Duplicate Lines in Coverage Gap Submission

Coverage Gap Duplicates Overview

Duplicates exist in Coverage Gap data files for a variety of reasons. Since most pharmaceutical manufacturers define duplicates differently, you must understand what is meant by a "duplicate." Every pharmacy serializes prescription reference numbers. You have a duplicate when the data file line has the same prescription reference number, filled at the same pharmacy, for the same product, on the same day. Some other factors are also considered when identifying the duplicates, like Fill Numbers, Date of Service, Quantity of Scripts, and Product ID.

Validata provides the Duplicate Check Rule Set to check for duplicates in the Submission being validated. The Duplicate Check Rule Set checks for duplicates between data in the selected Submission and across all Submissions. You can either specify that duplicates be identified within data received from the same source (internal duplicate check) or within data received from different sources (external duplicate check). You can define the columns of data that are compared for duplicates, as well as the date of service and transaction data selections. For detailed documentation, see Validate Submission Files for Duplicates and Configuring the Duplicate Check Rule Set.

When a Coverage Gap Submission is validated using the Duplicate Check Rule Set validation and the validation mechanism finds duplicate lines in the Submission, those duplicate lines are displayed under the Duplicates tab on the Submission Details page. The Validation Analyst can view the lines that contain duplicates within this Submission and across Submissions listed on the Duplicates page table. This allows the Validation Analyst to take the required action by removing the duplicate lines from one of the Submissions.

Viewing the Duplicate Lines

To view the duplicate lines:

1. Open a Coverage Gap Submission.

2. Click the Duplicates Tab.
   All the Coverage Gap data file lines included in the Submission that are duplicated within this Submission and duplicates across Submissions are displayed in the table. For a detailed description of the columns displayed in the Duplicates table, see List of Columns on the Duplicates Table.
   
   

3. The duplicate lines from the current Submission are listed on the Duplicates table by default. On clicking the arrow icon on the Line ID, the Analyst can view all the other linked Submissions to which the respective data file line is associated.
   

4. Click the Line ID link to navigate to the respective Submission > Data lines page. You can also navigate to the Submission, where the Line is duplicated, by following one of the below:

   • Mouse over the Submission ID and a popup window is displayed showing the Submission details. Click Go to Submission link.

   • Mouse over the Submission Name and a popup window is displayed showing Submission details. Click Go to Submission link.

On the Submission page, the Analyst can take required action like removing the file from the Submission.

List of Columns on the Duplicates Table

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

• Line ID: The unique system-generated ID assigned to the data file 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 utilization line when a Submission is validated. 

Notes:

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

• An empty value is displayed when a 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 file 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 line. Click on the Error Code to view the full description of the errors.

• Line Status: Displays the current status of the utilization 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, and the submitted utilization line is not stamped with an Error Code of severity level Critical or Major, the line is assigned an Included status.

  • Excluded: When Submission is validated using a Validation Set, and the submitted utilization line is stamped with an Error Code of severity level Critical or Major, the line is assigned an Excluded status.

When a Coverage Gap data file Line Status is overridden manually from Excluded to Included or vice versa, the Line Status column displays one of the following values:

• Override -Excluded

• Override - Included

For detailed documentation about the Override Line Status, see Overriding Submission Line's Validation Result.  

Submission

• Submission ID: Specifies the ID of the Submission with which the Line is associated.

• Submission Name: Specifies the Name of the Submission with which the Line is associated.

• Rebate Period Start Date: Specifies the Rebate Period start date for the Submission.

• Rebate Period End Date: Specifies the Rebate Period end date for the Submission.

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

• Dispute:

• Dispute Status: Identifies where the Coverage Gap Data Line’s dispute status is. One of the following values is displayed:

  • <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. On expanding the group header this column is displyed.

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.

• Gap Amount This Period: Net payment amount this quarter, calculated as the "current amount" minus the "previous amount."

• Reported Gap Discount Current Amount: New gap discount amounts invoiced this quarter.  

• Reported Gap Discount Previous Amount:

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. Based on the Service Provider ID Qualifier value, this column value is retrieved.

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

• NPI: the assigned NPI 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 Duplicates Table

The Validata application allows the Analyst to sort and filter the lines on the Duplicates 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.

The sorting and filter functionality on the Duplicates list is the same as the Coverage Gap Submission Data Lines table. For more details see Sorting and Filtering the Lines on the Data lines Table.

Downloading the Coverage Gap Duplicates List Table Rows

The Validation Analyst can download the lines from the Duplicates 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 Duplicates list table.

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

The downloading Duplicates list table row is the same as the Coverage Gap Submission Data Lines table download. For more details, see Downloading the Data Lines List Table Rows.