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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

PRE-AUTHORIZATION-NUM

Data Element

DE Number

CRX159

System DE Number

CRX.003.159

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00003

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition A number, code or other value that indicates the services provided on this claim have been authorized by the payee or other service organization, or that a referral for services has been approved. (Also referred to as a Prior Authorization or Referral Number).
Size X(18)
FLF Start Position 413
FLF Stop Position 430
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must be 18 characters or less
2. Value must not contain a pipe or asterisk symbols
3. Situational
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
CIP288 CIP.003.288 PRE-AUTHORIZATION-NUM CIP00003 CLAIM-LINE-RECORD-IP
CLT235 CLT.003.235 PRE-AUTHORIZATION-NUM CLT00003 CLAIM-LINE-RECORD-LT
COT223 COT.003.223 PRE-AUTHORIZATION-NUM COT00003 CLAIM-LINE-RECORD-OT