Procella HelpdeskFile Format: Procella system exports the data in Tab-delimited CSV File
Export File Naming Format: <ExportDate>_<ExportTime>_<ID>_<PbmID>_CLAIM_EXTRACTION_<FromDate>_<ToDate>.csv
Example: 240404_111989_1234_ACMEPBM_CLAIM_EXTRACTION_20240101_20240201.csv
| FIELD # | EXTRACT FIELD NAME | DESCRIPTION | CODES/Values |
| 1 | DataFileType | Extract Format | CESTD_V05.1 |
| 2 | BIN | Card Issuer ID or Bank ID Number used for network routing. | |
| 3 | Processor_Control_Number | Number assigned by the processor. | |
| 4 | Filler_01 | For Future Use | |
| 5 | Filler_02 | For Future Use | |
| 6 | Filler_03 | For Future Use | |
| 7 | Filler_04 | For Future Use | |
| 8 | File_Type | Code identifying whether the file contained is test or production data. | P - Production |
| 9 | Record_Indicator | Action to be taken on record | 0 - New Record 1 - Overwrite Existing 2 - Delete Existing Record |
| 10 | Transaction_Response_Status | Code indicating the status of the transaction. | A - Approved D - Duplicate of Paid P - Paid R - Rejected S - Duplicate of Approved |
| 11 | Claim_Status_Code | The end status of the claim. | 0 - Reject 1 - Paid 2 - Reversal 3 - Denied 4 - Duplicate of Approved |
| 12 | Claim_Type_Code | The type of claim processed | 1 - POS Claim 2 – DMR |
| 13 | Transaction_Code | Code identifying the type of transaction. | B1 - Billing Transaction B2 - Reversal Transaction |
| 14 | Response_Status | A - Approved D - Duplicate of Paid P - Paid R - Rejected S - Duplicate of Approved | |
| 15 | Provider Network | The Name of the Provider Network used for processing | |
| 16 | Cardholder_ID | The Cardholder ID assigned to the family | |
| 17 | Member_Last_Name | The Member Last Name | |
| 18 | Member_First_Name | The Member First Name | |
| 19 | Submitted_Date_Of_Birth_Member | The Submitted Date of Birth of the Member | |
| 20 | Gender_Code | The Submitted Gender Code of the Member | U - Unknown M - Male F - Female |
| 21 | Submitted_Person_Code | The Submitted Person Code for the Member | |
| 22 | Filler_06 | For Future Use | |
| 23 | Group_ID_Adjudicated | Group ID used for Adjudication | |
| 24 | Group_ID_Submitted | Group ID submitted on the claim | |
| 25 | Other_Coverage_Code | The Other Coverage Code as submitted for the Member | |
| 26 | Provider_ID_Qualifier | Code qualifying the Service Provider ID | 01 - NPI 02 - Blue Cross ID 03 - Blue Shield ID 04 - Medicare ID 05 - Medicaid ID 06 - UPIN 07 - NCPDP ID 08 - State License ID 09 - Tricare ID 10 - HIN 11 - Federal Tax ID 12 - DEA 13 - State Issued ID 14 - Plan Specific 15 - HCIdea ID |
| 27 | Provider_ID | The Service Provider ID of the dispensing provider. | |
| 28 | Filler_07 | For Future Use | |
| 29 | Provider_Name | The name of the Provider | |
| 30 | Provider_Address1 | The Street Address of the provider | |
| 31 | Provider_Address2 | The Street Address of the provider | |
| 32 | Provider_City | The City of the provider | |
| 33 | Provider_State | The State of the Provider | |
| 34 | Provider_Zip | The Zip Code of the Provider | |
| 35 | Prescriber_Id_Qualifier | The Prescriber ID Qualifier | 01 - NPI 02 - Blue Cross ID 03 - Blue Shield ID 04 - Medicare ID 05 - Medicaid ID 06 - UPIN 07 - NCPDP ID 08 - State License ID 09 - Tricare ID 10 - HIN 11 - Federal Tax ID 12 - DEA 13 - State Issued ID 14 - Plan Specific 15 - HCIdea ID |
| 36 | Prescriber_Id | The Submitted Prescriber ID | |
| 37 | Prescriber_Last_Name | Prescriber Last Name | |
| 38 | Prescriber_First_Name | Prescriber First Name | |
| 39 | Service_Reference_Number_Qualifier | Indicates the type of billing submitted. | 1 - Rx Billing |
| 40 | Service_Reference_Number | Reference number assigned by the provider for the dispensed drug/product and/or service provided. | |
| 41 | Product_Service_Id_Qualifier | Code qualifying the value in 'Product/Service ID' (407-D7). | 03 - National Drug Code |
| 42 | Product_Service_Id | ID of the product dispensed or service provided. | |
| 43 | Date_Service | The date of service of the claim. Also known as the date the Provider filled the prescription for the member. | |
| 44 | Date_Adjudication | The date the claim was processed adjusted to Eastern Time Zone | |
| 45 | Time_Adjudicated | The UTC Time the claim was adjudicated | |
| 46 | Date_Adjudication_UTC | The date the claim was processed based on Coordinated Univeral Time/Zulu | |
| 47 | Quantity_Dispensed | The metric quantity dispensed for the claim. | |
| 48 | Fill_Number | The code indicating whether the prescription is an original or a refill. | |
