Term Name

Communication
Event
Assessment
Party
Claim
Physical Object
Location
Bill
Bill line item
Medical treatment
Accident
Diagnosis
Medical condition
Morbidity
Type of disease
Injury
Provider
Third party administrator
Body part
Postal address
Record type
Mitchell bill identifier Code
International classification for diseases type code
Bill international classification for diseases sequence number
International classification for diseases procedure code
Bill international classification for diseases code date
Present on admission code
Bill international classification for diseases version code
Bill usage type code
Bill international classification for diseases code type
Future use field billed icd code
filler field
Batch identifier
Run Date
Record delete indicator
Snapshot year month
Snapshot day
adjuster
Patient admission date
Patient admission hour
Admitting diagnosis code
Alternative other billing provider identifier
National provider identifier
Bill auditor external identifier
Bill auditor identifier
Bill charge indicator
Bill charges amount
Bill coder identifier
Bill coder external identifier
Bill international classification for diseases version code
Bill posted date
Bill reviewer received date
Bill created date
Bill modification date
Bill source identifier
Bill status indicator
National provider identifier
Billing provider taxonomy code
Branch external identifier
Bill california inpatient multiplier number
Bill received date
Bill carrier sequence number
Bill duplicate case number
Bill original case number
Check tracking number
Claim number
Client disclaimer identifier
Client type of bill code
Bill company number
Bill composite factor amount
Bill contact electronic mail address
Bill contact phone number
Claimant injury date
Bill review date
Bill date verification received
Bill date verification requested
Bill document scan date
Defendant attorney external identifier
Diagnosis related group drug
Patient discharge date
Patient discharge hour
Bill document control number
Drug discharge fraction number
Drug value amount
Drug weight number
Bill check issue due date
Batch identifier
Load timestamp
Client external claim identifier
External provider identifier
National provider identifier
Filler field 1
Filler field 2
Filler field 3
Filler field 4
Filler field 5
Filler field 6
Bill beginning of service first date
Bill force payment indicator
Bill document control number
Bill geographical client state abbreviation
Bill global drug fee amount
Hospital admission source code
Hospital admission type code
Internal use field ehub identifier
Bill last service date
Mitchell adjuster identifier
Mitchell bill identifier Code
Bill branch identifier
Claim identifier
Defendant attorney identifier
Insurer identifier
Plaintiff attorney identifier
Mitchell policy identifier
Mitchell provider identifier
Miscellaneous data element text
Bill network service code
Billable line number
Service line number
New york surcharge late filing rate
New york surcharge timely filing rate
Provider license number
National provider identifier
National provider identifier
National provider identifier
Provider paid date
Patient account number
Patient discharge indicator
Bill payment authorization code
Payment status code
Place of medical service code
Plaintiff attorney external identifier
Policy identifier
Preferred provider organization contract identifier
Preferred provider organization vendor code
Preferred provider organization vendor internal revenue service number
Preferred provider organization vendor sub code
Preferred provider organization vendor subnet name
Preferred provider organization network identifier
Preferred provider organization network jurisdictional indicator
Preferred provider organization network jurisdictional insurer sequence number
Prior authorization referral number
Product review code
Provider license number
Provider invoice number
Provider internal revenue service number
Provider medicare number
Provider first consulted date
Provider bill submission date
Provider specialty code
Provider specialty code
Provider state abbreviation
Provider type identifier
Provider zip code
Record type
National provider identifier
Referring provider first name
Referring provider identifier
Referring provider last name
Rendering provider middle name
Rendering provider suffix
Provider region code
Rendering provider first name
Rendering provider last name
Rendering provider middle name
Rendering provider suffix
Resource utility group name
Retail sales tax zip code
Site disclaimer identifier
Snapshot day
Snapshot year month
Bill adjudicated state abbreviation
Bill state disclaimer identifier
State required form identifier
State type of bill code
Sub product code
Texas bill type indicator
Total bill charge indicator
Total bill charges amount
Total payable amount
Total payable amount indicator
Total prior allowance amount
