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).
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Accepted QuantityTotal quantity accepted for payment.
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.
Adjusted QuantityA correction between the 'Total Quantity' (601-39) submitted and the 'Accepted Quantity' (601-86).
Adjusted Rebate Per UnitThe dollar difference between the 'Rebate Per Unit Amount' (601-52) and the 'Paid Per Unit Amount' (601-95).
Adjusted Variance DifferenceThe 'Total Quantity' (601-39) times the 'Adjusted Rebate Per Unit' (601-70) amount.
Amount Paid This TransactionDollar amount paid with this transaction.
Benefit Stage QualifierCode qualifying the 'Benefit Stage Amount' (394-MW).
Change DateIdentifies the date the change is effective.
Change IdentifierIdentifies type of change being made.
City Free-form text for city name.
Claim NumberA unique identifier for a prescription and claim processor
Compound CodeCode indicating whether or not the prescription is a compound.
Contracting Organization (PMO) Contract NumberContract number assigned by the contracting organization.
Contracting Organization (PMO) ID CodeID code assigned by the contracting organization.
Contracting Organization (PMO) ID QualifierIndicates the type of data being submitted in the 'Contracting Organization (PMO) ID Code' (600-66) field.
Contracting Organization (PMO) Market Basket CodeThe market basket name or code being submitted to PICO to identify market basket being submitted.
Contracting Organization (PMO) NameThe name of the contracting organization.
Contracting Organization (PMO) Total Lives CoveredThe total number of lives (the sum of enrollees and dependents or the product of enrollees and calculation multiplier) covered by the contracting organization.
Current Amount Paid To DateThe cumulative dollar amount of rebates paid to date.
Current Rebate Per UnitThe current rebate per unit amount after adjustment.
Current Units Disputed To DateThe cumulative number of units in dispute.
Current Units Paid To DateThe cumulative number of units paid to date.
Current Units To DateThe cumulative number of units submitted for rebate calculation.
Data LevelThe level of data being submitted.
Data Provider ID CodeCode assigned to identify the data provider.
Data Provider ID QualifierIdentifies the type of data being submitted in the 'Data Provider ID Code' (601-32) field.
Data Provider NameName of the data provider.
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.
Days SupplyEstimated number of days the prescription will last.
Diagnosis CodeCode identifying the diagnosis of the patient.
Dispense As Written (DAW)/ Product Selection CodeCode indicating whether or not the prescriber's instructions regarding generic substitution were followed.
Dispensing StatusCode 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.
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).
Drug DescriptionName of drug.
Eligible PlanIndicates whether or not the plan is eligible for rebates.
Encrypted Patient ID CodeEncrypted patient ID.
Entity Country CodeCode of the country.
Entity Zip/Postal CodeCode defining international postal code excluding punctuation of the entity indicated.
Fill NumberThe code indicating whether the prescription is an original or a refill.
Formulary Benefit Design TypeIdentifies the type of formulary benefit design utilized by the plan.
Formulary CodeCode assigned by PMO to identify the formulary used.
Formulary DescriptionDescription of the formulary used by the PMO.
Formulary Start DateRepresents the date on which the formulary became effective.
Formulary Termination DateRepresents the date on which the formulary was terminated.
Grand Total Accepted QuantityThe sum of the 'Accepted Quantity' (601-86) fields submitted within the 'RD' record type.
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.
Grand Total QuantityThe sum of the 'Total Quantity' (601-39) fields submitted within the 'UD' record type.
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