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File
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. |
Diagram 4: Claim RX File – Claim Record Segment Relationships
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)