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TMSIS Dataguide Medicaid.gov

Version:

3.38.0

CLAIM-DX-RX

File Segment

File Segment Number

CRX00004

File Name

CRX - CLAIM PHARMACY

Last updated

Data Elements Reference
DE Number System DE Number Data Element Definition Valid Values
CRX196 CRX.004.196 RECORD-ID The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). CRX196 Values
CRX197 CRX.004.197 SUBMITTING-STATE A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. CRX197 Values
CRX198 CRX.004.198 RECORD-NUMBER A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file. N/A
CRX199 CRX.004.199 ICN-ORIG A unique number assigned by the state's payment system that identifies an original or adjustment claim. N/A
CRX200 CRX.004.200 ICN-ADJ A unique claim number assigned by the state's payment system that identifies the adjustment claim for an original transaction. N/A
CRX201 CRX.004.201 ADJUSTMENT-IND Indicates the type of adjustment record. CRX201 Values
CRX202 CRX.004.202 ADJUDICATION-DATE The date on which the payment status of the claim was finally adjudicated by the state. For Encounter Records (Type of Claim = 3, C, W), use date the encounter was processed by the state. N/A
CRX203 CRX.004.203 DIAGNOSIS-TYPE Indicates the context of the diagnosis code from the provider's claim (i.e., an NCPDP claim can have up to 5 diagnosis codes). The type of diagnosis code (e.g., principal, admitting, external cause of injury, or other) is captured here. The order in which the diagnosis code was reported is captured in the Diagnosis Sequence Number. CRX203 Values
CRX204 CRX.004.204 DIAGNOSIS-SEQUENCE-NUMBER The order in which the diagnosis occurred on the provider's claim for a given type of diagnosis code (e.g., an NCPDP claim can have up to 5 diagnosis codes). N/A
CRX205 CRX.004.205 DIAGNOSIS-CODE-FLAG Flag used to identify wither the associated Diagnosis Code value is a ICD-9 or ICD-10 code. CRX205 Values
CRX206 CRX.004.206 DIAGNOSIS-CODE ICD-9 or ICD-10 diagnosis codes used as a tool to group and identify diseases, disorders, symptoms, poisonings, adverse effects of drugs and chemicals, injuries and other reasons for patient encounters. Diagnosis codes should be passed through to T-MSIS exactly as they were submitted by the provider on their claim (with the exception of removing the decimal). For example: 210.5 is coded as '2105'. CRX206 Values
CRX207 CRX.004.207 STATE-NOTATION A free text field for the submitting state to enter whatever information it chooses. N/A
Definition
A record segment to capture data about the diagnosis code(s) associated with a claim.

File Segment Length
1600