CRX.003.170

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

PROFESSIONAL-SERVICE-FEE-SUBMITTED

Data Element

DE Number

CRX170

System DE Number

CRX.003.170

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 charge to cover the clinical services, not otherwise covered under the professional dispensing fee. (Example - not filling a prescription because of therapeutic duplication).
Size	S9(11)V99
FLF Start Position	969
FLF Stop Position	981
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-7623	If a claim line is a non-denied claim from an RX file, then the PROFESSIONAL-SERVICE-FEE-SUBMITTED 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	CRX170/ PROFESSIONAL-SERVICE-FEE-SUBMITTED	ADD DE	Data Dictionary - Record Layout	N/A	DE_NO\|DATA_ELEMENT_NAME\|SIZE\|FILE NAME\|FILE SEGMENT CRX170\|PROFESSIONAL-SERVICE-FEE-SUBMITTED\|S9(11)V99\|CLAIMRX\|CLAIM-LINE-RECORD-RX-CRX00003
06/24/2022	3.0.0	CRX170	ADD	Data Dictionary	N/A	\|DE NO\| DATA ELEMENT NAME\|NECESSITY \|DEFINITION\|CODING REQUIREMENT\|FILENAME\| FILE SEGMENT NAME CRX170\|PROFESSIONAL-SERVICE-FEE-SUBMITTED\|Conditional\|The charge to cover the clinical services, not otherwise covered under the professional dispensing fee. (Example "not filling a prescription because of therapeutic duplication")\|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