Prescription Update Callback
INFO
Root Fields
Field Name | Type | Notes |
---|---|---|
APIKey | string | Optional field that can be used for authentication purposes. It’s up to the third party partner whether this field will be required or not. |
PharmacyNumber | string | Number to help identify the pharmacy the data is coming from. By default BestRx will send the NPI number, but that can be changed if requested by the receiving partner. |
PharmacyNumber_Alt | string | An alternate pharmacy identifier can be provided if needed. Most integrations will not need this value. |
transaction_id | string | Unique identifier for the particular fill of the prescription. This value should be used when considering whether to add a new record or update an existing one. |
transaction_date | string | Date transaction is sent in YYYY-MM-DD format. This value is sent as the UTC date. |
transaction_time | string | Time transaction is sent in HH:MM:SS (24 hour) format. This value is sent as the UTC time. |
transaction_time_fraction | string | Time fraction transaction is sent, with 7 decimal places |
rx_number | string | Prescription number |
patient_id | integer | Unique identifier of the patient in the BestRx system. |
patient_last_name | string | Patient’s last name |
patient_first_name | string | Patient’s first name |
patient_middle_name | string | Patient’s middle name |
patient_prefix | string | Prefix to patient’s name (ie Mr. Mrs., etc) |
patient_suffix | string | Suffix to patient’s name (ie Jr, III, etc) |
patient_address1 | string | Patient street address line 1 |
patient_address2 | string | Patient street address line 2 ( ie Unit Number or other identifying info) |
patient_city | string | Patient’s city portion of address |
patient_state | string | Patient’s state portion of address |
patient_zip | string | Patient’s zip code |
patient_home_phone | string | Patient’s home phone number |
patient_cell_phone | string | Patient’s cell phone number |
patient_work_phone | string | Patient’s work phone number |
patient_dob | string | Patient date of birth in YYYY-MM-DD format |
patient_gender | string | Patient’s gender (M/F/N) **N=Non-Binary |
patient_email | string | Patient’s email address |
patient_group | array | Array of groups that the patient is linked to. This is a repeating field. Please refer to the Groups section of this document for more info. |
family_email | string | Family’s shared email address |
patient_short_remark | string | Short remark relating to the patient |
patient_remark | string | Long remark relating to the patient |
family_remark | string | Shared remark relating to entire family |
patient_shipto_organization | string | Ship To organization name |
patient_shipto_last_name | string | Ship To last name |
patient_shipto_first_name | string | Ship To first name |
patient_shipto_careof | string | Ship To “care of” name |
patient_shipto_address1 | string | Ship To street address line 1 |
patient_shipto_address2 | string | Ship To street address line 2 |
patient_shipto_city | string | Ship To City |
patient_shipto_state | string | Ship To state |
patient_shipto_zip | string | Ship To zip code |
patient_shipto_phone | string | Phone number related to the Ship To Address |
is_deactivated | boolean | Indicated whether the prescription was deactivated by the pharmacy (true/false) |
transferred_out | boolean | Indicates whether the prescription was transferred out to another pharmacy (true/false) |
transferred_pharmacy | string | Name of the pharmacy the prescription was transferred to |
transferred_pharmacy_address1 | string | Address line 1 of the pharmacy the prescription was transferred to |
transferred_pharmacy_address2 | string | Address line 2 of the pharmacy the prescription was transferred to |
