RXA_ADJUD_MESSAGE

Description: |
Contains various information relating to a single contact of an adjudication record. Adjudication records are used by Ambulatory Pharmacy during prescription copay adjudication.

Primary Key

Column Name | Ordinal Position |
--- | --- | ---
RECORD_ID | 1 |
CONTACT_DATE_REAL | 2 |

Column Information

| Name | Type | Discontinued? |
--- | --- | --- | --- | ---
1 | RECORD_ID | NUMERIC | No |
The unique identifier for the adjudication record.
2 | CONTACT_DATE_REAL | FLOAT | No |
A unique, internal contact date in decimal format. The integer portion of the number indicates the date of the contact. The digits after the decimal distinguish different contacts on the same date and are unique for each contact on that date. For example, .00 is the first/only contact, .01 is the second contact, etc.
3 | CONTACT_DATE | DATETIME | No |
The date of this contact in calendar format.
4 | CM_CT_OWNER_ID | VARCHAR | No |
The Community ID (CID) of the instance that owns this contact. This is only populated if you use IntraConnect.
5 | CONTACT_SERIAL_NUM | NUMERIC | No |
The contact number for this adjudication
6 | CONTACT_NUM | NUMERIC | No |
The unique contact number for this adjudication
7 | NAME_HX | VARCHAR | No |
Stores the history of the record name
8 | CONTACT_TYPE_C_NAME | VARCHAR | No |
The contact type category ID for the adjudication record.
May contain organization-specific values: No
Category Entries:
Primary
Secondary
Tertiary
Quaternary
Quinary
Senary
Septenary
Octonary
Nonary
9 | STATUS_C_NAME | VARCHAR | No |
The status category ID of the adjudication message.
May contain organization-specific values: No
Category Entries:
Not Attempted
Pending
Success
Failure
Cash
Charge Recalculation Needed
In Progress
Medical Billing
10 | VERSION_NUM_C_NAME | VARCHAR | No |
Version number category ID of the NCPDP message
May contain organization-specific values: No
Category Entries:
5.1
D.0
F6
United Arab Emirates
11 | TX_CODE_C_NAME | VARCHAR | No |
The transaction code category ID of the adjudication message (Billing, Rebill, Reversal...)
May contain organization-specific values: No
Category Entries:
Bill (B1)
Reversal (B2)
Rebill (B3)
Eligibility (E1)
Authorization
Cancellation
Claim
Information Reporting (N1)
Medical Bill
Medical Reversal
12 | RESPONSE_STATUS_C_NAME | VARCHAR | No |
The response status category ID if the message was accepted or rejected.
May contain organization-specific values: No
Category Entries:
Accepted
Rejected
13 | SERVICE_PROV_QUAL_C_NAME | VARCHAR | No |
The provider ID type category ID (NPI, DEA, State License...) that was sent over RX adjudication
May contain organization-specific values: No
Category Entries:
National Provider Identifier (NPI)
Blue Cross
Blue Shield
Medicare
Medicaid
UPIN
NCPDP Provider ID
State License
Champus
Health Industry Number (HIN)
Federal Tax ID
Drug Enforcement Administration (DEA)
State Issued
Plan Specific
Other
14 | SERVICE_PROV | VARCHAR | No |
ID assigned to a pharmacy or provider (201-B1).
15 | SERVICE_DATE | DATETIME | No |
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 (401-D1).
16 | MESSAGE | VARCHAR | No |
Free form message.
17 | GROUP_ID | VARCHAR | No |
ID assigned to the cardholder group or employer group (301-C1).
18 | PLAN_ID | VARCHAR | No |
Assigned by the Pharmacy Benefits Manager to identify a set of parameters, benefits, or coverage criteria used to adjudicate a claim.
19 | NETWORK_REIMBURSE | VARCHAR | No |
As defined by the Pharmacy Benefits Bander, this field identifies the network, for the covered member, used to calculate the reimbursement to the pharmacy.
