United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Action Item Name Version State Type Organization
Pharmacy Claims File Submission December 1, 2010 - v2.1 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
Pharmacy Claims File Submission June 7, 2013 - v3.1 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
Pharmacy Claims File Submission October 1, 2014 - v4.0 Massachusetts File Specification Massachusetts Center for Health Information and Analysis (MCHIA)
File Specification: Pharmacy Claims File Submission - December 1, 2010 - v2.1 (Massachusetts) Pharmacy Claims File Submission - June 7, 2013 - v3.1 (Massachusetts) Pharmacy Claims File Submission - October 1, 2014 - v4.0 (Massachusetts)
[Shared] Responsible Organization:
Massachusetts Center for Health Information and Analysis Massachusetts Center for Health Information and Analysis Massachusetts Center for Health Information and Analysis
[Shared] Definition:
A MA APCD File Type for reporting all Paid Pharmacy Claim Lines of a given time period. File accommodates Replacement and Void lines. A MA APCD File Type for reporting all Paid Pharmacy Claim Lines of a given time period. File accommodates Replacement and Void lines. A MA APCD File Type for reporting all Paid Pharmacy Claim Lines of a given time period. File accommodates Replacement and Void lines.
File Specification: Pharmacy Claims File Submission - December 1, 2010 - v2.1 (Massachusetts) Pharmacy Claims File Submission - June 7, 2013 - v3.1 (Massachusetts) Pharmacy Claims File Submission - October 1, 2014 - v4.0 (Massachusetts)
HD001
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
 
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
Header Elements
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
Header Elements
HD002
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
HD003
[Shared] Name: National Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
[Shared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
HD004
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
 
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
PHARMACY CLAIM
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
PHARMACY CLAIM
HD005
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
HD006
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Unshared] Type: Date Period - Integer
[Shared] Length: 6
HD007
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Record Count
[Shared] Type: Integer
[Shared] Length: 10
HD008
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
HD009
Data Element: HD009
not present in this file submission.
[Unshared] Name: APCD Version Number
[Unshared] Type: Decimal - Numeric
[Unshared] Length: 3
Codes:
2.1
Prior Version; valid only for reporting periods prior to October 2013
3.0
Current Version; required for reporting periods as of October 2013
 
 
[Unshared] Name: APCD Version Number
[Unshared] Type: Decimal - Numeric
[Unshared] Length: 3
Codes:
2.1
Prior Version; valid only for reporting periods prior to October 2013
3.0
Version 3.0; required for reporting periods as of October 2013 No longer valid as of May 2015
4.0
Version 4.0; required for reporting periods October 2013 onward as of May 2015
PC001
[Unshared] Name: Payer
[Unshared] Type: Text
[Unshared] Length: 8
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
[Unshared] Name: Submitter
[Unshared] Type: Integer
[Unshared] Length: 6
PC002
[Unshared] Name: Plan ID
[Unshared] Type: Text
[Unshared] Length: 30
[Unshared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
[Unshared] Name: National Plan ID
[Unshared] Type: Integer
[Unshared] Length: 10
PC003
[Shared] Name: Insurance Type Code/Product
[Unshared] Type: Text
[Shared] Length: 2
Codes:
09
Self-pay
10
Central Certification
11
Other Non-Federal Programs
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Risk
17
Dental Maintenance Organization (DMO)
AM
Automobile Medical
BL
Blue Cross / Blue Shield
CC
Commonwealth Care
CE
Commonwealth Choice
CH
Champus
CI
Commercial Insurance Co.
DS
Disability
HM
Health Maintenance Organization
LI
Liability
LM
Liability Medical
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
OF
Other Federal Program
 
