Procella HelpdeskOverview
The Basis of Cost/MAC price data provides the ability of the PBM to create custom pricing. The pricing information is used in various edits (Ingredient, Dispensing Fee).
Assumptions
There is a prerequisite to loading the Basis of Cost data. The Basis of Cost process requires a registered Basis of Cost code. This code is setup in the Administration section under Basis of Cost Registration
Loads
Basis of Cost/MAC loads are intended to populate pricing information. Refer to this documentation on how to configure batch job and load the data into the system
When processing a batch file, there are 3 different item types of drug codes that can be used.
NDC9
NDC11
GPI14
Keep in mind that the most specific record is the NDC11. An NDC9 record may have one or more matching NDC11’s. The GPI14, the broadest item type, can include multiple NDC11’s in one GPI14 code, .
The GPI14 is the generic product indicator as published by Wolters Kluwer. This reflects the entire 14-digit code that represents all NDC products with the same Drug Name, Dosage and Strength. The GPI14 does not differentiate between brands and generics. Unit Costs submitted at the GPI14 level will be loaded for ALL NDC’s within the GPI14. This allows easier management with the batch file process.
The NDC9 code reflects the first 9 digits of an 11-digit National Drug Code. This item type implies that the unit cost is not specific to the package size of the drug reflected by the NDC. Therefore, during processing, any NDC that has a matching first 9 digits will receive the unit price.
The NDC11 code reflects the most specific level for the price file load. All pricing is stored at the NDC11 level. Therefore, submitting a record at the NDC11 code will load the unit price for one NDC11 only.
When the batch file is loaded, the order of the records is automatically resorted. All GPI14 records will be sorted, then the NDC9 records will be sorted, and then the NDC11 records will be sorted. The process does this as the last record loaded at the NDC11 level is kept when the NDC11 is reflected in GPI14 and/or NDC9 records. This maintains the most specific of the item types to be maintained.
While it is not required, sorting the file as noted above is recommended as a best business practice.
Action Codes
There are 3 action codes available for the Price List Batch file.
A – Add Record. The A code indicates to the system that a new record is being added and it does not match any previous record.
C – Change Record. The C code indicates that an existing record, but the unit price or End Date is being updated. This is typically used when an incorrect unit cost is submitted.
D – Deactivate Record. The Deactivate Record code effectively removes the record from processing. A Deactivated Record must match exactly all data elements with the exception of the Action Code. A Deactivated Record, once loaded, will not be used in processing moving forward. It is considered Inactive or logically deleted.
When you are adding a record, use the A-Action Code. This inserts the record into the system. If a record has an A-Action Code and the submitted record matches an existing record in the system, the record will be treated as a C-Change Record.
If a record is supplied with a C-Action Code, the system will check the existing records to see if there is a prior match. If there is a matching logic : (Basis of Cost Code, PBM Code, NDC11, Start Date. )
File Naming
Currently, the file name should end with the word 'SORTED'. It is recommended to follow the below format for easy reading
<PBMCODE>_PRICELOAD_<BASISOFCOSTCODE>_<DATE>_SORTED.txt
For eg.
ACMEPBM_PRICELOAD_ASCWALG_20230701_SORTED.txt
File Type
- The file is pipe delimited ( | ). The MAC batch file is a text file.
- The text file doesn't need any header row. Below is a sample of a batch file.
A|BIGMAC|GPI14|80302010102060| 0.1293 |20190101|99991231
A|BIGMAC|GPI14|86201000002000| 0.3070 |20190101|99991231
A|BIGMAC|GPI14|78110000000100| 0.0366 |20190101|99991231
A|BIGMAC|GPI14|78110000000300| 0.0359 |20190101|99991231
The data load begins once the file is validated - file name and format should match as mentioned int this article.
File Format Basis of Cost/MAC List
| Field Name | Length | Type | R/O | Description |
|---|---|---|---|---|
| Action_Code | 1 | A | R | Action Code of the member record. A = Add, C = Change, D = Deactivate Record |
| Basis_of_Cost_Code | 10 | A | R | The Basis of Cost code established for this price list. |
| Item_Type | 5 | A/N | R | Options: NDC11, NDC9, GPI14 |
| Item_ID | 14 | N | R | If the Item Type is: NDC11, Item ID must be 11 digits (all numbers). May be zero left padded up to 4 digits. 0000####### NDC9, Item ID must be 9 digits (all numbers). May be zero left padded up to 4 digits. 0000##### GPI14, Item ID must be 14 digits (number and character). May be zero left padded 0############# |
| Unit_Price | 16 | A/N | R | This is the UNIT price. 12 Digit Length; 9 digits to the left of the decimal, 6 to the right of the decimal; Total of 16 digits including the decimal. Format: #########.###### |
| Start_Date | 8 | N | R | The date the unit price is effective. Format: CCYYMMDD. Example: 20180901 is valid. |
| End_Date | 8 | N | R | The date the unit price is effective through. Format: CCYYMMDD. Example: 99991231 is valid. |
During the load process, the records may get rejected due to invalid data. Some of the common errors are listed below. Refer to this documentation to understand the error file that is generated for each load. The error file contains all the errors/warnings that occurred when loading the data into the system.
Invalid Action Code: If the submitted Action Code is not A, C, or D, the record will be rejected.
Invalid Item Type: If the submitted Item Type does not match NDC9, NDC11 or GPI14, the record will be rejected.
Invalid Item ID: If the value in the Item ID field does not match any record in the drug file, the record will be rejected.
Invalid Basis of Cost: If the Basis of Cost code is not the same as the filename or is not registered in the system, the record will be rejected.
Invalid PBM Code: If the PBMCODE is not valid in the filename or registered in the system, the record will be rejected.
Invalid Date: There are two date fields in the format. If the value submitted is not a valid value, the record will be rejected. If the End Date value is before the Start Date value, the record will be rejected.