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Data Element
COT176
COT.003.176
Definition | The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element. |
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Size | S9(11)V99 |
FLF Start Position | 235 |
FLF Stop Position | 247 |
Segment Key Field Identifier | Not Applicable |
Coding Requirements | 1. Situational 2. Value must be between -99999999999.99 and 99999999999.99 3. Value must be expressed as a number with 2-digit precision (e.g. 100.50) 4. Value must be 11 digits or less left of the decimal i.e. 9999999999 99 |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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DE Number | System DE Number | DE Name | File Segment Number | File Segment Name |
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CRX123 | CRX.003.123 | BENEFICIARY-COPAYMENT-PAID-AMOUNT | CRX00003 | CLAIM-LINE-RECORD-RX |