 
TV
Title V
VA
Veterans Administration Plan
WC
Workers' Compensation
 
 
[Shared] Name: Insurance Type Code/Product
[Unshared] Type: Lookup Table - Text
[Shared] Length: 2
Codes:
09
Self-pay
10
Central Certification
11
Other Non-Federal Programs
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Risk
17
Dental Maintenance Organization (DMO)
AM
Automobile Medical
BL
Blue Cross / Blue Shield
CC
Commonwealth Care
CE
Commonwealth Choice
CH
Champus
CI
Commercial Insurance Co.
DS
Disability
HM
Health Maintenance Organization
LI
Liability
LM
Liability Medical
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
OF
Other Federal Program
TF
HSN Trust Fund
TV
Title V
VA
Veterans Administration Plan
WC
Workers' Compensation
ZZ
Other
[Shared] Name: Insurance Type Code/Product
[Unshared] Type: Lookup Table - Text
[Shared] Length: 2
Codes:
09
Self-pay
10
Central Certification
11
Other Non-Federal Programs
12
Preferred Provider Organization (PPO)
13
Point of Service (POS)
14
Exclusive Provider Organization (EPO)
15
Indemnity Insurance
16
Health Maintenance Organization (HMO) Medicare Risk
17
Dental Maintenance Organization (DMO)
AM
Automobile Medical
BL
Blue Cross / Blue Shield
CC
Commonwealth Care
CE
Commonwealth Choice
CH
Champus
CI
Commercial Insurance Co.
DS
Disability
HM
Health Maintenance Organization
LI
Liability
LM
Liability Medical
MA
Medicare Part A
MB
Medicare Part B
MC
Medicaid
OF
Other Federal Program
TF
HSN Trust Fund
TV
Title V
VA
Veterans Administration Plan
WC
Workers' Compensation
ZZ
Other
PC004
[Shared] Name: Payer Claim Control Number
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Payer Claim Control Number
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Payer Claim Control Number
[Shared] Type: Text
[Shared] Length: 35
PC005
[Shared] Name: Line Counter
[Shared] Type: Integer
[Shared] Length: 4
[Shared] Name: Line Counter
[Shared] Type: Integer
[Shared] Length: 4
[Shared] Name: Line Counter
[Shared] Type: Integer
[Shared] Length: 4
PC005A
[Shared] Name: Version Number
[Shared] Type: Integer
[Shared] Length: 4
[Shared] Name: Version Number
[Shared] Type: Integer
[Shared] Length: 4
[Shared] Name: Version Number
[Shared] Type: Integer
[Shared] Length: 4
PC006
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 30
PC007
[Shared] Name: Subscriber SSN
[Unshared] Type: Text
[Shared] Length: 9
[Shared] Name: Subscriber SSN
[Unshared] Type: Numeric
[Shared] Length: 9
[Shared] Name: Subscriber SSN
[Unshared] Type: Numeric
[Shared] Length: 9
PC008
[Shared] Name: Plan Specific Contract Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Plan Specific Contract Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Plan Specific Contract Number
[Shared] Type: Text
[Shared] Length: 30
PC009
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Member Suffix or Sequence Number
[Shared] Type: Text
[Shared] Length: 20
PC010
[Shared] Name: Member SSN
[Unshared] Type: Text
[Shared] Length: 9
[Shared] Name: Member SSN
[Unshared] Type: Numeric
[Shared] Length: 9
[Shared] Name: Member SSN
[Unshared] Type: Numeric
[Shared] Length: 9
PC011
[Shared] Name: Individual Relationship Code
[Unshared] Type: Integer
[Shared] Length: 2
Codes:
1
Spouse
4
Grandfather or Grandmother
5
Grandson or Granddaughter
7
Nephew or Niece
 
 
 
 
 
 
 
