CMS-R-144 - Record Format Crosswalk

CMS-R-144 State Invoice_Record Format_Crosswalk_07.2021_Updated_12.03.2020.xlsx

Medicaid Drug Rebate Program (MDRP): Quarterly State Invoice (CMS-R-144) and State Agency Contact Form (CMS-368)

CMS-R-144 - Record Format Crosswalk

OMB: 0938-0582

Document [xlsx]
Download: xlsx | pdf
12/2019 (old version) 10/2020 (new version) Type of Change Reason for Change Burden Change
Header:
MEDICAID DRUG REBATE PROGRAM
STATE INVOICE RECORD FORMAT
(Form CMS-R-144)
Effective: February 1, 2020
Header:
MEDICAID DRUG REBATE PROGRAM
ELECTRONIC STATE INVOICE
Form CMS-R-144
RECORD FORMAT
Effective: July 1, 2021


Rev To align Header with other Medicaid Drug Rebate Program documentation. N/A
N/A New File Format Column:
Ordinal Position
Coresponding Rows Numbered 1-15
Add To update File Format to include .CSV Ordinal Numbering Column N/A
File Format - Column Name Update:
Field
File Format - Column Name Update:
Field Name (.TXT)
Header Row (.CSV
Rev To include .CSV Header Row in additon to the .TXT Field Name N/A
File Format - Field Positions:
1 - 120
File Format - Field Positions:
1 - 136
Rev Field positions were adjusted due to increased field sizes in several other fields N/A
Unit Rebate Amount (URA)
Size: 12
Position: 33 - 44
Remarks: 9(5).9(6)
Unit Rebate Amount
Size: 15
Position: 33-47
Remarks: 99999.999999
Rev To update the field size from 12 to 15 digits, to remove (URA). N/A
Units Reimbursed
Size: 15
Position: 45 - 59
Remarks: 9(11).999
Units Reimbursed
Size: 16
Position: 48 - 63
Remarks: 999999999999.999
Rev To update the field size from 15 to 16 digits N/A
Rebate Amount Claimed
Size: 12
Position: 60 - 71
Remarks: 9(9).99
Rebate Amount Claimed
Size: 16
Position: 64 - 79
Remarks: 9999999999999.99
Rev To update the field size from 12 to 16 digits N/A
Number of Prescriptions
Size: 8
Position: 72 - 79
Remarks: 9(8)
Number of Prescriptions
Size: 8
Position: 80 - 87
Remarks: 99999999
Rev To update the field poistions due to icreased field sizes in preceding fields N/A
Medicaid Amount Reimbursed (MAR)
Size: 13
Position: 80 - 92
Remarks: 9(10).99
Medicaid Amount Reimbursed
Size: 16
Position: 88 - 103
Remarks: 9999999999999.99
Rev To update the field size from 13 to 16 digits, and to remove (MAR) N/A
Non-Medicaid Amount Reimbursed (NMAR)
Size: 13
Position: 93 - 105
Remarks: 9(10).99
Non-Medicaid Amount Reimbursed
Size: 16
Position: 104 - 119
Remarks: 9999999999999.99
Rev To update the field size from 13 to 16 digits, and to remove (NMAR) N/A
Total Amount Reimbursed (TAR)
Size: 14
Position: 106 – 119
Remarks: 9(11).99
Total Amount Reimbursed
Size: 16
Position: 120 – 135
Remarks: 9999999999999.99
Rev To update the field size from 14 to 16 digits, and to remove (TAR) N/A
Filler
Position: 120 - 120
Remarks: N/A
Filler - State Invoice
Delete Flag - SDUD Submission to CMS
Position: 136 - 136
Remarks: See Data Definitions
Rev The Filler position pertains only to the State Invoice whereas a Delete Flag will be used in the SDUD Submission to CMS. N/A
All fields with decimals now require actual decimal
Del Verbiage no longer relevant N/A
File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
File Created0000-00-00

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