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TMSIS Dataguide Medicaid.gov
Version 3.27.0

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

File Segment

File Segment Number

TPL00003

File Name

TPL - THIRD-PARTY LIABILITY

Last updated

No Updates

Data Elements Reference
DE Number System DE Number Data Element Definition Valid Values
TPL029 TPL.003.029 RECORD-ID The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). TPL029 Values
TPL030 TPL.003.030 SUBMITTING-STATE A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. TPL030 Values
TPL031 TPL.003.031 RECORD-NUMBER

A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file.

 N/A
TPL032 TPL.003.032 MSIS-IDENTIFICATION-NUM

A state-assigned unique identification number used to identify a Medicaid/CHIP enrolled individual (except on service tracking payments). Value may be an SSN, temporary SSN or State-assigned eligible individual identifier. MSIS Identification Numbers are a unique "key" value used to maintain referential integrity of data distributed over multiples files, segments and reporting periods. See T-MSIS Guidance Document, "CMS Guidance: Reporting Shared MSIS Identification Numbers" for information on reporting the MSIS Identification Numbers ID for pregnant women, unborn children, mothers, and their deemed newborns younger than 1 year of age who share the same MSIS Identification Number. https://www.medicaid.gov/medicaid/data-and-systems/macbis/tmsis/tmsis-blog/entry/47572

 N/A
TPL033 TPL.003.033 INSURANCE-CARRIER-ID-NUM The state-assigned identification number of the Third Party Liability (TPL) Entity. N/A
TPL034 TPL.003.034 INSURANCE-PLAN-ID The ID number issued by the Insurance carrier providing third party liability insurance coverage to beneficiaries. Typically the Plan ID/Plan Number is on the beneficiaries' insurance card. N/A
TPL035 TPL.003.035 GROUP-NUM The group number of the TPL health insurance policy. N/A
TPL036 TPL.003.036 MEMBER-ID Member identification number as it appears on the card issued by the TPL insurance carrier. N/A
TPL037 TPL.003.037 INSURANCE-PLAN-TYPE Code to classify the type of insurance plan providing TPL coverage. TPL037 Values
TPL038 TPL.003.038 ANNUAL-DEDUCTIBLE-AMT Annual amount paid each year by the enrollee in the plan before a health plan benefit begins. N/A
TPL044 TPL.003.044 POLICY-OWNER-FIRST-NAME Individual's first name; first name component of full name (e.g. First Name, Middle Initial, Last Name). N/A
TPL045 TPL.003.045 POLICY-OWNER-LAST-NAME Individual's last name; last name component of full name (e.g. First Name, Middle Initial, Last Name). N/A
TPL046 TPL.003.046 POLICY-OWNER-SSN Unique identifier issued to an individual by the SSA for the purpose of identification. N/A
TPL047 TPL.003.047 POLICY-OWNER-CODE This code identifies the relationship of the policy holder to the Medicaid/CHIP beneficiary. TPL047 Values
TPL048 TPL.003.048 INSURANCE-COVERAGE-EFF-DATE The first calendar day on which all of the other data elements in the same segment were effective. N/A
TPL049 TPL.003.049 INSURANCE-COVERAGE-END-DATE The last calendar day on which all of the other data elements in the same segment were effective. N/A
TPL050 TPL.003.050 STATE-NOTATION

A free text field for the submitting state to enter whatever information it chooses.

 N/A
TPL089 TPL.003.089 COVERAGE-TYPE A code to indicate the level of coverage being provided under this policy for the insured by the TPL carrier. TPL089 Values
Definition
A record to capture insurance policy information needed to facilitate pursuit of the third party liability.

File Segment Length
900