| Name | Description | Type | Additional information |
|---|---|---|---|
| GroupNo |
Gets or sets Group identifier |
integer |
None. |
| FacilityBranchNo |
Gets or sets the Facility Branch identifier |
integer |
None. |
| FacilityUrl |
Gets or sets the Facility Url |
string |
None. |
| TransactionCode |
Gets or sets the Transaction code |
string |
None. |
| MemberSeqNo |
Gets or sets the Member sequence identifier |
integer |
None. |
| Member |
Gets or sets the Member |
MemberModel |
None. |
| PrescriptionReferenceNumber |
Gets or sets the Prescription reference number |
string |
None. |
| FillNumber |
Gets or sets the Fill number |
integer |
None. |
| ProductID |
Gets or sets the Product identifier |
string |
None. |
| DateOfService |
Gets or sets the Date of Service |
date |
None. |
| SubmittedClaimNumber |
Gets or sets the Submitted Claim number |
string |
None. |
| ResubmittedClaimNumber |
Gets or sets the Resubmitted Claim number |
string |
None. |
| Approved |
Gets or sets the Approved indicator |
boolean |
None. |
| Notes |
Gets or sets the Notes |
string |
None. |
| PriorAuthPersistentNo |
Gets or sets the Prior Auth Presistent identifier |
integer |
None. |
| PriorAuthPersistentUrl |
Gets or sets the Prior Auth Persistent Url |
string |
None. |
| QuantityDispensed |
Gets or sets the Quantity Dispensed |
decimal number |
None. |
| DaysSupply |
Gets or sets the Days supply |
integer |
None. |
| CopayOverride |
Gets or sets the Copay override |
decimal number |
None. |
| CoinsuranceOverride |
Gets or sets the Coinsurance override (Enter the percentage in decimal form (e.g., 0.25 for 25%)) |
decimal number |
None. |
| OverrideTypeNo |
Gets or sets the Override type identifier |
integer |
None. |
| OverrideTypeUrl |
Gets or sets the Override Type Url |
string |
None. |
| VariableCopayAmount |
Gets or sets the Variable Copay Amount |
decimal number |
None. |
| OOPCopayOverride |
Gets or sets the out of pocket Copay Override |
decimal number |
None. |
| OOPCoinsuranceOverride |
Gets or sets the out of pocket Coinsurance Override (Enter the percentage in decimal form (e.g., 0.25 for 25%)) |
decimal number |
None. |
| CopayCardAmount |
Gets or sets the Copay Card Amount |
decimal number |
None. |
| ExemptFromDeductible |
Gets or sets Exempty From Deductible indicator |
boolean |
None. |
| ExemptFromOutOfPocketLimit |
Gets or sets Exempt From Out of Pocket Limit indicator |
boolean |
None. |
| Url |
Gets or sets the link representing a link back to the resource |
string |
None. |
| ID |
Gets or sets the identifier for the resource |
integer |
None. |