TPL.003.037

INSURANCE-PLAN-TYPE

Data Element

DE Number

TPL037

System DE Number

TPL.003.037

File Name

TPL - THIRD-PARTY LIABILITY

File Segment Number

TPL00003

File Segment Name

TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-INFO

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Code to classify the type of insurance plan providing TPL coverage.
Size	X(2)
FLF Start Position	110
FLF Stop Position	111
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Insurance Plan Type List (VVL) 2. Conditional 3. Value must be 2 characters or less 4. Value must have an associated Insurance Plan ID

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Valid Value Code Set	Valid Value Code	Valid Value Name	Effective Start Date	Effective End Date
INSURANCE-PLAN-TYPE	01	Medical or comprehensive health insurance plan (e.g. HMO)	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	02	Dental health insurance plan	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	03	Vision health insurance plan	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	04	Prenatal/delivery health insurance plan	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	05	Long term care health insurance plan (Long Term PIHP)	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	06	Transportation health insurance plan (Transportation PAHP)	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	07	A managed care plan	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	08	Disease management health insurance plan (Disease Management PAHP)	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	09	PAHP (Medical only)	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	10	Comprehensive health insurance and Long Term Care (hybrid)	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	11	Other health insurance plan	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	12	Veterans Administration health benefits	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	13	Indian Health Service Program health benefits	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	14	TRICARE health benefits	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	15	Eligible enrolled in private LTC insurance	01/01/0001	12/31/9999
INSURANCE-PLAN-TYPE	16	Fee-for-Service insurance	01/01/0001	12/31/9999

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RULE ID	RULE Definition
RULE-3091	If the insurance plan type is populated on a TPL medicaid eligible person health insurance coverage information file, then the insurance plan type reported must be found in the list of valid values.
RULE-6959	If a segment is a TPL Medicaid eligible person health insurance coverage information segment from a TPL file, then the insurance plan type value reported must be compatible with the specified T-MSIS picture format: X(2).

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Measure ID	Measure Name
TPL-1-004-3	# of MSIS IDs with a valid Insurance Plan Type

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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
TPL057	TPL.004.057	INSURANCE-PLAN-TYPE	TPL00004	TPL-MEDICAID-ELIGIBLE-PERSON-HEALTH-INSURANCE-COVERAGE-CATEGORIES