Total prior allowance indicator
Hospital type of bill
Wholesale sales tax zip code
Allowed units on line procedure count
Basis of cost determination code
Prescription day supply number
Diagnosis reference list
Pharmacy dispensed as written code
Durable medical equipment billing frequency code
Provider services start date
Provider services end date
Drug supply dispensing fee amount
Drug supply dispensing fee indicator
Batch identifier
Run Date
filler field
Fee schedule allowance amount
Fee schedule amount indicator
Line charge amount
Line charge indicator
National provider identifier
Line sequence number
Lines external identifier
Mitchell bill identifier Code
Prescription refill indicator
Paid procedure code
Paid procedure code prefix
Place of medical service code
Prior allowance amount
Prior allowance indicator
Medical procedure code
Medical procedure code
Units billed count
Real estate evaluation paragraph description
Real estate evaluation paragraph code text
Real estate evaluation paragraph identifier
Record delete indicator
Record type
Reeval paragraph source text
Rendering provider secondary identifier qualifier
Rendering provider secondary identifier
Line of a hospital bill revenue code
Prescription RX number
Service code identifier
Snapshot day
Snapshot year month
System procedure allowed code
Medical type of service code
Usual and customary amount
Usual and customary amount indicator
Line user procedure allowed code
Batch identifier
Run Date
Filler field
Line sequence number
Mitchell bill identifier Code
Record delete indicator
Record type
Reduction amount
Reduction amount identifier
Reduction code
Reduction description
Snapshot day
Snapshot year month
Batch identifier
Run date
Payment external type code
Filler field
Bill adjustment reason group code
Jurisdiction state abbreviation
Level code
Line sequence number
Mitchell bill identifier Code
Modified date
"Bill line item legal valuation objection reason external code,
Bill line item message modifier legal valuation reason code,
Bill line item state reason code "
Modifier message code sequence number
Bill line reason sequence number
Bill line reason client code
Reason line sequence number
Bill line reason type code
Payment line reason value code
Record delete indicator
Record type
Reduction code
Smartadvisor site location code
Snapshot day
Snapshot year month
State statute verbiage
Utilization review disclaimer code
Claimant card last print date
Claimant card last print timestamp
Pharmacy payment check number
Claim count
Claim number
Pharmacy sale type code
Pharmacy sale type description
Clinical medication name
Prescription supply days lasting count
Prescription day supply end date
Batch identifier
Run date
State fee schedule prescription price amount
State fee schedule prescription price unit amount
Prescription filled date
Physician address line text
Physician city name
Physician fax number
Physician first name
Physician last name
Physician phone number
Physician specialty description
Physician state abbreviation
Physician zip code
Patient injury date
Customer invoice date
Invoice number
Claimant injury catastrophic indicator
Clinical compound indicator
Extended release opioid medication indicator
Prescription first fill program indicator
Maintenance medication drug indicator
Medispan opioid class 2 medication indicator
Transmucosal immediate release fentanyl medication indicator
Opioid medication indicator
Opioid class 2 medication indicator
Medication compound indicator
Medication over the counter indicator
Network pharmacy indicator
Physician dispensed medication indicator
Medicine repackaged indicator
Retail customer indicator
Medication specialty drug indicator
Medication stimulant drug indicator
Medication stimulant drug indicator
Jurisdiction state abbreviation
Medication refills remaining count
Medispan drug enforcement agency class code
Medispan drug group code
Medispan generic equivalent description
Medispan generic product identifier
Medispan medication name
Medispan medication form description
Medispan medication form description
Medication strength text
Medispan medication therapeutic class description
Claimant internal identifier
Medication morphine equivalent dose amount
National association of boards of pharmacy dispensing site class code
National association of boards of pharmacy dispensing site class description
National association of boards of pharmacy dispensing site type code
National association of boards of pharmacy dispensing site type description
National association of boards of pharmacy address line text
National association of boards of pharmacy city name
National association of boards of pharmacy code
National association of boards of dispensing pharmacy name
National association of boards of pharmacy national provider identifier
National association of boards of pharmacy dispensing pharmacy phone number