transferred_pharmacy_city | string | City of the pharmacy the prescription was transferred to |
transferred_pharmacy_state | string | State of the pharmacy the prescription was transferred to |
transferred_pharmacy_zip | string | Zip code of the pharmacy the prescription was transferred to |
transferred_pharmacy_phone | string | Phone number of the pharmacy the prescription was transferred to |
transferred_pharmacy_fax | string | Fax number |
transferred_pharmacy_ncpdp | string | NCPDP number of the pharmacy the prescription was transferred to |
transferred_pharmacy_npi | string | NPI number of the pharmacy the prescription was transferred to |
transferred_pharmacy_dea | string | DEA number of the pharmacy the prescription was transferred to |
transfer_date | string | The date the prescription was transferred |
transfer_contact_name | string | The contact name of the person at the pharmacy the prescription was transferred to |
transfer_rph_initials | string | Initials of the pharmacist at your pharmacy that handled the transfer |
transfer_rph_user_id | string | BestRx User ID of the pharmacist at your pharmacy that handled the transfer |
transfer_rph_last_name | string | Last Name of the pharmacist at your pharmacy that handled the transfer |
transfer_rph_first_name | string | First Name of the pharmacist at your pharmacy that handled the transfer |
transferfrom_pharmacy | object | Information about the pharmacy that transferred the prescription to this pharmacy. Please see the Pharmacy Info section for more details |
bill_status | string | Coded value for the Billing Status of the prescription. Please refer to Appendix A for a list of bill status codes and their descriptions. |
bill_status_text | string | Text Description for the billing status of this prescription. |
workflow_status | string | Coded value for the Workflow Status of the prescription. Please refer to Appendix B for a list of workflow statuses and their descriptions. |
workflow_status_text | string | Text Description for the workflow status of the prescription |
workflow_queues | array | Array of workflow queues the prescription is in. This is a repeating field. Please refer to the Workflow Queues section of this document for more info. |
fill_number | string | Fill Number of the prescription (1 = original, 2 = first refill, 3 = second refill, etc). |
fill_date | string | Date the prescription was filled. Also knows as Date of Service. Value will be in YYYY-MM-DD format. |
fill_time | string | Time prescription was entered into the system. Value will be in HH:MM:SS (24 hour) format. |
picked_up | string | Indicates if the prescription was picked up (true/false) |
delivered | string | Indicates if the prescription was delivered (true/false) |
qty_ordered | string | Quantity that the doctor prescribed for each fill |
qty_filled | string | Quantity that was dispensed for this fill |
days_supply | string | Days supply dispensed for this fill |
refills_authorized | string | Number of refills authorized by the doctor |
refills_remaining | string | Number of refills that are remaining for this prescription. This could be a decimal value if there were partial fills involved. |
refill_number | string | Refill number of the prescription (0 = original, 1 = first refill, 2 = second refill, etc). |
refill_exp_date | string | Latest date at which the prescription can still be refilled. |
item_upc_code | string | For OTC items, the UPC code of the item |
drug_ndc | string | The NDC of the dispensed drug. |
drug_ndc_10digit | string | The NDC of the dispensed drug in 10-digit format without dashes. |
drug_ndc_10digit_formatted | string | The NDC of the dispensed drug in 10-digit format with dashes. |
drug_gpi | string | The GPI of the dispensed drug. The GPI allows you to check if drugs with different NDC’s are therapeutically equivalent or related.Please see Appendix C for more info about GPI values. |
