CRX.002.160

MEDICARE-COMB-DED-IND

Data Element

DE Number

CRX160

System DE Number

CRX.002.160

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00002

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

09/12/2024

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Code indicating that the amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare deductible was combined with their coinsurance amount because the amounts could not be separated.
Size	X(1)
FLF Start Position	1350
FLF Stop Position	1350
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Medicare Combined Deductible Indicator List (VVL) 2. Value must be 1 character 3. Value must be in [0,1] or not populated 4. If value equals "1", then Total Medicare Coinsurance amount must not be populated 5. If value equals "0", then Crossover Indicator must equals "0" 6. If value equals "1", then Crossover Indicator must equals "1" 7. Conditional

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Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date
MEDICARE-COMB-DED-IND	0	Amount not combined with coinsurance amount		01/01/0001	12/31/9999
MEDICARE-COMB-DED-IND	1	Amount combined with coinsurance amount		01/01/0001	12/31/9999

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RULE ID	RULE Definition
RULE-1970	If the medicare comb ded indicator is populated on a non-denied claim line from an RX file, then the medicare comb ded indicator reported must be found in the list of valid values.
RULE-1971	If a claim is a non-denied, non-crossover RX claim that is not an encounter claim, then the medicare comb ded indicator must be an amount not combined with the coinsurance amount.
RULE-6904	If a claim line is a non-denied claim line from an RX file, then the Medicare COMB bed indicator value reported must be compatible with specified T-MSIS picture format: X(1).

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Measure ID	Measure Name
No data available in table

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DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP128	CIP.002.128	MEDICARE-COMB-DED-IND	CIP00002	CLAIM-HEADER-RECORD-IP
CLT078	CLT.002.078	MEDICARE-COMB-DED-IND	CLT00002	CLAIM-HEADER-RECORD-LT
COT064	COT.002.064	MEDICARE-COMB-DED-IND	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.002.160	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0,1] or not populated4. If value equals "1", then Total Medicare Coinsurance amount must not be populated5. If value equals "0", then Crossover Indicator must equals "0"6. If value equals "1", then Crossover Indicator must equals "1"7. Conditional
08/01/2023	3.11.0	CRX.002.160	UPDATE	Coding requirement	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. Value must be 1 character5. If value equals '1', then Total Medicare Coinsurance amount must not be populated.6. If value equals '0', then Crossover Indicator must equals '0'7. If value equals '1', then Crossover Indicator must equals '1'8. Conditional	1. Value must be in Medicare Combined Deductible Indicator List (VVL)2. Value must be 1 character3. Value must be in [0, 1] or not populated4. If value equals '1', then Total Medicare Coinsurance amount must not be populated.5. If value equals '0', then Crossover Indicator must equals '0'6. If value equals '1', then Crossover Indicator must equals '1'7. Conditional