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File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Pharmacy Fixed Format File Submission February 20, 2013 Maryland File Specification Maryland Health Care Commission (MHCC)
Pharmacy Fixed Format File Submission September 13, 2013 Maryland File Specification Maryland Health Care Commission (MHCC)
Pharmacy Fixed Format File Submission January 9, 2014 Maryland File Specification Maryland Health Care Commission (MHCC)
File Specification: Pharmacy Fixed Format File Submission - February 20, 2013 (Maryland) Pharmacy Fixed Format File Submission - September 13, 2013 (Maryland) Pharmacy Fixed Format File Submission - January 9, 2014 (Maryland)
[Shared] Responsible Organization:
Maryland Health Care Commission Maryland Health Care Commission Maryland Health Care Commission
[Shared] Definition:
Not provided Not provided Not provided
File Specification: Pharmacy Fixed Format File Submission - February 20, 2013 (Maryland) Pharmacy Fixed Format File Submission - September 13, 2013 (Maryland) Pharmacy Fixed Format File Submission - January 9, 2014 (Maryland)
1
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
2
Pharmacy Services
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
2
Pharmacy Services
[Shared] Name: Record Identifier
[Shared] Type: numeric
[Shared] Length: 1
Codes:
2
Pharmacy Services
2
[Unshared] Name: Patient IdentifierP (payer encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Unshared] Name: Patient IdentifierP (payor encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Unshared] Name: Patient IdentifierP (payor encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
3
[Shared] Name: Patient IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Shared] Name: Patient IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
[Shared] Name: Patient IdentifierU (UUID encrypted)
[Shared] Type: alphanumeric
[Shared] Length: 12
4
[Shared] Name: Patient Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
[Shared] Name: Patient Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
[Shared] Name: Patient Sex
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Male
2
Female
3
Unknown
5
[Unshared] Name: Patient Zip Code
[Shared] Type: numeric
[Unshared] Length: 5
[Unshared] Name: Patient Zip Code+4-digit add-on
[Shared] Type: numeric
[Unshared] Length: 10
[Unshared] Name: Patient Zip Code+4-digit add-on
[Shared] Type: numeric
[Unshared] Length: 10
6
[Shared] Name: Patient Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Patient Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Patient Year and Month of Birth
[Shared] Type: numeric
[Shared] Length: 8
7
[Shared] Name: Pharmacy NCPDP Number
[Shared] Type: numeric
[Shared] Length: 7
[Shared] Name: Pharmacy NCPDP Number
[Shared] Type: numeric
[Shared] Length: 7
[Shared] Name: Pharmacy NCPDP Number
[Shared] Type: numeric
[Shared] Length: 7
8
[Unshared] Name: Pharmacy Zip Code
[Shared] Type: numeric
[Unshared] Length: 5
[Unshared] Name: Pharmacy Zip Code+4-digit add-on
[Shared] Type: numeric
[Unshared] Length: 10
[Unshared] Name: Pharmacy Zip Code+4-digit add-on
[Shared] Type: numeric
[Unshared] Length: 10
9
[Shared] Name: Practitioner DEA #
[Shared] Type: alphanumeric
[Shared] Length: 11
[Shared] Name: Practitioner DEA #
[Shared] Type: alphanumeric
[Shared] Length: 11
[Shared] Name: Practitioner DEA #
[Shared] Type: alphanumeric
[Shared] Length: 11
10
[Shared] Name: Fill Number
[Shared] Type: numeric
[Shared] Length: 2
Codes:
1-99
Refill number
00
New prescription/Original
[Shared] Name: Fill Number
[Shared] Type: numeric
[Shared] Length: 2
Codes:
1-99
Refill number
00
New prescription/Original
[Shared] Name: Fill Number
[Shared] Type: numeric
[Shared] Length: 2
Codes:
1-99
Refill number
00
New prescription/Original
11
[Shared] Name: NDC Number
[Shared] Type: numeric
[Shared] Length: 11
[Shared] Name: NDC Number
[Shared] Type: numeric
[Shared] Length: 11
[Shared] Name: NDC Number
[Shared] Type: numeric
[Shared] Length: 11
12
[Shared] Name: Drug Compound
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Non-compound
2
Compound
[Shared] Name: Drug Compound
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Non-compound
2
Compound
[Shared] Name: Drug Compound
[Shared] Type: numeric
[Shared] Length: 1
Codes:
1
Non-compound
2
Compound
13
[Shared] Name: Drug Quantity
[Shared] Type: numeric
[Shared] Length: 5
[Shared] Name: Drug Quantity
[Shared] Type: numeric
[Shared] Length: 5
[Shared] Name: Drug Quantity
[Shared] Type: numeric
[Shared] Length: 5
14
[Shared] Name: Drug Supply
[Shared] Type: numeric
[Shared] Length: 3
[Shared] Name: Drug Supply
[Shared] Type: numeric
[Shared] Length: 3
[Shared] Name: Drug Supply
[Shared] Type: numeric
[Shared] Length: 3
15
[Shared] Name: Date Filled
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date Filled
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date Filled
[Shared] Type: numeric
[Shared] Length: 8
16
[Shared] Name: Date Prescription Written
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date Prescription Written
[Shared] Type: numeric
[Shared] Length: 8
[Shared] Name: Date Prescription Written
[Shared] Type: numeric
[Shared] Length: 8
17
[Shared] Name: Billed Charge
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Billed Charge