drug_name | string | The name of the dispensed drug |
drug_strength | string | The strength of the drug (ie “20 MG”) |
drug_mfg | string | The manufacturer of the drug |
drug_schedule | string | The DEA control schedule of the dispensed drug. |
drug_is_generic | string | Indicates if the drug is generic (true/false) |
drug_brand_name | string | For generic drugs, the brand drug name |
drug_package_size | string | The package size of the drug when purchased from the drug wholesaler |
drug_form | string | The form that the drug comes in. Ex: Tablet, Capsule, Gram, ML, etc. |
drug_color | string | The color of the drug |
drug_shape | string | The shape of the drug |
drug_front_imprint | string | The imprint or markings on the front of the drug |
drug_back_imprint | string | The imprint or markings on the back of the drug |
drug_misc_info | string | Miscellaneous info that can help with identifying the drug |
lot_number | string | Lot number of the dispensed drug |
lot_exp_date | string | Lot expiration date of the dispensed drug (YYYY-MM-DD) |
retail | string | The amount the pharmacy normally would charge for this prescription if the patient was to pay cash. Also knows as Usual & Customary Charges. |
billed | string | Amount that was billed to the insurance. |
payers | array | Array of insurance payers linked to this prescription. This is a repeating field. Please refer to the Payers section of this document for more info. |
cost | string | The acquisition cost of this drug for the quantity dispensed. |
patient_amount_due | string | The total amount that the patient is responsible for this prescription. This includes all copays, deductibles, coinsurances, etc from all of the patient’s insurances that have been billed. |
due_from_insurance | string | The total amount due from insurance from all of the patient’s insurances that have been billed. |
total_paid | string | The total amount the pharmacy can expect to receive for the prescription. This includes anything the insurance will pay as well as anything the patient will pay. |
margin | string | The profit margin made on this prescription. Essentially it will be the same as total_paid - cost. |
margin_percent | string | Profit margin percentage |
(100 * ((total_paid - cost) / cost) | ||
is340b | string | Indicates if it’s a 340B prescription (true/false) |
dispense_as_written | string | “true” or “false” value indicating DAW |
daw_code | string | DAW code of the prescription |
date_rx_written | string | Date the doctor wrote the prescription |
signature | string | The SIG directions of the prescription (ie TAKE 1 TABLET DAILY) |
dosage_info | array | Array of dosage info linked to this prescription. This is a repeating field. Please refer to the Dosage Info section of this document for more info. |
rx_source | string | How the prescription reached the pharmacy 1 = Written 2 = Telephone 3 = Electronic 4 = Fax 5 = Generated by Pharmacy or Transferred to Pharmacy |
rph_initials | string | Initials of the registered pharmacist that filled or verified the prescription |
tech_initials | string | Initials of the technician that helped to fill the prescription |
rx_serial_number | string | The serial number of the prescription from the doctor’s prescription pad |
submission_clar_code | string | Submission Clarification Code used to override a reject during insurance billing |
other_coverage_code | string | Other Coverage Code used to bill insurance to a secondary or tertiary payer |
horizon_graveyard_code | string | Codified reason a prescription was not filled. Only used for pharmacies that report data to Horizon |
diagnosis | array | Array of diagnosis code linked to this prescription. This is a repeating field. Please refer to the Diagnosis section of this document for more info. |
