CRX.002.027

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TMSIS Dataguide

Medicaid.gov

Version:

ADJUDICATION-DATE

Data Element

DE Number

CRX027

System DE Number

CRX.002.027

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state.
Size	9(8)
FLF Start Position	160
FLF Stop Position	167
Segment Key Field Identifier	5
Coding Requirements	1. The date must be a valid calendar date in the form "CCYYMMDD" 2. Value should be on or before End of Time Period (CRX.001.010) 3. 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-1764	If a claim is from an RX file, then the adjudication date value reported must be a valid date of the form CCYYMMDD.
RULE-1766	If adjudication date is populated on a non-denied claim from an RX file that is not a Medicaid or Medicaid-expansion, S-CHIP, or other Capitated Payment and end of time period is populated on the file header, then the adjudication value reported must be before or equal to the end of time period value reported.
RULE-7186	If a claim header is from an RX file, then submitting state, original ICN, adjustment ICN, adjudication date, and adjustment indicator values reported must be unique across all RX claim headers.
RULE-7316	#N/A
RULE-7434	All non-denied RX claim header records must have a corresponding claim line record.
RULE-7573	All denied RX claim header records must have a corresponding claim line record.
RULE-7636	All non-denied, paid RX claim header records must have a corresponding non-denied claim line record.

Measure ID	Measure Name
MIS-8-001-1	% missing: ADJUDICATION-DATE (CRX00002)
ALL-16-007-7	% of claim header record segments missing ADJUDICATION-DATE (CRX00002)
RULE-7316	% of claim header record segments missing ADJUDICATION-DATE (CRX00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP098	CIP.002.098	ADJUDICATION-DATE	CIP00002	CLAIM-HEADER-RECORD-IP
CIP286	CIP.003.286	ADJUDICATION-DATE	CIP00003	CLAIM-LINE-RECORD-IP
CIP328	CIP.004.328	ADJUDICATION-DATE	CIP00004	CLAIM-DX-IP
CLT050	CLT.002.050	ADJUDICATION-DATE	CLT00002	CLAIM-HEADER-RECORD-LT
CLT233	CLT.003.233	ADJUDICATION-DATE	CLT00003	CLAIM-LINE-RECORD-LT
CLT274	CLT.004.274	ADJUDICATION-DATE	CLT00004	CLAIM-DX-LT
COT035	COT.002.035	ADJUDICATION-DATE	COT00002	CLAIM-HEADER-RECORD-OT
COT221	COT.003.221	ADJUDICATION-DATE	COT00003	CLAIM-LINE-RECORD-OT
COT280	COT.004.280	ADJUDICATION-DATE	COT00004	CLAIM-DX-OT
CRX157	CRX.003.157	ADJUDICATION-DATE	CRX00003	CLAIM-LINE-RECORD-RX
CRX202	CRX.004.202	ADJUDICATION-DATE	CRX00004	CLAIM-DX-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
12/19/2024	4.0.1	CRX.002.027	UPDATE	Coding requirement	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CIP.001.010)3. Mandatory4. Value should be on or after associated Admission Date value	1. The date must be a valid calendar date in the form "CCYYMMDD"2. Value should be on or before End of Time Period (CRX.001.010)3. Mandatory
09/16/2024	4.0.0	CRX.002.027	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.027	ADD	N/A		Created