Handling Coverage Gap Files

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Validata performs additional processing for Coverage Gap data and invoice files to support:

Signed Overpunch
Because the Third Party Administrator that provides Coverage Gap files uses old technology, Coverage Gap data and invoice files use signed overpunch, which is a way to save space by replacing the sign and the final digit of a number with a character. The built-in import mapping sets for Coverage Gap data and invoice files provide a mask that translates signed overpunch during import. Signed overpunch is also supported when creating the Dispute Submission report and file. Signed overpunch is not supported during export for Coverage Gap data and invoice files.
Multiple Headers and Trailers
Coverage gap data and invoice files have multiple headers and trailers that map values to the same fields for header, trailer, and/or detail files. For example, the detail file has a manufacturer and a labeler header, and both of them map to fields called File ID. The built-in mappings sets for Coverage Gap data and invoice files handle multiple headers and trailers correctly during import and export.

Signed Overpunch

When importing a file that has a mask for a numeric field that indicates it will be using signed overpunch, the system translates the values correctly. Based on the table below, if the last digit for the field in the file matches the Code Imported, it translates to the appropriate number and sign.

Negative Values		Positive Values
Code Imported	Translates To	Code Imported	Translates To
}	0-	{	0+
J	1-	A	1+
K	2-	B	2+
L	3-	C	3+
M	4-	D	4+
N	5-	E	5+
O	6-	F	6+
P	7-	G	7+
Q	8-	H	8+
R	9-	I	9+

For example, if the file contains the value 10M, that would get translated to 104- during import, whereas the value 10D would translate to 104+.

If you import a number for a field with a signed overpunch mask, but the value in the file does not contain an overpunch sign, it is imported as a straight number with the rest of the mask applied.

If you import a number for a field without a signed overpunch mask, but the value in the file has an overpunch sign, the value is imported as it is, and an error is caught during the Date & Numeric validation.

If you import a number for a field with a signed overpunch mask but the mask is entered incorrectly, for example, the mask shows as S999999999V99, the value is imported as it is, with no update done based on the mask, and an error is caught during the Date & Numeric validation because the value still has a character.

Multiple Headers and Trailers

When importing a file with multiple headers and trailers, all the header and trailer information is stored in the system in such a way that it can be referenced later to export the header and trailer values associated with prescription-level information. Note that this information is not available through the user interface.

For example:

Manufacturer 1 Header
Labeler 1 Header
     DETCG row 1 for labeler 1
     DETCG row 2 for labeler 1
Labeler 1 Trailer
Labeler 2 Header
     DETCG row 1 for labeler 2
     DETCG row 2 for labeler 1
     DETCG row 3 for labeler 1
     Labeler 2 Trailer
Manufacturer 1 Trailer
Manufacturer 2 Header
     Labeler 3 Header
          DETCG row 1 for labeler 3
     Labeler 3 Trailer
Manufacturer 2 Trailer

For a data file, only information in the DETCG rows are available to review in the system. For an invoice file, only information in LBLR rows are available to review in the system.

For a data file, the systems associates the DETCG row and the labeler header and trailer by considering the labeler code. This is done by comparing the first five digits of the Product ID field in the detail record with the Labeler code field in the header and trailer.

When exporting with multiple headers and trailers, the information in the file is grouped appropriately within the correct header and trailer records. Assuming that the export mapping set includes the same headers and trailers as the import mapping set, this means that given the above example for import, the DETCG rows for labeler 1 are enclosed within the labeler 1 headers and trailers, and likewise for the other labelers, and the labeler 1 and labeler 2 trailers are enclosed within the manufacturer 1 header and trailer, and likewise for manufacturer 2.

The system handles the mapping correctly, even if the export mapping set does not include some header or trailer information and even if the export mapping set includes the same header or trailer information but the fields are mapped in a different order.

Note that for import mapping sets, items that are listed as being in both the header and trailer are suppressed in the options for mapping the trailer. Only the items that are distinct for the trailer appear. For export mapping sets, all options are available for both the header and trailer.