CRX.003.132

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TMSIS Dataguide

Medicaid.gov

Version:

PRESCRIPTION-QUANTITY-ACTUAL

Data Element

DE Number

CRX132

System DE Number

CRX.003.132

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 quantity of a drug that is dispensed for a prescription as reported ny National Drug Code on the claim line. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field.
Size	S9(9)V(9)
FLF Start Position	308
FLF Stop Position	325
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value may include up to 9 digits to the left of the decimal point, and 9 digits to the right e.g. 123456789.123456789 2. 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-1935	If a claim line is a non-denied claim line from an RX file, then the claim prescription quantity actual value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(9)V999999999.
RULE-7357	If a claim is a non-denied claim from an RX file and has the type of claim equal to '1','A','3','C', and is not a crossover claim, then the claim line prescription quantity actual must be populated.
RULE-7751	If a non-denied claim from an RX file has the type of claim Medicaid or Medicaid-expansion CHIP Managed Care Encounter or Separate CHIP Encounter, and is not a crossover claim, then the claim line prescription quantity actual must be populated.
RULE-7817	If a non-denied claim from an RX file has the type of claim Medicaid or Medicaid-expansion CHIP Managed Care Fee-for-service or Separate CHIP Fee-for-service, and is not a crossover claim, then the claim line prescription quantity actual must be populated.

Measure ID	Measure Name
FFS-14-007-4	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
FFS-14-008-2	% of claim headers with missing Prescription Quantity Actual
FFS-16-007-4	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
FFS-16-008-2	% of claim headers with missing Prescription Quantity Actual
MCR-17-007-4	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
MCR-17-008-2	% of claim headers with missing Prescription Quantity Actual
MCR-19-006-4	% of claim headers with PRESCRIPTION-QUANTITY-ACTUAL = 1
MCR-19-008-2	% of claim headers with missing Prescription Quantity Actual
MIS-9-019-19	% missing: PRESCRIPTION-QUANTITY-ACTUAL (CRX00003)
MIS-28-018-18	% missing: PRESCRIPTION-QUANTITY-ACTUAL (CRX00003)
MIS-86-017-17	% missing: PRESCRIPTION-QUANTITY-ACTUAL (CRX00003)
RULE-7817	% of claim lines with missing Prescription Quantity Actual
RULE-7751	% of claim lines with missing Prescription Quantity Actual

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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
12/19/2024	4.0.1	CRX.003.132	UPDATE	Definition	The quantity of a drug that is dispensed for a prescription as reported by National Drug Code on the claim line. For use with CLAIMRX claims/encounters. For CLAIMOT claims/encounters, use the Service Quantity Actual field. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field.	The quantity of a drug that is dispensed for a prescription as reported ny National Drug Code on the claim line. For use with CLAIMOT and CLAIMRX claims. For CLAIMIP and CLAIMLT claims/encounter records, use the Revenue Center Quantity Actual field.
09/16/2024	4.0.0	CRX.003.132	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.132	ADD	N/A		Created