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TMSIS Dataguide Medicaid.gov
Version 3.27.0

COMBINED-BENE-COST-SHARING-PAID-AMOUNT

Data Element

DE Number

CRX166

System DE Number

CRX.002.166

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00002

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances
Definition The combined amounts the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment, coinsurance, and/or deductible for the covered services on the claim. Only report this data element when the claim does not differentiate among copayment, coinsurance, and/or deductible payments made by the beneficiary. Do not include beneficiary cost sharing payments made by a third party/ies on behalf of the beneficiary.
Size S9(11)V99
FLF Start Position 1396
FLF Stop Position 1408
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
DE Number System DE Number DE Name File Segment Number File Segment Name
CIP295 CIP.002.295 COMBINED-BENE-COST-SHARING-PAID-AMOUNT CIP00002 CLAIM-HEADER-RECORD-IP
CLT242 CLT.002.242 COMBINED-BENE-COST-SHARING-PAID-AMOUNT CLT00002 CLAIM-HEADER-RECORD-LT
COT233 COT.002.233 COMBINED-BENE-COST-SHARING-PAID-AMOUNT COT00002 CLAIM-HEADER-RECORD-OT