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).