 
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Self/Employee
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
[Shared] Name: Individual Relationship Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Self/Employee
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
[Shared] Name: Individual Relationship Code
[Unshared] Type: Lookup Table - Text
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
01
Spouse
04
Grandfather or Grandmother
05
Grandson or Granddaughter
07
Nephew or Niece
10
Foster Child
15
Ward
17
Stepson or Stepdaughter
19
Child
20
Self/Employee
21
Unknown
22
Handicapped Dependent
23
Sponsored Dependent
24
Dependent of a Minor Dependent
29
Significant Other
32
Mother
33
Father
36
Emancipated Minor
39
Organ Donor
40
Cadaver Donor
41
Injured Plaintiff
43
Child Where Insured Has No Financial Responsibility
53
Life Partner
76
Dependent
PC012
[Shared] Name: Member Gender
[Unshared] Type: Text
[Shared] Length: 1
Codes:
F
Female
M
Male
O
Other
U
Unknown
[Shared] Name: Member Gender
[Unshared] Type: Lookup Table - Text
[Shared] Length: 1
Codes:
F
Female
M
Male
O
Other
U
Unknown
[Shared] Name: Member Gender
[Unshared] Type: Lookup Table - Text
[Shared] Length: 1
Codes:
F
Female
M
Male
O
Other
U
Unknown
PC013
[Shared] Name: Member Date of Birth
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
PC014
[Shared] Name: Member City Name of Residence
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Member City Name of Residence
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Member City Name of Residence
[Shared] Type: Text
[Shared] Length: 50
PC015
[Shared] Name: Member State
[Unshared] Type: Text
[Shared] Length: 2
[Shared] Name: Member State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
[Shared] Name: Member State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
PC016
[Shared] Name: Member ZIP Code
[Unshared] Type: Text
[Unshared] Length: 11
[Shared] Name: Member ZIP Code
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
[Shared] Name: Member ZIP Code
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
PC017
[Shared] Name: Date Service Approved (AP Date)
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Date Service Approved (AP Date)
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Date Service Approved (AP Date)
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
PC018
[Shared] Name: Pharmacy Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Pharmacy Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Pharmacy Number
[Shared] Type: Text
[Shared] Length: 30
PC019
[Shared] Name: Pharmacy Tax ID Number
[Unshared] Type: Text
[Unshared] Length: 10
[Shared] Name: Pharmacy Tax ID Number
[Unshared] Type: Numeric
[Unshared] Length: 9
[Shared] Name: Pharmacy Tax ID Number
[Unshared] Type: Numeric
[Unshared] Length: 9
PC020
[Shared] Name: Pharmacy Name
[Shared] Type: Text
[Shared] Length: 100
[Shared] Name: Pharmacy Name
[Shared] Type: Text
[Shared] Length: 100
[Shared] Name: Pharmacy Name
[Shared] Type: Text
[Shared] Length: 100
PC021
[Unshared] Name: National Pharmacy ID Number
[Unshared] Type: Text
[Unshared] Length: 20
[Unshared] Name: National Provider ID - Pharmacy
[Unshared] Type: External Code Source 3 - Integer
[Unshared] Length: 10
[Unshared] Name: National Provider ID - Pharmacy
[Unshared] Type: External Code Source 3 - Integer
[Unshared] Length: 10
PC022
[Shared] Name: Pharmacy Location City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Pharmacy Location City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Pharmacy Location City
[Shared] Type: Text
[Shared] Length: 30
PC023
[Shared] Name: Pharmacy Location State
[Unshared] Type: Text
[Shared] Length: 2
[Shared] Name: Pharmacy Location State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
[Shared] Name: Pharmacy Location State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
PC024
[Shared] Name: Pharmacy ZIP Code
[Unshared] Type: Text
[Unshared] Length: 11
[Shared] Name: Pharmacy ZIP Code
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
[Shared] Name: Pharmacy ZIP Code
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
PC024A
[Shared] Name: Pharmacy Country Code
[Unshared] Type: Text
[Shared] Length: 3
[Shared] Name: Pharmacy Country Code
[Unshared] Type: External Code Source 1 - Text
[Shared] Length: 3
[Shared] Name: Pharmacy Country Code
[Unshared] Type: External Code Source 1 - Text
[Shared] Length: 3
PC025
[Shared] Name: Claim Status
[Unshared] Type: Integer
[Shared] Length: 2
Codes:
 
 
 
 
 
 
 
