CRX.002.059

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

MEDICARE-REIM-TYPE

Data Element

DE Number

CRX059

System DE Number

CRX.002.059

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A code to indicate the type of Medicare reimbursement.
Size	X(2)
FLF Start Position	358
FLF Stop Position	359
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Medicare Reimbursement Type List (VVL) 2. Value is mandatory and must be provided, when Crossover Indicator is equal to '1' (Crossover Claim) 3. Value must be 2 characters 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-1824	If the medicare reim type is populated on a non-denied claim from an RX file, then the medicare reim type reported must be found in the list of valid values.
RULE-6648	If a claim is a non-denied claim from an RX file, then the sMedicare reimbursement type value reported must be compatible with specified T-MSIS picture format: X(2).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP133	CIP.002.133	MEDICARE-REIM-TYPE	CIP00002	CLAIM-HEADER-RECORD-IP
CLT083	CLT.002.083	MEDICARE-REIM-TYPE	CLT00002	CLAIM-HEADER-RECORD-LT
COT069	COT.002.069	MEDICARE-REIM-TYPE	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After