COT.003.212

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

XXI-MBESCBES-CATEGORY-OF-SERVICE

Data Element

DE Number

COT212

System DE Number

COT.003.212

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 code to indicate the category of service for the paid claim. The category of service is the line item from the CMS-21 form that states use to report their expenditures and request federal financial participation.
Size	X(3)
FLF Start Position	725
FLF Stop Position	727
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in XXI MBESCBES Category of Service List (VVL) 2. Conditional 3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported 4. If XIX MBESCBES Category of Service is populated then value must not be populated 5. Value must be 3 characters or less

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

RULE ID	RULE Definition
RULE-1695	If the XXI MBESCBES category of service is populated on a non-denied claim line from an OT file, then the XXI MBESCBES category of service value reported must be in the list of valid values for XXI MBESCBES category of service.
RULE-6133	If a claim is a non-denied claim from an OT file, then the XXI MBESCBES category of service value reported must be compatible with specified T-MSIS picture format: X(3)
RULE-7378	If a claim is a non-denied, non-void separate CHIP fee for service or supplemental claim from an OT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to '0.00' and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
RULE-7390	If a claim is a non-denied, non-void Medicaid/Medicaid-expansion CHIP or separate CHIP service tracking claim from an OT file, and the service tracking payment amount is a non-null value and cms 64 category for federal reimbursement is equal to '02', then the claim line must have a value populated for XXI MBESCBES category of service.
RULE-7535	If a claim is a non-denied, non-void Medicaid fee for service, Medicaid M-CHIP capitation, Medicaid CHIP supplemental, Separate CHIP fee for service or Separate CHIP supplemental Separate CHIP capitation claim from an OT file, and the total medicaid paid amount is a non-null value and does not equal zero, and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service has a null value.
RULE-7639	If a claim is a non-denied, non-void Medicaid fee for service, Medicaid CHIP supplemental or Medicaid CHIP capitation claim from an OT file, and the total medicaid paid amount is a non-null value and non-zero, and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
RULE-7941	If a claim is a non-denied, Medicaid or Medicaid M-CHIP capitation or Separate CHIP capitation claim from an OT file, and the total medicaid paid amount is a non-null value and does not equal zero, and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service must not be populated.
RULE-7943	If a claim is a non-denied, separate CHIP capitation claim from an OT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to '0.00' and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
RULE-7944	If a claim is a non-denied, non-void Medicaid or M-CHIP capitation claim from an OT file, and the total medicaid paid amount is a non-null value and non-zero, and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
RULE-7959	If a claim is a non-denied, Medicaid or M-CHIP supplemental or Separate CHIP supplemental claim from an OT file, and the total medicaid paid amount is a non-null value and does not equal zero, and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service must not be populated.
RULE-7967	If a claim is a non-denied, separate CHIP supplemental claim from an OT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to 0.00 and cms 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
RULE-7971	If a claim is a non-denied, non-void Medicaid or M-CHIP supplemental claim from an OT file, and the total medicaid paid amount is a non-null value and greater than zero, and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.
RULE-7939	If a claim is a non-denied, Medicaid or Medicaid M-CHIP fee for service or Separate CHIP fee for service claim from an OT file, and the total medicaid paid amount is a non-null value and does not equal zero, and claim line XIX-MBESCBES category of service is populated, then claim line XXI-MBESCBES category of service must not be populated.
RULE-7951	If a claim is a non-denied, separate CHIP fee for service claim from an OT file, and the total medicaid paid amount is a non-null value and the total medicaid paid amount is not equal to zero and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES-CATEGORY-OF-SERVICE must be populated.
RULE-7955	If a claim is a non-denied, non-void Medicaid or M-CHIP fee for service claim from an OT file, and the total medicaid paid amount is a non-null value and greater than zero, and CMS 64 category for federal reimbursement is equal to '02', then the XXI-MBESCBES category of service must be populated.

Measure ID	Measure Name
ALL-20-003-3	% of claim lines with both XIX and XXI MBESCBES Category of Service
MIS-52-001-1	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)
MIS-76-001-1	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)
RULE-7378	% of claim lines on non-zero paid claims with Title XXI funding with missing XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)
RULE-7535	% of claim lines with both XIX and XXI MBESCBES Category of Service
RULE-7390	% missing: XXI-MBESCBES-CATEGORY-OF-SERVICE (COT00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP271	CIP.003.271	XXI-MBESCBES-CATEGORY-OF-SERVICE	CIP00003	CLAIM-LINE-RECORD-IP
CLT225	CLT.003.225	XXI-MBESCBES-CATEGORY-OF-SERVICE	CLT00003	CLAIM-LINE-RECORD-LT
CRX151	CRX.003.151	XXI-MBESCBES-CATEGORY-OF-SERVICE	CRX00003	CLAIM-LINE-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	COT.003.212	UPDATE	Coding requirement	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '2', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less	1. Value must be in XXI MBESCBES Category of Service List (VVL)2. Conditional3. (CHIP Claim) if the associated CMS-64 Category for Federal Reimbursement value is '02', then a valid value is mandatory and must be reported4. If XIX MBESCBES Category of Service is populated then value must not be populated5. Value must be 3 characters or less
03/19/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	UPDATE	Data Dictionary - Valid Values	\|Data Element\|Effective Date\|End Date\|Value\|Name\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|48\|Balance\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|49\|Less: Collections\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|50\|Total\|	N/A
12/17/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	add values to XXI-MBESCBES-CATEGORY-OF-SERVICE.psv	VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|2A\|Inpatient Hospital Services - DSH\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|3A\|Inpatient Mental Health - DSH\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|3B\|Certified Community Behavior Health Clinic Payments\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A2\|Drug Rebate - State\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A3\|MCO - National Agreement\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A4\|MCO - State Sidebar Agreement\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A5\|Increased ACA OFFSET - Fee for Service - 100%\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|8A6\|Increased ACA OFFSET - MCO - 100%\| XXI-MBESCBES-CATEGORY-OF-SERVICE\|00010101\|99991231\|21A\|Home and Community-Based Services - Regular Payment (WAIVER)\|
12/03/2021	3.0.0	XXI-MBESCBES-CATEGORY-OF-SERVICE	ADD	Data Dictionary - Valid Values	N/A	\|VALUE_SET_ID\|EFFECTIVE_DATE\|END_DATE\|VALUE\|NAME\|DESCRIPTION\| \|XXI-MBESCBES-CATEGORY-OF-SERVICE\|20210311\|99991231\|26\|ARP Section 9821 COVID Vaccine/Vaccine Administration\|