RXA_ADJUD_MESSAG_2

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 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 | BIN_NUM | VARCHAR | No |
The BIN (Bank Identification Number) used during prescription adjudication. This number can be stored in the plan and payor, and a different number can be returned based on whether the adjudication is primary or not. (101-A1)
5 | PROCESSOR_CTRL_NUM | VARCHAR | No |
The processor control number used during prescription adjudication. This number can be stored in the plan and payor, and a different number can be returned based on whether the adjudication is primary or not.(104-A4)
6 | ORG_PRESC_PROD_CODE | VARCHAR | No |
NCPDP code of the initially prescribed product or service.(445-EA)
7 | 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.
8 | I_TX_CODE_ID | NUMERIC | No |
NCPDP code identifying the type of transaction.
9 | I_TX_CODE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
10 | I_HEADER_RESP_ST_ID | NUMERIC | No |
NCPDP code indicating the status of the transmission.
11 | I_HEADER_RESP_ST_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
12 | I_SVC_PROV_QUAL_ID | NUMERIC | No |
NCPDP code qualifying the 'Service Provider ID' (201-B1).
13 | I_SVC_PROV_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
14 | I_PYR_QUAL_ID | NUMERIC | No |
NCPDP code indicating the type of payer ID.
15 | I_PYR_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
16 | I_MCAID_MEM_ID_NUM | VARCHAR | No |
A unique member identification number assigned by the Medicaid Agency.
17 | I_MEDICAID_AGNC_NUM | VARCHAR | No |
The Medicaid Agency Number sent to the payer (116-N6)
18 | I_CARDHOLDER_ID | VARCHAR | No |
Insurance ID assigned to the cardholder or identification number used by the plan.
19 | I_MCARE_D_CVG_ID | NUMERIC | No |
Code indicating the position of Medicare Part D in the billing order (139-UR).
20 | I_MCARE_D_CVG_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
21 | I_CMS_LICS_LEVEL | VARCHAR | No |
ID for the formulary list
22 | I_CONTRACT_NUMBER | VARCHAR | No |
Code indicating the status of the transmission.
23 | I_FORMULARY_ID | VARCHAR | No |
ID for the formulary list.
24 | I_BENEFIT_ID | VARCHAR | No |
Insurance ID assigned to the cardholder or identification number used by the plan.
25 | I_NXT_MDCR_D_EFF_DT | DATETIME | No |
A Medicare Part D coverage's effective starting date
26 | I_NXT_MDCR_D_TR_DT | DATETIME | No |
A Medicare Part D coverage's effective ending date
27 | I_PATIENT_FIRST_NAM | VARCHAR | No |
Patient's first name sent to the payer (310-CA)
28 | I_PATIENT_LAST_NAME | VARCHAR | No |
Patient's last name sent to the payer (311-CB)
29 | I_BIRTH_DATE | DATETIME | No |
ID for the formulary list
30 | I_TX_RESP_STAT_ID | NUMERIC | No |
NCPDP code indicating the status of the transaction.
31 | I_TX_RESP_STAT_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
32 | I_HELP_DESK_QUAL_ID | NUMERIC | No |
NCPDP code qualifying the phone number in the 'Help Desk Phone Number' (550-8F).
33 | I_HELP_DESK_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
34 | I_TX_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)
35 | I_INT_CTRL_NUM | VARCHAR | No |
Number assigned by the processor to identify an adjudicated claim when supplied in payer-to-payer coordination of benefits only.
36 | I_URL | VARCHAR | No |
The web page address sent to the payer (987-MA)
37 | I_RX_RF_NUM_QUAL_ID | NUMERIC | No |
NCPDP code indicating the type of billing submitted.
38 | I_RX_RF_NUM_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
39 | I_MCAID_CLAIM_NUM | VARCHAR | No |
Claim number assigned by the Medicaid Agency.
40 | I_TAX_EXEMPT_IND_ID | NUMERIC | No |
Code indicating the source of the percentage tax exempt status of the claim.
