Name: | Pharmacy Fixed Format File Submission |
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State: | Maryland |
Definition: | Not provided |
Version | January 9, 2014 |
Data Element ID | Data Element | Description | Type | Format | Length |
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Record Identifier | The value is 2 | numeric | 1 | |
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Patient IdentifierP (payor encrypted) | Patient's unique identification number assigned by payor and encrypted. | alphanumeric | 12 | |
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Patient IdentifierU (UUID encrypted) | Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. | alphanumeric | 12 | |
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Patient Sex | Sex of Patient. | numeric | 1 | |
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Patient Zip Code+4-digit add-on | Zip code of patient's residence. | numeric | 10 | |
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Patient Year and Month of Birth | Date of patient's birth using 00 instead of day. | numeric | CCYYMM00 | 8 |
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Pharmacy NCPDP Number | Unique 7 digit number assigned by the National Council for Prescription Drug Program (NCPDP). | numeric | 7 | |
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Pharmacy Zip Code+4-digit add-on | Zip code of pharmacy where prescription was filled and dispensed. | numeric | 10 | |
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Practitioner DEA # | Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act. | alphanumeric | 11 | |
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Fill Number | The code used to indicate if the prescription is an original prescription or a refill. Use '01' for all refills if the specific number of the prescription refill is not available. | numeric | 2 | |
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NDC Number | National Drug Code 11 digit number. | numeric | 11 | |
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Drug Compound | Indicates a mix of drugs to form a compound medication. | numeric | 1 | |
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Drug Quantity | Number of units of medication dispensed. | numeric | 5 | |
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Drug Supply | Estimated number of days of dispensed supply. | numeric | 3 | |
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Date Filled | Date prescription was filled. | numeric | CCYYMMDD | 8 |
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Date Prescription Written | Date prescription was written. | numeric | CCYYMMDD | 8 |
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Billed Charge | Retail amount for drug including dispensing fees and administrative costs. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. | numeric | 9 | |
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Reimbursement Amount | Amount paid to the pharmacy by payor. Do not include patient copayment or sales tax. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. | numeric | 9 | |
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Prescription Claim Number | Internal payor claim number used for tracking. | numeric | 15 | |
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Prescription Claim Paid Date | The date a claim was authorized for payment. | numeric | CCYYMMDD | 8 |
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Prescribing Practitioner Individual National Provider Identifier (NPI) number | Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner. | alphanumeric | 10 | |
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Patient Deductible | The fixed amount that the patient must pay for covered pharmacy services before benefits are payable. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. | numeric | 9 | |
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Patient Coinsurance/Patient Co-payment | The specified amount or percentage the patient is required to contribute towards covered pharmacy services after any applicable deductible. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. | numeric | 9 | |
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Other Patient Obligations | Any patient obligations other than the deductible or coinsurance/co-payment. This could include obligations for non-formulary drugs, non-covered pharmacy services, or penalties. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. | numeric | 9 | |
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Date of Enrollment | The first day of the reporting period the patient is in this delivery system (in this data submission time period). (see Source Company on page 26) | numeric | CCYYMMDD | 8 |
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Date of Disenrollment | The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26) | numeric | CCYYMMDD | 8 |
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Source of Processing | The source processing the pharmacy claim. | alphanumeric | 1 | |
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Payor ID Number | Payor assigned submission identification number. | alphanumeric | 4 | |
29 | Source System | Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) | alphanumeric | 1 | |
30 | Reporting Quarter | Indicate the quarter number for which the data is being submitted. | numeric | 1 |
Data Element ID | Data Element | Code | Value |
---|---|---|---|
1 | Record Identifier | 2 | Pharmacy Services |
4 | Patient Sex | 1 | Male |
2 | Female | ||
3 | Unknown | ||
10 | Fill Number | 1-99 | Refill number |
00 | New prescription/Original | ||
12 | Drug Compound | 1 | Non-compound |
2 | Compound | ||
27 | Source of Processing | 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 | ||
30 | Reporting Quarter | 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 |