CRX.003.145

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TMSIS Dataguide

Medicaid.gov

Version 3.28.0

COMPOUND-DOSAGE-FORM

Data Element

DE Number

CRX145

System DE Number

CRX.003.145

File Name

CRX - CLAIM PHARMACY

File Segment Number

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The physical form of a dose of medication, such as a capsule or injection.
Size	X(2)
FLF Start Position	370
FLF Stop Position	371
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Compound Dosage Form List (VVL) 2. Value must be 2 characters 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-1950	If the compound dosage form is populated on a non-denied claim from an RX file, then the compound dosage form reported must be found in the list of valid values.
RULE-6716	If a claim line is a non-denied claim line from an RX file, then the compound dosage form value reported must be compatible with specified T-MSIS picture format: X(2).

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