doctor_id | integer | Unique identifier of the prescriber in the BestRx system. |
doctor_last_name | string | Prescriber’s last name |
doctor_first_name | string | Prescriber’s first name |
doctor_middle_name | string | Prescriber’s middle name |
doctor_prefix | string | Prefix to prescriber’s name (ie Mr. Mrs., etc) |
doctor_suffix | string | Suffix to prescriber’s name (ie MD, DO, etc) |
doctor_npi | string | Prescriber’s NPI number |
doctor_dea | string | Prescriber’s DEA number |
doctor_state_licno | string | Prescriber's State License number |
doctor_dps_no | string | Prescriber's DPS number |
doctor_medicaid_no | string | Prescriber's Medicaid number |
doctor_upin | string | Prescriber's UPIN number |
doctor_address1 | string | Prescriber’s street address line 1 |
doctor_address2 | string | Prescriber’s street address line 1 (ie Suite Number or other identifying info) |
doctor_city | string | Prescriber’s city portion of the address |
doctor_state | string | Prescriber’s state portion of the address |
doctor_zip | string | Prescriber’s zip code |
doctor_phone | string | Prescriber’s office phone number |
doctor_fax | string | Prescriber’s fax number |
doctor_email | string | Prescriber’s email address |
doctor_remark | string | Remarks associated with the prescribers |
doctor_profession_code | string | Prescriber's Profession Code |
doctor_profession_desc | string | Prescriber's Profession Code Description |
doctor_ama_specialty_code | string | Prescriber's AMA Specialty Code |
doctor_ama_grouping | string | Prescriber's AMA Grouping |
doctor_ama_classification | string | Prescriber's AMA Classification |
doctor_ama_specialization | string | Prescriber's AMA Specialization |
doctor_surescripts_service_level | string | The service levels that this prescriber is enabled for with Surescripts. Possible values are New, Refill, Change, RxFill, Cancel, MedHistory, Eligibility, Resupply, Census, CCR, Controlled Substances, RxFill Indicator Change, Long Term Care, CI Message, CI Event, ePA, RLE, Medication Adherence, High Risk Medication, Missing Medication, PDC, MmpocMpiSearch, Disposition Request, Disposition Acknowledgement, Patient Med Benefit Check, and Specialty Patient Onboard |
next_refill_date | string | Date that the next refill is due for the prescription |
drug_therapeutic_class | string | Therapeutic class of the drug (at this time this field will not be populated) |
prescribed_drug | string | Drug that was prescribed by the doctor |
filled_by | string | The person at the pharmacy that “filled’ the prescription |
erx_message_id | string | Message ID from the e-prescription message |
erx_prescriber_order_no | string | Prescriber Order Number from the e-prescription message |
rx_remark | string | Remarks associated with the prescription |
erx_pharmacy_remark | string | Pharmacy related remarks related to the e-prescription message for this prescription |
erx_prescriber_remark | string | Prescriber related remarks related to the e-prescription message for this prescription |
erx_drug_notes | string | The medication notes sent by the prescriber in the e-prescription message for this prescription |
written_date_remark | string | Remarks related to the written date for this prescription (ie why was prescription filled after normal allowable time after written date) |
inactivate_rx_remark | string | Remarks related to explaining why a prescription was deactivated |
shipping_provider | string | Shipping provider used to ship prescription to patient. Current support values are “FedEx”, “UPS” and “USPS”. |
shipping_tracking_number | string | Tracking number of shipment the prescription was a part of |
dispense_using | string | Lets you know what type of packing the prescription will use (ie Safety Caps, Easy Caps, Bubble Packs, Pouch, etc) |
