United States Health Information Knowledgebase

 

File Submission Comparison

Selected Items
Item Name Version State Type Organization
Pharmacy Claims File Submission February 2014 - v1.1 Rhode Island File Specification Rhode Island Department of Health (RIDoH)
Pharmacy Claims File Submission June 2014 - v1.3 Rhode Island File Specification Rhode Island Department of Health (RIDoH)
File Specification: Pharmacy Claims File Submission - February 2014 - v1.1 (Rhode Island) Pharmacy Claims File Submission - June 2014 - v1.3 (Rhode Island)
[Shared] Responsible Organization:
Rhode Island Department of Health Rhode Island Department of Health
[Shared] Definition:
Not provided Not provided
File Specification: Pharmacy Claims File Submission - February 2014 - v1.1 (Rhode Island) Pharmacy Claims File Submission - June 2014 - v1.3 (Rhode Island)
HD001
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
header record
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
HD
header record
HD002
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
HD003
[Shared] Name: Placeholder
[Shared] Type: Text
[Shared] Length: 30
Codes:
Null
 
[Shared] Name: Placeholder
[Shared] Type: Text
[Shared] Length: 30
Codes:
Null
 
HD004
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
pharmacy claims data
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
pharmacy claims data
HD005
[Shared] Name: Period Beginning Date
[Shared] Type: Integer
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Shared] Type: Integer
[Shared] Length: 6
HD006
[Shared] Name: Period Ending Date
[Shared] Type: Integer
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Shared] Type: 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
HD008
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Comments
[Shared] Type: Text
[Shared] Length: 80
PC001
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
Codes:
RIC
Commercial carrier
RIG
Governmental agency
RIT
Third-party administrator
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
Codes:
RIC
Commercial carrier
RIG
Governmental agency
RIT
Third-party administrator
PC002
[Shared] Name: NAIC
[Shared] Type: Text
[Shared] Length: 5
[Shared] Name: NAIC
[Shared] Type: Text
[Shared] Length: 5
PC003
[Shared] Name: Insurance Type / Product Code
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Insurance Type / Product Code
[Shared] Type: Text
[Shared] Length: 2
PC004
[Shared] Name: Payer Claim Control Number
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Payer Claim Control Number
[Shared] Type: Text
[Shared] Length: 50
PC004A
[Shared] Name: Claim Submitter's Identifier
[Shared] Type: Text
[Shared] Length: 38
[Shared] Name: Claim Submitter's Identifier
[Shared] Type: Text
[Shared] Length: 38
PC005
[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
PC006
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 50
[Shared] Name: Insured Group or Policy Number
[Shared] Type: Text
[Shared] Length: 50
PC007
[Shared] Name: Subscriber Social Security Number
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Subscriber Social Security Number
[Shared] Type: Text
[Shared] Length: 9
PC008
[Shared] Name: Plan-Specific Contract Number
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Plan-Specific Contract Number
[Shared] Type: Text
[Shared] Length: 80
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
PC010
[Shared] Name: Member Social Security Number
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Member Social Security Number
[Shared] Type: Text
[Shared] Length: 9
PC010A
[Shared] Name: Unique Member Identifier
[Shared] Type: String
[Shared] Length: 32
[Shared] Name: Unique Member Identifier
[Shared] Type: String
[Shared] Length: 32
PC011
[Shared] Name: Member Relationship
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Member Relationship
[Shared] Type: Text
[Shared] Length: 2
PC012
[Shared] Name: Member Gender
[Shared] Type: Text
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
[Shared] Name: Member Gender
[Shared] Type: Text
[Shared] Length: 1
Codes:
F
Female
M
Male
U
Unknown
PC013
[Shared] Name: Member Date of Birth
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Member Date of Birth
[Shared] Type: Date
[Shared] Length: 8
PC014
[Shared] Name: Member City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Member City
[Shared] Type: Text
[Shared] Length: 30
PC015
[Shared] Name: Member State or Province
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Member State or Province
[Shared] Type: Text
[Shared] Length: 2
PC016
[Shared] Name: Member ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Member ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
PC017
[Shared] Name: Payment Date / Settlement Date
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Payment Date / Settlement Date
[Shared] Type: Date
[Shared] Length: 8
PC018
[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
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Pharmacy Tax ID Number
[Shared] Type: Text
[Shared] Length: 9
PC020
[Shared] Name: Pharmacy Name
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Pharmacy Name
[Shared] Type: Text
[Shared] Length: 30
PC020A
[Shared] Name: Mail-Order Pharmacy
[Shared] Type: Text
[Shared] Length: 1
Codes:
N
No
U
Unknown
Y
Yes
[Shared] Name: Mail-Order Pharmacy
[Shared] Type: Text
[Shared] Length: 1
Codes:
N
No
U
Unknown
Y
Yes
PC020B
[Shared] Name: Out-of-Network Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
I
In network
 
