CRX.003.128

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MEDICARE-COINS-AMT

Data Element

DE Number

CRX128

System DE Number

CRX.003.128

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 paid by Medicaid/CHIP on this claim toward the recipient's Medicare coinsurance at the claim detail level. If the Medicare coinsurance amount can be identified separately from Medicare deductible payments, code that amount in this field. If Medicare coinsurance and deductible payments cannot be separated, populate the Medicare Deductible Amount.
Size	S9(11)V99
FLF Start Position	264
FLF Stop Position	276
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. If associated Medicare Combined Deductible Indicator is '1', then value must not be populated (or must be 99998) 4. Value must not be populated if Medicare Deductible Amount is not populated 5. 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-1932	If a claim is a non-denied claim from an RX file, then the medicare coinsurance amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
06/24/2022	3.0.0	MEDICARE-COINS-AMT	UPDATE	Data Dictionary	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT\| CRX128\|MEDICARE-COINS-AMT\|The amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare coinsurance at the claim detail level. If the Medicare coinsurance amount can be identified separately from Medicare deductible payments, code that amount in this field. If Medicare coinsurance and deductible payments cannot be separated, populate the MEDICARE-DEDUCTIBLE-AMT. See US Dollar Amount (DT)\| 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.(payments can't be separated) value 99998 is an exception to the US Dollar Amount requirements 4.(N) conditional	DE NO\|DATA ELEMENT NAME\|DEFINITION\|CODING REQUIREMENT\| CRX128\|MEDICARE-COINS-AMT\|The amount paid by Medicaid/CHIP on this claim toward the recipient's Medicare coinsurance at the claim detail level. If the Medicare coinsurance amount can be identified separately from Medicare deductible payments, code that amount in this field. If Medicare coinsurance and deductible payments cannot be separated, populate the Medicare Deductible Amount.\| 1. Value must be between -99999999999.99 and 99999999999.99 2. if associated Medicare Combined Deductible Indicator is '1', then value must not be populated (or must be 99998) 3. Value must be expressed as a number with 2-digit precision (e.g. 100.50 ) 4. Value must not be populated if Medicare Deductible Amount is not populated 5. Conditional