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
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 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)
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
	The unique ID of the pharmacy (service provider).
15	SERVICE_DATE	DATETIME	No
	The service date of the order. This is typically the date the pharmacy starts processing the order.
16	MESSAGE	VARCHAR	No
	Free text message sent back from the payor.
17	GROUP_ID	VARCHAR	No
	The Group ID number submitted in the adjudication attempt
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
	The amount paid for the drug ingredient. Amount included in 'Total Amount Paid'
31	DISPENSE_FEE_PAID	NUMERIC	No
	Dispensing fee paid included in the "Total Amount Paid" sent out in adjudication (NCPDP Field 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 sales tax paid which is included in the Total Amount Paid
35	PERC_SALES_TAX_RATE	NUMERIC	No
	Percentage sales tax rate used to calculate Percentage Sales Tax Amount Paid
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'
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 dollar amount of any payment from another source including coupons.
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 number identifying the prior authorization assigned by the PBM.
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.