| PDE_ID |
CCW Encrypted Part D Event Number |
| BENE_ID |
CCW Encrypted Beneficiary ID Number |
| DOB_DT |
Patient Date of Birth (DOB) |
| SEX_CD |
Patient Sex |
| SRVC_DT |
RX Service Date |
| PD_DT |
Paid Date |
| RX_SRVC_RFRNC_NUM |
RX Service Reference Number |
| PROD_SRVC_ID |
Product Service ID |
| PLAN_CNTRCT_REC_ID |
Plan Contract ID |
| PLAN_PBP_REC_NUM |
Plan Benefit Package ID |
| CMPND_CD |
Compound Code |
| DAW_PROD_SLCTN_CD |
Dispense as Written (DAW) Product Selection Code |
| QTY_DSPNSD_NUM |
Quantity Dispensed |
| DAYS_SUPLY_NUM |
Days Supply (Part D) |
| FILL_NUM |
Number of drug fills |
| DSPNSTCD_STUS_CD |
Dispensing Status Code |
| DRUG_CVRG_STUS_CD |
Drug Coverage Status Code |
| ADJSTMT_DLTN_CD |
Adjustment Deletion Code |
| NSTD_FRMT_CD |
Non-Standard Format Code |
| PRCNG_EXCPTN_CD |
Pricing Exception Code |
| CTSTRPHC_CVRG_CD |
Catastrophic Coverage Code |
| GDC_BLW_OOPT_AMT |
Gross Drug Cost Below Part D Out-of-Pocket Threshold (GDCB) |
| GDC_ABV_OOPT_AMT |
Gross Drug Cost Above Part D Out-of-Pocket Threshold (GDCA) |
| PTNT_PAY_AMT |
Amount Paid by Patient |
| OTHR_TROOP_AMT |
Other True Out-of-Pocket (TrOOP) Amount |
| LICS_AMT |
Amount paid for the PDE by Part D low income subsidy |
| PLRO_AMT |
Reduction in patient liability due to payments by other payers (PLRO) |
| CVRD_D_PLAN_PD_AMT |
Amount paid by Part D plan for the PDE (drug is covered by Part D) |
| NCVRD_PLAN_PD_AMT |
Amount paid by Part D plan for the PDE (drug is not covered by Part D) |
| TOT_RX_CST_AMT |
Total Drug Cost (Part D) |
| RX_ORGN_CD |
Prescription Origination Code |
| RPTD_GAP_DSCNT_NUM |
Gap Discount Amount |
| BRND_GNRC_CD |
Brand-Generic Code Reported by Submitting Plan |
| PHRMCY_SRVC_TYPE_CD |
Pharmacy service type code |
| PTNT_RSDNC_CD |
Patient Residence Code |
| SUBMSN_CLR_CD |
Submission clarification code |
| BENEFIT_PHASE |
Benefit Phase of Part D Event |
| CCW_PHARM_ID |
CCW Pharmacy Identifier |
| NCPDP_ID |
NCPDP Pharmacy Identifier |
| PRSCRBR_ID |
Prescriber Identification Number |
| PRSCRBR_ID_QLFYR_CD |
Prescriber identification number qualifier code |
| CCW_PRSCRBR_ID |
CCW Prescriber Identifier |
| PDE_PRSCRBR_ID_FRMT_CD |
PDE Prescriber ID Format Code |
| PRIOR_AUTHORIZATION_YN |
Prior Authorization Indicator (Event) |
| TIER_ID |
Medicare Part D Formulary Tier Identifier |
| QUANTITY_LIMIT_YN |
Quantity Limit Indicator (Event) |
| STEP |
Maximum Step Number |
| FORMULARY_ID |
Formulary Identification Number |
| FRMLRY_RX_ID |
CCW Formulary Drug Identifier |
| PTD_MODEL_IND |
Part D Model Indicator |
| OTHR_TROOP_AMOUNT_IND |
Other True Out-of-Pocket (TrOOP) Amount Indicator |