CRX.002.156

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

DISPENSING-PRESCRIPTION-DRUG-PROV-NUM

Data Element

DE Number

CRX156

System DE Number

CRX.002.156

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 state-specific provider id of the provider who actually dispensed the prescription medication.
Size	X(30)
FLF Start Position	1320
FLF Stop Position	1349
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be 30 characters or less 2. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match Submitting State Provider ID (PRV.002.019) or 3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match Provider Identifier (PRV.005.081) where the Provider Identifier Type (PRV.005.077) equals "1" 4. Mandatory

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

RULE ID	RULE Definition
RULE-1964	If the dispensing prescription drug provider number is populated on a non-denied claim from the RX file, then either the dispensing prescription drug provider number value reported must be equal to a provider identifier value reported with a provider identifier type value for state-assigned Medicaid provider identifiers on a provider identifiers segment from a PRV file where the effective and end dates of the provider identifiers segment overlap with the prescription fill date on the claim OR the dispensing prescription drug provider number value reported must be equal to a submitting state provider ID on a provider main attributes segment from a PRV file where the effective and end dates of the provider main attributes segment overlap with the prescription fill date on the claim.
RULE-6283	If a claim is a non-denied claim from an RX file, then the dispensing presciption drug provider number value reported must be compatible with specified T-MSIS picture format: X(30).
RULE-7446	If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is an Medicaid and S-CHIP FFS and encounter original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status on the prescription fill date.
RULE-7928	If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP Encounter or Separate CHIP Encounter original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the prescription fill date is within effective and end dates of the provider medicaid enrollment segment on the pharmacy claim.
RULE-7936	If the dispensing prescription drug provider number is populated on a non-denied claim from an RX file and the claim is a Medicaid or M-CHIP FFS or Separate CHIP FFS original or adjustment paid claim, the claim dispensing prescription drug provider number is equal to the submitting state provider identifier on the provider medicaid enrollment segment with an active provider enrollment status where the prescription fill date is within effective and end dates of the provider medicaid enrollment segment on the pharmacy claim.

Measure ID	Measure Name
ALL-21-008-8	% of DISPENSING-PRESCRIPTION-DRUG-PROV-NUM on claim headers that do not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Prescription Fill Date
ALL-4-004-4	% of billing and dispensing provider numbers on claims that are not found in the provider file
MIS-8-012_1-35	% missing: DISPENSING-PRESCRIPTION-DRUG-PROV-NUM (CRX00002)
RULE-1964	% of claim headers with a Dispensing Provider Number that is not found on the provider file on the Prescription Fill Date
MIS-27-001-10	% missing: DISPENSING-PRESCRIPTION-DRUG-PROV-NUM (CRX00002)
MIS-85-010-10	% missing: DISPENSING-PRESCRIPTION-DRUG-PROV-NUM (CRX00002)
RULE-7446	% of claim headers that have a DISPENSING-PRESCRIPTION-DRUG-PROV-NUM that does not have a match in PRV00007 with active provider enrollment status (PROV-MEDICAID-ENROLLMENT-STATUS-CODE in (1, 2, 3, 4, 5, 6) on Prescription Fill Date
RULE-7928	% of claim headers with a Dispensing Prescription Drug Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Prescription Fill Date
RULE-7936	% of claim headers with a Dispensing Prescription Drug Provider Number that does not have a match in PRV00007 with an active provider enrollment status on Prescription Fill Date

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.002.156	UPDATE	Coding requirement	1. Value must be 30 characters or less2. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match Submitting State Provider ID (PRV.002.019) or3. When Type of Claim not in ('Z','3','C','W',"2","B","V"," 4","D","X") then value may match Provider Identifier (PRV.005.081) where the Provider Identifier Type (PRV.005.077) = '1'4. Mandatory	1. Value must be 30 characters or less2. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match Submitting State Provider ID (PRV.002.019) or3. When Type of Claim not in [Z,3,C,W,2,B,V,4,D,X] then value may match Provider Identifier (PRV.005.081) where the Provider Identifier Type (PRV.005.077) equals "1"4. Mandatory