CRX.002.048

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

OTHER-INSURANCE-IND

Data Element

DE Number

CRX048

System DE Number

CRX.002.048

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The field denotes whether the insured party is covered under an other insurance plan other than Medicare or Medicaid.
Size	X(1)
FLF Start Position	319
FLF Stop Position	319
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 1 character 2. Value must be in [0,1] or not populated 3. Value must be in Other Insurance Indicator List (VVL) 4. Conditional

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1805	If the other insurance indicator is populated on a non-denied claim from an RX file, then the other insurance indicator reported must be found in the list of valid values.
RULE-6519	If a claim is a non-denied claim from an RX file, then the other health insurance value reported must be compatible with specified T-MSIS picture format: X(1).

Measure ID	Measure Name
MIS-8-017-17	% missing: OTHER-INSURANCE-IND (CRX00002)
TPL-2-004-7	% of claim headers with OTHER-INSURANCE-IND = 1
TPL-3-004-7	% of claim headers with OTHER-INSURANCE-IND = 1
TPL-4-004-7	% of claim headers with OTHER-INSURANCE-IND = 2
TPL-5-004-7	% of claim headers with OTHER-INSURANCE-IND = 1
MIS-27-017-17	% missing: OTHER-INSURANCE-IND (CRX00002)
MIS-85-017-17	% missing: OTHER-INSURANCE-IND (CRX00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP121	CIP.002.121	OTHER-INSURANCE-IND	CIP00002	CLAIM-HEADER-RECORD-IP
CLT071	CLT.002.071	OTHER-INSURANCE-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT057	COT.002.057	OTHER-INSURANCE-IND	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional	1. Value must be 1 character2. Value must be in [0,1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional
08/01/2023	3.11.0	CRX.002.048	UPDATE	Coding requirement	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Value must be 1 character5. Conditional	1. Value must be 1 character2. Value must be in [0, 1] or not populated3. Value must be in Other Insurance Indicator List (VVL)4. Conditional