National association of boards of pharmacy dispensing pharmacy state abbreviation
National association of boards of pharmacy dispensing pharmacy zip code
Claim adjuster email address text
Claim adjuster first name
Claim adjuster identifier
Claim adjuster last name
Branch identifier
Branch name
Brand generic indicator
Claim created date
Claim identifier
OPS claim load date
Customer identifier
Customer identifier
Customer account name
Medicine dispense as written code
Medication drug enforcement administration code
Claimant employer code
Claimant employer identifier
Claimant employer name
National drug code number
Original claim created date
Claimant patient address line
Patient city name
Patient prescription coverage begin date
Patient prescription coverage end date
Patient date of birth
Patient first name
Patient formulary text
Patient formulary description
Patient international classification of diseases diagnosis code
Patient identifier
Patient last name
Patient phone number
Patient state abbreviation
Patient zip code
Drug enforcement administration prescriber number
National provider identifier
Prescription RX number
Medicine brand code
Medicine brand description
Third party administrator biller name
Pharmacy paid date
Tax identification number
Tax identification number
Tax identification number
Record delete indicator
Retail cost amount
Retail unit cost amount
Original paid claim reversal identifier
Snapshot day
Snapshot year month
Customer billed amount
Customer billed unit amount
Provider license number
Pharmacy transaction submission date
Claim transaction status code
Claim transaction status description
Units
Usual customary cost amount
Usual customary cost per unit amount
Prescription prescribed year
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits paid 25th percent
Visits paid 50th percent
Visits paid 75th percent
Disease and procedure mean visits per claim amount
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits billed 25th percent
Visits billed 50th percent
Visits billed 75th percent
Disease and procedure mean visits per claim amount
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits paid 25th percent
Visits paid 50th percent
Visits paid 75th percent
Disease and procedure mean visits per claim amount
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits billed 25th percent
Visits billed 50th percent
Visits billed 75th percent
Disease and procedure mean visits per claim amount
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits paid 25th percent
Visits paid 50th percent
Visits paid 75th percent
Disease and procedure mean visits per claim amount
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits billed 25th percent
Visits billed 50th percent
Visits billed 75th percent
Disease and procedure mean visits per claim amount
Claimant card last print date
Claimant card last print timestamp
Pharmacy payment check number
Claim count
Claim number
Pharmacy sale type code
Pharmacy sale type description
Clinical medication name
Prescription supply days lasting count
Prescription day supply end date
Batch identifier
Run date
State fee schedule prescription price amount
State fee schedule prescription price unit amount
Prescription filled date
Physician address line text
Physician city name
Physician fax number
Physician first name
Physician last name
Physician phone number
Physician specialty description
Physician state abbreviation
Physician zip code
Patient injury date
Customer invoice date
Invoice number
Claimant injury catastrophic indicator
Clinical compound indicator
Extended release opioid medication indicator
Prescription first fill program indicator
Maintenance medication drug indicator
Medispan opioid class 2 medication indicator
Transmucosal immediate release fentanyl medication indicator
Opioid medication indicator
Opioid class 2 medication indicator
Medication compound indicator
Medication over the counter indicator
Network pharmacy indicator
Physician dispensed medication indicator
Medicine repackaged indicator
Retail customer indicator
Medication specialty drug indicator
Medication stimulant drug indicator
Medication stimulant drug indicator
Jurisdiction state abbreviation
Medication refills remaining count
Medispan drug enforcement agency class code
Medispan drug group code
Medispan generic equivalent description
Medispan generic product identifier
Medispan medication name
Medispan medication form description
Medispan medication form description
Medication strength text
Medispan medication therapeutic class description
Claimant internal identifier
Medication morphine equivalent dose amount
National association of boards of pharmacy dispensing site class code
National association of boards of pharmacy dispensing site class description
National association of boards of pharmacy dispensing site type code
