CRX.002.047

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TMSIS Dataguide

Medicaid.gov

Version:

TOT-OTHER-INSURANCE-AMT

Data Element

DE Number

CRX047

System DE Number

CRX.002.047

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 amount paid by insurance other than Medicare or Medicaid on this claim.
Size	S9(11)V99
FLF Start Position	306
FLF Stop Position	318
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. Situational

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

RULE ID	RULE Definition
RULE-1804	If a claim is a non-denied claim from an RX file, then the total other insurance 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-8-031-31	% missing: TOT-OTHER-INSURANCE-AMT (CRX00002)
MIS-27-031-31	% missing: TOT-OTHER-INSURANCE-AMT (CRX00002)
MIS-85-031-31	% missing: TOT-OTHER-INSURANCE-AMT (CRX00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP119	CIP.002.119	TOT-OTHER-INSURANCE-AMT	CIP00002	CLAIM-HEADER-RECORD-IP
CLT070	CLT.002.070	TOT-OTHER-INSURANCE-AMT	CLT00002	CLAIM-HEADER-RECORD-LT
COT056	COT.002.056	TOT-OTHER-INSURANCE-AMT	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/10/2025	4.0.13	CRX.002.047	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.002.047	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. Situational
09/16/2024	4.0.0	CRX.002.047	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.047	ADD	N/A		Created