Lookup Drug Rebate Report the value that defines the element. Rebate PC 72 11/8/12 Table - tlkpFlagIndicators int[1] Eligibility EXAMPLE: 1 = Yes, drug is eligible for a All 100% A2 Indicator Integer Indicator rebate to any entity. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report the amount of state sales tax applied to this claim line. Report 0 if state Required Amount of sales tax does not apply. Do not code when State applicable sales decimal or round up / down to whole PC 73 11/8/12 Integer Currency PC023 98% A2 Sales Tax tax on the claim dollars code zero cents (00) when does not = line applicable. EXAMPLE: 150.00 is MA reported as 15000; 150.70 is reported as 15070 Riskholders report the of the DBA here. DBAs report the OrgID of the Delegated CHIA defined insurance carrier here. This element Benefit and maintained contains the CHIA assigned organization PC 74 11/8/12 Integer ID Link to varchar[6] Org ID for ID for the DBA. Contact the APCD for the All 98% A2 linking across appropriate value. If no DBA is affiliated submitters with this claim line do not report any value ID here: i.e., do not repeat the OrgID from PC001 Lookup Formulary Report the value that defines the element. Formulary PC 75 11/8/12 - tlkpFlagIndicators int[1] inclusion EXAMPLE: 1 = Yes, drug is on the All 100% A2 Code Integer identifier formulary. Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Report Pharmaceutical Route of of Lookup Route of Administration Indicator that defines PC 76 11/8/12 Table - char[2] All 80% A2 Administration method of drug administration. Numeric EXAMPLE: 11 = Oral Value Description
PC 72 Rebate Indicator 11/8/12 Lookup Table - Integer tlkpFlagIndicators int[1] Drug Rebate Eligibility Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, drug is eligible for a rebate to any entity. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PC 73 State Sales Tax 11/8/12 Integer Currency Amount of applicable sales tax on the claim line Report the amount of state sales tax applied to this claim line. Report 0 if state sales tax does not apply. Do not code decimal or round up / down to whole dollars code zero cents (00) when applicable. EXAMPLE: 150.00 is reported as 15000; 150.70 is reported as 15070 Required when PC023 does not = MA 98% A2 PC 74 Delegated Benefit ID 11/8/12 Integer ID Link to varchar[6] CHIA defined and maintained Org ID for linking across submitters Riskholders report the of the DBA here. DBAs report the OrgID of the insurance carrier here. This element contains the CHIA assigned organization ID for the DBA. Contact the APCD for the appropriate value. If no DBA is affiliated with this claim line do not report any value here: i.e., do not repeat the OrgID from PC001 All 98% A2 PC 75 Formulary Code 11/8/12 Lookup - Integer tlkpFlagIndicators int[1] Formulary inclusion identifier Report the value that defines the element. EXAMPLE: 1 = Yes, drug is on the formulary. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PC 76 of 11/8/12 Lookup Table - Numeric char[2] Route of Administration Report Pharmaceutical Route of Administration Indicator that defines method of drug administration. EXAMPLE: 11 = Oral All 80% A2 Value Description
v6-apcd-pharmacy-claim-file-submission-guide-Redline-.docx