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Pharmacy Fixed Format File Submission

Maryland

Versions: Pharmacy Fixed Format File Submission• Pharmacy Fixed Format File Submission• Pharmacy Fixed Format File SubmissionCompare Versions


Name:Pharmacy Fixed Format File Submission
State:Maryland
Definition:Not provided
VersionJanuary 9, 2014

File Specification for Pharmacy Fixed Format File Submission

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier The value is 2 numeric 1
Multiple versions2 Patient IdentifierP (payor encrypted) Patient's unique identification number assigned by payor and encrypted. alphanumeric 12
Multiple versions3 Patient IdentifierU (UUID encrypted) Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. alphanumeric 12
Multiple versions4 Patient Sex Sex of Patient. numeric 1
Multiple versions5 Patient Zip Code+4-digit add-on Zip code of patient's residence. numeric 10
Multiple versions6 Patient Year and Month of Birth Date of patient's birth using 00 instead of day. numeric CCYYMM00 8
Multiple versions7 Pharmacy NCPDP Number Unique 7 digit number assigned by the National Council for Prescription Drug Program (NCPDP). numeric 7
Multiple versions8 Pharmacy Zip Code+4-digit add-on Zip code of pharmacy where prescription was filled and dispensed. numeric 10
Multiple versions9 Practitioner DEA # Drug Enforcement Agency number assigned to an individual registered under the Controlled Substance Act. alphanumeric 11
Multiple versions10 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
Multiple versions11 NDC Number National Drug Code 11 digit number. numeric 11
Multiple versions12 Drug Compound Indicates a mix of drugs to form a compound medication. numeric 1
Multiple versions13 Drug Quantity Number of units of medication dispensed. numeric 5
Multiple versions14 Drug Supply Estimated number of days of dispensed supply. numeric 3
Multiple versions15 Date Filled Date prescription was filled. numeric CCYYMMDD 8
Multiple versions16 Date Prescription Written Date prescription was written. numeric CCYYMMDD 8
Multiple versions17 Billed Charge Retail amount for drug including dispensing fees and administrative costs. MUST INCLUDE 2 IMPLIED DECIMAL PLACES. numeric 9
Multiple versions18 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
Multiple versions19 Prescription Claim Number Internal payor claim number used for tracking. numeric 15
Multiple versions20 Prescription Claim Paid Date The date a claim was authorized for payment. numeric CCYYMMDD 8
Multiple versions21 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
Multiple versions22 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
Multiple versions23 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
Multiple versions24 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
Multiple versions25 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
Multiple versions26 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
Multiple versions27 Source of Processing The source processing the pharmacy claim. alphanumeric 1
Multiple versions28 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

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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
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