An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide Medicaid.gov
Version 3.27.0

COT - CLAIM OTHER

File

File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
COT00001 FILE-HEADER-RECORD-OT A record containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
COT00002 CLAIM-HEADER-RECORD-OT A record to capture data about another type of claim or encounter (besides IP, LT, and RX) that applies to the claim in its totality.
COT00003 CLAIM-LINE-RECORD-OT A record to capture data about specific goods or services rendered to a Medicaid/CHIP enrollee during an outpatient visit.
Definition
Professional, Dental, Outpatient Institutional claims and encounter, capitation payments and other financial transactions.

Overview

Diagram 3: Claim OT File – Claim Record Segment Relationships

cot_overview

Description of Diagram 3:

Each claim record in the T-MSIS other claims file is composed of two types of record segments: One claim header segment and multiple claim line segments. Each claim line segment joins to its claim header segment on the following four data elements:

1. SUBMITTING-STATE
2. ICN-ORIG
3. ICN-ADJ
4. ADJUDICATION-DATE
5. ADJUSTMENT-IND (LINE-ADJUSTMENT-IND)