20 | PAYOR_QUALIFIER_C_NAME | VARCHAR | No |
NCPDP code indicating the type of payor ID.
May contain organization-specific values: No
Category Entries:
National Payor ID
Health Industry Number
Bank Information Number (BIN)
National Association of Insurance Commissioners
Other
21 | PAYOR_ID | VARCHAR | No |
The ID of the payer from the Payer ID field of the adjudication response.
22 | TX_RESP_C_NAME | VARCHAR | No |
The status category ID of the adjudication transaction.
May contain organization-specific values: No
Category Entries:
Approved
Captured
Duplicate of Paid
PA Deferred
Paid
Duplicate of Capture
Rejected
Duplicate of Approved
23 | AUTH_NUM | VARCHAR | No |
Number assigned by the PBM to identify an authorized transaction.
24 | ADDL_MESSAGE | VARCHAR | No |
This is a free text message sent from the PBM.
25 | HELPDESK_PH_QUAL_C_NAME | VARCHAR | No |
NCPDP code qualifying the phone number in the 'Help Desk Phone Number' (550-8F) Field 550-8F)
May contain organization-specific values: No
Category Entries:
Switch
Intermediary
Processor/PBM
Other
26 | HELP_DESK_PHONE_NUM | VARCHAR | No |
Ten-digit phone number of the help desk.
27 | PRESC_REF_NUM_C_NAME | VARCHAR | No |
Reference number (prescription or service) category ID assigned by the provider for the order.
May contain organization-specific values: No
Category Entries:
Rx Billing
Service Billing
28 | PRESC_REFRENCE_NUM | VARCHAR | No |
Reference number assigned by the provider for the dispensed drug/product and/or service provided.
29 | PAT_PAY_AMOUNT | NUMERIC | No |
Amount that is calculated by the PBM and returned to the pharmacy as the TOTAL amount to be paid by the patient to the pharmacy: The patient's total cost share, including copayments, amounts applied to deductible, over maximum amounts, penalties, etc.
30 | INGREDIENT_COSTPAID | NUMERIC | No |
Drug ingredient cost paid included in the Total Amount Paid (509-F9).
31 | DISPENSE_FEE_PAID | NUMERIC | No |
Dispensing fee paid included in the Total Amount Paid (509-F9).
32 | TAX_EXEMPT_IND_C_NAME | VARCHAR | No |
NCPDP code indicating the payor as exempt from taxes.
May contain organization-specific values: No
Category Entries:
Tax Exempt
Not Tax Exempt
33 | FLAT_SALES_TAX_PAID | NUMERIC | No |
Amount of flat sales tax paid. Included in the "Total Amount Paid".
34 | PERC_SALES_TAX_PAID | NUMERIC | No |
Amount of percentage tax paid which is included in the Total Amount Paid (509-F9).
35 | PERC_SALES_TAX_RATE | NUMERIC | No |
Percentage tax rate used to calculate Percentage Tax Amount Paid (559-AX).
36 | PERC_SALES_TX_BAS_C_NAME | VARCHAR | No |
NCPDP code indicating the percentage sales tax paid basis.
May contain organization-specific values: No
Category Entries:
Gross Amount Due
Ingredient Cost
Ingredient Cost + Dispensing Fee
37 | INCENTIVE_AMT_PAID | NUMERIC | No |
Amount represents the contractually agreed upon incentive fee paid for specific services rendered. Amount is included in the Total Amount Paid (509-F9).
38 | PROF_SERVICE_FEE | NUMERIC | No |
Amount representing the contractually agreed upon fee for professional services rendered. This amount is included in the Total Amount Paid
39 | OTHER_PAYOR_AMT_REC | NUMERIC | No |
Total amount recognized by the processor of any payment from another source.
40 | TOTAL_AMOUNT_PAID | NUMERIC | No |
Total amount to be paid by the claim's pharmacy benefit manager (PBM).