41 | I_TAX_EXEMPT_IND_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
42 | I_BAS_REIM_DET_ID | NUMERIC | No |
NCPDP code identifying how the reimbursement amount was calculated for 'Ingredient Cost Paid' (506-F6).
43 | I_BAS_REIM_DET_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
44 | I_BAS_DISP_FEE_ID | NUMERIC | No |
NCPDP code indicating how the reimbursement amount was calculated for 'Dispensing Fee Paid' (507-F7).
45 | I_BAS_DISP_FEE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
46 | I_BAS_CALC_COPAY_ID | NUMERIC | No |
NCPDP code indicating how the Copay reimbursement amount was calculated for 'Patient Pay Amount' (505-F5).
47 | I_BAS_CALC_COPAY_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
48 | I_BAS_FLAT_TAX_ID | NUMERIC | No |
Code indicating how the reimbursement amount was calculated for Regulatory Fee Amount Paid (558-AW).
49 | I_BAS_FLAT_TAX_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
50 | I_BAS_PCT_TAX_ID | NUMERIC | No |
Code indicating how the reimbursement amount was calculated for Percentage Tax Amount Paid (559-AX).
51 | I_BAS_PCT_TAX_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
52 | I_AMT_ATTR_PROC_FEE | NUMERIC | No |
This specifies the amount that is attributed to the processor fee.
53 | I_PAT_SAL_TAX_AMT | NUMERIC | No |
Patient percentage tax obligation or portion thereof when benefit is set up to directly pass percentage tax onto the patient.
54 | I_PLAN_SAL_TAX_AMT | NUMERIC | No |
The sales tax amount attributed to the plan.
55 | I_AMT_COINS | NUMERIC | No |
The amount of coinsurance that was calculated.
56 | I_BAS_CALC_COINS | NUMERIC | No |
Code indicating how the Coinsurance reimbursement amount was calculated for Patient Pay Amount (505-F5).
57 | I_BAS_CALC_COINS_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
58 | I_EST_GENERC_SAVING | NUMERIC | No |
The amount, not included in the Total Amount Paid (509-F9), that the patient would have saved if they had chosen the generic drug instead of the brand drug.
59 | I_SP_ACC_AMT_REM | NUMERIC | No |
The amount remaining on the spending amount. (128-UC)
60 | I_HPFA_AMT | NUMERIC | No |
Medicare Part D Coverage Code
61 | I_AMT_PROV_NET_SEL | NUMERIC | No |
The amount that has been attributed to the provider network selection
62 | I_AMT_PROD_SEL_BRAN | NUMERIC | No |
The amount that is attributed to product selection for branded drugs.
63 | I_AMT_NPRF_FRM_SEL | NUMERIC | No |
The amount that is attributed to a product selection for non preferred formulary selections.
64 | I_AMT_BRND_NPRF_FRM | NUMERIC | No |
The amount that is attributed to product selection for Brand non preferred formulary selections.
65 | I_AMT_ATTR_CVG_GAP | NUMERIC | No |
The amount that is attributed to the coverage gap.
66 | I_INGR_COST_CNTRCTD | NUMERIC | No |
Informational field used 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 product being dispensed.
67 | I_DISP_FEE_CNTRCTD | NUMERIC | No |
Informational field used 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 dispensing fee for product being dispensed.
68 | I_PCT_TAX_PD_ID | NUMERIC | No |
Code indicating the percentage tax paid basis.
69 | I_PCT_TAX_PD_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
70 | I_COPAY_AMT | NUMERIC | No |
The amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to a per prescription copay.
71 | REVERSE_OF_RXA_ID | NUMERIC | No |
The unique ID of the original adjudication that this reversal or rebill is reversing.
72 | REVERSE_OF_DATE_REAL | FLOAT | No |
Unique contact date in decimal format of the original adjudication that this reversal or rebill is reversing.
73 | IS_MANUALLY_APPROVED_YN | VARCHAR | No |
Indicates if the adjudication attempt was manually approved. 'N' or NULL indicate that the attempt was not manually approved. 'Y' indicates that the attempt as manually approved.
