CRX.003.121

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TMSIS Dataguide

Medicaid.gov

Version 3.36.0

BILLED-AMT

Data Element

DE Number

CRX121

System DE Number

CRX.003.121

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
Size	S9(11)V99
FLF Start Position	179
FLF Stop Position	191
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-1924	If a claim is a non-denied claim from an RX file, then the billed amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name
MIS-9-003-3	% missing: BILLED-AMT (CRX00003)
MIS-28-003-3	% missing: BILLED-AMT (CRX00003)
MIS-86-002-2	% missing: BILLED-AMT (CRX00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
COT174	COT.003.174	BILLED-AMT	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/12/2024	3.29.0	CRX.003.121	UPDATE	Definition	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
09/12/2024	3.29.0	CRX.003.121	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 (e.g. 100.50)3. Conditional
08/09/2023	3.11.0	CRX.003.121	UPDATE	Definition	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.	The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider.For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.
12/04/2020	2.4.0	TOT-BILLED-AMT	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\| DEFINITION\| NECESSITY \|CODING REQUIREMENT\| \|CIP112 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|CLT063 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|COT048 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\| \|CRX039 \|TOT-BILLED-AMT\| Not Applicable \|Not Applicable \|If TYPE-OF-CLAIM = "4", then TOT-BILLED-AMT must = "00000000".\|	N/A
06/11/2021	3.0.0	TOT-BILLED-AMT	UPDATE	Data Dictionary	"If associated Type of Claim value is 2, 4, 5, B, D, or E, then value should not be populated"	N/A
07/23/2021	3.0.0	TOT-BILLED-AMT (CIP.002.112)	UPDATE	Data Dictionary	“If associated Type of Claim value is 2, 4, 5, B, D, or E, then value should not be populated"	N/A
07/15/2022	3.0.1	CRX121	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX121\|BILLED-AMT\|The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan.	DE NO\| DATA ELEMENT NAME COMPUTING\|DEFINITION CRX121\|BILLED-AMT\|The amount billed at the claim detail level as submitted by the provider. For encounter records, Type of Claim = 3, C, or W, this field should be populated with the amount that the provider billed the managed care plan. For sub-capitated encounters from a sub-capitated entity that is not a sub-capitated network provider, report the amount that the provider billed the sub-capitated entity at the claim line detail level. Report a null value in this field if the provider is a sub-capitated network provider. For sub-capitated encounters from a sub-capitated network provider, if the sub-capitated network provider directly employs the provider that renders the service to the enrollee, report a null value in this field.