CRX.003.123

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

BENEFICIARY-COPAYMENT-PAID-AMOUNT

Data Element

DE Number

CRX123

System DE Number

CRX.003.123

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 the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element.
Size	S9(5)V99
FLF Start Position	205
FLF Stop Position	211
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Situational 2. Value must be 5 digits or less left of the decimal i.e. 99999.99

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

RULE ID	RULE Definition
RULE-1926	If a claim is a non-denied claim from an RX file, then the beneficiary copayment paid amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(5)V99.

Measure ID	Measure Name
MIS-9-005-5	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00003)
MIS-28-005-5	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00003)
MIS-86-004-4	% missing: BENEFICIARY-COPAYMENT-PAID-AMOUNT (CRX00003)

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
COT176	COT.003.176	BENEFICIARY-COPAYMENT-PAID-AMOUNT	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
08/28/2023	3.12.0	CRX.003.123	UPDATE	Necessity	Conditional	Situational
08/28/2023	3.12.0	CRX.003.123	UPDATE	Coding requirement	1. Conditional2. Value must be 5 digits or less left of the decimal i.e. 99999.99	1. Situational2. Value must be 5 digits or less left of the decimal i.e. 99999.99
06/24/2022	3.0.0	CRX123/ BENEFICIARY-COPAYMENT-PAID-AMOUNT	Rename DE	Data Dictionary - Record Layout	DE No\|Data Element Name CRX123\|COPAY-AMT	DE No\|Data Element Name CRX123\|BENEFICIARY-COPAYMENT-PAID-AMOUNT
06/24/2022	3.0.0	CRX123	UPDATE	Data Dictionary	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION CRX123\|COPAY-AMT \|Conditional\|The copayment amount paid by an enrollee for the service, which does not include the amount paid by the insurance company.	\|DE NO\| DATA ELEMENT NAME\|NECESSITY\|DEFINITION CRX123\|BENEFICIARY-COPAYMENT-PAID-AMOUNT\|Optional\|The amount the beneficiary or his or her representative (e.g., their guardian) paid towards their copayment for the covered services on a claim line. Do not include copayment payments made by a third party/ies on behalf of the beneficiary. This is a copayment paid for a service in the corresponding claim line for OT and RX claim files. The Beneficiary Copayment Paid Amount is an optional line level data element reported for OT and RX claim file types, only. If the beneficiary copayment paid amount is not available at the claim line level, report the total copayment paid amount in the header level copayment data element.