CRX.002.165

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT

Data Element

DE Number

CRX165

System DE Number

CRX.002.165

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 deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.
Size	S9(11)V99
FLF Start Position	1383
FLF Stop Position	1395
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 (e.g. 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-7628	If a claim is a non-denied claim from an RX file, then the TOT-BENEFICIARY-DEDUCTIBLE-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
CIP294	CIP.002.294	TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	CIP00002	CLAIM-HEADER-RECORD-IP
CLT241	CLT.002.241	TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	CLT00002	CLAIM-HEADER-RECORD-LT
COT232	COT.002.232	TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	COT00002	CLAIM-HEADER-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/10/2023	3.11.0	CRX.002.165	UPDATE	Definition	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.	The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.
08/10/2023	3.11.0	CRX.002.165	UPDATE	Last update date	12/08/2022	8/10/2023
06/24/2022	3.0.0	CRX165/ TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|S9(11)V99\|CLAIMRX\|CLAIM-HEADER-RECORD-RX-CRX00002
06/24/2022	3.0.0	CRX165	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|Conditional\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.\|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
10/07/2022	3.0.3	CIP294, CLT241, COT232, CRX165	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP294\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible. CLT241\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible. COT232\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible. CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability for covered services on the claim. Do not subtract out any payments made toward the deductible.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION\| CIP294\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible. CLT241\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible. COT232\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible. CRX165\|TOT-BENEFICIARY-DEDUCTIBLE-LIABLE-AMOUNT\|The total deductible amount on a claim the beneficiary is obligated to pay for covered services. This amount is the total Medicaid or contract negotiated beneficiary deductible liability minus previous beneficiary payments that went toward their deductible. Do not subtract out any payments for the given claim that went toward the deductible.