CRX.002.055

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

PROGRAM-TYPE

Data Element

DE Number

CRX055

System DE Number

CRX.002.055

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	A code to indicate special Medicaid program under which the service was provided.
Size	X(2)
FLF Start Position	343
FLF Stop Position	344
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Program Type List (VVL) 2. Value must be 2 characters 3. Mandatory 4. (Community First Choice) If value equals '11', then State Plan Option Type (ELG.011.163) must equal '01' for the same time period 5. If value equals '13', then State Plan Option Type (ELG.011.163) must equal '02' for the same time period

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

RULE ID	RULE Definition
RULE-1814	If the program type is populated on a non-denied claim from an RX file, then the program type value reported must be in the list of valid values for program type.
RULE-6221	If a claim is a non-denied claim from an RX file, then the program type value reported must be compatible with specified T-MSIS picture format: X(2).

Measure ID	Measure Name
ALL-13-002-2	% of MSIS IDs limited to family planning (RESTRICTED-BENEFITS-CODE = 6) with non-family planning services (PROGRAM-TYPE not equal 2)
ALL-18-004-4	# of claim headers with TYPE-OF-CLAIM = U, V, W, X or Y that aren’t MFP (PROGRAM-TYPE = 08)
MIS-8-024-24	% missing: PROGRAM-TYPE (CRX00002)
MIS-27-024-24	% missing: PROGRAM-TYPE (CRX00002)
MIS-85-024-24	% missing: PROGRAM-TYPE (CRX00002)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP129	CIP.002.129	PROGRAM-TYPE	CIP00002	CLAIM-HEADER-RECORD-IP
CLT079	CLT.002.079	PROGRAM-TYPE	CLT00002	CLAIM-HEADER-RECORD-LT
COT065	COT.002.065	PROGRAM-TYPE	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
04/17/2020	2.4.0	PROGRAM-TYPE CIP129, CLT079, COT065, CRX055	ADD	Data Dictionary - Valid Values	N/A	Data Element Name\| DE ID\| Code\| Description\| Effective Date\| End Date\| PROGRAM-TYPE\| CIP129, CLT079, COT065, CRX055\| 17\| COVID-19 Testing Services (1905(a)(3) and 2103(c))\| 3/18/2020\| 12/31/9999\|
06/24/2022	3.0.0	AFFILIATED-PROGRAM-TYPE	UPDATE	Data Dictionary	\|DE No\|Data Element Name\|Definition\| \|PRV119\|AFFILIATED-PROGRAM-TYPE\| A code to identify the category of program that the provider is affiliated. see Affiliated Program Type List (VVL.004) (health plan federal assigned) if associated Affiliated Program Type (DE) value is 1, then value must be the federal-assigned plan ID of the health plan in which a provider is enrolled to provide services. (health plan state assigned) if associated Affiliated Program Type (DE) value is 2, then value must be the state-assigned plan ID of the health plan in which a provider is enrolled to provide services. (waiver) if associated Affiliated Program Type (DE) value is 3, then value must be the core Federal Waiver ID in which a provider is allowed to deliver services to eligible beneficiaries. (health home entity) if associated Affiliated Program Type (DE) value is 4, then value must be the name of a health home in which a provider is participating. (other) if associated Affiliated Program Type (DE) value is 5, then value must be an identifier for something other than a health plan, waiver, or health home entity.\|	\|DE No\|Data Element Name\|Definition\| \|PRV119\|AFFILIATED-PROGRAM-TYPE\|A code to identify the category of program that the provider is affiliated.\|