RXA_ADJUD_MESSAGE_6

Description: |
Contains information relating to a single contact of an adjudication record. Adjudication records are used by pharmacy during prescription claim 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 (.1 item) for the adjudication record.
2 | CONTACT_DATE_REAL | FLOAT | No |
A unique contact date in decimal format. The integer portion of the number indicates the date of 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 | O_N_PAYER_IIN | VARCHAR | No |
IIN number of the payer for which the N is being generated (C52-9Y).
5 | O_N_PAYER_PCN | VARCHAR | No |
The Processor Control Number (if used) of the payer which the N is being generated (C53-9Z).
6 | O_N_PAYER_CH_ID_S | VARCHAR | No |
Cardholder number for the beneficiary of the payer for which the N is being generated (C54-AA).
7 | O_N_PAYER_GRP_ID_S | VARCHAR | No |
The Group ID of the secondary, tertiary, etc. payer for the payer which the N is being generated (C55-AB).
8 | O_N_PYR_ADJ_PRG_TYP_ID | NUMERIC | No |
The type of prescription benefit plan/program under which the claim was adjudicated (C48-9U).
9 | O_N_PYR_ADJ_PRG_TYP_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
10 | O_N_TRANS_SRC_TYPE_ID | NUMERIC | No |
Method in which record of payment was transmitted from the N payer to receiver (C56-AC).
11 | O_N_TRANS_SRC_TYPE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
12 | O_N_TRAN_RECON_ID_S | VARCHAR | No |
The Reconciliation ID (B98-34) returned by the supplemental payer for which the N is being generated.
13 | O_TRANS_REF_NUM | VARCHAR | No |
A reference number assigned by the provider to each of the data records in the batch or real-time transactions. The purpose of this number is to facilitate the process of matching the transaction response to the transaction. The transaction reference number assigned should be returned in the response (880-K5).
14 | O_EMP_ADDR_LINE_ONE | VARCHAR | No |
Free-form text for address line 1 information (B15-8D).
15 | O_EMP_ADDR_LINE_TWO | VARCHAR | No |
Free-form text for address line 2 information (B16-7G).
16 | O_EMP_CNTRY_CODE_ID | NUMERIC | No |
Code of the country (B35-1V).
17 | O_EMP_CNTRY_CODE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
18 | O_EMPLYR_PHONE_EXT | VARCHAR | No |
Extension of the telephone number (B19-7K).
19 | O_EMP_CT_FIRST_NAME | VARCHAR | No |
First name of the employer's primary contact (B17-7H).
20 | O_EMP_CT_LAST_NAME | VARCHAR | No |
Last name of the employer's primary contact (B18-7J).
21 | O_PAY_ST_ADR_LN_ONE | VARCHAR | No |
Line 1 of street address of the entity to receive payment for claim (B24-7R).
22 | O_PAY_ST_ADR_LN_TWO | VARCHAR | No |
Line 2 of street address of the entity to receive payment for claim (B25-7S).
23 | O_PAY_TO_COUNTRY_ID | NUMERIC | No |
Code of the country (B39-1Z).
24 | O_PAY_TO_COUNTRY_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
25 | I_INS_ADL_PLAN_NAME | VARCHAR | No |
The name of the plan (600-96).
26 | I_RECONCIL_ID_S | VARCHAR | No |
A unique identifier assigned by the processor for the transaction response statuses of Paid/Duplicate of Paid, Capture/Duplicate of Capture, or Approved/Duplicate of Approved that provides a means to identify that transaction should any subsequent transaction or other associated activity occur (B98-34).
27 | I_ADJ_PROG_TYPE_ID | NUMERIC | No |
The type of prescription benefit plan/program under which the claim was adjudicated (A28-ZR).
28 | I_ADJ_PROG_TYPE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
29 | I_NEXT_AV_FILL_DATE | DATETIME | No |
Date on which this prescription will have passed the plan's minimum consumption requirements and may be considered for dispensing (B04-BT).
30 | I_SRC_INVLD_PROV_ID | NUMERIC | No |
Identifies data source used to determine invalid provider status. This data may be obtained directly from the authoritative source or supplied through a vendor (E87-ZV).
31 | I_SRC_INVLD_PROV_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
32 | I_STE_INVLD_PROV_ID | NUMERIC | No |
Identifies the state from which the Invalid Provider Data Source originated (E88-ZZ).
33 | I_STE_INVLD_PROV_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
34 | I_PLAN_OVERRIDE_IND | VARCHAR | No |
Identifies claim request field in which specific values can be submitted to override plan benefit claim rejection (D54-RC).
35 | I_MAX_AGE_QUAL_ID | NUMERIC | No |
Code qualifying the maximum age (931-F8).
36 | I_MAX_AGE_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
37 | I_MAX_AGE | INTEGER | No |
Maximum age at which the product/service is covered (inclusive) (932-GA).
38 | I_MIN_AGE_QUAL_ID | NUMERIC | No |
Code qualifying the Minimum Age (944-GR).
