Viewing Data Lines for Coverage Gap Submission

About Data lines Tab

When the Validation Analyst creates a new Coverage Gap Submission, the imported lines to the Validata application from those Coverage Gap data file are listed on the Data lines tab. All lines included in the respective Coverage Gap data file with their relevant details and column headings are listed in the Data lines table. 

Note: The Validation Analyst can only view the Data lines tab for the Coverage Gap Submissions. For standard Submission, the Line Level Details tab is available.

On the Data lines list table, the Analyst can:

• Review the line details before and after validating the Submission on the Data lines list table.

• Override Errors and Line Status for selected lines after a Submission is validated. For more information, see Overriding Submission Line's Validation Result.

• View the history of a selected Line

• Add comment for a Line

• Sort and filter the lines on the Data lines table

• Copy the Line details 

• Download the Data lines table rows

Data lines List Table

This section lists all the group headers and the column details displayed on the data lines list table, as per the table's presentation order. The columns are grouped under a group header on the list table. 

• Line ID: The unique system-generated ID assigned to the utilization line.

• Comment: By clicking the comment icon, the Analyst can view if there are any existing comments added to the utilization line and also can add new comments for a utilization line.

• Error Code: Displays the error codes that are tagged to the Coverage Gap Data line when a Submission is validated. 

Notes:

• An empty value is displayed Until the Coverage Gap Submission is validated using a Validation Set.

• An empty value is displayed when a Coverage Gap Submission is validated, but the lines do not have any errors. 

Each error code is displayed in the column as an abbreviation of the complete error code with a color shading to indicate the severity level.

• Warning (Yellow)

• Major (Orange)

• Critical (Red)

When a Coverage Gap Data line is associated with more than one error, and the error codes flow beyond the width of the Error Code column, the number indicator specifies the number of errors associated with the Coverage Gap Data line. Click on the Error Code to view the full description of the errors.

Notes:

• You can override the severity of the error from a severity level Major to Warning. For detailed documentation, see Overriding Submission Line's Validation Result.  

• You can not override the severity of the error when the severity level is critical.

• Line Status: Displays the current status of the Coverage Gap Data line. One of the following values is displayed:

  • New: The Line Status column displays New when a Submission is created and not validated.

  • Included: When Submission is validated using a Validation Set, the Line is assigned with Included Status in one of the following scenarios:

    • When the Coverage Gap data line is not stamped with any Error Codes.

    • When the Coverage Gap data line is assigned with Error Code but its severity level of error is of type Warming.

  • Excluded: When Submission is validated using a Validation Set, and the submitted Coverage Gap Data line is stamped with an Error Code of severity level Critical or Major, the line is assigned an Excluded status.
    The Validation Analyst can manually override the Line Status from Included to Excluded and vice versa. For more details see, Overriding Line status.

Dispute/Error Results: In this group header section, all the Dispute-related information associated with a data line is displayed.

• Dispute: Using the Dispute toggle, the Analyst can dispute the data line. For detailed documentation disputing a data line see Updating the Dispute Status for the Data Lines.

• Dispute Status: Identifies where the Coverage Gap Data Line’s current dispute status is. The Dispute Status value is updated when the data line is processed for dispute. For detailed documentation, see Coverage Gap Dispute Process.

  • <NULL>: Nothing is disputed for the utilization line.

  • Disputed: Disputes are identified but not yet reported to the TPA.

  • Submitted: Disputes are identified and have been submitted to the TPA, but no reply has been sent.

  • Accepted: The TPA has accepted the dispute for consideration.

  • Rejected: The TPA has rejected the dispute for consideration.

  • Resubmit: Errors that caused rejection have been updated and the item can be resubmitted for dispute consideration.

  • Upheld: The TPA has reviewed and upheld the dispute.

  • Denied: The TPA has reviewed and denied the dispute.

• Dispute Reason Codes: The dispute reasons associated with the Coverage Gap Data Line.

• TPA Dispute Edit Codes: The codes associated with the rejection or denial provided by the TPA. If the dispute status is not Rejected or Denied, this field is blank.

• Dispute Text: The dispute text associated with the disputed data line is displayed.

• Dispute Resolution Text: Dispute Resolution text that was added when the TPA dispute resolution file was read.

Submission Descriptive: In this group header section, all the Submission details related columns are listed.

• File Name: Displays the name of the Coverage Gap data file.

• Current Reporting Period: Calendar year/quarter of the most recent invoice period as of when this report was created.

• Transaction Type: The type of Submission i.e. Coverage Gap is displayed.

• Duplicate Processed: Specifies whether duplicate validation has been run for the data line or not.
  Note: This column is not displayed by default on the Data lines list table. However, it is displayed when the group header is expanded.

Transaction Descriptive: In this group header section, all the transaction data line related columns are listed.

• Prescription/Service Reference Number: The reference number assigned by the provider for the dispensed drug/product.