is_medsync_shortfill | boolean | Indicates if this is a MedSync short fill |
claim_reject_info | array | Array of reject codes and descriptions associated with the claim transmittal. This is a repeating field. Please refer to the Claim Reject Info section of this document for more info. |
pbm_message | string | Message sent from the PBM in the NCPDP field 504-F4 |
claim_additional_messages | array | Array of messages sent back in the NCPDP field 526-FQ. This is a repeating field. Please refer to the Claim Additional Messages section of this document for more info. |
Pharmacy Info Fields
Field Name | Type | Notes |
---|---|---|
pharmacy_name | string | Name of the pharmacy |
address | object | Contains address info of the pharmacy. Please see the Address Info section for more info. |
phone_number | string | Phone Number of the pharmacy |
fax_number | string | Fax Number of the pharmacy |
npi | string | NPI Number of the pharmacy |
ncpdp | string | NCPDP Number of the pharmacy |
dea | string | DEA Number of the pharmacy |
Address Info Fields
Field Name | Type | Notes |
---|---|---|
address1 | string | Street Address Line 1 |
address2 | string | Street Address Line 2 |
city | string | City component of address |
state | string | State component of address |
zipcode | string | Zip Code component of address |
Group Fields
Field Name | Type | Notes |
---|---|---|
group_code | string | Internal code of the group in the BestRx system. |
group_name | string | Name of the group. |
Payer Fields
Field Name | Type | Notes |
---|---|---|
plan_seq_no | string | The sequence number of the plans associated with this prescription. This is the order in which the plans were billed for (1 = primary, 2 = secondary, etc). |
plan_code | string | The code of the insurance plan. The code is assigned by the pharmacy and has no significance in terms of actual billing purposes. |
plan_name | string | The name of the insurance plan |
plan_bin | string | The BIN of the insurance plan |
plan_pcn | string | The Processor Control Number of the insurance plan |
card_id | string | The patient’s Cardholder ID for this plan |
group | string | The patient’s Group Number for this plan |
person_code | string | The patient’s Person Code for this plan |
relation_code | string | The patient’s Relationship Code for this plan |
plan_bill_status | string | Coded value for the Billing Status of this plan. Please refer to Appendix A for a list of bill status codes and their descriptions. |
plan_bill_status_text | string | Text Description for the billing status of this plan. |
cost_paid | string | Cost paid by insurance/payer |
disp_fee_paid | string | Dispensing fee paid by insurance/payer |
tax_paid | string | Tax paid by insurance/payer |
discount | string | Discount applied to prescription |
pat_pay_amount | string | Patient pay amount after billing to insurance/payer |
due_from_payer | string | Total amount that will be paid by this insurance/payer |
applied_to_deductible | string | The amount from this prescription that was applied to the patient’s deductible |
accumulated_deductible | string | Amount met by the patient/family in a deductible plan |
remaining_deductible | string | Amount not met by the patient/family in the deductible plan |
Diagnosis Fields
Field Name | Type | Notes |
---|---|---|
qualifier | string | Qualifier indicating the type of diagnosis code 01 = ICD9 02 = ICD10 |
code | string | Diagnosis code |
description | string | Diagnosis description for code |
Dosage Fields
Field Name | Type | Notes |
---|---|---|
dose_slot | integer | Dosage slot (ie sequence of dose during the day). Currently BestRx supports up to 6 slots, so you can expect a value of 1-6 here. |
dose_time | string | Dosage time. This can include specific times (ie 8:00 AM or 7:00 PM) or can contain keywords (ie (MORNING, LUNCH, DINNER, BEDTIME). |
