CRX.002.085

PRESCRIPTION-FILL-DATE

Data Element

DE Number

CRX085

System DE Number

CRX.002.085

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00002

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Date the drug, device, or supply was dispensed by the provider.
Size	9(8)
FLF Start Position	622
FLF Stop Position	629
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 8 characters in the form "CCYYMMDD" 2. The date must be a valid calendar date (i.e Feb 29th only on the leap year, never April 31st or Sept 31st) 3. Value must be on or before associated End of Time Period (CRX.001.010) 4. Value must be on or after associated Start of Time Period (CRX.001.009) 5. Value must be on or after associated Date Prescribed (CRX.002.084) 6. Value must be on or after associated eligible party's Date of Birth (ELG.002.024) 7. Value must be on or before associated eligible party's Date of Death (ELG.002.025) 8. Value must be populated when Adjustment Indicator (CRX.002.025) does not equal "1" and Type of Claim (CRX.002.029) does not equal "Z" 9. Mandatory

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1863	If date prescribed and prescription fill date are populated on a non-denied claim from an RX file, then the date prescribed value reported must be before or equal to the prescription fill date value reported.
RULE-1867	If a claim is a non-denied claim from an RX file, then the prescription fill date value reported must be a valid date of the form CCYYMMDD.
RULE-1869	If prescription fill date is populated on a non-denied claim from an RX file and end of time period is populated on the file header, then the prescription fill date value reported must be before or equal to the end of time period value reported.
RULE-1871	If a claim is a non-denied, non-void claim from an RX file and the primary demographics eligibility segment has a valid value populated for date of death, and the claim header has a valid value populated for prescription fill date, then prescription fill date is less than or equal to the date of death.
RULE-7197	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an RX file, then the plan ID must be equal to the plan ID on a managed care participation segment from an ELG file with the same MSIS ID and where the prescription fill date on the claim is within the effective and end dates of the managed care participation segment.
RULE-7201	If plan ID is populated on a non-denied Medicaid, S-CHIP, or Other encounter from an RX file, then the plan ID must be equal to the plan ID on a managed care main segment from an MCR file where the prescription fill date is within the contract effective and end dates on the managed care main segment.
RULE-7214	If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an RX file, and is a Medicaid or Medicaid-expansion CHIP FFS, Medicaid or Medicaid-expansion CHIP Encounter, separate CHIP FFS or separate CHIP Encounter claim, then the prescription fill date must be populated.
RULE-7414	If a claim in a non-denied, original or adjustment FFS or Encounter crossover claim from an RX file, and the MSIS ID is populated and the prescription fill date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'
RULE-7549	If the 1115A demonstration indicator is equal to 1 (yes) on a non-denied claim from an RX file, and the prescription fill date is within the 1115A effective and end dates, then the 1115A demonstration indicator value reported on the 1115A demonstration information segment must be populated with a 1 value.
RULE-7718	If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an RX file, and is a Medicaid or Medicaid-expansion CHIP Encounter or separate CHIP Encounter claim, then the claim header prescription fill date must be populated.
RULE-7773	If a claim is a non-denied claim from an RX file, and the waiver type is populated, and the claim prescription fill date is between the waiver enrollment effective and end dates, then the claim waiver type is equal to the waiver participation waiver type.
RULE-7809	If a claim is a non-denied claim and is an original claim or a replacement/resubmission claim payment from an RX file, and is a Medicaid or Medicaid-expansion CHIP Fee for Service or Separate CHIP Fee for Service claim, then the claim header prescription fill date must be populated.
RULE-7928	If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the prescription fill date is within effective and end dates of the provider medicaid enrollment segment on the pharmacy claim.
RULE-7936	If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the prescription fill date is within effective and end dates of the provider medicaid enrollment segment on the pharmacy claim.
RULE-7742	If a claim in a non-denied, original or adjustment Encounter crossover claim from an RX file, and the MSIS ID is populated and the presription fill date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'
RULE-7984	If a claim in a non-denied, original or adjustment FFS crossover claim from an RX file, and the MSIS ID is populated and the presription fill date is populated with a date that overlaps with the reported eligibility determinant effective and end dates, and the primary eligibility group indicator is equal to '1', then the dual eligible code is equal to '01', '02', '04', '08'

