| Name | Description | Type | Additional information |
|---|---|---|---|
| ClaimNo | integer |
None. |
|
| TransactionResponseStatus | string |
None. |
|
| RejectMessage | string |
None. |
|
| PharmacyPrice | decimal number |
None. |
|
| PatientPayAmount | decimal number |
None. |
|
| TotalAmountPaid | decimal number |
None. |
|
| IsSuccessful | boolean |
None. |
|
| ResponseString |
NCPDP Response String (Base64 encoded) |
string |
None. |
| AdminFee | decimal number |
None. |
|
| AmountAppliedToPeriodicDeductible | decimal number |
None. |
|
| AmountOfCoPay | decimal number |
None. |
|
| AmountOfCoInsurance | decimal number |
None. |
|
| IngredientCostPaid | decimal number |
None. |
|
| DispensingFeePaid | decimal number |
None. |
|
| BasisOfReimbursement | string |
None. |