| 49 | Days_Supply | Estimated number of days the prescription will last. | |
| 50 | Date_Rx_Written | The date the Prescription was written by the Prescriber. | |
| 51 | DAW_PSC_Code | Dispense As Written, Product Service Selection Code | 0 - No Product Selection Indicated 1 - Substitution Not Allowed by Prescriber 2 - Substitution Allowed, Patient Requested Product Dispensed 3 - Substitution Allowed, Pharmacist Selected Product Dispensed 4 - Substitution Allowed, Generic not in Stock 5 - Substitution Allowed, Brand dispensed as Generic 6 - Override 7 - Substitution not allowed, Brand Mandated by law. 8 - Substitution Allowed, Generic Drug not available in Marketplace 9 - Substitution Allowed by Prescriber, Plan Requested Brand |
| 52 | Number_Refills_Authorized | Number of refills authorized by the prescriber. | |
| 53 | Unit_Of_Measure | The Strength Unit of Measure (SUM), when combined with the Strength, represents the dosage strength as provided by the manufacturer. | |
| 54 | Compound_Code | Code indicating whether or not the prescription is a compound. | 1 - Not a Compound 2 - Compound |
| 55 | Reject_Code_1 | NCPDP Standard Reject Code, first code | See NCPDP Reject Code listing |
| 56 | Reject_Code_2 | NCPDP Standard Reject Code, second code | See NCPDP Reject Code listing |
| 57 | Reject_Code_3 | NCPDP Standard Reject Code, third code | See NCPDP Reject Code listing |
| 58 | Reject_Code_4 | NCPDP Standard Reject Code, forth code | See NCPDP Reject Code listing |
| 59 | Reject_Code_5 | NCPDP Standard Reject Code, fifth code | See NCPDP Reject Code listing |
| 60 | Drug_Name | The Drug Name for the dispensed product | |
| 61 | Generic_Name | The Generic Name of the drug dispensed | |
| 62 | Multi_Source_Code | The Multi-Source Code identifies drug products as either single- or multiple-source original drug products or a generic copy of the standard drug product. | N - Single Source Product M - Single-Source, co-licensed product O - Multi-source, originator product Y - Multi Source Product |
| 63 | Maintenance_Drug_Indicator | The Maintenance Drug Code indicates whether or not the drug is considered a maintenance drug. | 0 - Undetermined 1 - Not a Maintenance Drug 2 - Maintenance Drug |
| 64 | Third_Party_Restriction_Code | The Third-Party Restriction Code can be used by Third Party Administrators (TPAs) for identifying drug products for formulary exclusion (such as oral contraceptives) or inclusion (for example, vitamins). | 1 - Insulin 2 - Oral Contraceptives 3 - Surgical Supply/Medical Device/Ostomy 4 - Blood Component 5 - Diagnostic Agent 6 - General Anesthetic 7 - Fertility Drugs 8 - Anorexic, Anti-obesity 9 - Multiple Vitamin A - Used for HIV Infection B - Bulk Chemicals C - Cosmetic Alteration Drugs D - Antidepressants F - Multiple Vitamin with Fluoride G - Growth Hormones/Biosynthetic Hormones H - Hypnotics/Sedatives I - Multiple Vitamin with Iron J - Digital Therapy K - Non Oral Systemic Contraceptives L - Contraceptives Other M - Immunosuppressants P - Antipsychotics S - Smoking Deterrents T - Antianxiety Agents V - Impotence and (HSDD) Agents |
| 65 | DEA_Class_Code | The DEA Class Code identifies federally controlled substances classified by the Drug Enforcement Administration (DEA). | 1 - No accepted Medical use 2 - High Abuse, Severe Dependence liability 3 - Moderate dependence Liability 4 - Limited abuse Potential 5 - Limited abuse Potential, small amounts |
| 66 | Rx_Otc_Indicator_Code | The RX-OTC Indicator Code indicates federal prescription (Rx) or Over-the-Counter (OTC) status. | O - OTC, Single Source P - OTC, Multiple Source R - Rx, Single Source S - Rx, Multiple Source |
| 67 | Generic_Product_Indicator | The Medispan Generic Product Identifier (GPI) categorizes drug products by a hierarchical therapeutic classification scheme. | |
| 68 | Formulary_Status_Code | The Status code for the drug dispensed on the Formulary | 1 - No Formulary on plan 2 - Formulary, Open 3 - Formulary, Closed 4 - Non-Formulary |
| 69 | Formulary_Compliance_Code | The compliance code for the drug on the Formulary. This reflects the Formulary and Preferred Drug status of the product dispensed. | F - Formulary, No Preferred Drug FP - Formulary, Preferred Drug FN - Formulary, Non-Preferred Drug NF - Non-Formulary, No Preferred Drug NP - Non-Formulary, Preferred Drug NN - Non-Formulary, Non-Preferred Drug 1X - No Formulary, No Preferred Drug 1P - No Formulary, Preferred Drug 1N - No Formulary, Non-Preferred Drug |