41 | BASIS_ING_REIMB_C_NAME | VARCHAR | No |
NCPDP code identifying how the reimbursement amount was calculated for Ingredient Cost Paid
May contain organization-specific values: No
Category Entries:
Not Specified
Ingredient Cost Paid as Submitted
Ingredient Cost Reduced to AWP Pricing
Ingredient Cost Reduced to AWP Less X% Pricing
Usual & Customary Paid as Submitted
Paid Lower of Ingredient Cost Plus Fess Versus Usual & Customary
MAC Pricing Ingredient Cost Paid
MAC Pricing Ingredient Cost Reduced to MAC
Contract Pricing
Acquisition Pricing
42 | AMT_ATTRB_SALES_TAX | NUMERIC | No |
Amount to be collected from the patient that is included in Patient Pay Amount that is due to sales tax paid.
43 | ACCUMULATED_DED_AMT | NUMERIC | No |
Amount in dollars met by the patient/family in a deductible plan.
44 | REMAINING_DED_AMT | NUMERIC | No |
Amount not met by the patient/family in the deductible plan.
45 | REMAINING_BEN_AMT | NUMERIC | No |
Amount remaining in a patient/family plan with a periodic maximum benefit.
46 | AMT_APPLIED_DEDUCT | NUMERIC | No |
Amount to be collected from a patient that is included in Patient Pay Amount that is applied to a periodic deductible.
47 | AMT_COPAY | NUMERIC | No |
Amount to be collected from the patient that is included in Patient Pay Amount that is due to a per prescription copay/coinsurance.
48 | AMT_ATTRIB_PROD_SEL | NUMERIC | No |
Amount to be collected from the patient that is included in the Patient Pay Amount that is due to the patient's selection of drug product.
49 | AMT_EXCEED_BEN_MAX | NUMERIC | No |
Amount to be collected from the patient that is included in Patient Pay Amount that is due to the patient exceeding a periodic benefit maximum
50 | BASIS_CALC_DISP_C_NAME | VARCHAR | No |
NCPDP code indicating how the reimbursement amount was calculated for Dispensing Fee Paid
May contain organization-specific values: No
Category Entries:
Not Specified
Quantity Dispensed
Quantity Intended To Be Dispensed
Usual & Customary/Prorated
Waived Due To Partial Fill
Other
51 | BASIS_CALC_COPAY_C_NAME | VARCHAR | No |
NCPDP code indicating how the reimbursement amount was calculated for Patient Pay Amount
The category values for this column were already listed for column: BASIS_CALC_DISP_C_NAME
52 | BASIS_CALC_FLATTX_C_NAME | VARCHAR | No |
NCPDP code indicating how the reimbursement amount was calculated for Flat Sales Tax Amount Paid
May contain organization-specific values: No
Category Entries:
Not Specified
Quantity Dispensed
Quantity Intended To Be Dispensed
53 | BASIS_PCT_SLS_TAX_C_NAME | VARCHAR | No |
NCPDP code indicating how the reimbursement amount was calculated for Percentage Sales Tax Amount Paid
The category values for this column were already listed for column: BASIS_CALC_FLATTX_C_NAME
54 | PRIOR_AUTH_PROC_DT | DATETIME | No |
Date the prior authorization request was processed.
55 | PRIOR_AUTH_EFF_DT | DATETIME | No |
Date the prior authorization became effective.
56 | PRIOR_AUTH_EXP_DT | DATETIME | No |
Date the prior authorization expires.
57 | PRIOR_AUTH_QUANTITY | NUMERIC | No |
Amount authorized by the prior authorization expressed in metric decimal units.
58 | PRIOR_AUTH_DOL_AUTH | NUMERIC | No |
Amount authorized in the prior authorization.
59 | PRIOR_AUTH_NM_REFIL | NUMERIC | No |
Number of refills authorized by the prior authorization.
60 | PRIOR_AUTH_ACCUM | NUMERIC | No |
Accumulated authorized amount expressed in metric decimal units.