39 | I_MIN_AGE_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
40 | I_MIN_AGE | INTEGER | No |
Minimum age at which the drug is covered (inclusive) (944-GR).
41 | I_MIN_AMT_QUAL_ID | NUMERIC | No |
Qualifies the amount in the Minimum Amount (D19-M1) field.
42 | I_MIN_AMT_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
43 | I_MIN_AMOUNT | NUMERIC | No |
Minimum amount for a quantity limit as specified in the Minimum Amount Qualifier (D20-M2).
44 | I_MAX_AMT_QUAL_ID | NUMERIC | No |
Qualifies the amount in the Maximum Amount (933-GB).
45 | I_MAX_AMT_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
46 | I_MAX_AMOUNT | NUMERIC | No |
Maximum amount for a quantity limit as specified in the Maximum Amount Qualifier (934-GC).
47 | I_MAX_TIME_PERD_ID | NUMERIC | No |
Type of time period associated with the overall Maximum Amount Qualifier (934-GC).
48 | I_MAX_TIME_PERD_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
49 | I_MAX_AMT_END_DATE | DATETIME | No |
Ending date of Specific Date Range (937-GH).
50 | I_MAX_AMT_STRT_DATE | DATETIME | No |
Starting date of Specific Date Range (936-GG).
51 | I_MAX_TME_PER_UNITS | INTEGER | No |
Number of units associated with the overall Maximum Amount Time Period (935-GF).
52 | I_REM_AMT_QUAL_ID | NUMERIC | No |
The specific plan benefit amount type represented in the Remaining Amount (D24-M6).
53 | I_REM_AMT_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
54 | I_REMAINING_AMOUNT | NUMERIC | No |
Remaining amount to a maximum quantity limit based on amounts accumulated, as specified in the Remaining Amount Qualifier (D25-M7).
55 | I_SUB_REQ_RECN_ID_S | VARCHAR | No |
The Reconciliation ID returned to the pharmacy on the paid claim transaction from the original/requesting payer (D15-KY).
56 | I_PAT_REG_FEE_AMT | NUMERIC | No |
Patient regulatory fee amount obligation or portion thereof when benefit is set up to directly pass regulatory fee onto the patient (D65-RS).
57 | I_PROF_SVC_FEE_AMT | NUMERIC | No |
Informational field used with service billings when Other Payer-Patient Responsibility Amount (352-NQ) or Patient Pay Amount (505-F5) is used for reimbursement. Amount is equal to contracted or reimbursable amount for service being rendered.
58 | I_O_BEN_PLAN_TYP_ID | NUMERIC | No |
The Medicare Plan specific to its beneficiary or benefit (C97-KS).
59 | I_O_BEN_PLAN_TYP_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
60 | I_O_BEN_LIS_LEV_ID | NUMERIC | No |
Low income co-pay category (C88-KF).
61 | I_O_BEN_LIS_LEV_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
62 | I_O_BEN_LIS_EF_DATE | DATETIME | No |
The effective date of the Low Income Subsidy benefit for the date of service requested (C87-KD).
63 | I_O_BEN_LIS_TN_DATE | DATETIME | No |
The termination date of the Low Income Subsidy benefit for the date of service requested (C89-KG).
64 | I_O_BEN_DIS_EF_DATE | DATETIME | No |
The effective date of the disability benefit for the date of service requested (C61-AH).
65 | I_O_BEN_ESRD_IND_ID | NUMERIC | No |
End Stage Renal Disease benefit indicator flag (C63-A5).
66 | I_O_BEN_ESRD_IND_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
67 | I_O_BN_ESRD_EF_DATE | DATETIME | No |
The effective date of the ESRD benefit for the date of service requested (C62-AJ).
68 | I_O_BN_ESRD_TR_DATE | DATETIME | No |
The termination date of the ESRD benefit for the date of service requested (C64-A6).
69 | I_O_BN_HOSP_EF_DATE | DATETIME | No |
The effective date of the hospice benefit for the date of service requested (C76-G4).
70 | I_O_BN_HOSP_TR_DATE | DATETIME | No |
The termination date of the Hospice benefit for the date of service requested (C79-G7).
71 | I_O_BEN_HSP_PRV_NUM | VARCHAR | No |
The Facility NPI (National Provider Identifier) of the Hospice Provider (C78-G6).
72 | I_O_BN_HOS_FAC_NAME | VARCHAR | No |
Name identifying the hospice where the service was rendered (C77-G5).
73 | I_O_BN_HOS_PHNE_NUM | VARCHAR | No |
Phone number of the hospice (C65-A8).
74 | I_O_BEN_INST_IND_ID | NUMERIC | No |
Code indicating the institutional service (C73-BJ).
75 | I_O_BEN_INST_IND_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
76 | I_O_BN_INST_EF_DATE | DATETIME | No |
The effective date of the institutional benefit for the date of service requested (C74-BK).
77 | I_O_BN_INST_TR_DATE | DATETIME | No |
The termination date of the institutional benefit for the date of service requested (C75-GD).