United States Health Information Knowledgebase

Data Elements Related to Manufacturer Rebate Standard

Name:	Manufacturer Rebate Standard
Definition:	Supports the electronic submission of rebate information from Pharmacy Management Organizations (PMOs) to Pharmaceutical Industry Contracting Organizations (PICOs).

Results 1-50 of 196

Select All	sort Name	sort Definition
Select 200043000	Accepted Quantity	Total quantity accepted for payment.
Select 200064000	Address Line 1	First line of address information.
Select 200066000	Address Line 2	Second line of address information.
Select 200070000	Adjudication Date	Date the claim or adjustment is processed.
Select 200071000	Adjudication Time	Time the claim or adjustment is processed.
Select 200072000	Adjusted Quantity	A correction between the 'Total Quantity' (601-39) submitted and the 'Accepted Quantity' (601-86).
Select 200073000	Adjusted Rebate Per Unit	The dollar difference between the 'Rebate Per Unit Amount' (601-52) and the 'Paid Per Unit Amount' (601-95).
Select 200074000	Adjusted Variance Difference	The 'Total Quantity' (601-39) times the 'Adjusted Rebate Per Unit' (601-70) amount.
Select 200119000	Amount Paid This Transaction	Dollar amount paid with this transaction.
Select 200187000	Benefit Stage Qualifier	Code qualifying the 'Benefit Stage Amount' (394-MW).
Select 200222000	Change Date	Identifies the date the change is effective.
Select 200223000	Change Identifier	Identifies type of change being made.
Select 200231000	City	Free-form text for city name.
Select 200236000	Claim Number	A unique identifier for a prescription and claim processor
Select 200283000	Compound Code	Code indicating whether or not the prescription is a compound.
Select 200307000	Contracting Organization (PMO) Contract Number	Contract number assigned by the contracting organization.
Select 200308000	Contracting Organization (PMO) ID Code	ID code assigned by the contracting organization.
Select 200309000	Contracting Organization (PMO) ID Qualifier	Indicates the type of data being submitted in the 'Contracting Organization (PMO) ID Code' (600-66) field.
Select 200310000	Contracting Organization (PMO) Market Basket Code	The market basket name or code being submitted to PICO to identify market basket being submitted.
Select 200311000	Contracting Organization (PMO) Name	The name of the contracting organization.
Select 200312000	Contracting Organization (PMO) Total Lives Covered	The total number of lives (the sum of enrollees and dependents or the product of enrollees and calculation multiplier) covered by the contracting organization.
Select 200337000	Current Amount Paid To Date	The cumulative dollar amount of rebates paid to date.
Select 200338000	Current Rebate Per Unit	The current rebate per unit amount after adjustment.
Select 200339000	Current Units Disputed To Date	The cumulative number of units in dispute.
Select 200340000	Current Units Paid To Date	The cumulative number of units paid to date.
Select 200341000	Current Units To Date	The cumulative number of units submitted for rebate calculation.
Select 200343000	Data Level	The level of data being submitted.
Select 200344000	Data Provider ID Code	Code assigned to identify the data provider.
Select 200345000	Data Provider ID Qualifier	Identifies the type of data being submitted in the 'Data Provider ID Code' (601-32) field.
Select 200346000	Data Provider Name	Name of the data provider.
Select 200354000	Date Of Service	Identifies 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.
Select 200359000	Days Supply	Estimated number of days the prescription will last.
Select 200372000	Diagnosis Code	Code identifying the diagnosis of the patient.
Select 200387000	Dispense As Written (DAW)/ Product Selection Code	Code indicating whether or not the prescriber's instructions regarding generic substitution were followed.
Select 200393000	Dispensing Status	Code indicating the quantity dispensed is a partial fill or the completion of a partial fill. Used only in situations where inventory shortages do not allow the full quantity to be dispensed.
Select 200394000	Disputed Quantity	The number of units that are in question or the difference between the 'Total Quantity' (601-39) and the 'Accepted Quantity' (601-86).
Select 200427000	Drug Description	Name of drug.
Select 200464000	Eligible Plan	Indicates whether or not the plan is eligible for rebates.
Select 200479000	Encrypted Patient ID Code	Encrypted patient ID.
Select 200487000	Entity Country Code	Code of the country.
Select 200494000	Entity Zip/Postal Code	Code defining international postal code excluding punctuation of the entity indicated.
Select 200526000	Fill Number	The code indicating whether the prescription is an original or a refill.
Select 200542000	Formulary Benefit Design Type	Identifies the type of formulary benefit design utilized by the plan.
Select 200543000	Formulary Code	Code assigned by PMO to identify the formulary used.
Select 200545000	Formulary Description	Description of the formulary used by the PMO.
Select 200549000	Formulary Start Date	Represents the date on which the formulary became effective.
Select 200552000	Formulary Termination Date	Represents the date on which the formulary was terminated.
Select 200569000	Grand Total Accepted Quantity	The sum of the 'Accepted Quantity' (601-86) fields submitted within the 'RD' record type.
Select 200570000	Grand Total Paid Amount	The sum of the 'Paid Rebate Amount' (601-96) fields submitted within the 'RS' record type OR the sum of the 'Paid Amount 1' (175-WH), 'Paid Amount 2' (176-WJ), 'Paid Amount 3' (177-WK), 'Paid Amount 4' (178-WL), and 'Paid Amount 5' (179-WM) fields submitted within the 'RD' record type.
Select 200571000	Grand Total Quantity	The sum of the 'Total Quantity' (601-39) fields submitted within the 'UD' record type.

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