61 | PRIOR_AUTH_NUM | VARCHAR | No |
Unique ID identifying the prior authorization assigned by the processor. (498-PY)
62 | INSTANT_OF_ENTRY_TM | DATETIME (Attached) | No |
Stores the date and time of entry when a record is edited
63 | CONTINUE_ON_FAIL_YN | VARCHAR | No |
Indicates if the adjudication attempt will continue to the next coverage if this fails. 'N' or NULL indicate that the attempt will not continue on failure. 'Y' indicates that the attempt will continue on failure.
May contain organization-specific values: No
Category Entries:
No
Yes
64 | PRIOR_AUTH_NUM_SENT | VARCHAR | No |
The number being sent in for prior authorization for prescription adjudication.
65 | PRIOR_AUTH_TYPE_C_NAME | VARCHAR | No |
The prior authorization category ID being sent during prescription adjudication.
May contain organization-specific values: No
Category Entries:
Not Specified
Prior Authorization
Medical Certification
Early Periodic Screening Diagnosis Treatment
Exemption from Copay
Exemption from RX
Family Plan. Indic.
Temporary Assistance for Needy Families
Payor Defined Exemption
66 | SUBMISSION_CLR_C_NAME | VARCHAR | No |
Additional information category ID of an adjudication message to tell the payor more information about the order for adjudication. Like the patient is a student or is going on vacation.
May contain organization-specific values: No
Category Entries:
Not Specified, Default
No Override
Other Override
Vacation Supply
Lost Prescription
Therapy Change
Starter Dose
Medically Necessary
Process Compound For Approved Ingredients
Meet Plan Limitations
Other
67 | DISPENSE_FEE_SUBMTD | NUMERIC | No |
Dispensing fee submitted by the pharmacy to the payer. (412-DC)
68 | PROF_SVC_FEE_SUBMTD | NUMERIC | No |
Amount submitted by the provider for professional services rendered. (440-E5)
69 | INCENTIV_AMT_SUBMTD | NUMERIC | No |
Amount represents a fee that is submitted by the pharmacy for contractually agreed upon services. (439-E3)
70 | QTY_PRESCRIBED | NUMERIC | No |
Prescribed amount expressed in metric decimal units. (460-ET)
71 | UNIT_DOSE_IND_C_NAME | VARCHAR | No |
NCPDP code indicating the type of unit dose dispensing. (429-DT)
May contain organization-specific values: No
Category Entries:
Not Specified
Not Unit Dose
Manufacturer Unit Dose
Pharmacy Unit Dose
72 | ORG_PRES_PROD_QF_C_NAME | VARCHAR | No |
NCPDP code qualifying the value in 'Originally Prescribed Product/Service' Code. (453-EJ)
May contain organization-specific values: No
Category Entries:
Not Specified
Universal Product Code (UPC)
Health Related Item (HRI)
National Drug Code (NDC)
Universal Product Number (UPN)
Department of Defense (DOD)
Drug Use Review/ Professional Pharmacy Service (DUR/PPS)
Common Procedure Terminology (CPT4)
Common Procedure Terminology (CPT5)
Health Care Financing Administration Common Procedural Coding System (HCPCS)
Pharmacy Practice Activity Classification (PPAC)
National Pharmaceutical Product Interface Code (NAPPI)
International Article Numbering System (EAN)
Drug Identification Number (DIN)
73 | LEVEL_OF_SERVICE_C_NAME | VARCHAR | No |
NCPDP code indicating the type of service the provider rendered. (418-DI)
May contain organization-specific values: No
Category Entries:
Not Specified
Patient Consulation
Home Delivery
Emergency
24 hour service
Patient Consulation Regarding Generic Product Selection
In-Home Service
74 | INTRMED_AUTH_TYP_C_NAME | VARCHAR | No |
NCPDP code indicating that authorization occurred for intermediary processing. (463-EW)
May contain organization-specific values: No
Category Entries:
Not Specified
