| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | audit id(+) | 0;1 | NUMERIC | B | This is the Audit ID that represents this specific audit record. | |
| 1 | prescription | 0;2 | POINTER | 52 | C | This is the prescription number associated with this audit record. |
| 2 | fill | 0;3 | NUMERIC | This is the Refill number associated with the prescription. The original fill is always '0'. | ||
| 3 | patient | 0;4 | POINTER | 2 | This is the Patient for whom the medication was prescribed. | |
| 4 | division | 0;5 | POINTER | 59 | D | This the Outpatient Pharmacy Division from which the RX/Fill was dispensed. |
| 5 | provider | 0;6 | POINTER | 200 | F | This is the Provider who prescribed the medication. |
| 6 | ndc | 0;7 | FREE TEXT | This is the National Drug Code (NDC) of the drug identified in the DRUG field. | ||
| 7 | drug | 0;8 | POINTER | 50 | This is the drug prescribed to the patient. | |
| 8 | bill cost | 0;9 | NUMERIC | This is the total bill cost for the TRICARE prescription being audited. | ||
| 9 | ecme number | 0;10 | FREE TEXT | This is the Electronic Claims Management Engine (ECME) number associated with the ePharmacy billing transaction. | ||
| 10 | qty | 0;11 | NUMERIC | This is the quantity of medication dispensed. | ||
| 11 | patient status | 1;1 | POINTER | 53 | This is the RX PATIENT STATUS that represents the authorization for the RX. This is independent of the eligibility code assigned to the patient by Medical Administration Service (MAS) representative. | |
| 12 | audit type | 1;2 | SET OF CODES | R:NCPDP REJECT N:NON BILLABLE RX I:INPATIENT P:PARTIAL FILL | This is the type of audit associated with a TRICARE/CHAMPVA Bypass or Override event. | |
| 13 | ncpdp reject code | 3;0 | MULTIPLE | 52.8713 | This multiple is used to store the NCPDP Rject Code(s) returned in the ECME response from the TRICARE payer indicating the reason(s) why the claim was rejected. | |
| 14 | user | 1;4 | POINTER | 200 | The person who is responsible for creating the audit record. This would either be a Pharmacy system user or Postmaster if the audit is created by a background process. | |
| 15 | date of action | 1;5 | DATE-TIME | E | This is the Date/Time that the event that generated the audit record occurred. | |
| 16 | date of service | 1;6 | DATE-TIME | This is the Date the prescription was filled or professional service rendered. | ||
| 17 | justification | 2;1 | FREE TEXT | This is used to hold the free-text explanation why the TRICARE or CHAMPVA prescription was bypassed or overridden. For partial fills, the reason is hard-coded to [TRICARE or CHAMPVA] "Partial Fill". For 'Inpatient Meds (Bypass)',the justification is hard-coded to [TRICARE or CHAMPVA] "INPATIENT/DISCHARGE". Overrides (TRICARE/CHAMPVA rejects and TRICARE/CHAMPVA non-billables) come from user entry. | ||
| 18 | eligibility | 1;3 | SET OF CODES | T:TRICARE C:CHAMPVA | This field is the eligibility indicator of the event type. |
Not Referenced