TPL.002.020

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

TPL-HEALTH-INSURANCE-COVERAGE-IND

Data Element

DE Number

TPL020

System DE Number

TPL.002.020

File Name

TPL - THIRD-PARTY LIABILITY

File Segment Number

File Segment Name

TPL-MEDICAID-ELIGIBLE-PERSON-MAIN

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A flag to indicate that the Medicaid/CHIP eligible person has some form of third party insurance coverage.
Size	X(1)
FLF Start Position	42
FLF Stop Position	42
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 1 character 2. Value must be in [0, 1] or not populated 3. Value must be in TPL Health Insurance Coverage Indicator List (VVL) 4. Mandatory 5. When value equals '1', there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID.

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

RULE ID	RULE Definition
RULE-3062	If the TPL health insurance coverage indicator is populated on a TPL medicaid eligible person main file, then the TPL health insurance coverage indicator reported must be found in the list of valid values.
RULE-6292	If a segment is a TPL Medicaid eligible person main segment from a TPL file, then the TPL health insurance coverage indicator value reported must be compatible with the specified T-MSIS picture format: X(1).

Measure ID	Measure Name
EL-11-001-1	% of full duals (DUAL-ELIGIBLE-CODE = 02, 04, and 08) receiving private health insurance (TPL-HEALTH-INSURANCE = 1)
MIS-12-002-2	% distinct MSIS IDs with only missing values in any active segment: TPL-HEALTH-INSURANCE-COVERAGE-IND (TPL00002)
TPL-1-002-4	# of MSIS IDs with TPL coverage (health insurance or other)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	TPL.002.020	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Value must be 1 character5. Mandatory6. When value equals '1', there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID.	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in TPL Health Insurance Coverage Indicator List (VVL)4. Mandatory5. When value equals '1', there must be one corresponding TPL Medicaid Eligible Person Health Insurance Coverage Information (TPL.003) segment with the same MSIS ID.