-001-1	% of claim lines with non-missing HCBS Service Code that have missing HCBS Taxonomy
ALL-34-002-2	% of claim lines with non-missing Procedure Code and either HCBS Service Code or HCBS Taxonomy that have a Procedure Code format that indicates a CPT or CDT code
EXP-11-002-84	Sum of Medicaid Paid Amount for HCBS Program
EXP-11-082-5	Average Medicaid Paid Amount for HCBS Program (exclude outliers with Medicaid Paid Amount > $200,000)
MIS-7-007-7	% missing: HCBS-SERVICE-CODE (COT00003)
MIS-26-008-8	% missing: HCBS-SERVICE-CODE (COT00003)
MIS-84-007-7	% missing: HCBS-SERVICE-CODE (COT00003)
RULE-7460	% of claim headers with HCBS-SERVICE-CODE = 4 that are missing Waiver ID
ALL-2-007-7	OT- % of active 1915(c) eligibles (WAIVER-TYPE = '06' - '20' or ‘33’) during the reporting period with 1915(c) claim records (HCBS-SERVICE-CODE = '5')

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CRX135	CRX.003.135	HCBS-SERVICE-CODE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After