CRX.003.146

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TMSIS Dataguide

Medicaid.gov

Version:

REBATE-ELIGIBLE-INDICATOR

Data Element

DE Number

CRX146

System DE Number

CRX.003.146

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	An indicator to identify claim lines with an NDC that is eligible for the drug rebate program.
Size	X(1)
FLF Start Position	372
FLF Stop Position	372
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Rebate Eligible Indicator List (VVL) 2. Value must be 1 character 3. 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-1951	If the rebate eligible indicator is populated on a non-denied claim line from an RX file, then the rebate eligible indicator reported must be found in the list of valid values.
RULE-6461	If a claim line is a non-denied claim line from an RX file, then the rebate eligible indicator value reported must be compatible with specified T-MSIS picture format: X(1).

Measure ID	Measure Name
MIS-9-020-20	% missing: REBATE-ELIGIBLE-INDICATOR (CRX00003)
MIS-28-019-19	% missing: REBATE-ELIGIBLE-INDICATOR (CRX00003)
MIS-86-018-18	% missing: REBATE-ELIGIBLE-INDICATOR (CRX00003)

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
03/15/2024	3.21.0	REBATE-ELIGIBLE-INDICATOR - 0	Update	Data Dictionary - Valid Values	NDC is not eligible for drug rebate program. (Manufacturer does not have a rebate agreement.)	NDC is not eligible for drug rebate program. (Manufacturer does not have a rebate agreement.) Drug meets the definition of a covered outpatient drug (COD), but manufacturer does not participate in the rebate program.
03/15/2024	3.21.0	REBATE-ELIGIBLE-INDICATOR - 1	Update	Data Dictionary - Valid Values	NDC is eligible for drug rebate program	NDC is eligible for drug rebate program NDC is listed on the MDP
03/15/2024	3.21.0	REBATE-ELIGIBLE-INDICATOR - 2	Update	Data Dictionary - Valid Values	NDC is exempt from the drug rebate program (biological and medical devices)	NDC is exempt from the drug rebate program (biological and medical devices) these are prescribed drugs that do not meet the definition of a COD. There are several examples, the easiest is insect repellant. State release 178 provides more details. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/prescription-drugs/downloads/rx-releases/state-releases/state-rel-178.pdf