dose_qty | string | Quantity of the drug to take for this particular dose |
dose_days | string | The days of the week that this dose should be administered “daily” = take every day “every_other_day” = take every other day “see_sig_instructions” = complicated instructions, so please look at signature field for more info “1” = Sunday “2” = Monday “3” = Tuesday “4” = Wednesday “5” = Thursday “6” = Friday “7” = Saturday Combination values also possible: “1;2;3” = Sunday, Monday, Tuesday “2;4;6” = Monday, Wednesday, Friday |
Workflow Queues
Field Name | Type | Notes |
---|---|---|
queue_code | integer | Internal record number of the queue in the BestRx system. |
queue_name | string | Name of the queue. |
Claim Reject Fields
Field Name | Type | Notes |
---|---|---|
reject_code | string | Rejection code sent for the claim in the NCPDP field 511-FB |
reject_description | string | The description associated with the Reject Code |
Claim Additional Messages Fields
Field Name | Type | Notes |
---|---|---|
message | string | Message sent back in this iteration of the NCPDP field 526-FQ |
Appendix A - Billing Status Codes and Descriptions
Code | Description |
---|---|
0 | Paid-Cash |
1 | Unbilled |
2 | Hold |
3 | Transmitted/Adjudicated |
4 | Paid by Ins (ie Reconciled) |
5 | Rejected |
6 | Transferred Out to Another Pharmacy (just this particular fill, not the entire prescription) |
Appendix B - Workflow Status Codes and Descriptions
Code | Description |
---|---|
-1 | Unspecified |
0 | Entered into System |
1 | Ready for Pickup |
2 | Ready for Delivery |
3 | Picked Up |
4 | Out for Delivery |
5 | Delivered |
6 | Unable to Deliver |
7 | Transferred Out to Another Pharmacy (just this particular fill, not the entire prescription) |
8 | Ready for Shipping |
9 | Shipped |
10 | Shipment Delivery Confirmed |
11 | Intake Complete |
12 | PA Request Pending |
13 | PA Request Sent |
14 | PA Request Received |
15 | Approved by Insurance |
16 | Rejected by Insurance |
17 | Label Printed |
18 | Verified before Fill |
19 | Filled |
20 | Verified before Dispense |
21 | Reversed from Insurance |
22 | Returned to Stock |
23 | Returned by Patient |
24 | On Hold |
25 | Delivery Cancelled |
26 | Shipment Order Created |
27 | Shipment Cancelled |
28 | Shipment in Transit |
29 | Shipment Delivered |
30 | Delivery Order Created |
31 | Shipment Exception |
32 | Returned by Shipment Provider |
33 | Queued |
34 | Verified Data Entry |
Appendix C - GPI Information
Subset | Record Type | Number of Characters | Description | Example |
---|---|---|---|---|
12-xx-xx-xx-xx-xx- | 1 | 2 | Drug Group | ENDOCRINE AND METABOLIC AGENTS - MISC.* |
12-34-xx-xx-xx-xx- | 2 | 4 | Drug Class | Posterior Pituitary Hormones** |
12-34-56-xx-xx-xx- | 3 | 6 | Drug Subclass | Vasopressin** |
12-34-56-78-xx-xx- | 6 | 8 | Drug Base Name | Desmopressin |
12-34-56-78-90-xx-xx | 4 | 10 | Drug Name/Drug Name Extension | Desmopressin Acetate |
12-34-56-78-90-12-xx | 7 | 12 | Drug Name and Dosage Form | Desmopressin Acetate Tablet |
12-34-56-78-90-12-34 | 5 | 14 | Full GPI with Drug Strength and Strength | Desmopressin Acetate Tablet 0.1 MG |
25 CONTRACEPTIVES
27 ANTIDIABETICS
36 ANTIHYPERTENSIVES
86 OPHTHALMIC AGENTS
37-10 Carbonic Anhydrase Inhibitors*
37-20 Loop Diuretics*
37-30 Mercurial Diuretics*
37-40 Osmotic Diuretics*
37-50 Potassium Sparing Diuretics*
37-60 Thiazides and Thiazide-Like Diuretics*
37-90 Diuretics-Miscellaneous*
37-99 Diuretic Combinations*
21-40 Antineoplastic - Hormonal and Related Agents*
21-40-20 Androgens - Antineoplastic**
21-40-22 Antiadrenals**
21-40-24 Antiandrogens**
21-40-26 Antiestrogens**
21-40-28 Aromatase Inhibitors**
21-40-30 Estrogens - Antineoplastic**
21-40-35 Estrogen Receptor Antagonist**
