CRX.002.173

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TMSIS Dataguide

Medicaid.gov

Version:

LTC-RCP-LIAB-AMT

Data Element

DE Number

CRX173

System DE Number

CRX.002.173

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 total amount paid by the patient for services where they are required to use their personal funds to cover part of their care before Medicaid funds can be utilized.
Size	S9(11)V99
FLF Start Position	894
FLF Stop Position	906
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-9017	if a claim is a non-denied claim from a RX file, then the recipient liability amount 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
CIP297	CIP.002.297	LTC-RCP-LIAB-AMT	CIP00002	CLAIM-HEADER-RECORD-IP
CLT145	CLT.002.145	LTC-RCP-LIAB-AMT	CLT00002	CLAIM-HEADER-RECORD-LT
COT235	COT.002.235	LTC-RCP-LIAB-AMT	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/16/2024	4.0.0	CRX.002.173	UPDATE	File segment	None	40
09/16/2024	4.0.0	CRX.002.173	ADD	N/A		Created