United States Health Information Knowledgebase

 

Data Elements Related to Audit Transaction Standard

Name: Audit Transaction Standard
Definition: Defines the record layout for batch audit transactions between Auditors and Providers to support electronic audit transactions that facilitate requests, responses, and final outcomes transmissions for both "Desk Top" claim audits and for in-store audit notices. This standard addresses the types of communication between Auditors and Providers and allows that communication to occur in an electronic environment rather than paper-based.
Results 1-50 of 69

sort Name
sort Definition
Approved Message CodeMessage code, on an approved claim/service, communicating the need for an additional follow-up.
Audit Control IdentificationInternal identification assigned by the audit entity to identify this transaction.
Audit Element Response 1Indicates status of the Audit Element Type.
Audit Element Response 2Indicates status of the Audit Element Type.
Audit Element Response 3Indicates status of the Audit Element Type.
Audit Element Response 4Indicates status of the Audit Element Type.
Audit Element Response 5Indicates status of the Audit Element Type.
Audit Element Type 1Indicates type of information for associated Prescription/Service Reference Number(s).
Audit Element Type 2Indicates type of information for associated Prescription/Service Reference Number(s).
Audit Element Type 3Indicates type of information for associated Prescription/Service Reference Number(s).
Audit Element Type 4Indicates type of information for associated Prescription/Service Reference Number(s).
Audit Element Type 5Indicates type of information for associated Prescription/Service Reference Number(s).
Audit Range EndIndicates the ending of the audit range of data.
Audit Range QualifierIndicates the type of range being requested.
Audit Range StartIndicates the beginning of the audit range of data.
Audit Request TypeType of audit being requested.
Audit SponsorPayer, Plan Sponsor or PBM who is requesting the audit be performed.
Authorization NumberNumber assigned by the processor to identify an authorized transaction.
Billing SequenceCode Identifying the billing sequence of the claim.
BIN NumberCard Issuer ID or Bank ID Number used for network routing.
Claim Sequence NumberIndicates the sequence of this claim within the set of claims submitted.
Date Of ServiceIdentifies date the prescription was filled or professional service rendered or subsequent payer began coverage following Part A expiration in a long-term care setting only.
Discrepancy AmountThe financial value that the pharmacy will be charged back due to the results of the audit.
Discrepancy Code 1The reason/findings for the Charge Back Amount.
Discrepancy Code 2The reason/findings for the Charge Back Amount.
Discrepancy Code 3The reason/findings for the Charge Back Amount.
Discrepancy MessageFree Text additional information to further define the discrepancy found.
Entity Address Line 1First line of the address of the entity indicated.
Entity Address Line 2Second line of the address of the entity indicated.
Entity CityCity in which the entity indicated is located.
Entity Contact First NameFirst name of contact within the entity indicated.
Entity Contact Last NameLast name of contact within the entity indicated.
Entity Country CodeCode of the country.
Entity EmailEmail address of the entity indicated.
Entity Fax NumberFax Number of the entity indicated.
Entity NameComplete name of the entity indicated.
Entity State/Province AddressState/Province Code of the entity.
Entity Telephone NumberTelephone number of the entity indicated.
Entity Telephone Number ExtensionExtension of the telephone number.
Entity Zip/Postal CodeCode defining international postal code excluding punctuation of the entity indicated.
Estimated Arrival Time DescriptionEstimated earliest time auditor will arrive for audit at the pharmacy using pharmacy local time.
Federal DEA ScheduleThe controlled substance schedule as defined by the Drug Enforcement Administration.
Fill NumberThe code indicating whether the prescription is an original or a refill.
Group IDID assigned to the cardholder group or employer group.
Header Response StatusCode indicating the status of the transmission.
Prescriber IDID assigned to the prescriber.
Prescriber ID QualifierCode qualifying the 'Prescriber ID' (411-DB).
Prescription/ Service Reference NumberReference number assigned by the provider for the dispensed drug/product and/or service provided.
Prescription/Service Reference Number QualifierIndicates the type of billing submitted.
Processor Control NumberNumber assigned by the processor.
Scroll To Top