21-40-40 Progestins - Antineoplastic**
21-40-50 LHRH Analogs**
21-40-55 Gonadotropin Releasing Hormone (GnRH) Antagonists**
21-40-60 Androgen Biosynthesis Inhibitors**
30-04-20-10 Alendronate
30-04-20-40 Etidronate
30-04-20-48 Ibandronate
30-04-20-60 Pamidronate
30-04-20-65 Risedronate
30-04-20-70 Tiludronate
30-04-20-90 Zoledronic Acid
22-10-00-20-10 Dexamethasone Acetate
22-10-00-20-20 Dexamethasone Sodium Phosphate
of active ingredient(s) in a multiple ingredient (combination) product. The fifth
subset designates the specific combination of ingredients in the drug product.
For example, Drug Subclass 43-99-30, Decongestant & Antihistamines, includes,
but is not limited to, the following combination drug products:
43-99-30-02-03 Acrivastine & Pseudoephedrine
43-99-30-02-05 Astemizole & Pseudoephedrine
43-99-30-02-10 Azatadine & Pseudoephedrine
43-99-30-02-25 Carbinoxamine & Phenylephrine
43-99-30-02-30 Chlorpheniramine & Phenylephrine
43-99-30-02-59 Loratadine & Pseudoephedrine
43-99-30-02-70 Promethazine & Phenylephrine
43-99-30-02-72 Promethazine & Pseudoephedrine
43-99-30-02-80 Triprolidine & Pseudoephedrine
43-99-30-03-05 Brompheniramine-Diphenhydramine-Phenylephrine
43-99-30-03-24 Chlorpheniramine-Pyrilamine & Phenylephrine
67-40-60-70-10-03 Sumatriptan Succinate Tablet
67-40-60-70-10-20 Sumatriptan Succinate Solution
67-40-60-70-10-62 Sumatriptan Succinate Device
67-40-60-70-10-64 Sumatriptan Succinate Kit
37-20-00-30-00-03-05 Furosemide Tab 20 MG
37-20-00-30-00-03-10 Furosemide Tab 40 MG
37-20-00-30-00-03-15 Furosemide Tab 80 MG
37-20-00-30-00-20-05 Furosemide Inj 10 MG/ML
37-20-00-30-00-20-50 Furosemide Oral Soln 10 MG/ML
of the GPI cannot define the route difference, as illustrated by the last two
rows in the table above. When strengths are not specified, the seventh subset may be “00”. For example, Drug Name 90-55-00-75, Hydrocortisone, includes the following
dosage forms without strengths:
90-55-00-75-10-29-00 Hydrocortisone Acetate Powder**
67-40-60-70-10-03 Sumatriptan Succinate Tablet
67-40-60-70-10-20 Sumatriptan Succinate Solution
67-40-60-70-10-62 Sumatriptan Succinate Device
67-40-60-70-10-64 Sumatriptan Succinate Kit
Example
{
"APIKey": "",
"PharmacyNumber": "1234567890",
"transaction_id": "888057520190315",
"transaction_date": "2019-03-15",
"transaction_time": "22:56:21",
"rx_number": "8880575",
"patient_id": 25731,
"patient_last_name": "DOE",
"patient_first_name": "JOHN",
"patient_middle_name": "WAYNE",
"patient_prefix": "",
"patient_suffix": "",
"patient_address1": "167 W GRAND AVE",
"patient_address2": "UNIT 1408",
"patient_city": "CHICAGO",
"patient_state": "IL",
"patient_zip": "60654",
"patient_home_phone": "3129555555",
"patient_cell_phone": "6304005555",
"patient_work_phone": "6308935555",
"patient_dob": "1980-04-23",
"patient_gender": "M",
"patient_email": "johndoe@email.com",
"patient_group": [
{
"group_code": "1",
"group_name": "Group Name One"
},
{
"group_code": "3",
"group_name": "Group Name Three"
}
],
"family_email": "",
"patient_short_remark": "Test short remark",
"patient_remark": "",
"family_remark": "",
"patient_shipto_organization": "",
"patient_shipto_last_name": "",
"patient_shipto_first_name": "",
"patient_shipto_careof": "",
"patient_shipto_address1": "",
"patient_shipto_address2": "",
"patient_shipto_city": "",
"patient_shipto_state": "",
"patient_shipto_zip": "",
"patient_shipto_phone": "",
"is_deactivated": false,
"transferred_out": false,
"transferred_pharmacy": "",
"transferred_pharmacy_address1": "",
"transferred_pharmacy_address2": "",
"transferred_pharmacy_city": "",
"transferred_pharmacy_state": "",
"transferred_pharmacy_zip": "",
"transferred_pharmacy_phone": "",
"transferred_pharmacy_fax": "",
"transferred_pharmacy_ncpdp": "",
"transferred_pharmacy_npi": "",
"transferred_pharmacy_dea": "",
"bill_status": "3",