 
01
Processed as primary
02
Processed as secondary
03
Processed as tertiary
04
Denied
19
Processed as primary, forwarded to additional payer(s)
20
Processed as secondary, forwarded to additional payer(s)
21
Processed as tertiary, forwarded to additional payer(s)
22
Reversal of previous payment
 
 
 
 
[Shared] Name: Claim Status
[Unshared] Type: Lookup Table - Numeric
[Shared] Length: 2
Codes:
1
Processed as primary
2
Processed as secondary
3
Processed as tertiary
4
Denied
 
 
 
 
 
 
 
 
19
Processed as primary, forwarded to additional payer(s)
20
Processed as secondary, forwarded to additional payer(s)
21
Processed as tertiary, forwarded to additional payer(s)
22
Reversal of previous payment
23
Not our claim, forwarded to additional payer(s)
25
Predetermination Pricing Only - no payment
[Shared] Name: Claim Status
[Unshared] Type: Lookup Table - Numeric
[Shared] Length: 2
Codes:
1
Processed as primary
2
Processed as secondary
3
Processed as tertiary
4
Denied
 
 
 
 
 
 
 
 
19
Processed as primary, forwarded to additional payer(s)
20
Processed as secondary, forwarded to additional payer(s)
21
Processed as tertiary, forwarded to additional payer(s)
22
Reversal of previous payment
23
Not our claim, forwarded to additional payer(s)
25
Predetermination Pricing Only - no payment
PC026
[Shared] Name: Drug Code
[Unshared] Type: Text
[Shared] Length: 11
[Shared] Name: Drug Code
[Unshared] Type: External Code Source 12 - Text
[Shared] Length: 11
[Shared] Name: Drug Code
[Unshared] Type: External Code Source 12 - Text
[Shared] Length: 11
PC027
[Shared] Name: Drug Name
[Unshared] Type: Text
[Shared] Length: 80
[Shared] Name: Drug Name
[Unshared] Type: External Code Source 12 - Text
[Shared] Length: 80
[Shared] Name: Drug Name
[Unshared] Type: External Code Source 12 - Text
[Shared] Length: 80
PC028
[Shared] Name: New Prescription or Refill
[Unshared] Type: Integer
[Shared] Length: 2
[Shared] Name: New Prescription or Refill
[Unshared] Type: Numeric
[Shared] Length: 2
[Shared] Name: New Prescription or Refill
[Unshared] Type: Numeric
[Shared] Length: 2
PC029
[Shared] Name: Generic Drug Indicator
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Generic Drug Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Generic Drug Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
PC030
[Shared] Name: Dispense as Written Code
[Unshared] Type: Integer
[Shared] Length: 1
Codes:
0
Not dispensed as written
1
Physician dispense as written
2
Member dispense as written
3
Pharmacy dispense as written
4
No generic available
5
Brand dispensed as generic
6
Override
7
Substitution not allowed, brand drug mandated by law
8
Substitution allowed, generic drug not available in marketplace
9
Other
[Shared] Name: Dispense as Written Code
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
0
Not dispensed as written
1
Physician dispense as written
2
Member dispense as written
3
Pharmacy dispense as written
4
No generic available
5
Brand dispensed as generic
6
Override
7
Substitution not allowed, brand drug mandated by law
8
Substitution allowed, generic drug not available in marketplace
9
Other
[Shared] Name: Dispense as Written Code
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
0
Not dispensed as written
1
Physician dispense as written
2
Member dispense as written
3
Pharmacy dispense as written
4
No generic available
5
Brand dispensed as generic
6
Override
7
Substitution not allowed, brand drug mandated by law
8
Substitution allowed, generic drug not available in marketplace
9
Other
PC031
[Shared] Name: Compound Drug Indicator
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Compound Drug Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Compound Drug Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
PC032
[Shared] Name: Date Prescription Filled
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Date Prescription Filled
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Date Prescription Filled
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
PC033
[Shared] Name: Quantity Dispensed
[Unshared] Type: Integer
[Shared] Length: 10
[Shared] Name: Quantity Dispensed
[Unshared] Type: Quantity - Integer
[Shared] Length: 10
[Shared] Name: Quantity Dispensed
[Unshared] Type: Quantity - Integer
[Shared] Length: 10
PC034
[Unshared] Name: Days Supply
[Unshared] Type: Integer
[Unshared] Length: 3
