CRX.003.112

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

ICN-ORIG

Data Element

DE Number

CRX112

System DE Number

CRX.003.112

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	A unique number assigned by the state's payment system that identifies an original or adjustment claim.
Size	X(50)
FLF Start Position	42
FLF Stop Position	91
Segment Key Field Identifier	2
Coding Requirements	1. Value must be 50 characters or less 2. Value must not contain a pipe or asterisk symbols 3. 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-1909	All non-denied RX claim line records must have a corresponding parent record.
RULE-1910	If the icn orig is populated on a non-denied claim line from an RX file, then the icn orig reported must not contain any pipe or asterisk characters.
RULE-6230	If a claim line is a non-denied claim line from an RX file, then the ICN origination value reported must be compatible with specified T-MSIS picture format: X(50).
RULE-7190	If a claim line is from an RX file, then submitting state, original ICN, adjustment ICN, adjudication date, line adjustment indicator, original line ICN, and adjustment line ICN values reported must be unique across all RX claim lines.
RULE-7329	If a segment is an RX claim line, icn orig must be populated.
RULE-7577	All denied RX claim line records must have a corresponding claim header record.

Measure ID	Measure Name
MIS-9-009-9	% missing: ICN-ORIG (CRX00003)
MIS-28-009-9	% missing: ICN-ORIG (CRX00003)
MIS-86-008-8	% missing: ICN-ORIG (CRX00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP019	CIP.002.019	ICN-ORIG	CIP00002	CLAIM-HEADER-RECORD-IP
CIP235	CIP.003.235	ICN-ORIG	CIP00003	CLAIM-LINE-RECORD-IP
CLT019	CLT.002.019	ICN-ORIG	CLT00002	CLAIM-HEADER-RECORD-LT
CLT188	CLT.003.188	ICN-ORIG	CLT00003	CLAIM-LINE-RECORD-LT
COT019	COT.002.019	ICN-ORIG	COT00002	CLAIM-HEADER-RECORD-OT
COT158	COT.003.158	ICN-ORIG	COT00003	CLAIM-LINE-RECORD-OT
CRX019	CRX.002.019	ICN-ORIG	CRX00002	CLAIM-HEADER-RECORD-RX

Published Date	Data Guide Version	Data Element	Action	Field	Before	After