CRX.003.126

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TMSIS Dataguide

Medicaid.gov

Version:

MEDICAID-FFS-EQUIVALENT-AMT

Data Element

DE Number

CRX126

System DE Number

CRX.003.126

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The amount that would have been paid had the services been provided on a Fee for Service basis.
Size	S9(11)V99
FLF Start Position	238
FLF Stop Position	250
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (e.g. 100.50) 3. If associated Type of Claim value in [3,C,W], then value is mandatory and must be provided 4. Conditional

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

RULE ID	RULE Definition
RULE-1929	If a claim is a non-denied claim from an RX file, then the medicaid FFS equivalent amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name
MIS-9-013-13	% missing: MEDICAID-FFS-EQUIVALENT-AMT (CRX00003)
MIS-28-012-12	% missing: MEDICAID-FFS-EQUIVALENT-AMT (CRX00003)
MIS-86-011-11	% missing: MEDICAID-FFS-EQUIVALENT-AMT (CRX00003)
MCR-18-009-9	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 11 (Family planning services and supplies for individuals of child-bearing age)
MCR-18-010-11	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 18 (Home health services - Medical supplies, equipment, and appliances suitable for use in the home)
MCR-18-011-12	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 33 (Prescribed drugs)
MCR-18-012-13	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 34 (Over-the-counter medications.)
MCR-18-013-14	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 36 (Medical equipment/prosthetic devices)
MCR-18-014-15	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 85 (Prenatal care and pre-pregnancy family planning services and supplies.)
MCR-18-015-16	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 89 (Disposable medical supplies.)
MCR-18-016-10	Ratio of Average FFS Equivalent to Average Paid for TYPE-OF-SERVICE = 127 (Indian Health Service (IHS) - Family Plan)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP255	CIP.003.255	MEDICAID-FFS-EQUIVALENT-AMT	CIP00003	CLAIM-LINE-RECORD-IP
CLT209	CLT.003.209	MEDICAID-FFS-EQUIVALENT-AMT	CLT00003	CLAIM-LINE-RECORD-LT
COT179	COT.003.179	MEDICAID-FFS-EQUIVALENT-AMT	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.003.126	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50)3. If associated Type of Claim value in [3,C,W], then value is mandatory and must be provided4. Conditional
08/14/2023	3.12.0	CRX.003.126	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim (CE) value equals '3, C, W', then value is mandatory and must be provided4. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. If associated Type of Claim value equals '3, C, W', then value is mandatory and must be provided4. Conditional