[Unshared] Name: Day's Supply
[Unshared] Type: Quantity - Integer
[Unshared] Length: 4
[Unshared] Name: Day's Supply
[Unshared] Type: Quantity - Integer
[Unshared] Length: 4
PC035
[Shared] Name: Charge Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Charge Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Charge Amount
[Shared] Type: Integer
[Shared] Length: 10
PC036
[Shared] Name: Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
PC037
[Shared] Name: Ingredient Cost/List Price
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Ingredient Cost/List Price
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Ingredient Cost/List Price
[Shared] Type: Integer
[Shared] Length: 10
PC038
[Shared] Name: Postage Amount Claimed
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Postage Amount Claimed
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Postage Amount Claimed
[Shared] Type: Integer
[Shared] Length: 10
PC039
[Shared] Name: Dispensing Fee
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Dispensing Fee
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Dispensing Fee
[Shared] Type: Integer
[Shared] Length: 10
PC040
[Shared] Name: Copay Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Copay Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Copay Amount
[Shared] Type: Integer
[Shared] Length: 10
PC041
[Shared] Name: Coinsurance Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Coinsurance Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Coinsurance Amount
[Shared] Type: Integer
[Shared] Length: 10
PC042
[Shared] Name: Deductible Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Deductible Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Deductible Amount
[Shared] Type: Integer
[Shared] Length: 10
PC043
[Shared] Name: Prescribing ProviderID
[Shared] Type: Text
[Unshared] Length: 28
[Shared] Name: Prescribing ProviderID
[Shared] Type: Text
[Unshared] Length: 30
[Shared] Name: Prescribing ProviderID
[Shared] Type: Text
[Unshared] Length: 30
PC044
[Shared] Name: Prescribing Physician First Name
[Shared] Type: Text
[Shared] Length: 25
[Shared] Name: Prescribing Physician First Name
[Shared] Type: Text
[Shared] Length: 25
[Shared] Name: Prescribing Physician First Name
[Shared] Type: Text
[Shared] Length: 25
PC045
[Shared] Name: Prescribing Physician Middle Name
[Shared] Type: Text
[Shared] Length: 25
[Shared] Name: Prescribing Physician Middle Name
[Shared] Type: Text
[Shared] Length: 25
[Shared] Name: Prescribing Physician Middle Name
[Shared] Type: Text
[Shared] Length: 25
PC046
[Shared] Name: Prescribing Physician Last Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Prescribing Physician Last Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Prescribing Physician Last Name
[Shared] Type: Text
[Shared] Length: 60
PC047
[Shared] Name: Prescribing Physician DEA Number
[Shared] Type: Text
[Unshared] Length: 20
[Shared] Name: Prescribing Physician DEA Number
[Shared] Type: Text
[Unshared] Length: 9
[Shared] Name: Prescribing Physician DEA Number
[Shared] Type: Text
[Unshared] Length: 9
PC048
[Unshared] Name: Prescribing Physician NPI
[Unshared] Type: Text
[Unshared] Length: 20
[Unshared] Name: National Provider ID - Prescribing
[Unshared] Type: External Code Source 3 - Integer
[Unshared] Length: 10
[Unshared] Name: National Provider ID - Prescribing
[Unshared] Type: External Code Source 3 - Integer
[Unshared] Length: 10
PC049
[Shared] Name: Prescribing Physician Plan Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Prescribing Physician Plan Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Prescribing Physician Plan Number
[Shared] Type: Text
[Shared] Length: 30
PC050
[Shared] Name: Prescribing Physician License Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Prescribing Physician License Number
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Prescribing Physician License Number
[Shared] Type: Text
[Shared] Length: 30
PC051
[Shared] Name: Prescribing Physician Street Address
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Prescribing Physician Street Address
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Prescribing Physician Street Address
[Shared] Type: Text
[Shared] Length: 50
PC052
[Shared] Name: Prescribing Physician Street Address 2
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Prescribing Physician Street Address 2
