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This variable is contained in the following files:
SAS Name
CLM_TYPE_CD
A code indicating what kind of payment is covered in this claim
| Code | Code value |
|---|---|
| 1 | A Fee-For-Service (FFS) Medicaid or Medicaid-expansion Claim |
| 2 | Medicaid or Medicaid-expansion Capitated Payment |
| 3 | Medicaid or Medicaid-expansion Managed Care Encounter (a.k.a. “Dummy”) record that simulates a bill for a service rendered to a patient covered under some form of Capitation Plan. This includes billing records submitted by providers to non-state entities (e.g., MCOs, health plans) for which the State has no financial liability since the at risk entity has already received a capitated payment from the State. |
| 4 | Medicaid or Medicaid-expansion CHIP Service Tracking Claim |
| 5 | Medicaid or Medicaid-expansion Supplemental Payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement) |
| A | Separate CHIP (Title XXI) claim: A Fee-for-Service (FFS) Claim |
| B | Separate CHIP (Title XXI) claim: Capitated Payment |
| C | Separate CHIP (Title XXI) Encounter record that simulates a bill for a service or items rendered to a patient covered under some form of Capitation Plan. This includes billing records submitted by providers to non-State entities (e.g., MCOs, health plans) for which a state has no financial liability as the at-risk entity has already received a capitated payment from the state |
| D | Separate CHIP (Title XXI) Service Tracking Claim |
| E | Separate CHIP (Title XXI) claim for a supplemental payment (above capitation fee or above negotiated rate) (e.g., FQHC additional reimbursement) |
| U | Other FFS claim |
| V | Other Capitated Payment |
| W | Other Managed Care Encounter |
| X | Non-Medicaid/CHIP service tracking claims |
| Y | Other Supplemental Payment |
| Null/missing | source value is missing or unknown |
Some claim types are for service tracking claims (notably, those where CLM_TYPE_CD = 4, D or X), which do not indicate a service for an individual (e.g., they may be used for lump sum payments such as those made to Disproportionate Share Hospitals (DSH) and have no corresponding diagnosis or procedure information). RIFs prior to August 2021 did not include these service tracking claims.
Source: T-MSIS Analytic File (TAF) Claims