CRX.003.169

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

TMSIS Dataguide

Medicaid.gov

Version 3.27.0

DISPENSE-FEE-PAID-AMT

Data Element

DE Number

CRX169

System DE Number

CRX.003.169

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 or the managed care plan on this claim or adjustment towards the cost of the pharmacy's professional dispensing fee for the prescription.
Size	S9(11)V99
FLF Start Position	956
FLF Stop Position	968
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-7622	If a claim line is a non-denied claim from an RX file, then the DISPENSE-FEE-PAID-AMT value reported must be compatible with 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	CRX169/ DISPENSE-FEE-PAID-AMT	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX169\|DISPENSE-FEE-PAID-AMT\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX169	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX169\|DISPENSE-FEE-PAID-AMT\|Conditional\|The amount paid by Medicaid or the managed care plan on this claim or adjustment towards the cost of the pharmacy's professional dispensing fee for the prescription.\|Value must be between -99999999999.99 and 99999999999.99 Value must be expressed as a number with 2-digit precision (e.g. 100.50 \|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003