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Prescribing Physician Street Address 2
[Shared] Type: Text
[Shared] Length: 50
PC053
[Shared] Name: Prescribing Physician City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Prescribing Physician City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Prescribing Physician City
[Shared] Type: Text
[Shared] Length: 30
PC054
[Shared] Name: Prescribing Physician State
[Unshared] Type: Text
[Shared] Length: 2
[Shared] Name: Prescribing Physician State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
[Shared] Name: Prescribing Physician State
[Unshared] Type: External Code Source 2 - Text
[Shared] Length: 2
PC055
[Shared] Name: Prescribing Physician Zip
[Unshared] Type: Text
[Unshared] Length: 10
[Shared] Name: Prescribing Physician Zip
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
[Shared] Name: Prescribing Physician Zip
[Unshared] Type: External Code Source 2 - Text
[Unshared] Length: 9
PC056
[Shared] Name: Product ID Number
[Shared] Type: Text
[Unshared] Length: 20
[Shared] Name: Product ID Number
[Shared] Type: Text
[Unshared] Length: 30
[Shared] Name: Product ID Number
[Shared] Type: Text
[Unshared] Length: 30
PC057
[Shared] Name: Mail Order pharmacy
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Mail Order pharmacy
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
[Shared] Name: Mail Order pharmacy
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Yes
2
No
3
Unknown
4
Other
5
Not Applicable
PC058
[Shared] Name: Script number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Script number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Script number
[Shared] Type: Text
[Shared] Length: 20
PC059
[Shared] Name: Recipient PCP ID
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Recipient PCP ID
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Recipient PCP ID
[Shared] Type: Text
[Shared] Length: 30
PC060
[Shared] Name: Single/Multiple Source Indicator
[Unshared] Type: Text
[Shared] Length: 1
Codes:
1
Multi-source brand
2
Multi-source brand with generic equivalent
3
Single source brand
4
Single source brand with generic equivalent
5
Unknown
[Shared] Name: Single/Multiple Source Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Multi-source brand
2
Multi-source brand with generic equivalent
3
Single source brand
4
Single source brand with generic equivalent
5
Unknown
[Shared] Name: Single/Multiple Source Indicator
[Unshared] Type: Lookup Table - Integer
[Shared] Length: 1
Codes:
1
Multi-source brand
2
Multi-source brand with generic equivalent
3
Single source brand
4
Single source brand with generic equivalent
5
Unknown
PC061
[Shared] Name: Member Street Address
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Member Street Address
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Member Street Address
[Shared] Type: Text
[Shared] Length: 50
PC062
[Shared] Name: Billing Provider Tax ID Number
[Unshared] Type: Text
[Unshared] Length: 10
[Shared] Name: Billing Provider Tax ID Number
[Unshared] Type: Numeric
[Unshared] Length: 9
[Shared] Name: Billing Provider Tax ID Number
[Unshared] Type: Numeric
[Unshared] Length: 9
PC063
[Shared] Name: Paid Date
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Paid Date
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Paid Date
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
PC064
[Shared] Name: Date Prescription Written
[Unshared] Type: Date
[Shared] Length: 8
[Shared] Name: Date Prescription Written
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
[Shared] Name: Date Prescription Written
[Unshared] Type: Full Date - Integer
[Shared] Length: 8
PC065
[Shared] Name: Coordination of Benefits/TPL Liability Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Coordination of Benefits/TPL Liability Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Coordination of Benefits/TPL Liability Amount
[Shared] Type: Integer
[Shared] Length: 10
PC066
[Shared] Name: Other Insurance Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Other Insurance Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Other Insurance Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
PC067
[Shared] Name: Medicare Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Medicare Paid Amount
[Shared] Type: Integer
[Shared] Length: 10
[Shared] Name: Medicare Paid Amount