 
O
Out of network
U
Unknown
[Shared] Name: Out-of-Network Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
I
In network
N
Not applicable
O
Out of network
U
Unknown
PC021
[Shared] Name: National Pharmacy ID Number
[Shared] Type: Text
[Shared] Length: 10
[Shared] Name: National Pharmacy ID Number
[Shared] Type: Text
[Shared] 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
PC023
[Shared] Name: Pharmacy Location State or Province
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Pharmacy Location State or Province
[Shared] Type: Text
[Shared] Length: 2
PC024
[Shared] Name: Pharmacy ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Pharmacy ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
PC024A
[Shared] Name: Pharmacy Country
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Pharmacy Country
[Shared] Type: Text
[Shared] Length: 30
PC025
[Shared] Name: Claim Status
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Claim Status
[Shared] Type: Text
[Shared] Length: 2
PC026
[Shared] Name: National Drug Code
[Shared] Type: Text
[Shared] Length: 11
[Shared] Name: National Drug Code
[Shared] Type: Text
[Shared] Length: 11
PC027
[Shared] Name: Drug Name
[Shared] Type: Text
[Shared] Length: 80
[Shared] Name: Drug Name
[Shared] Type: Text
[Shared] Length: 80
PC028
[Shared] Name: New Prescription or Refill
[Shared] Type: Integer
[Shared] Length: 2
Codes:
00
New prescription
01-99
Number of refill(s)
[Shared] Name: New Prescription or Refill
[Shared] Type: Integer
[Shared] Length: 2
Codes:
00
New prescription
01-99
Number of refill(s)
PC029
[Shared] Name: Generic Drug Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
N
No, branded drug
Y
Yes, generic drug
[Shared] Name: Generic Drug Indicator
[Shared] Type: Text
[Shared] Length: 1
Codes:
N
No, branded drug
Y
Yes, generic drug
PC030
[Shared] Name: Dispense as Written Code
[Shared] Type: Integer
[Shared] Length: 1
[Shared] Name: Dispense as Written Code
[Shared] Type: Integer
[Shared] Length: 1
PC031
[Shared] Name: Compound Drug Indicator
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Compound Drug Indicator
[Shared] Type: Text
[Shared] Length: 1
PC032
[Shared] Name: Date Prescription Filled
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Date Prescription Filled
[Shared] Type: Date
[Shared] Length: 8
PC033
[Shared] Name: Quantity Dispensed
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Quantity Dispensed
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC034
[Shared] Name: Days' Supply
[Shared] Type: Integer
[Shared] Length: 3
[Shared] Name: Days' Supply
[Shared] Type: Integer
[Shared] Length: 3
PC035
[Shared] Name: Charge Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Charge Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC036
[Shared] Name: Paid Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Paid Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC037
[Shared] Name: Ingredient Cost / List Price
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Ingredient Cost / List Price
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC038
[Shared] Name: Postage Amount Claimed
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Postage Amount Claimed
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC039
[Shared] Name: Dispensing Fee
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Dispensing Fee
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC040
[Shared] Name: Copay Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Copay Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC041
[Shared] Name: Coinsurance Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Coinsurance Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC042
[Shared] Name: Deductible Amount
[Shared] Type: Decimal
[Unshared] Length: 10
[Shared] Name: Deductible Amount
[Shared] Type: Decimal
[Unshared] Length: 10,2
PC044
[Shared] Name: Prescribing Provider First Name
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Prescribing Provider First Name
[Shared] Type: Text
[Shared] Length: 35
PC045
[Shared] Name: Prescribing Provider Middle Initial
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Prescribing Provider Middle Initial
[Shared] Type: Text
[Shared] Length: 1
PC046