National association of boards of pharmacy dispensing site type description
National association of boards of pharmacy address line text
National association of boards of pharmacy city name
National association of boards of pharmacy code
National association of boards of dispensing pharmacy name
National association of boards of pharmacy national provider identifier
National association of boards of pharmacy dispensing pharmacy phone number
National association of boards of pharmacy dispensing pharmacy state abbreviation
National association of boards of pharmacy dispensing pharmacy zip code
Claim adjuster email address text
Claim adjuster first name
Claim adjuster identifier
Claim adjuster last name
Branch identifier
Branch name
Brand generic indicator
Claim created date
Claim identifier
OPS claim load date
Customer identifier
Customer identifier
Customer account name
Medicine dispense as written code
Medication drug enforcement administration code
Claimant employer code
Claimant employer identifier
Claimant employer name
National drug code number
Original claim created date
Claimant patient address line
Patient city name
Patient prescription coverage begin date
Patient prescription coverage end date
Patient date of birth
Patient first name
Patient formulary text
Patient formulary description
Patient international classification of diseases diagnosis code
Patient identifier
Patient last name
Patient phone number
Patient state abbreviation
Patient zip code
Drug enforcement administration prescriber number
National provider identifier
Prescription RX number
Medicine brand code
Medicine brand description
Third party administrator biller name
Pharmacy paid date
Tax identification number
Tax identification number
Tax identification number
Record delete indicator
Retail cost amount
Retail unit cost amount
Original paid claim reversal identifier
Snapshot day
Snapshot year month
Customer billed amount
Customer billed unit amount
Provider license number
Pharmacy transaction submission date
Claim transaction status code
Claim transaction status description
Units
Usual customary cost amount
Usual customary cost per unit amount
Prescription prescribed year
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits paid 25th percent
Visits paid 50th percent
Visits paid 75th percent
Disease and procedure mean visits per claim amount
Bill review payment code
Disease and procedure mean cost per claim amount
Procedure cost per visit amount
Current procedural terminology code
Current procedural terminology name
Batch identifier
Run date
International classification for diseases code
International classification for diseases description
Disease and procedure incidence per 100000 workers per year rate
Official disability guidelines automatic approval visits count
Disease and procedure claim frequency percent
Snapshot year month
Visits billed 25th percent
Visits billed 50th percent
Visits billed 75th percent
Disease and procedure mean visits per claim amount
Practice address line
Practice address line
Practice address city name
Tax form contact name
Tax form contact name
Tax form contact name
Tax form control number
Tax form country code
Tax form fax number
Tax form mail code
Tax form phone number
Practice state abbreviation
Tax form utilization review contact name
Tax form utilization review contact name
Tax form utilization review contact name
Tax form zip code
Tax form facility name
Authorized authority begin date
Authorized authority end date
Billing street address line
Billing street address line
Billing address city name
Billing contact name
Billing contact name
Billing contact name
Billing address country code
Billing facility name
Billing fax number
Billing mail code
Billing phone number
Billing address state abbreviation
Billing utilization review contact name
Billing utilization review contact name
Billing utilization review contact name
Billing address zip code
Create date
Create user identifier
Error text
Batch identifier
Run date
External provider identifier
National provider identifier
Filler field
Future use group code
Provider group name
Medical examiner number
Medicare number
Mitchell provider identifier
Modified date
Modified user identifier
National council for prescription drug program identification
Provider payment day number
Practice address line
Practice address line
Practice city name
Practice contact first name
Practice contact last name
Practice contact middle initial
Practice country code
Practice facility name
Attorney fax number
Practice mail code
Practice phone number
Practice state abbreviation
Practice utilization review contact last name
Practice utilization review contact middle initial
Practice utilization review contact practice first name
Practice zip code
Provider entity type code
Provider first name
Provider last name
Provider middle name
National provider identifier
