United States Health Information Knowledgebase

 

Data Elements Related to Medical Rebate Data Submission Standard

Name: Medical Rebate Data Submission Standard
Definition: Provides a standardized format for health plans' rebate submissions to multiple manufacturers throughout the industry.
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Unit Of MeasureNCPDP standard product billing codes.
Transmission DateDate the file was created.
Total Record CountTotal number of records being submitted, including header and trailer.
Total QuantityTotal quantity being submitted.
Therapeutic Class DescriptionA text description of the 'Therapeutic Class Code' (601-25) field.
Therapeutic Class Code QualifierIdentifies type of data being submitted in the 'Therapeutic Class Code' (601-25) field.
Therapeutic Class CodeCode assigned to product being reported.
Submit CodeThe code on the file defining the type of submission for the entire batch (identified by the batch number). Indicates the action to perform on the submitted file.
Service Provider State/Province AddressState/Province Code of the service provider
Service Provider ID QualifierCode qualifying the 'Service Provider ID' (201-B1).
Service Provider IDID assigned to a pharmacy or provider.
Service Provider Country CodeIndicates the country of the provider.
Segment Qualifier 6Indicates for the Segment Field the definition of how the rebates are stratified in the batch number.
Segment Qualifier 5Indicates for the Segment Field the definition of how the rebates are stratified in the batch number.
Segment Qualifier 4Indicates for the Segment Field the definition of how the rebates are stratified in the batch number.
Segment Qualifier 3Indicates for the Segment Field the definition of how the rebates are stratified in the batch number.
Segment Qualifier 2Indicates for the Segment Field the definition of how the rebates are stratified in the batch number.
Segment Qualifier 1Indicates for the Segment Field the definition of how the rebates are stratified in the batch number.
Segment 6The business segmentation of rebates to permit one file to go to each manufacturer.
Segment 5The business segmentation of rebates to permit one file to go to each manufacturer.
Segment 4The business segmentation of rebates to permit one file to go to each manufacturer.
Segment 3The business segmentation of rebates to permit one file to go to each manufacturer.
Segment 2The business segmentation of rebates to permit one file to go to each manufacturer.
Segment 1The business segmentation of rebates to permit one file to go to each manufacturer.
Requested Rebate AmountThe total rebate being requested for the reported product.
Reimbursement DateDate provider was reimbursed for product being reported.
Record TypeType of record being submitted.
Record Purpose IndicatorIdentifies the purpose of the record being submitted.
Rebate Period Start DateFirst day of the rebate period.
Rebate Period End DateLast day of the rebate period.
Quarterly Member IndicatorNumber indicating the number of times a member is billed in the billing period.
Product/Service ID QualifierCode qualifying the value in 'Product/Service ID' (407-D7).
Product/Service IDID of the product dispensed or service provided.
Product DescriptionDescription of product being submitted.
Prescription TypeIdentifies the prescription as either a new/refill, an adjusted prescription or a reversal.
Prescription/Service Reference Number QualifierIndicates the type of billing submitted.
Prescription/ Service Reference NumberReference number assigned by the provider for the dispensed drug/product and/or service provided.
Prescriber ID QualifierCode qualifying the 'Prescriber ID' (411-DB).
Prescriber IDID assigned to the prescriber.
Plan Reimbursed AmountTotal amount the MCO pays to the provider (after removing the co-pay or deductible from the Allowable cost)
Plan NameThe name of the plan.
Plan ID QualifierIdentifies the type of data being submitted in the 'Plan ID Code' (600-94) field.
Plan ID CodeID assigned to identify the plan.
Place of ServiceCode identifying the place where a drug or service is dispensed or administered.
Patient Liability AmountAmount of patient's out-of-pocket cost.
Medical Rebate Version Release NumberVersion and release number of standard being submitted
Manufacturer (PICO) NameName of the manufacturer.
Manufacturer (PICO) ID QualifierIndicates the type of data being submitted in the 'Manufacturer (PICO) ID Code' (600-48) field.
Manufacturer (PICO) ID CodeCode assigned to identify the manufacturer.
Manufacturer (PICO) Contract NumberContract number assigned by the manufacturer.
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