CRX.003.129

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

MEDICARE-PAID-AMT

Data Element

DE Number

CRX129

System DE Number

CRX.003.129

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 Medicare on this claim. For claims where Medicare payment is only available at the header level, report the entire payment amount on the T-MSIS claim line with the highest charge or the 1st non-denied line. Zero fill Medicare Paid Amount on all other claim lines.
Size	S9(11)V99
FLF Start Position	277
FLF Stop Position	289
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 Crossover Indicator value is "0", then the value must not be populated. 4. Conditional 5. If value is populated, Crossover Indicator must be equal to "1"

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

RULE ID	RULE Definition
RULE-1933	If a claim is a non-denied claim from an RX file, then the medicare paid amount value reported must be a valid dollar amount that matches the specified T-MSIS picture format: S9(11)V99.
RULE-7660	If a claim is a non-denied, crossover Medicaid Encounter, original or adjustment paid claim from an RX file, then the claim must have a non-null value and not zero value for medicare paid amount or total medicare coinsurance amount or total medicare deductible amount.
RULE-7665	If a claim is a non-denied, non-crossover Medicaid Encounter, original or adjustment paid claim from an RX file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.
RULE-7777	If a claim is a non-denied, crossover Medicaid or M-CHIP or Separate CHIP Fee-for-Service, original or adjustment paid claim from an RX file, then the claim must have a non-null value and not zero value for medicare paid amount or total medicare coinsurance amount or total medicare deductible amount.
RULE-7781	If a claim is a non-denied, non-crossover Medicaid or M-CHIP or Separate CHIP Fee-for-Service, original or adjustment paid claim from an RX file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.
RULE-7839	If a claim is a non-denied, non-crossover Medicaid or M-CHIP or Separate CHIP Supplemental, original or adjustment paid claim from an RX file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.
RULE-7843	If a claim is a non-denied, non-crossover Medicaid or M-CHIP or Separate CHIP Service Tracking, original or adjustment paid claim from an RX file, then the claim must have a null value or zero value for medicare paid amount, total medicare coinsurance amount and total medicare deductible amount.

Measure ID	Measure Name
FFS-53-004-4	% of non-crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero
FFS-54-004-4	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
MCR-63-004-4	% of non-crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero
MCR-64-004-4	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
MIS-9-015-15	% missing: MEDICARE-PAID-AMT (CRX00003)
MIS-28-014-14	% missing: MEDICARE-PAID-AMT (CRX00003)
MIS-86-013-13	% missing: MEDICARE-PAID-AMT (CRX00003)
FFS-54-004_1-8	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
MCR-64-004_1-8	% of crossover claim headers where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
RULE-7665	% of non-crossover encounter claims where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero
RULE-7777	% of crossover claims where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, and TOT-MEDICARE-DEDUCTIBLE-AMT are 0 or missing
RULE-7781	% of non-crossover claims where MEDICARE-PAID-AMT, TOT-MEDICARE-COINS-AMT, or TOT-MEDICARE-DEDUCTIBLE-AMT is non-zero

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP228	CIP.002.228	MEDICARE-PAID-AMT	CIP00002	CLAIM-HEADER-RECORD-IP
CLT179	CLT.002.179	MEDICARE-PAID-AMT	CLT00002	CLAIM-HEADER-RECORD-LT
COT182	COT.003.182	MEDICARE-PAID-AMT	COT00003	CLAIM-LINE-RECORD-OT

Published Date	Data Guide Version	Data Element	Action	Field	Before	After
09/01/2023	3.12.0	CRX.003.129	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. If associated Crossover Indicator value is "0", then the Medicare Paid Amount must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"	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. If associated Crossover Indicator value is "0", then the value must not be populated.4. Conditional5. If value is populated, Crossover Indicator must be equal to "1"
04/17/2020	2.4.0	CRX129	UPDATE	Data Dictionary	Necessity \| Required	Necessity \| Conditional
03/11/2022	3.0.0	CRX129	UPDATE	Data Dictionary	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CRX129 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim or adjustment.\|	DE NO\| DATA ELEMENT NAME\| DEFINITION\| CRX129 \| MEDICARE-PAID-AMT \|The amount paid by Medicare on this claim. For claims where Medicare payment is only available at the header level, report the entire payment amount on the T-MSIS claim line with the highest charge or the 1st non-denied line. Zero fill Medicare Paid Amount on all other claim lines.\|