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Billed Charge
[Shared] Type: numeric
[Shared] Length: 9
18
[Shared] Name: Reimbursement Amount
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Reimbursement Amount
[Shared] Type: numeric
[Shared] Length: 9
[Shared] Name: Reimbursement Amount
[Shared] Type: numeric
[Shared] Length: 9
19
[Shared] Name: Prescription Claim Number
[Shared] Type: numeric
[Shared] Length: 15
[Shared] Name: Prescription Claim Number
[Shared] Type: numeric
[Shared] Length: 15
[Shared] Name: Prescription Claim Number
[Shared] Type: numeric
[Shared] Length: 15
20
[Unshared] Name: Prescribing Practitioner Individual National Provider Identifier (NPI) number
[Unshared] Type: alphanumeric
[Unshared] Length: 10
[Unshared] Name: Prescribing Practitioner Individual National Provider Identifier (NPI) number
[Unshared] Type: alphanumeric
[Unshared] Length: 10
[Unshared] Name: Prescription Claim Paid Date
[Unshared] Type: numeric
[Unshared] Length: 8
21
[Unshared] Name: Patient Deductible
[Unshared] Type: numeric
[Unshared] Length: 9
[Unshared] Name: Patient Deductible
[Unshared] Type: numeric
[Unshared] Length: 9
[Unshared] Name: Prescribing Practitioner Individual National Provider Identifier (NPI) number
[Unshared] Type: alphanumeric
[Unshared] Length: 10
22
[Unshared] Name: Patient Coinsurance or Patient Co-payment
[Shared] Type: numeric
[Shared] Length: 9
[Unshared] Name: Patient Coinsurance or Patient Co-payment
[Shared] Type: numeric
[Shared] Length: 9
[Unshared] Name: Patient Deductible
[Shared] Type: numeric
[Shared] Length: 9
23
[Unshared] Name: Other Patient Obligations
[Shared] Type: numeric
[Shared] Length: 9
[Unshared] Name: Other Patient Obligations
[Shared] Type: numeric
[Shared] Length: 9
[Unshared] Name: Patient Coinsurance/Patient Co-payment
[Shared] Type: numeric
[Shared] Length: 9
24
[Unshared] Name: Date of Enrollment
[Shared] Type: numeric
[Unshared] Length: 8
[Unshared] Name: Date of Enrollment
[Shared] Type: numeric
[Unshared] Length: 8
[Unshared] Name: Other Patient Obligations
[Shared] Type: numeric
[Unshared] Length: 9
25
[Unshared] Name: Date of Disenrollment
[Shared] Type: numeric
[Shared] Length: 8
[Unshared] Name: Date of Disenrollment
[Shared] Type: numeric
[Shared] Length: 8
[Unshared] Name: Date of Enrollment
[Shared] Type: numeric
[Shared] Length: 8
26
[Unshared] Name: Source of Processing
[Unshared] Type: alphanumeric
[Unshared] Length: 1
Codes:
1
Processed Internally by Payer
2
Argus Health Systems, Inc.
3
Caremark, LLC
4
Catalyst Rx, Inc.
5
Envision Pharmaceutical Services, Inc.
6
Express Scripts, Inc.
7
Medco Health, LLC
8
National Employee Benefit Companies, Inc. dba/Ideal Scripts
9
NextRx Services, Inc.
A
Atlantic Prescription Services, LLC
B
Benecard Services, Inc.
C
BioScrip PBM Services, LLC
D
Futurescripts, LLC
E
Health E Systems
F
HealthTran, LLC
G
Innoviant, Inc.
H
MaxorPlus
I
Medical Security Card Company
J
MedImpact Healthcare Systems, Inc.
K
MemberHealth, LLC
L
PharmaCare Management Services, LLC
M
Prime Therapeutics, LLC
N
Progressive Medical, Inc.
O
RxAmerica, LLC
P
RxSolutions, Inc.
Q
Scrip World, LLC
R
Tmesys, Inc.
S
WellDynerx, Inc.
T
Other Source Not Listed
Z
Unknown
[Unshared] Name: Source of Processing
[Unshared] Type: alphanumeric
[Unshared] Length: 1
Codes:
1
Processed Internally by Payor
2
Argus Health Systems, Inc.
3
Caremark, LLC
4
Catalyst Rx, Inc.
5
Envision Pharmaceutical Services, Inc.
6
Express Scripts, Inc.
7
Medco Health, LLC
8
National Employee Benefit Companies, Inc. dba/Ideal Scripts
9
NextRx Services, Inc.
A
Atlantic Prescription Services, LLC
B
Benecard Services, Inc.
C
BioScrip PBM Services, LLC
D
Futurescripts, LLC
E
Health E Systems
F
HealthTran, LLC
G
Innoviant, Inc.
H
MaxorPlus
I
Medical Security Card Company
J
MedImpact Healthcare Systems, Inc.
K
MemberHealth, LLC
L
PharmaCare Management Services, LLC
M
Prime Therapeutics, LLC
N
Progressive Medical, Inc.
O
RxAmerica, LLC
P
RxSolutions, Inc.
Q
Scrip World, LLC
R
Tmesys, Inc.
S
WellDynerx, Inc.
T
Other Source Not Listed
Z
Unknown
[Unshared] Name: Date of Disenrollment
[Unshared] Type: numeric
[Unshared] Length: 8
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
27
[Unshared] Name: Payer ID Number
[Shared] Type: alphanumeric
[Unshared] Length: 4
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
P020
Aetna Life Insurance Co.
P030
Aetna Health, Inc.
P070
American Republic Insurance Co.
P130
CareFirst BlueChoice, Inc.
P131
CareFirst of Maryland, Inc.
P132
Group Hospitalization & Medical Services, Inc. (GHMSI)
P160
CIGNA Healthcare Mid-Atlantic, Inc.
P180
Connecticut General Life Ins. Co.
P220
Corporate Health Insurance Co.
P280
Assurant Health/Time Insurance Co.
P320
Golden Rule Insurance Co.
P480
Kaiser Permanente Mid-Atlantic States
P500
MAMSI Life and Health Ins. Co.
P520
MD-Individual Practice Association, Inc.
P530
MEGA Life & Health Insurance Co.
P620
Optimum Choice, Inc.
P680
Coventry Healthcare of Delaware, Inc.
P760
State Farm Mutual Automobile Ins. Co.
P820
United Healthcare Insurance Co.
P870
United Healthcare of the Mid-Atlantic, Inc.
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: PayorID Number
[Shared] Type: alphanumeric
[Unshared] Length: 4
Codes:
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
P020
Aetna Life Insurance Co.
P030
Aetna Health, Inc.
 