Measure ID	Measure Name
RULE-7197	% of claim headers with a valid value for Plan ID Number that do not have a corresponding ELG Managed Care Participation segment for the same time period
RULE-1845	% of claim headers with a Billing Provider Number that is not found on the provider file on the Prescription Fill Date
RULE-1964	% of claim headers with a Dispensing Provider Number that is not found on the provider file on the Prescription Fill Date
MIS-27-023-23	% missing: PRESCRIPTION-FILL-DATE (CRX00002)
MIS-85-023-23	% missing: PRESCRIPTION-FILL-DATE (CRX00002)
RULE-7645	% of claim headers with an MSIS ID not enrolled on Prescription Fill Date
RULE-7442	% of claim headers with a BILLING-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Prescription Fill Date
RULE-7446	% of claim headers that have a DISPENSING-PRESCRIPTION-DRUG-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Prescription Fill Date
RULE-7201	% of claim headers with a valid value for Plan ID Number that do not have a corresponding MCR Managed Care Main segment for the same time period
RULE-1758	% of claim headers with an MSIS ID not enrolled on Prescription Fill Date
RULE-7809	% missing: PRESCRIPTION-FILL-DATE (CRX00002)
RULE-7718	% missing: PRESCRIPTION-FILL-DATE (CRX00002)
RULE-7900	% of claim headers with an MSIS ID not enrolled on Prescription Fill Date
RULE-7923	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
RULE-7931	% of claim headers with a Billing Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Beginning Date of Service
RULE-7928	% of claim headers with a Dispensing Prescription Drug Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Prescription Fill Date
RULE-7936	% of claim headers with a Dispensing Prescription Drug Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Prescription Fill Date
RULE-7785	% of claim headers with an MSIS ID not enrolled on Prescription Fill Date
FFS-25-004-4	% of MSIS IDs enrolled on Prescription Fill Date
ALL-14-004-4	% of MSIS IDs on crossover claim headers not enrolled as duals (QMB, QMB Plus, SLMB Plus, Other) on Prescription Fill Date
ALL-14-008-8	% of MSIS IDs on crossover claim headers enrolled as premium only dual groups (SLMB, QI, QDWI) on Prescription Fill Date
ALL-21-004-4	% of BILLING-PROV-NUM on claim headers that do not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Prescription Fill Date
ALL-21-008-8	% of DISPENSING-PRESCRIPTION-DRUG-PROV-NUM on claim headers that do not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Prescription Fill Date
FFS-14-002-7	% of claim headers with Prescription Fill Date within the past year
FFS-14-003-6	% of claim headers with Prescription Fill Date = Date Prescribed
FFS-16-002-7	% of claim headers with Prescription Fill Date within the past year
FFS-16-003-6	% of claim headers with Prescription Fill Date = Date Prescribed
ALL-13-002-2	% of MSIS IDs limited to family planning (RESTRICTED-BENEFITS-CODE = 6) with non-family planning services (PROGRAM-TYPE not equal 2)
FFS-25-008-8	% of MSIS IDs enrolled on Prescription Fill Date
MCR-17-002-7	% of claim headers with Prescription Fill Date within the past year
MCR-17-003-6	% of claim headers with Prescription Fill Date = Date Prescribed
MCR-19-002-7	% of claim headers with Prescription Fill Date within the past year
MCR-19-003-6	% of claim headers with Prescription Fill Date = Date Prescribed
MCR-31-005-5	% of MSIS IDs enrolled on Prescription Fill Date
MCR-31-010-10	% of MSIS IDs enrolled on Prescription Fill Date
MIS-8-023-23	% missing: PRESCRIPTION-FILL-DATE (CRX00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name