May contain organization-specific values: No
Category Entries:
No
Yes
74 | PREVIOUS_ADJ_RXA_ID | NUMERIC | No |
Gets the adjudication attempt ID of the previous coverage in the filing order at the moment of this adjudication attempt. For primary coverage adjudications, this will always be null. For secondary coverages, this will point to the primary coverage. For tertiary coverages, this will point to the secondary coverage.
75 | PREVIOUS_ADJ_DATE_REAL | FLOAT | No |
Gets the unique adjudication attempt date of the previous coverage in the filing order at the moment of this adjudication attempt. For primary coverage adjudications, this will always be null. For secondary coverages, this will point to the primary coverage. For tertiary coverages, this will point to the secondary coverage.
76 | M3P_STATUS_C_NAME | VARCHAR | No |
This is the M3P status inferred from the NCPDP vD.0 field Approved Message Codes (548-6F). Blank - No M3P related status 1 - Patient is likely to benefit from M3P (Code 056) 2 - Patient is enrolled in the M3P (Code 057) and the coverage applied correctly 3 - Patient is enrolled in the M3P (Code 057) but the coverage not applied correctly 4 - Patient not longer participating/elected not to participate (Code 058)
May contain organization-specific values: No
Category Entries:
Likely to Benefit (Code 056)
Is Enrolled (Code 057) But Coverage Is Not Applied
Is Enrolled (Code 057) And Coverage Is Applied
Not Participating (Code 058)
77 | RESUB_DOCUMENT_ID | VARCHAR | No |
The document attached in the Resubmission/Attachment field.
78 | O_PAT_ID_ASSC_STATE_ID | NUMERIC | No |
State/Province Code associated with the Patient ID Qualifier (331-CX) and the Patient ID (332-CY).
79 | O_PAT_ID_ASSC_STATE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
80 | O_PAT_ID_ASSC_CNTRY_ID | NUMERIC | No |
Code of the country (B38-1Y).
81 | O_PAT_ID_ASSC_CNTRY_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
82 | O_VETERINARY_USE_ID | NUMERIC | No |
To indicate that the prescription was dispensed for use on something other than human (A45-1R).
83 | O_VETERINARY_USE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
84 | O_SPECIES | VARCHAR | No |
A basic biological classification containing individuals that resemble one another and may interbreed (E06-S8).
85 | O_PROV_FIRST_NAME | VARCHAR | No |
First name of the provider (B96-4A).
86 | O_PROV_LAST_NAME | VARCHAR | No |
Last name of the provider (B97-4M).
87 | O_RECON_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).
88 | O_AS_RX_NUM_QUAL_ID | NUMERIC | No |
Code qualifying the Associated Prescription/Service Reference Number ID (456-EN) to which the claim/service is related.
89 | O_AS_RX_NUM_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
90 | O_MULT_RX_GRP_ID_S | VARCHAR | No |
Unique ID assigned by the prescriber or pharmacy system to link multiple product orders together (D21-M3).
91 | O_MLT_RX_GRP_RSN_ID | NUMERIC | No |
Indicates the reason for the quantity dispensed and/or days supply as a result of the prescriber issuing grouped prescriptions (D22-M4).
92 | O_MLT_RX_GRP_RSN_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
93 | O_TOTL_PRES_QTY_REM | NUMERIC | No |
Accumulated Total Prescribed Quantity Remaining as of the date of service. Calculated value based on: (Quantity Prescribed (460-ET)) * (Number Of Refills Authorized (415-DF) + 1) - Accumulated Quantity Dispensed (442-E7) inclusive of current fill.
94 | O_PREP_ENV_TYPE_ID | NUMERIC | No |
Code identifying the environment in which the medication was prepared (C99-KU).
95 | O_PREP_ENV_TYPE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
96 | O_PREP_ENV_EVT_CODE_ID | NUMERIC | No |
Event which required a special preparation environment (C98-KT).
97 | O_PREP_ENV_EVT_CODE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
98 | O_AS_PRES_PROV_QUAL_ID | NUMERIC | No |
Code qualifying the Associated Prescription/Service Provider ID (580-XY) to which the claim/service is related.