 
P130
CareFirst BlueChoice, Inc.
P131
CareFirst of Maryland, Inc.
P132
Group Hospitalization & Medical Services, Inc. (GHMSI)
P160
Cigna Health and Life Insurance Co., Inc.
P180
Connecticut General Life Insurance Co.
P220
Corporate Health Insurance Co.
P280
Assurant Health/Time Insurance Co.
P320
Golden Rule Insurance Co.
P480
Kaiser Permanente Mid-Atlantic States
P500
MAMSI Life and Health Insurance Co.
P520
MD-Individual Practice Association, Inc.
P530
MEGA Life and Health Insurance Co.
P620
Optimum Choice, Inc.
P680
Coventry Healthcare of Delaware, Inc.
P760
State Farm Mutual Automobile Insurance Co.
P820
UnitedHealthcare Insurance Co.
P870
United Healthcare of the Mid-Atlantic, Inc.
 
 
 
 
 
 
 
 
 
 
[Unshared] Name: Source of Processing
[Shared] Type: alphanumeric
[Unshared] Length: 1
Codes:
1
Processed Internally by Payor
2
Argus Health Systems, Inc.
3
Caremark, LLC
4
Catalyst Rx, Inc.
5
Envision Pharmaceutical Services, Inc.
6
Express Scripts, Inc.
7
Medco Health, LLC
8
National Employee Benefit Companies, Inc. dba/Ideal Scripts
9
NextRx Services, Inc.
A
Atlantic Prescription Services, LLC B Benecard Services, Inc.
C
BioScrip PBM Services, LLC D Futurescripts, LLC
E
Health E Systems
F
HealthTran, LLC
G
Innoviant, Inc.
H
MaxorPlus
I
Medical Security Card Company
J
MedImpact Healthcare Systems, Inc.
K
MemberHealth, LLC
L
PharmaCare Management Services, LLC
M
Prime Therapeutics, LLC
N
Progressive Medical, Inc.
O
RxAmerica, LLC
P
RxSolutions, Inc.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Q
Scrip World, LLC
R
Tmesys, Inc.
S
WellDynerx, Inc.
T
Other Source Not Listed
Z
Unknown
28
[Unshared] Name: Source System
[Shared] Type: alphanumeric
[Unshared] Length: 1
[Unshared] Name: Source System
[Shared] Type: alphanumeric
[Unshared] Length: 1
[Unshared] Name: Payor ID Number
[Shared] Type: alphanumeric
[Unshared] Length: 4
29
Data Element: 29
not present in this file submission.
Data Element: 29
not present in this file submission.
[Unshared] Name: Source System
[Unshared] Type: alphanumeric
[Unshared] Length: 1
30
Data Element: 30
not present in this file submission.
Data Element: 30
not present in this file submission.
[Unshared] Name: Reporting Quarter
[Unshared] Type: numeric
[Unshared] Length: 1
Codes:
1
First Quarter = January 1 thru March 31
2
Second Quarter = April 1 thru June 30
3
Third Quarter = July 1 thru September 30
4
Fourth Quarter = October 1 thru December 31
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