Provider specialty code
Provider specialty code
Provider status code
Provider subset
Provider suffix title
Tax identification number
Provider suffix tax identifier
Bill provider type code
Record delete indicator
Record type
Provider reference data
Snapshot day
Snapshot year month
Tax identification type code
Provider surcharge provider code
Work comprehensive number
Workers compensation state abbreviation
Claimant card last print date
Claimant card last print timestamp
Pharmacy payment check number
Claim count
Claim number
Pharmacy sale type code
Pharmacy sale type description
Clinical medication name
Prescription supply days lasting count
Prescription day supply end date
Batch identifier
Run date
State fee schedule prescription price amount
State fee schedule prescription price unit amount
Prescription filled date
Physician address line text
Physician city name
Physician fax number
Physician first name
Physician last name
Physician phone number
Physician specialty description
Physician state abbreviation
Physician zip code
Patient injury date
Customer invoice date
Invoice number
Claimant injury catastrophic indicator
Clinical compound indicator
Extended release opioid medication indicator
Prescription first fill program indicator
Maintenance medication drug indicator
Medispan opioid class 2 medication indicator
Transmucosal immediate release fentanyl medication indicator
Opioid medication indicator
Opioid class 2 medication indicator
Medication compound indicator
Medication over the counter indicator
Network pharmacy indicator
Physician dispensed medication indicator
Medicine repackaged indicator
Retail customer indicator
Medication specialty drug indicator
Medication stimulant drug indicator
Medication stimulant drug indicator
Jurisdiction state abbreviation
Medication refills remaining count
Medispan drug enforcement agency class code
Medispan drug group code
Medispan generic equivalent description
Medispan generic product identifier
Medispan medication name
Medispan medication form description
Medispan medication form description
Medication strength text
Medispan medication therapeutic class description
Claimant internal identifier
Medication morphine equivalent dose amount
National association of boards of pharmacy dispensing site class code
National association of boards of pharmacy dispensing site class description
National association of boards of pharmacy dispensing site type code
National association of boards of pharmacy dispensing site type description
National association of boards of pharmacy address line text
National association of boards of pharmacy city name
National association of boards of pharmacy code
National association of boards of dispensing pharmacy name
National association of boards of pharmacy national provider identifier
National association of boards of pharmacy dispensing pharmacy phone number
National association of boards of pharmacy dispensing pharmacy state abbreviation
National association of boards of pharmacy dispensing pharmacy zip code
Claim adjuster email address text
Claim adjuster first name
Claim adjuster identifier
Claim adjuster last name
Branch identifier
Branch name
Brand generic indicator
Claim created date
Claim identifier
OPS claim load date
Customer identifier
Customer identifier
Customer account name
Medicine dispense as written code
Medication drug enforcement administration code
Claimant employer code
Claimant employer identifier
Claimant employer name
National drug code number
Original claim created date
Claimant patient address line
Patient city name
Patient prescription coverage begin date
Patient prescription coverage end date
Patient date of birth
Patient first name
Patient formulary text
Patient formulary description
Patient international classification of diseases diagnosis code
Patient identifier
Patient last name
Patient phone number
Patient state abbreviation
Patient zip code
Drug enforcement administration prescriber number
National provider identifier
Prescription RX number
Medicine brand code
Medicine brand description
Third party administrator biller name
Pharmacy paid date
Tax identification number
Tax identification number
Tax identification number
Record delete indicator
Retail cost amount
Retail unit cost amount
Original paid claim reversal identifier
Snapshot day
Snapshot year month
Customer billed amount
Customer billed unit amount
Provider license number
Pharmacy transaction submission date
Claim transaction status code
Claim transaction status description
Units
Usual customary cost amount
Usual customary cost per unit amount
Prescription prescribed year
Insured address line text
Insured address line text
Adjuster name
Branch identifier
Company city name
Claim external identifier
Claim identifier
Claim system name
Policy copay amount
Policy copay percentage
Create date
Create user identifier