| 70 | Preferred_Drug_Status_Code | The Preferred Drug Tier for the dispensed drug. | NP - Non-Preferred Drug XP - No Preferred Drugs P1 - Preferred Drug Tier 1 P2 - Preferred Drug Tier 2 P3 - Preferred Drug Tier 3 P4 - Preferred Drug Tier 4 P5 - Preferred Drug Tier 5 P6 - Preferred Drug Tier 6 P7 - Preferred Drug Tier 7 P8 - Preferred Drug Tier 8 P9 - Preferred Drug Tier 9 |
| 71 | Usual_And_Customary | Amount charged cash customers for the prescription exclusive of sales tax or other amounts claimed. | |
| 72 | Gross_Amount_Due | The Submitted Gross Amount Due value as submitted by the provider. | |
| 73 | Filler_10 | For Future Use | |
| 74 | Ingredient_Cost_Paid | The contracted ingredient cost paid to the Provider | |
| 75 | Dispensing_Fee_Paid_Provider | The dispensing fee paid to the Provider | |
| 76 | Amount_Attributed_To_Tax | Amount to be collected that is attributable to tax. | |
| 77 | Patient_Pay_Amount | The total amount the Patient Pays towards the claim. | |
| 78 | Amount_Of_Copay | Amount to be collected from the patient that is due to a per prescription coinsurance/copay. | |
| 79 | Basis_Of_Cost | The cost basis used for the reimbursement determination | 1 - SBM Ingredient 2 - AWP 3 - Ingr Reduced to AWP less X% 4 - U&C 5 - Paid Lower of U&C/Contract 6 - MAC Pricing Ingredient Cost Paid 7 - MAC Pricing Ingredietn reduced to MAC 8 - Contract Price 9 - Acquisition Price 10 - Average Sales Price 11 - Average Manufacturer Price 12 - 340B/Disproportionate Share Pricing 13 - Wholesale Acquisition Price 14 - Ohter Payer-Patient Responsibility Amount 15 - Patient Pay Amount 16 - Coupon Payment 17 - Special Patient Reimbursement 18 - Direct Price 19 - State Fee Schedule 20 - National Average Drug Acquisition Cost 21 - State Average Acquisition Cost 22 - Ingredient Cost Paid based on Submitted Basis of Cost of Free Product |
| 80 | Brand_Class | The Brand Class of the drug | |
| 81 | Brand_Name_Code | The Brand Name Code indicates the type of name used in the Drug Name | T - Trademarked Name B - Branded Generic Name G - Generic Name |
| 82 | AWP_Total_Cost | The Total AWP before discount for the quantity dispensed. | |
| 83 | Net_Amount_Due | The Net Amount Due (Total Rx Cost less Patient Pay) | |
| 84 | Transaction_Id_Cross_Reference | The Procella Internal Transaction ID of the referenced claim. This is typically null, present only when the claim has been reversed. The Transaction ID Cross Reference on a REVERSED claim will be the Transaction ID of the associated PAID claim. The Transaction ID Cross Reference on a PAID claim will be the Transaction ID of the associated REVERSED claim. | |
| 85 | Transaction_Id | The Procella Internal Unique Transaction ID assigned to the claim | |
| 86 | SBM_Authorization_Number | Number submitted by the provider to identify the prior authorization. | |
| 87 | Program_Admin_Fee_Amount | The final amount of the applied Program Administration Fee that is the member responsibility. | |
| 88 | Program_Admin_Fee_Status | Indicates if the Program Admin Fee was a full fee or a partial fee. | |
| 89 | Brand_Class_Final | The Brand class of the drug after processing rules. | |
| 90 | Plan_ID | The Plan ID used for claim processing. | |
| 91 | Plan_Name | The Name of the Plan. | |
| 92 | FAMILY ATTR_1 | This is for client use to store any common attribute applicable to the Family. (For eg., if any specific coverage code value to be stored). | |
| 93 | FAMILY ATTR_2 | This is for client use to store any common attribute applicable to the Family | |
| 94 | FAMILY ATTR_3 | This is for client use to store any common attribute applicable to the Family | |
| 95 | FAMILY ATTR_4 | This is for client use to store any common attribute applicable to the Family | |
| 96 | FAMILY ATTR_5 | This is for client use to store any common attribute applicable to the Family | |
| 97 | MEMBER ATTR_1 | This is for client use to store any specific attribute applicable to the Member. For eg., This attribute can be used to indicate Diabetic patient or Out of state-dependent etc. | |
| 98 | MEMBER ATTR_2 | This is for client use to store any specific attribute applicable to the Member | |
| 99 | MEMBER ATTR_3 | This is for client use to store any specific attribute applicable to the Member | |
| 100 | MEMBER ATTR_4 | This is for client use to store any specific attribute applicable to the Member | |
| 101 | MEMBER ATTR_5 | This is for client use to store any specific attribute applicable to the Member |