CRX.003.119

CLAIM-LINE-STATUS

Data Element

DE Number

CRX119

System DE Number

CRX.003.119

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00003

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The claim line status codes from the 277 transaction set identify the status of a specific detail claim line rather than the entire claim. Only report the claim line for the final, adjudicated claim.
Size	X(3)
FLF Start Position	164
FLF Stop Position	166
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Claim Status List (VVL) 2. Value must be 3 characters or less 3. Conditional 4. If value in [545,585,654], then Claim Denied Indicator must be "0" and Claim Status Category must be "F2"

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Link to Claim Status List

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-1796	If the total Medicare deductible amount is populated on a non-denied claim from an RX file, then the total Medicare deductible amount is equal to the sum of all non-denied line-level Medicare deductible amounts.
RULE-1920	If the claim line status is populated on a non-denied claim from an RX file, then the claim line status value reported must be in the list of valid values for 'claim status'.
RULE-6264	If a claim line is a non-denied claim line from an RX file, then the claim line status value reported must be compatible with specified T-MSIS picture format: X(3).
RULE-7281	If a claim is a non-denied claim from an RX file that is an original claim and is a Medicaid or Medicaid-expansion CHIP, Medicaid or Medicaid-expansion CHIP encounter, separate CHIP FFS or encounter claim, and the payment level indicator is for line, then the sum of the claim line medicaid paid amount is equal to the claim header total medicaid paid amount
RULE-7636	All non-denied, paid RX claim header records must have a corresponding non-denied claim line record.
RULE-7685	If a claim is a non-denied claim from an RX file that is an original claim and is a Medicaid or Medicaid-expansion CHIP encounter, separate CHIP encounter claim, and the payment level indicator is for line, then the sum of the claim line medicaid paid amount is equal to the claim header total medicaid paid amount.
RULE-7793	If a claim is a non-denied claim from an RX file that is an original claim and is a Medicaid or Medicaid-expansion CHIP or Separate CHIP Fee-for-Service claim, and the payment level indicator is for line, then the sum of the claim line medicaid paid amount is equal to the claim header total medicaid paid amount.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP242	CIP.003.242	CLAIM-LINE-STATUS	CIP00003	CLAIM-LINE-RECORD-IP
CLT195	CLT.003.195	CLAIM-LINE-STATUS	CLT00003	CLAIM-LINE-RECORD-LT
COT165	COT.003.165	CLAIM-LINE-STATUS	COT00003	CLAIM-LINE-RECORD-OT