Report Name
RXC Status Report
About This Report
This report provides the validation results of each data element of the RXC validation process by HIOS.
Project Type
IVA
Service Type
Full Service, Clinical Only
Intended User
Manager / Technical User
Best For
An IVA Program manager can track the program results and efficacy for RXC Audits.
Using This Report
- Download the report and use within Excel
- Create pivot table to get the validation statuses across all Prescription Drug categories
- Drill down and see detailed data like Provider ID Validation, Fill Date Validation, NDC Validation, Claim Date Validation, RXC Validation, Claim Identifier Validation and HCPCs Validation across different prescription drug categories
What Information Can I Filter?
| Project |
| Enrollee ID |
| Member ID |
| Client Member ID |
| Claim ID |
| Dispensing Provider ID |
| NDC |
| HCPCS |
| Chase ID |
| HIOS |
| Stratum Level |
| RXC |
What Do The Fields Mean?
| Field | Data Dictionary Definition |
| Enrollee Count | (Original Measure: Member Count) A distinct count measure of the associated data items |
| RXC Screenshots Received | (Original Measure: Iva Rxc Data Count) A distinct count measure of the associated data items |
| RXC Chases Validated MRR | (Original Measure: Iva Rxc Data Count, filtered to Rxc Validated = '1', and Workflow Status = 'Overread' ) A distinct count measure of the associated data items |
| RXC Chases in OR1 | (Original Measure: Iva Extract Radvde Count, filtered to Workflow Status = 'Overread' ) A distinct count measure of the associated data items |
| RXC Chases Validated OR1 | (Original Measure: Iva Rxc Data Count, filtered to Rxc Validated = '1', and Workflow Status = 'Overread2' ) A distinct count measure of the associated data items |
| RXC Chases in OR2 | (Original Measure: Iva Rxc Data Count, filtered to Workflow Status = 'Overread2' ) A distinct count measure of the associated data items |
| RXC Chases Validated OR2 | (Original Measure: Iva Rxc Data Count, filtered to Rxc Validated = '1', and Workflow Status = 'Delivery' or 'Completed' ) A distinct count measure of the associated data items |
| RXC Chases Completed | (Original Measure: Vw Mr50 Chase Workflow Summary Count, filtered to Workflow Status = 'Delivery' or 'Completed') A distinct count measure of the associated data items |
| RXC Count | (Original Measure: Iva Rxc Data Member Rxc Count) A distinct count of member/rxc combinations |
| RXC Chases No Match MRR | (Original Measure: Iva Rxc Data Count, filtered to Rxc Validated is not equal to '1', and Workflow Status = 'Overread' ) A distinct count measure of the associated data items |
| RXC Chases No Match OR1 | (Original Measure: Iva Rxc Data Count, filtered to Rxc Validated is not equal to '1', and Workflow Status = 'Overread2' ) A distinct count measure of the associated data items |
| RXC Chases No Match OR2 | (Original Measure: Iva Rxc Data Count, filtered to Rxc Validated is not equal to '1', and Workflow Status = 'Delivery' or 'Completed' ) A distinct count measure of the associated data items |
| RXC Status Report (Table) | Report provides relevant data for RXC chases selected by the client. |
| Project ID | The internal identifier associated with a project |
| HIOS | Plan identifier for IVA plans only |
| Project Name | The name associated with a project |
| Measure Year | The measure year associated with a project |
| Client ID | The internal identifier associated with a client |
| Client Name | Name of the Client |
| Data load ID for Sample | Client's internal Chase ID |
| Chase ID | The internal identifier associated with a chase |
| Current Chase Status | The status of a chase, based upon its workflow status and pend and invoice status |
| Member ID | The internal identifier associated with a member |
| Client Member ID | The client identifier associated with a member |
| Enrollee ID | Client or government supplied identifier for a member (outside of the Member ID field) |
| Full Name | The first and last name of a member |
| Member DOB Date | The date of birth of the member |
| Member Gender | The gender of a member |
| Stratum Level | The stratum indicator of the stratum in which the enrollee was included. Strata 1-9 represent low, medium and high-risk enrollees with at least one (1) HCC or (1) RXC for each age model. Stratum 10 includes enrollees with no HCCs and no RXCs. Note: Only the adult RA model includes RXCs therefore only the adult strata 1-3 will include enrollees with RXCs |
| Rxc | Numerical identifier associated with the rx condition within a given condition model |
| Rxc Name | The description of a rx condition category |
| Claim Identifier | The identifier provided for the claim associated with the chase |
| Claim Processed Date Time | The time stamp associated when the client processed an incoming claim |
| Prescription Fill Date | The time stamp associated with the fulfillment of a prescription |
| Dispensing Provider ID | The identifier for a provider who dispensed a prescription |
| Ndc | The national drug code (ndc) |
| Hcpcs | The HCPCS is a procedure code associated with a claim used in the crosswalk between RXCs and medical claims for IVA |
| Member Rxc List | A list of all prescription condition categories (RXC) associated with a member |
| Claim Number | A ranking based upon member id and rxc to indicate the number of claims available for a client to choose to satisfy the RXC audit |
| Hcpcs Validated | Determines if the HCPCS in the medical record screenshot matched between the source data and the auditor's findings for IVA RXC validation |
| Claim Identifier Validated | Determines if the date of the claim identified by the auditor matches the ndc identified by the government |
| Claim Date Validated | Determines if the date of the claim identified by the auditor matches the ndc identified by the government |
| Ndc Validated | Determines if the ndc identified by the auditor matches the ndc identified by the government |
| Fill Date Validated | Determines if the date of the prescription fill identified by the auditor matches the ndc identified by the government |
| Provider ID Validated | Determines if the provider ID identified by the auditor matches the ndc identified by the government |
| Rxc Validated | A flag the indicates whether all data elements have been validated for a given RXC |