CRX.003.149

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TMSIS Dataguide

Medicaid.gov

Version:

CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT

Data Element

DE Number

CRX149

System DE Number

CRX.003.149

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	A code to indicate the Federal funding source for the payment.
Size	X(2)
FLF Start Position	378
FLF Stop Position	379
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL) 2. Value must be 2 characters 3. (Federal Funding under Title XXI) if value equals "02", then the eligibles CHIP Code (ELG.003.054) must be in [2, 3] 4. (Federal Funding under Title XIX) if value equals "01" then the eligible's CHIP Code (ELG.003.054) must be "1" 5. Conditional 6. If Type of Claim is in [1,2,5,A,B,E,U,V,Y] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported. 7. If Type of Claim is in [4,D] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.

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

RULE ID	RULE Definition
RULE-1954	If the CMS 64 category for federal reimbursement is populated on a non-denied claim line from an RX file, then the CMS 64 category for federal reimbursement value reported must be in the list of valid values for CMS 64 category for federal reimbursement.
RULE-1955	If the MSIS ID on a non-denied, non-void claim header from an RX file is equal to the MSIS ID reported with a CHIP code for Medicaid-expansion CHIP or separate XXI CHIP on a variable demographic eligibility segment from an ELG file, then the CMS-64 category for federal reimbursement value reported must be for Title XXI Medicaid funding.
RULE-6734	If a claim line is a non-denied claim line from an RX file, then the CMS 64 category for federal reimbursement value reported must be compatible with specified T-MSIS picture format: X(2).
RULE-7206	If the MSIS ID on a non-denied, non-void claim header from an RX file is equal to the MSIS ID reported with a CHIP code for Medicaid on a variable demographic eligibility segment from an ELG file, then the CMS-64 category for federal reimbursement value reported must be for Title XIX Medicaid funding.
RULE-7265	If a claim is a non-denied claim from an RX file, that is a Medicaid or Medicaid-expansion FFS or a Separate CHIP FFS claim and is an original claim or a replacement/resubmission claim payment and total medicaid paid amt is non-null and not zero, then the claim line CMS-64 category for federal reimbursement must be populated.

Measure ID	Measure Name
MIS-28-001-1	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CRX00003)
RULE-7265	% missing: CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CRX00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP269	CIP.003.269	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT	CIP00003	CLAIM-LINE-RECORD-IP
CLT219	CLT.003.219	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT	CLT00003	CLAIM-LINE-RECORD-LT
COT210	COT.003.210	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.003.149	UPDATE	Coding requirement	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals '02', then the eligible's CHIP Code (ELG.003.054) must be in ['2', '3']4. (Federal Funding under Title XIX) if value equals '01' then the eligible's CHIP Code (ELG.003.054) must be '1'5. Conditional6. If Type of Claim is in ['1','2','5','A','B','E','U','V','Y'] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in ['4','D'] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.	1. Value must be in CMS 64 Category for Federal Reimbursement List (VVL)2. Value must be 2 characters3. (Federal Funding under Title XXI) if value equals "02", then the eligibles CHIP Code (ELG.003.054) must be in [2, 3]4. (Federal Funding under Title XIX) if value equals "01" then the eligible's CHIP Code (ELG.003.054) must be "1"5. Conditional6. If Type of Claim is in [1,2,5,A,B,E,U,V,Y] and the Total Medicaid Paid Amount is populated on the corresponding claim header, then value must be reported.7. If Type of Claim is in [4,D] and the Service Tracking Payment Amount on the relevant record is populated, then value must be reported.
09/11/2020	2.4.0	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP 269, CLT 219, COT 210, CRX 149)	UPDATE	Data Dictionary - Valid Values	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|99991231\|	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|20200430\|
10/02/2020	2.4.0	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP 269, CLT 219, COT 210, CRX 149)	UPDATE	Data Dictionary - Valid Values	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|20200430\|	\|Code\|Description\|Effective Date\|End Date\| \|03\|Federal funding under ACA\|00010101\|20200930\|
12/04/2020	2.4.0	CMS-64-CATEGORY-FOR-FEDERAL-REIMBURSEMENT (CIP269-0002, CLT219-0002, COT210-0002, CRX149-0002)	UPDATE	Data Dictionary	CIP269-0002 : If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI. CLT219-0002: If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI. COT210-0002: If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI. CRX149-0002: If an individual is not eligible for S-CHIP, then any associated claims records should not have reimbursed with federal funding under Title XXI.	CIP269: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3'] CLT219: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3'] COT210: (federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3'] CRX149: I(federal Funding under Title XXI) if value equals ‘02’, then the eligible’s CHIP Code (ELG.003.054) must be in ['2', '3']