| Name | Description | Type | Additional information |
|---|---|---|---|
| PharmacyNPI |
Gets or sets a Pharmacy NPI. If this field is supplied IngredientCostSubmitted, DispenseFeeSubmitted, IncentiveFeeSubmitted, UsualAndCustomaryAmount, and GrossAmountDue are required. |
string |
None. |
| IngredientCostSubmitted |
Gets or sets the ingredient cost submitted. If this field is supplied PharmacyNPI, DispenseFeeSubmitted, IncentiveFeeSubmitted, UsualAndCustomaryAmount, and GrossAmountDue are required. |
decimal number |
None. |
| DispenseFeeSubmitted |
Gets or sets the dispense fee submitted. If this field is supplied PharmacyNPI, IngredientCostSubmitted, IncentiveFeeSubmitted, UsualAndCustomaryAmount, and GrossAmountDue are required. |
decimal number |
None. |
| IncentiveFeeSubmitted |
Gets or sets the incentive fee submitted. If this field is supplied PharmacyNPI, IngredientCostSubmitted, DispenseFeeSubmitted, UsualAndCustomaryAmount, and GrossAmountDue are required. |
decimal number |
None. |
| UsualAndCustomaryAmount |
Gets or sets the usual and customary amount. If this field is supplied PharmacyNPI, IngredientCostSubmitted, DispenseFeeSubmitted, IncentiveFeeSubmitted, and GrossAmountDue are required. |
decimal number |
None. |
| GrossAmountDue |
Gets or sets the gross amount due. If this field is supplied PharmacyNPI, IngredientCostSubmitted, DispenseFeeSubmitted, IncentiveFeeSubmitted, and UsualAndCustomaryAmount are required. |
decimal number |
None. |
| RxCPersonID |
Gets or sets the patient's RxClearinghouse ID |
integer |
None. |
| NDC |
Gets or sets the drug's NDC |
string |
None. |
| PlanContractNo |
Gets or sets the plan contract identifier |
integer |
None. |
| PrescriptionReferenceNumber |
Gets or sets the claim's Rx Number |
string |
None. |
| FillNumber |
Gets or sets the claim's Fill Number |
byte |
None. |
| QuantityDispensed |
Gets or sets the claim's Quantity Dispensed |
decimal number |
None. |
| QuantityPrescribed |
Gets or sets the claim's quantity prescribed. |
integer |
None. |
| DaysSupply |
Gets or sets the claim's Days Supply |
byte |
None. |
| DateOfService |
Gets or sets the claim's Date of Service |
date |
None. |
| FlatSalesTax |
Gets or sets the claim's flat sales tax. |
decimal number |
None. |
| SalesTaxPercent |
Gets or sets the claim's sales tax percent. |
decimal number |
None. |
| DAWCode |
Gets or sets the claim's Dispense as Written code |
string |
None. |
| DateWritten |
Gets or sets the claim's date the prescription was written. |
date |
None. |
| PrescriberID |
Gets or sets the claim's prescriber's ID, typically the NPI number. |
string |
None. |
| PrescriberFirstName |
Gets or sets the claim's prescriber's first name. |
string |
None. |
| PrescriberLastName |
Gets or sets the claim's prescriber's last name. |
string |
None. |
| SubmissionClarificationCode |
Gets or sets the claim's submission clarification code. |
string |
None. |
| ReasonForServiceCode |
Gets or sets the claim's reason for service code. |
string |
None. |
| ProfessionalServiceCode |
Gets or sets the claim's professional service code. |
string |
None. |
| ResultOfServiceCode |
Gets or sets the claim's result of service code. |
string |
None. |
| OtherPayerPatientResponsibilityAmount |
Gets or sets the claim's other payer balance if this is a secondary claim. |
decimal number |
None. |
| IsEmergencyPrescription |
Gets or sets whether the prescription is an emergency prescription for the claim. |
boolean |
None. |
| IsCompound |
Gets or sets whether the prescription is a compound for the claim. |
boolean |
None. |
| CompoundIngredients | Collection of CompoundIngredientModel |
None. |
|
| IngredientCostPaid |
Gets or sets the ingredient cost paid. If this field is supplied DispenseFeePaid, IncentiveFee, and SalesTaxPaid are required. |
decimal number |
None. |
| DispenseFeePaid |
Gets or sets the dispense fee paid. If this field is supplied IngredientCostPaid, IncentiveFee, and SalesTaxPaid are required. |
decimal number |
None. |
| IncentiveFee |
Gets or sets the incentive fee that is added to the drug price. If this field is supplied IngredientCostPaid, DispenseFeePaid, and SalesTaxPaid are required. |
decimal number |
None. |
| SalesTaxPaid |
Gets or sets the total amount of sales tax paid (including flat rate amount). If this field is supplied IngredientCostPaid, DispenseFeePaid, and IncentiveFee are required. |
decimal number |
None. |
| Copay |
Gets or sets the member responsible amount. If this field is supplied CoinsuranceRate is required. |
decimal number |
None. |
| CoinsuranceRate |
Gets or sets the member responsible rate. If this field is supplied Copay is required. |
decimal number |
None. |
| OOPCopay |
Gets or sets the member out of pocket amount. If this field is supplied OOPCoinsuranceRate is required. |
decimal number |
None. |
| OOPCoinsuranceRate |
Gets or sets the member out of pocket rate. If this field is supplied OOPCopay is required. |
decimal number |
None. |
| ExemptFromDeductible |
Gets or sets a value indicating whether the claim is exempt from deductible. |
boolean |
None. |
| ExemptFromOutOfPocketLimit |
Gets or sets a value indicating whether the claim is exempt from out-of-pocket limit. |
boolean |
None. |
| ExternalClaimNo |
Gets or sets an external claim number. |
string |
None. |
| Notes |
Gets or sets a claim's notes. |
string |
None. |
| DiagnosisCodes | Collection of DiagnosisCodeModel |
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. |