• Date of Service: The date that the prescription was filled or that the professional service was rendered.

• Detail Reference Number: A unique Coverage Gap reference number for this Coverage Gap discount. Use this number to track changes in this Coverage Gap discount record from quarter to quarter.

• Sequence Number: An incrementing batch sequence number that starts at 1 and continues in the order for each data line.

• Report ID: Year/quarter item was placed on the invoice. Format is: "YYYYQQ".

• Previous Report ID: Preceding year/quarter that item was placed on the invoice. Format is: "YYYYQQ".

• Previous Reporting Period: Calendar year/quarter of the preceding invoice period when the invoiced PDE represents an adjustment to a previously invoiced PDE. If the record was not reported in a previous period, this field is filled with zeros.

• Filler: Undefined field.

Product: In this group header section, Product/Service related columns are listed.

• Product/Service ID: The ID of the dispensed product.

• Product Description: Description of the submitted product. The Product Description value is populated when a Coverage Gap Submission is validated using a Validation Set that is configured using the Identify Product Rule Set.

Rx Metrics: In this group header section, all the Rx related columns are listed.

• Fill Number: A code indicating whether the prescription is an original or a refill.

• Total Quantity: The total quantity submitted in the respective Rx.

• Rebate Days Supply: The days supply of the product being reported.

Service Provider: In this group header section, all the Service Provider related columns are listed.

• Service Provider ID Qualifier: The code that qualifies the Service Provider ID.

• Service Provider ID: The ID assigned to a pharmacy or provider.

• NCPDP ID: The assigned NCPDP ID to the pharmacy.

• Medicaid ID: 

• Primary Provider Type Code: The primary provider type code.

• Dispenser Class Code: The class of pharmacy that filled the prescription.

• Service Provider Name: The pharmacy's name that submitted the utilization line.

• Service Provider Address/ Address 2/ City/ State: The address, city, state, and postal code of the Pharmacy that submitted the data line.

• 340B Status Code:

Contract: In this group header section, all the Contract related column is listed.

• Contract ID: The ID of the contract associated with the coverage gap data line.

Sorting and Filtering the Lines on the Data lines Table

All the Coverage Gap Data file lines are displayed on the Data lines list table. The Validata application allows the Analyst to sort and filter the lines on the Data lines list table by applying the available filter options. The filter/sort choices made by the user will be retained from user session to user session until the user changes the options, either by resetting, changing the sort/filter, or selecting from the saved searches. The Analyst can save the filter/sort applied to the Data lines list table using the Saving Searches option.

Downloading the Data Lines List Table Rows

The Validation Analyst can download the lines from the Data lines list table in Excel or CSV format. The Analyst can set the following preferences when downloading the lines:

• Download all the rows or only the filtered rows displayed on the Data lines list table.

• Download all the columns or only configured columns displayed on the Data lines list table.

Note: When a Line contains any comments, on the downloaded records the comment text will not displayed. Only a Yes or No value will be displayed for the comment component in the downloaded file, where:

• Yes: Specifies, the line contains a comment.

• No: Specifies, the line does not contain a comment.

To download the Data lines list table rows:

1. Click the overflow menu on the Data lines page (three stacked dots).

2. Select the Download option.

3. The Download Options window is displayed. Specify the following details:

   1. For the Rows field, All is the default selected option. This means all the rows on the Data lines list will be downloaded. When you have applied any filters and to download only the filtered rows, opt in for the Filter Only option. When there are no filters applied to the Data lines list table, and the user input for Rows is Filtered Only, all the rows from the Data lines list table will be downloaded.

   2. For the Columns field, All is the default selected option. Selecting 'All' will include all available columns. Selecting 'Visible Only' will include only columns currently chosen to display. The columns will be downloaded in the order currently shown on the Data lines list table. The downloaded data will retain the sort applied to the contents on the Data lines list table.

   3. From the File Format drop-down, select in which format you want to export the data. By default, CSV is chosen. You can also set the Excel option.

   4. A default file name is displayed in the File Name field. You can update the default name.

   5. Click Ok.

4. The downloaded file is saved on your local machine.

Viewing Coverage Gap Data line History

The Validata application maintains the history of all actions taken on every data file line within a Submission like when the data line was uploaded, validated, line status overridden to include/exclude, error overridden, or dispute status submitted or dispute reason code updated etc.. . You can view the details specific to each action taken, including when the action occurred and who initiated it. The Validation Analyst can view the data line history for a selected row on the Data lines list table.

To view Coverage Gap data line history, do one of the following:

1. On the Data lines list table, select a row. The History icon is displayed.
   Note: When more than one row is selected on the Data lines list table, the History icon is disabled.
   
   

2. Click the History icon. A window is opened. In the header section of the window, the selected Line’s ID is displayed, and the history table is shown.

Or

1. On the Data lines table, right-click on the line.

2. Select the History option. A window is opened. In the header section of the window, the selected Line’s ID is displayed, and the history table is shown.