[Shared] Name: Prescribing Provider Last Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Prescribing Provider Last Name
[Shared] Type: Text
[Shared] Length: 60
PC047
[Shared] Name: Prescribing Provider DEA Number
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Prescribing Provider DEA Number
[Shared] Type: Text
[Shared] Length: 9
PC047A
[Shared] Name: Prescribing Provider State License Number
[Shared] Type: Text
[Shared] Length: 20
[Shared] Name: Prescribing Provider State License Number
[Shared] Type: Text
[Shared] Length: 20
PC047B
[Shared] Name: Prescribing Provider Street Address
[Shared] Type: Text
[Shared] Length: 55
[Shared] Name: Prescribing Provider Street Address
[Shared] Type: Text
[Shared] Length: 55
PC047C
[Shared] Name: Prescribing Provider City
[Shared] Type: Text
[Shared] Length: 30
[Shared] Name: Prescribing Provider City
[Shared] Type: Text
[Shared] Length: 30
PC047D
[Shared] Name: Prescribing Provider State or Province
[Shared] Type: Text
[Shared] Length: 2
[Shared] Name: Prescribing Provider State or Province
[Shared] Type: Text
[Shared] Length: 2
PC047E
[Shared] Name: Prescribing Provider ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
[Shared] Name: Prescribing Provider ZIP/Postal Code
[Shared] Type: Text
[Shared] Length: 9
PC048
[Shared] Name: Prescribing Provider NPI
[Shared] Type: Text
[Shared] Length: 10
[Shared] Name: Prescribing Provider NPI
[Shared] Type: Text
[Shared] Length: 10
PC048A
[Shared] Name: Prescribing Provider Plan ID
[Shared] Type: Text
[Shared] Length: 15
[Shared] Name: Prescribing Provider Plan ID
[Shared] Type: Text
[Shared] Length: 15
PC080
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
PC081
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
PC082
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
PC083
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
PC084
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
[Shared] Name: Placeholder
[Shared] Type: N/A
[Shared] Length: N/A
PC101
[Shared] Name: Subscriber Last Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Subscriber Last Name
[Shared] Type: Text
[Shared] Length: 60
PC102
[Shared] Name: Subscriber First Name
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Subscriber First Name
[Shared] Type: Text
[Shared] Length: 35
PC103
[Shared] Name: Subscriber Middle Initial
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Subscriber Middle Initial
[Shared] Type: Text
[Shared] Length: 1
PC104
[Shared] Name: Member Last Name
[Shared] Type: Text
[Shared] Length: 60
[Shared] Name: Member Last Name
[Shared] Type: Text
[Shared] Length: 60
PC105
[Shared] Name: Member First Name
[Shared] Type: Text
[Shared] Length: 35
[Shared] Name: Member First Name
[Shared] Type: Text
[Shared] Length: 35
PC106
[Shared] Name: Member Middle Initial
[Shared] Type: Text
[Shared] Length: 1
[Shared] Name: Member Middle Initial
[Shared] Type: Text
[Shared] Length: 1
PC899
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
pharmacy claims record
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
pharmacy claims record
TR001
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
TR
trailer record
[Shared] Name: Record Type
[Shared] Type: Text
[Shared] Length: 2
Codes:
TR
trailer record
TR002
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
[Shared] Name: Submitter Code
[Shared] Type: Text
[Shared] Length: 8
TR003
[Shared] Name: Placeholder
[Shared] Type: Text
[Shared] Length: 30
Codes:
Null
 
[Shared] Name: Placeholder
[Shared] Type: Text
[Shared] Length: 30
Codes:
Null
 
TR004
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
pharmacy claims data
[Shared] Name: Type of File
[Shared] Type: Text
[Shared] Length: 2
Codes:
PC
pharmacy claims data
TR005
[Shared] Name: Period Beginning Date
[Shared] Type: Integer
[Shared] Length: 6
[Shared] Name: Period Beginning Date
[Shared] Type: Integer
[Shared] Length: 6
TR006
[Shared] Name: Period Ending Date
[Shared] Type: Integer
[Shared] Length: 6
[Shared] Name: Period Ending Date
[Shared] Type: Integer
[Shared] Length: 6
TR007
[Shared] Name: Date Processed
[Shared] Type: Date
[Shared] Length: 8
[Shared] Name: Date Processed
[Shared] Type: Date
[Shared] Length: 8
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