COT.003.209

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

BENEFIT-TYPE

Data Element

DE Number

COT209

System DE Number

COT.003.209

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 benefit category corresponding to the service reported on the claim or encounter record. Note: The code definitions in the valid value list originate from the Medicaid and CHIP Program Data System (MACPro) benefit type list. See Appendix H: Benefit Types
Size	X(3)
FLF Start Position	715
FLF Stop Position	717
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Benefit Type Code List (VVL) 2. Value must be 3 characters 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-1689	If the benefit type is populated on a non-denied claim line from an OT file, then the benefit type value reported must be in the list of valid values.
RULE-6316	If a claim line is a non-denied claim line from an OT file, then the benefit type value reported must be compatible with specified T-MSIS picture format: X(3).

Measure ID	Measure Name
ALL-1-001-7	% of claim lines with BENEFIT-TYPE = 002 (outpatient hospital)
ALL-1-002-8	% of claim lines with BENEFIT-TYPE = 010 (physician)
ALL-1-003-1	# of unique Benefit Type values reported for mandatory ambulatory-only benefit (see DD Appendix H)
ALL-1-006-4	# of unique Benefit Type values reported for optional ambulatory-only benefit (see DD Appendix H)
ALL-1-009-9	% of claim lines with Benefit Type values representing a combination ambulatory/institutional benefit (see DD Appendix H)
ALL-1-012-12	% of claim lines with Benefit Type values representing ambulatory-only benefit (see DD Appendix H)
MIS-7-003-3	% missing: BENEFIT-TYPE (COT00003)
MIS-26-004-4	% missing: BENEFIT-TYPE (COT00003)
MIS-84-003-3	% missing: BENEFIT-TYPE (COT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP268	CIP.003.268	BENEFIT-TYPE	CIP00003	CLAIM-LINE-RECORD-IP
CLT218	CLT.003.218	BENEFIT-TYPE	CLT00003	CLAIM-LINE-RECORD-LT
CRX148	CRX.003.148	BENEFIT-TYPE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
04/17/2020	2.4.0	BENEFIT-TYPE CIP268, CLT218, COT209, CRX148	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID \|Code \|Description\| Effective Date\| End Date\| BENEFIT-TYPE \|CIP268, CLT218, COT209, CRX148\| 107\| In vitro diagnostic products (as defined in section 809.3(a) of title 21, Code of Federal Regulations) administered during any portion of the emergency period defined in paragraph (1)(B) of section 1135(g) beginning on or after the date of the enactment of this subparagraph for the detection of SARS–CoV–2 or the diagnosis of the virus that causes COVID–19, and the administration of such in vitro diagnostic products\| 3/18/2020\| 12/31/9999\| BENEFIT-TYPE\| CIP268, CLT218, COT209, CRX148\| 108\| COVID–19 testing-related s ervices\| 3/18/2020\| 12/31/9999\|