CRX.003.168

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TMSIS Dataguide

Medicaid.gov

Version:

INGREDIENT-COST-PAID-AMT

Data Element

DE Number

CRX168

System DE Number

CRX.003.168

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 amount paid by Medicaid or the managed care plan on this claim or adjustment at the claim detail level towards the cost of ingredients for the prescription or drug.
Size	S9(11)V99
FLF Start Position	444
FLF Stop Position	456
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-7621	If a claim line is a non-denied claim from an RX file, then the INGREDIENT-COST-PAID-AMT 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

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
07/10/2025	4.0.13	CRX.003.168	UPDATE	Necessity	Conditional	Situational
07/10/2025	4.0.13	CRX.003.168	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.003.168	UPDATE	File segment	None	41
09/16/2024	4.0.0	CRX.003.168	ADD	N/A		Created