99 | O_AS_PRES_PROV_QUAL_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
100 | O_AS_PRES_PROV_ID_S | VARCHAR | No |
Related Service Provider ID to which the claim/service is associated (580-XY).
101 | O_AS_PRES_FILL_NUM | INTEGER | No |
Related Fill Number to which the claim/service is associated (582-X0).
102 | O_TIME_OF_SVC_TM | DATETIME (UTC) | No |
The time at which the service is performed as local time that will correspond with the actual date of service (678-Y6).
103 | O_SALES_TX_ID_S | VARCHAR | No |
A reference identifier assigned to the sale transaction as assigned by the merchant (681-ZF).
104 | O_RPT_ADJ_PROG_TYPE_ID | NUMERIC | No |
The type of prescription benefit plan/program under which the reported claim adjudicated (A29-ZS).
105 | O_RPT_ADJ_PROG_TYPE_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
106 | O_ORIG_PROD_ID_Q_ID | NUMERIC | No |
Code qualifying the value in Original Manufacturer Product ID (C01-4N).
107 | O_ORIG_PROD_ID_Q_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
108 | O_ORIG_PROD_ID_S | VARCHAR | No |
Original ID of the Original Manufacturer/Labeler product for the dispensed repackaged drug used by the repackager to create the drug being dispensed (C01-4N).
109 | O_LTPAC_DISP_FRQ_ID | NUMERIC | No |
Code indicating the frequency of dispensing medication to a LTPAC patient (C91-KK).
110 | O_LTPAC_DISP_FRQ_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
111 | O_LTPAC_BILL_MTD_ID | NUMERIC | No |
Code indicating the billing methodology used for the claim (C90-KH).
112 | O_LTPAC_BILL_MTD_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
113 | O_NUM_LTPAC_DIS_EVT | INTEGER | No |
Value indicating the number of times pharmacy dispensed product or service for the claim period requested (C92-KM).
114 | O_DN_DISP_BF_DATE | DATETIME | No |
The earliest date the prescriber indicates a prescribed drug can be dispensed (D18-K9).
115 | O_CMPND_LO_CMPLX_ID | NUMERIC | No |
Value used by the pharmacy to indicate the complexity involved in the preparation of the compounded prescription (C60-AG).
116 | O_CMPND_LO_CMPLX_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
117 | O_PRES_ID_ASC_ST_ID | NUMERIC | No |
State/Province Code associated with the Prescriber ID Qualifier (466-EZ) and the Prescriber ID (411-DB).
118 | O_PRES_ID_ASC_ST_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
119 | O_PR_ID_AS_CNTRY_ID | NUMERIC | No |
Code of the country (B41-3B).
120 | O_PR_ID_AS_CNTRY_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
121 | O_PRES_PHONE_NUM_EX | VARCHAR | No |
Extension of the telephone number (B26-7T).
122 | O_PRES_ADD_LINE_ONE | VARCHAR | No |
Free form text for prescriber address line 1 information (B27-7U).
123 | O_PRES_ADD_LINE_TWO | VARCHAR | No |
Free form text for prescriber address line 2 information (B28-7V).
124 | O_PRESC_DEA_NUM | VARCHAR | No |
ID assigned to a health care provider (e.g. Practitioner, Hospital, Manufacturer, etc.) by the US Drug Enforcement Administration, allowing them to distribute, dispense, administer, or conduct research with respect to controlled substances in the course of professional practice or research (D01-KV).
125 | O_PRES_PLC_SERV_ID | NUMERIC | No |
Code identifying the place where the patient encounter occurred as reported by the prescriber (D57-RG).
126 | O_PRES_PLC_SERV_ID_EXT_CODE_LST_NAME | VARCHAR | No |
The name of the list value.
127 | O_PRESC_MIDDLE_NAME | VARCHAR | No |
Individual Middle Name (E12-0F).
128 | O_SUBRGTN_AMT_RQSTD | NUMERIC | No |
Amount paid by the plan to the pharmacy (D14-KX).