RXA_ADJUD_MESSAG_4
Description:
Adjudication fields for D.0.

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 O_MEDICAID_INT_NUM VARCHAR No
Claim number assigned by the Medicaid Agency.
5 O_PHR_SERV_TYPE_ID NUMERIC No
The type of service being performed by a pharmacy when different contractual terms exist between a payer and the pharmacy, or when benefits are based upon the type of service performed.
6 O_PHR_SERV_TYPE_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
7 O_INGRD_COST_SUBMIT NUMERIC No
Submitted ingredient cost of the dispensed prescription. This amount is included in the 'Gross Amount Due' (430-DU).
8 O_DISP_FEE_SUBMIT NUMERIC No
Dispensing fee submitted by the pharmacy. This amount is included in the 'Gross Amount Due' (430-DU).
9 O_PROF_SERV_FEE NUMERIC No
The amount submitted by the provider for professional services rendered.
10 O_PAT_PAID_AMT NUMERIC No
Amount the pharmacy received from the patient for the prescription dispensed.
11 O_INCENTIVE_AMT NUMERIC No
Amount represents a fee that is submitted by the pharmacy for contractually agreed upon services. This amount is included in the 'Gross Amount Due' (430-DU).
12 O_FLAT_TAX NUMERIC No
Flat sales tax submitted for prescription. This amount is included in the 'Gross Amount Due' (430-DU).
13 O_PERC_TAX_AMT NUMERIC No
Percentage of sales tax submitted.
14 O_PERC_TAX_RTE NUMERIC No
Percentage sales tax rate used to calculate 'Percentage Sales Tax Amount Submitted' (482-GE).
15 O_PERC_TAX_BASIS_ID NUMERIC No
Code indicating the basis for percentage sales tax.
16 O_PERC_TAX_BASIS_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
17 O_USUAL_AND_CUSTOM NUMERIC No
Amount charged to cash customers for the prescription exclusive of sales tax or other amounts claimed.
18 O_GROSS_AMT_DUE NUMERIC No
Code qualifying the length of need.
19 O_BASIS_COST_DET_ID NUMERIC No
NCPDP code indicating the method by which 'Ingredient Cost Submitted' (Field 409-D9) was calculated.
20 O_BASIS_COST_DET_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
21 O_MEDICAID_AMT_PD NUMERIC No
Amount paid by the Medicaid Agency.
22 O_PROV_ID_QUAL_ID NUMERIC No
Code qualifying the 'Provider ID' (444-E9).
23 O_PROV_ID_QUAL_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
24 O_PROV_ID VARCHAR No
Unique ID assigned to the person responsible for the dispensing of the prescription or provision of the service.
25 O_PRESC_ID_QUAL_ID NUMERIC No
Code qualifying the 'Prescriber ID' (411-DB).
26 O_PRESC_ID_QUAL_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
27 O_PRESC_ID VARCHAR No
ID assigned to the prescriber.
28 O_PRESC_LAST_NAME VARCHAR No
Individual's last name.
29 O_PCP_QUAL_ID NUMERIC No
Code qualifying the 'Primary Care Provider ID' (421-DL).
30 O_PCP_QUAL_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
31 O_PCP_ID VARCHAR No
ID assigned to the primary care provider. Used when the patient is referred to a secondary care provider.
32 O_PCP_LAST_NAME VARCHAR No
Individual's last name.
33 O_PRESC_STREET VARCHAR No
Free-form text for prescriber address information.
34 O_PRESC_CITY VARCHAR No
Free-form text for the prescriber city name.
35 O_PRESC_STATE_ID NUMERIC No
Standard State/Province code as defined by the appropriate government agency.
36 O_PRESC_STATE_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
37 O_PRESC_ZIP VARCHAR No
Code defining international postal zone excluding punctuation and blanks (zip codes in US).
38 O_DATE_OF_INJURY_DT DATETIME No
Date on which the injury occurred.
39 O_EMPLOYER_NAME VARCHAR No
Employer's full name.
40 O_EMPLOYER_STREET VARCHAR No
Free-form text for address information.
41 O_EMPLOYER_CITY VARCHAR No
Free-form text for city name.
42 O_EMPLOYER_STATE_ID NUMERIC No
Standard State/Province Code as defined by appropriate government agency.
43 O_EMPLOYER_STATE_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
44 O_EMPLOYER_ZIP VARCHAR No
Code defining international postal zone excluding punctuation and blanks (zip code for US).
45 O_EMPLOYER_PHONE VARCHAR No
Employer's ten-digit phone number.
