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Data Elements Related to Post Adjudication Standard

Name: Post Adjudication Standard
Definition: Supplies detailed drug or utilization claim information after the claim has been adjudicated.
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Accumulated Deductible AmountAmount in dollars met by the patient/family in a deductible plan.
Address Line 1First line of address information.
Address Line 2Second line of address information.
Adjudication DateDate the claim or adjustment is processed.
Adjudication TimeTime the claim or adjustment is processed.
Adjustment Reason CodeReason for adjustment
Adjustment TypeType of adjustment.
Administrative Fee AmountAdministrative fee charge per claim.
Administrative Fee Effect IndicatorIndicates how the transaction should be counted for administrative fee determination.
AgeCalculated from Date of Birth (304-C4).
Amount Applied To Periodic DeductibleAmount to be collected from a patient that is included in 'Patient Pay Amount' (505-F5) that is applied to a periodic deductible.
Amount Applied To Periodic DeductibleAmount to be collected from a patient that is included in 'Patient Pay Amount' (505-F5) that is applied to a periodic deductible.
Amount Attributed to Processor FeeAmount to be collected from the patient that is included in Patient Pay Amount (505-F5) that is due to the processing fee imposed by the processor.
Amount Attributed To Product SelectionAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of drug product.
Amount Attributed to Product Selection / Brand DrugAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of a Brand product.
Amount Attributed to Product Selection / Brand Non-Preferred Formulary SelectionAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of a Brand Non-Preferred Formulary product.
Amount Attributed to Product Selection / Non-Preferred Formulary SelectionAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of a Non-Preferred Formulary product.
Amount Attributed to Provider Network SelectionAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's provider network selection.
Amount Attributed To Sales TaxAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to sales tax paid.
Amount Exceeding Periodic Benefit MaximumAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient exceeding a periodic benefit maximum.
Amount of CoinsuranceAmount to be collected from the patient that is included in 'Patient Pay Amount' (5(5-F5) that is due to a per prescription coinsurance.
Amount Of CopayAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to a per prescription copay.
Associated Prescription/ Service DateDate of the 'Associated Prescription/Service Reference Number' (456-EN).
Associated Prescription/ Service Reference NumberRelated 'Prescription/Service Reference Number' (402-D2) to which the service is associated.
Authorization NumberNumber assigned by the processor to identify an authorized transaction.
Average Cost Per Quantity Unit PriceAverage Cost Per Quantity as defined by processor.
Average Generic Unit PriceAverage Generic Price per unit as defined by processor.
Average Wholesale Unit PriceAverage Wholesale Price per unit for the drug as defined by processor.
Basis of Calculation - CoinsuranceCode indicating how the Coinsurance reimbursement amount was calculated for 'Patient Pay Amount' (5(5-F5).
Basis Of Calculation - CopayCode indicating how the Copay reimbursement amount was calculated for 'Patient Pay Amount' (505-F5).
Basis Of Calculation-Dispensing FeeCode indicating how the reimbursement amount was calculated for 'Dispensing Fee Paid' (507-F7).
Basis Of Calculation - Flat Sales TaxCode indicating how the reimbursement amount was calculated for 'Flat Sales Tax Amount Paid' (558-AW).
Basis Of Calculation - Percentage Sales TaxCode indicating how the reimbursement amount was calculated for 'Percentage Sales Tax Amount Paid' (559-AX).
Basis Of Reimbursement DeterminationCode identifying how the reimbursement amount was calculated for 'Ingredient Cost Paid' (506-F6).
Batch NumberA number generated by the sender to uniquely identify this batch from others, especially when multiple batches may be sent in one day.
Benefit IDAssigned by processor to identify a set of parameters, benefits, or coverage criteria used to adjudicate a claim.
Benefit Stage AmountThe amount of claim allocated to the Medicare stage identified by the 'Benefit Stage Qualifier' (393-MV).
Benefit Stage QualifierCode qualifying the 'Benefit Stage Amount' (394-MW).
Benefit TypeIndicates the type of acceptable claims for the group based on the Benefit setup.
Billing Cycle End DateCycle end date.
Cardholder Date Of BirthDate of Birth of Member.
Cardholder IDInsurance ID assigned to the cardholder or identification number used by the plan.
Carrier NumberAccount Number assigned during installation.
Check DateMember Claims - Actual member check date Non member Claims - Pharmacy check date
City Free-form text for city name.
Claim Date Received In The MailDate paper claim was received in the mail.
Claim Media TypeClaim submission type code.
Claim/Reference IDIdentifies the claim number assigned by Worker's Compensation Program.
Claim Sequence NumberIndicates the sequence of this claim within the set of claims submitted.
Client Assigned Location CodeThe location of the member within the Client's Company from Client eligibility when submitted by the client.
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