Data Dictionary Report Template



|Name: Participant is locked in to a pharmacy on the date of |  |  |  |

|service, but not the pharmacy on the claim. | | | |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |

|Name: A Clinical segment was received with an eligibility, a reversal, a prior|  |  |  |

|authorization reversal, or a prior authorization inquiry request. | | | |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |

|Name: M/I OTHER COVERAGE CODE |  |  |  |

|Conditions |

|Name: Missing/Invalid DUR/PPS Segment |  |  |  |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Field Name |Copybook |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |

|Name: Plan Limits Exceeded on Intended Partial Fill Values |  |  |  |

|Conditions |

|Name: Other Amount Claimed Submitted Count Does Not Match Number Of |  |  |  |

|Repetitions | | | |

|Conditions |Field Name |Copybook |1 |

|Conditions |Column |Table |1 |

|Conditions |Field name |Copybook |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |

|Name: Claim not processed |  |  |  |

|Conditions |

|Name: Claim not processed |  |  |  |

|Conditions |

|Name: Claim not processed |  |  |  |

|Conditions |

|Name: Claim not processed |  |  |  |

|Conditions |

|Name: Cannot adjust a credit of adjustment history claim |  |  |  |

|Conditions |Column |Table |1 |

|Conditions |Column |Table |1 |

|Conditions |

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