CRX.003.171

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TMSIS Dataguide

Medicaid.gov

Version:

PROFESSIONAL-SERVICE-FEE-PAID-AMT

Data Element

DE Number

CRX171

System DE Number

CRX.003.171

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 paid by Medicaid or the managed care plan on this claim or adjustment towards the costs of clinical services not otherwise covered under the professional dispensing fee.
Size	S9(11)V99
FLF Start Position	982
FLF Stop Position	994
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. 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-7624	If a claim line is a non-denied claim from an RX file, then the PROFESSIONAL-SERVICE-FEE-PAID-AMT value reported must be compatible with the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.003.171	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. 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. Conditional
06/24/2022	3.0.0	CRX171/ PROFESSIONAL-SERVICE-FEE-PAID-AMT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX171\|PROFESSIONAL-SERVICE-FEE-PAID-AMT\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX171	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX171\|PROFESSIONAL-SERVICE-FEE-PAID-AMT\|Conditional\|The amount paid by Medicaid or the managed care plan on this claim or adjustment towards the costs of clinical services not otherwise covered under the professional dispensing fee.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003