Claimant birth date
Claimant injury date
Policy deductible amount
Batch identifier
Run date
Filler field
Claim first name
Claim patient gender indicator
Jurisdiction state abbreviation
Jurisdictional claim identifier
Claimant last name
Branch location code
Claim identifier
Claimant middle initial text
Modification date
Modification user identifier
Policy detail of limit warning percentage
Policy identifier
Policy limit amount
Policy valid period number
Record delete indicator
Record type
Claimant relation to insured text
Snapshot day
Snapshot year month
Patient social security number
Claim state abbreviation
Claims status indicator
Claim zip code
Claimant card last print date
Claimant card last print timestamp
Pharmacy payment check number
Claim count
Claim number
Pharmacy sale type code
Pharmacy sale type description
Clinical medication name
Prescription supply days lasting count
Prescription day supply end date
Batch identifier
Run date
State fee schedule prescription price amount
State fee schedule prescription price unit amount
Prescription filled date
Physician address line text
Physician city name
Physician fax number
Physician first name
Physician last name
Physician phone number
Physician specialty description
Physician state abbreviation
Physician zip code
Patient injury date
Customer invoice date
Invoice number
Claimant injury catastrophic indicator
Clinical compound indicator
Extended release opioid medication indicator
Prescription first fill program indicator
Maintenance medication drug indicator
Medispan opioid class 2 medication indicator
Transmucosal immediate release fentanyl medication indicator
Opioid medication indicator
Opioid class 2 medication indicator
Medication compound indicator
Medication over the counter indicator
Network pharmacy indicator
Physician dispensed medication indicator
Medicine repackaged indicator
Retail customer indicator
Medication specialty drug indicator
Medication stimulant drug indicator
Medication stimulant drug indicator
Jurisdiction state abbreviation
Medication refills remaining count
Medispan drug enforcement agency class code
Medispan drug group code
Medispan generic equivalent description
Medispan generic product identifier
Medispan medication name
Medispan medication form description
Medispan medication form description
Medication strength text
Medispan medication therapeutic class description
Claimant internal identifier
Medication morphine equivalent dose amount
National association of boards of pharmacy dispensing site class code
National association of boards of pharmacy dispensing site class description
National association of boards of pharmacy dispensing site type code
National association of boards of pharmacy dispensing site type description
National association of boards of pharmacy address line text
National association of boards of pharmacy city name
National association of boards of pharmacy code
National association of boards of dispensing pharmacy name
National association of boards of pharmacy national provider identifier
National association of boards of pharmacy dispensing pharmacy phone number
National association of boards of pharmacy dispensing pharmacy state abbreviation
National association of boards of pharmacy dispensing pharmacy zip code
Claim adjuster email address text
Claim adjuster first name
Claim adjuster identifier
Claim adjuster last name
Branch identifier
Branch name
Brand generic indicator
Claim created date
Claim identifier
OPS claim load date
Customer identifier
Customer identifier
Customer account name
Medicine dispense as written code
Medication drug enforcement administration code
Claimant employer code
Claimant employer identifier
Claimant employer name
National drug code number
Original claim created date
Claimant patient address line
Patient city name
Patient prescription coverage begin date
Patient prescription coverage end date
Patient date of birth
Patient first name
Patient formulary text
Patient formulary description
Patient international classification of diseases diagnosis code
Patient identifier
Patient last name
Patient phone number
Patient state abbreviation
Patient zip code
Drug enforcement administration prescriber number
National provider identifier
Prescription RX number
Medicine brand code
Medicine brand description
Third party administrator biller name
Pharmacy paid date
Tax identification number
Tax identification number
Tax identification number
Record delete indicator
Retail cost amount
Retail unit cost amount
Original paid claim reversal identifier
Snapshot day
Snapshot year month
Customer billed amount
Customer billed unit amount
Provider license number
Pharmacy transaction submission date
Claim transaction status code
Claim transaction status description
Units
Usual customary cost amount
Usual customary cost per unit amount
Prescription prescribed year