46 O_EMPLOYER_CONTACT VARCHAR No
Employer primary contact.
47 O_CARRIER_ID VARCHAR No
Carrier code assigned in Worker's Compensation Program.
48 O_CLAIM_ID VARCHAR No
Identifies the claim number assigned by Worker's Compensation Program.
49 O_BILL_TYPE_IND_ID NUMERIC No
NCPDP code that identifies the entity submitting the billing transaction.
50 O_BILL_TYPE_IND_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
51 O_PAY_TO_QUAL_ID NUMERIC No
The code that qualifies 'Pay to ID' (119-TT).
52 O_PAY_TO_QUAL_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
53 O_PAY_TO_ID VARCHAR No
The unique identifier of the entity to receive payment for a claim.
54 O_PAY_TO_NAME VARCHAR No
Name of the entity to receive payment for claim.
55 O_PAY_TO_STREET VARCHAR No
Street address of the entity to receive payment for claim.
56 O_PAY_TO_CITY VARCHAR No
City of the entity to receive payment for claim.
57 O_PAY_TO_STATE_ID NUMERIC No
Standard State/Province code as defined by the appropriate government agency.
58 O_PAY_TO_STATE_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
59 O_PAY_TO_ZIP VARCHAR No
Code defining international postal zone excluding punctuation and blanks (zip code for US).
60 O_GEN_EQ_PROD_Q_ID NUMERIC No
NCPDP code qualifying the 'Generic Equivalent Product ID' (126-UA).
61 O_GEN_EQ_PROD_Q_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
62 O_GEN_EQ_PROD_ID VARCHAR No
ID that identifies the generic equivalent of the brand product dispensed.
63 O_COUPON_TYPE_ID NUMERIC No
NCPDP code indicating the type of coupon being used.
64 O_COUPON_TYPE_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
65 O_COUPON_NUM VARCHAR No
Unique serial number assigned to the prescription coupons.
66 O_COUPON_VALUE NUMERIC No
Value of the coupon.
67 O_CMPND_DOSE_FRM_ID NUMERIC No
Dosage form of the complete compound mixture.
68 O_CMPND_DOSE_FRM_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
69 O_CMPND_DISP_FRM_ID NUMERIC No
NCPDP standard product billing codes.
70 O_CMPND_DISP_FRM_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
71 O_ADD_DOC_TYPE_ID NUMERIC No
Unique identifier for the additional data being submitted.
72 O_ADD_DOC_TYPE_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
73 O_REQ_BEGIN_DATE DATETIME No
The beginning date of need.
74 O_REQ_REVISED_DATE DATETIME No
The effective date of the revision or re-certification provided by the certifying physician.
75 O_REQ_STATUS_ID NUMERIC No
A unique code identifying the type of request.
76 O_REQ_STATUS_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
77 O_LEN_NEED_QUAL_ID NUMERIC No
NCPDP code qualifying the length of need.
78 O_LEN_NEED_QUAL_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
79 O_LENGTH_OF_NEED INTEGER No
Duration the physician expects the patient to require use of the ordered item.
80 O_PRESC_SIGNED_DATE DATETIME No
The date the form was completed and signed by the ordering physician.
81 O_SUPPORT_DOCUMENT VARCHAR No
Free text message for the Supporting Documentation field.
82 O_FACILITY_ID VARCHAR No
ID assigned to the patient's clinic/host party.
83 O_FACILITY_NAME VARCHAR No
Location of service's provided.
84 O_FACILITY_STREET VARCHAR No
Free-form text for facility address information.
85 O_FACILITY_CITY VARCHAR No
Free-form text for facility city name.
86 O_FACILITY_STATE_ID NUMERIC No
Standard State/Province code as defined by the appropriate government agency.
87 O_FACILITY_STATE_ID_EXT_CODE_LST_NAME VARCHAR No
The name of the list value.
88 O_FACILITY_ZIP VARCHAR No
Code defining international postal zone excluding punctuation and blanks (zip code for US).
89 O_NARRATIVE_MSG VARCHAR No
Free-form text for the Narrative Message field.
90 O_PRESC_FIRST_NAME VARCHAR No
Individual's first name.
91 O_PRESC_PHONE_NO VARCHAR No
Ten-digit phone number of the prescriber.
92 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.
93 SINGL_COMPON_CLM_YN VARCHAR No
Indicates if the adjudication attempt was adjudicating a single component for compound. 'N' or NULL indicate that the attempt was not adjudicating a single component of a compound. 'Y' indicates that the attempt was adjudicating a single component of a compound..
May contain organization-specific values: No
Category Entries:
No
Yes