Intermediary Authorization
Other Override
75 | INTRAUTH_IDENTIFIER | VARCHAR | No |
Value indicating intermediary authorization occurred. (464-EX)
76 | COUPON_TYPE_C_NAME | VARCHAR | No |
NCPDP code indicating the type of coupon being used. (485-KE)
May contain organization-specific values: No
Category Entries:
Price Discount
Free Product
Other
77 | COUPON_VALUE_AMT | NUMERIC | No |
Value of the coupon. (487-NE)
78 | PRIOR_AUTH_REQTYP_C_NAME | VARCHAR | No |
NCPDP code identifying type of prior authorization request. (498-PA)
May contain organization-specific values: No
Category Entries:
Initial
Reauthorization
Deferred
79 | PRIORAUTH_RQBEG_DT | DATETIME | No |
Beginning date for a prior authorization request. (498-PB)
80 | PRIORAUTH_RQEND_DT | DATETIME | No |
Ending date for a prior authorization request. (498-PC)
81 | PRIORAUTH_BAS_RQ_C_NAME | VARCHAR | No |
NCPDP code describing the reason for prior authorization request. (498-PD)
May contain organization-specific values: No
Category Entries:
Medical Exception
Plan Requirement
Increase Plan Limitation
82 | PRIOR_AUTH_REP_FNAM | VARCHAR | No |
First name of the patient's authorized representative (498-PE)
83 | PRIOR_AUTH_REP_LNAM | VARCHAR | No |
Last name of the patient's authorized representative. (498-PF)
84 | PRIOR_ATH_REP_STADD | VARCHAR | No |
Street address of the patient's representative. (498-PG)
85 | PRI_ATH_REP_CITYADD | VARCHAR | No |
City of the patient's representative. (498-PH)
86 | PRI_ATH_REP_STATE_C_NAME | VARCHAR | No |
State or province category ID of the patient's representative. (498-PJ)
May contain organization-specific values: Yes
87 | PRI_ATH_REP_ZIP | VARCHAR | No |
ZIP code or other postal zone code of the patient's representative. (498-PK)
88 | PRI_ATH_NUM_ASSGN | VARCHAR | No |
Unique number identifying the prior authorization assigned by the processor. (498-PY)
89 | PRI_ATH_AUTH_NUM | VARCHAR | No |
Number assigned by the processor to identify an authorized transaction. (503-F3)
90 | PRI_ATH_SUPP_DOC | VARCHAR | No |
Free-text comments supplied by the pharmacy that may be used to process a prior authorization transaction. (498-PP)
91 | SMOKER_CODE_C_NAME | VARCHAR | No |
NCPDP code indicating the patient as a smoker or non-smoker. (334-1C)
May contain organization-specific values: No
Category Entries:
Non-Smoker
Smoker
92 | PREGNANCY_IND_C_NAME | VARCHAR | No |
NCPDP code indicating the patient as pregnant or not pregnant. (335-2C)
May contain organization-specific values: No
Category Entries:
Not Pregnant
Pregnant
93 | PRESCRIBER_LOC_CODE | VARCHAR | No |
Location address code assigned to the prescriber as identified in the National Provider System (NPS). (467-1E)
94 | ALT_IDENTIFIER | VARCHAR | No |
Person identifier to be used for controlled product reporting. Identifier may be that of the patient or the person picking up the prescription as required by the governing body. (330-CW)
95 | COUPON_NUM | VARCHAR | No |
Unique serial number assigned to the prescription coupons. (486-ME)
96 | PAT_ID_QF_C_NAME | VARCHAR | No |
NCPDP code qualifying the Patient ID sent in 332-CY. (331-CX)
May contain organization-specific values: No
Category Entries:
Social Security Number
Driver's License Number
US Military ID
Other
97 | PAT_IDENTIFIER | VARCHAR | No |
ID assigned to the patient. (332-CY)
98 | EMPLOYER | VARCHAR | No |
A unique ID assigned to the employer. (333-CZ)
99 | PAT_PAID_AMT_SUBMTD | NUMERIC | No |
Amount the pharmacy received from the patient for the prescription dispensed.
100 | PAT_DOB_DT | DATETIME | No |
Date of birth of patient.