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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

TOT-SDP-ALLOWED-AMT

Data Element

DE Number

CRX177

System DE Number

CRX.002.177

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00002

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition The component (in dollar and cents) of the total allowed amount that represents the difference between what would have been the managed care plan's typical contractual allowed amount and the enhanced allowed amount for this specific claim as defined by the State's SPA, waiver, or demonstration for a State Directed Payment model per 42 CFR 438.6(c)(1)(iii).
Size S9(11)V99
FLF Start Position 972
FLF Stop Position 984
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
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP338 CIP.002.338 TOT-SDP-ALLOWED-AMT CIP00002 CLAIM-HEADER-RECORD-IP
CLT258 CLT.002.258 TOT-SDP-ALLOWED-AMT CLT00002 CLAIM-HEADER-RECORD-LT
COT252 COT.002.252 TOT-SDP-ALLOWED-AMT COT00002 CLAIM-HEADER-RECORD-OT