CRX.002.163

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT

Data Element

DE Number

CRX163

System DE Number

CRX.002.163

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 total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment.
Size	S9(11)V99
FLF Start Position	1357
FLF Stop Position	1369
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be between -99999999999.99 and 99999999999.99 2. Value must be expressed as a number with 2-digit precision (eg. 100.50) 3. 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-7626	If a claim is a non-denied claim from an RX file, then the TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT value reported must be compatible with the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP292	CIP.002.292	TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	CIP00002	CLAIM-HEADER-RECORD-IP
CLT239	CLT.002.239	TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	CLT00002	CLAIM-HEADER-RECORD-LT
COT230	COT.002.230	TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.002.163	UPDATE	Coding requirement	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (e.g. 100.50 )3. Conditional	1. Value must be between -99999999999.99 and 99999999999.992. Value must be expressed as a number with 2-digit precision (eg. 100.50)3. Conditional
06/24/2022	3.0.0	CRX163/ TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX163\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|S9(11)V99\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX163	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX163\|TOT-BENEFICIARY-COPAYMENT-LIABLE-AMOUNT\|Conditional\|The total copayment amount on a claim that the beneficiary is obligated to pay for covered services. This is the total Medicaid or contract negotiated beneficiary copayment liability for covered service on the claim. Do not subtract out any payments made toward the copayment.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 )\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002