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TMSIS Dataguide Medicaid.gov
Version 3.28.0

CRX - CLAIM PHARMACY

File

View Changelog
File Segments Reference

The table below lists the File Segments included in the File:

File Segment Number File Segment Name File Segment Definition
CRX00001 FILE-HEADER-RECORD-RX A record containing metadata necessary to identify the file itself, when it was created and the number of records it contains.
CRX00002 CLAIM-HEADER-RECORD-RX A record to capture data about a pharmacy claim or encounter that applies to the claim in its totality.
CRX00003 CLAIM-LINE-RECORD-RX A record to capture data about specific prescription goods or services rendered to a Medicaid/CHIP enrollee.
Definition
Pharmacy claims and managed care encounter records.

Overview

Diagram 4: Claim RX File – Claim Record Segment Relationships

crx_overview

Description of Diagram 4:

Each claim record in the T-MSIS prescription drug (RX) claims file is composed of two types of record segments: One claim header segment and multiple claim line segments. Each claim line segment joins to its claim header segment on the following four data elements:

1. SUBMITTING-STATE
2. ICN-ORIG
3. ICN-ADJ
4. ADJUDICATION-DATE
5. ADJUSTMENT-IND (LINE-ADJUSTMENT-IND)