CRX.002.067

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

HEALTH-HOME-PROV-IND

Data Element

DE Number

CRX067

System DE Number

CRX.002.067

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	Indicates whether the claim is submitted by a provider or provider group enrolled in the Health Home care model to provide services for the beneficiary on the claim. Health home providers provide service for patients with chronic illnesses. States that do not specify an eligible individual's health home provider number, if applicable, should not report claims that indicate the claim is submitted by a provider or provider group enrolled in the health home model.
Size	X(1)
FLF Start Position	454
FLF Stop Position	454
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Health Home Provider Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0,1] or not populated 4. If there is an associated Health Home Entity Name value, then value must be "1" 5. 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-1836	If the health home provider indicator is populated on a non-denied claim from an RX file, then the health home provider indicator reported must be found in the list of valid values.
RULE-1837	If a non-denied RX claim has a value populated for health home entity name, then the health home provider indicator must be equal to '1'.
RULE-6932	If a claim line is a non-denied claim line from an RX file, then the health home provider indicator value reported must be compatible with specified T-MSIS picture format: X(1).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP176	CIP.002.176	HEALTH-HOME-PROV-IND	CIP00002	CLAIM-HEADER-RECORD-IP
CLT127	CLT.002.127	HEALTH-HOME-PROV-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT109	COT.002.109	HEALTH-HOME-PROV-IND	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.002.067	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional
08/28/2023	3.12.0	CRX.002.067	UPDATE	Coding requirement	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Value must be 1 character6. Conditional	1. Value must be in Health Home Provider Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If there is an associated Health Home Entity Name value, then value must be "1"5. Conditional