"bill_status_text": "Transmitted",
"workflow_status": "11",
"workflow_status_text": "Approved by Insurance",
"fill_number": "2",
"fill_date": "2019-03-15",
"fill_time": "22:50:46",
"picked_up": "false",
"delivered": "false",
"qty_ordered": "30",
"qty_filled": "30",
"days_supply": "30",
"refills_authorized": "5",
"refills_remaining": "4",
"refill_number": "1",
"refill_exp_date": "2019-12-03",
"item_upc_code": "",
"drug_ndc": "43547036109",
"drug_ndc_10digit": "4354736109",
"drug_ndc_10digit_formatted": "43547-361-09",
"drug_gpi": "36150040200330",
"drug_name": "LOSARTAN 50MG TAB SOL",
"drug_strength": "50 MG",
"drug_schedule": "0",
"drug_is_generic": "true",
"drug_brand_name": "COZAAR 50 MG TABLET",
"drug_package_size": "90",
"drug_form": "EACH",
"drug_color": "WHITE TO OFF WHITE",
"drug_shape": "ROUND,CONVEX,BEVELED EDGE",
"drug_front_imprint": "S",
"drug_back_imprint": "11 2",
"drug_misc_info": "Convex,White to off-white,Beveled edge",
"lot_number": "",
"lot_exp_date": "",
"retail": "80.00",
"billed": "75.38",
"payers": [
{
"plan_seq_no": "1",
"plan_code": "TESTREJ70",
"plan_name": "TEST REJECTION CODE 70",
"plan_bin": "330033",
"plan_pcn": "REJ70",
"card_id": "44444444",
"group": "",
"person_code": "",
"relation_code": "",
"plan_bill_status": "5",
"plan_bill_status_text": "Rejected",
"cost_paid": "0.00",
"disp_fee_paid": "0.00",
"tax_paid": "0.00",
"discount": "0.00",
"pat_pay_amount": "0.00",
"due_from_payer": "0.00"
},
{
"plan_seq_no": "2",
"plan_code": "TESTCPAY50",
"plan_name": "TEST COPAY 50",
"plan_bin": "330033",
"plan_pcn": "COPAY50",
"card_id": "44444444",
"group": "",
"person_code": "",
"relation_code": "",
"plan_bill_status": "3",
"plan_bill_status_text": "Transmitted",
"cost_paid": "218.20",
"disp_fee_paid": "0.00",
"tax_paid": "0.00",
"discount": "0.00",
"pat_pay_amount": "50.00",
"due_from_payer": "168.20"
}
],
"cost": "0.89",
"patient_amount_due": "50.00",
"due_from_insurance": "168.20",
"total_paid": "218.20",
"margin": "217.31",
"margin_percent": "24416.85",
"is340b": "true",
"dispense_as_written": "false",
"daw_code": "0",
"date_rx_written": "2018-12-04",
"signature": "TAKE 1 TABLET DAILY|TOME 1 TABLETA AL DIA",
"dosage_info": [
{
"dose_slot": 1,
"dose_time": "MORNING",
"dose_qty": "1",
"dose_days": "daily"
}
],
"rx_source": "1 - Written",
"rph_initials": "HD",
"tech_initials": "",
"rx_serial_number": "",
"submission_clar_code": "20",
"other_coverage_code": "03",
"horizon_graveyard_code": "",
"diagnosis": [
{
"qualifier": "02",
"code": "I10",
"description": "Essential (primary) hypertension"
},
{
"qualifier": "02",
"code": "I27.0",
"description": "Primary pulmonary hypertension"
}
],
"doctor_id": 4696,
"doctor_last_name": "SMITH",
"doctor_first_name": "MICHELLE",
"doctor_middle_name": "",
"doctor_prefix": "",
"doctor_suffix": "",
"doctor_npi": "1679856987",
"doctor_dea": "MR2314019",
"doctor_address1": "WEST CITY MEDICAL CENTER",
"doctor_address2": "SECOND FLOOR",
"doctor_city": "CHICAGO",
"doctor_state": "IL",
"doctor_zip": "60612",
"doctor_phone": "7732229987",
"doctor_fax": "7732229999",
"doctor_email": "michellesmith@email.com",
"doctor_remark": "",
"next_refill_date": "2019-04-14",
"drug_therapeutic_class": "",
"prescribed_drug": "LOSARTAN 50MG TAB SOL",
"filled_by": "",
"erx_message_id": "",
"erx_prescriber_order_no": "",
"rx_remark": "",
"erx_pharmacy_remark": "",
"erx_prescriber_remark": "",
"written_date_remark": "",
"inactive_rx_remark": "",
"shipping_provider": "",
"shipping_tracking_number": "",
"dispense_using": "Safety Caps",
"is_medsync_shortfill": false,
"claim_reject_info": [
{
"reject_code": "05",
"reject_description": "M/I Service Provider Number"
}
],
"pbm_message": "",
"claim_additional_messages": [
{
"message": "sample message text"
},
{
"message": "more sample message text"
}
]
}
Modified at 2025-03-21 18:46:51