Current Active Requests: Claim
Welcome to the Claim section of Current Active Requests. Below are options for claim history and submission of raw of NCPDP. These sections will include descriptors of both, as well as sample requests/parameters for each.
Claim History
Returns information on Paid and Reversal transactions for a member. By default, only the most recent paid claim for a Pharmacy, Rx, Fill Date combination will be returned, but all paid and reversals for the same combination can be returned by setting IncludeFullHistory to true.
Sample Request / Parameters
/ClaimHistory
curl --location --request POST 'https://clientapi.test.ad.rxlogic.com/ClaimHistory' \
--header 'Content-Type: application/x-www-form-urlencoded' \
--data-urlencode 'MemberId=' \
--data-urlencode 'MemberKey=JHELIGNAME004' \
--data-urlencode 'PersonCode=01' \
--data-urlencode 'SenderId=test' \
--data-urlencode 'DateStartRange=2021-05-15T05:33:27.146Z' \
--data-urlencode 'DateEndRange=2021-06-08T03:52:13.035Z'
--data-urlencode 'IncludeFullHistory=false'
Claim History accepts parameters of Member ID (internal key), Cardholder ID (MemberKey), Person Code, SenderId, and a Date start and End Range including time. Either Member Id, or Member Key and Person Code need to be provided to resolve the member. End Range is not inclusive, meaning to include claims from 3/8/2022 a date of 3/9/2022 should be provided.
Sender ID is optional. IncludeFullHistory is optional, and will be treated as false is not provided. A sample response is seen below.
[
{
"ClientCode": "76",
"PlanCode": "2",
"MemberId": "480929",
"ExternalGroupId": "JHELIG4",
"FirstName": "ELIGNAMEFOUR",
"LastName": "TESTNAMEFOUR",
"DateOfBirth": "1980-04-30T00:00:00",
"Gender": "M",
"AuthorizationNumber": null,
"FillDate": null,
"LabelName": "",
"NDC": "00548560100",
"Quantity": 30.000,
"DaysSupply": 5.0,
"PharmacyName": "FAMILY PHARMACY OF BATON ROUGE",
"PrescriberName": "",
"MemberKey": "480929",
"PersonCode": "01",
"NABP": "1936218"
}
]
/* Enter your code */
Submit Raw NCPDP
Submit raw NCPDP is an endpoint that allows submission of an NCPDP formatted request for adjudication, and returns back an NCPDP formatted response. The request can either be sent as a live or test claim.
Below is a sample request/parameters
(/SubmitRawNCPDP).
Parameters are explained below:
|
FIELD |
REQUIRED? |
Additional Info |
|---|---|---|
|
TransmissionId |
Required |
GUID value. Can be sent as either the default 00000000-0000-0000-0000-000000000000 to have the system automatically assign a GUID, or a client generated value. If sending a value other than the default, this value must be unique across all previously submitted transactions so the use of a GUID generator is recommended. |
|
Request |
Required |
NCPDP formatted request, including the standard control characters within the string. |
|
SenderId |
Optional |
This field only needs to be submitted if using an agreed upon value from RxLogic. Default value of RAWNCPDPAPI will be stored on transaction if no value submitted. |
|
Keyed |
Optional |
true/false (default: false) If true, tags the transaction as keyed which may impact fees charged on the transaction during billing. |
|
Selfpay |
Optional |
true/false (default: false) If true, tags the transaction as selfpay which directs payment to the member instead of pharmacy. |
|
UserName |
Optional |
This field only needs to be submitted if using an agreed upon value from RxLogic. Default value of CLAIMSUBMITAPI will be stored on transaction if no value submitted. |
|
TestClaim |
Optional |
true/false (default: false) If true, transaction is tagged as test. |
curl --location 'https://rxltestclientapi.rxlogic.com//SubmitRawNCPDP' \
--header 'Content-Type: application/json' \
--header 'apiKey: 00000000-0000-0000-0000-000000000000' \
--data-raw '{
"TransmissionId": "00000000-0000-0000-0000-000000000000",
"Request": "000000D0B1 1011285003384 20230918 AM01C419800430C50CADISPFEECBCOB AM04C2DISPFEECOBCCDISPFEECDCOBC1DISPFEECOBC301 AM02EY01 AM03EZ01DB1942252895 AM054C15C16C037C004682E820230926HB15E1NR1NP06NQ420{ AM07EM1D2202309260003E103D700071015623E730000D530D31D61DE20230714DJ3NX1C88281U701 AM10EF01EG1EC12G1 AM11D9999990{DC75{H71H801HE1000{DQ999990{DU999990{DN02 AM087E1E4ARE5ASE600 AM13VE1",
"SenderId": "SENDTEST2",
"Keyed": false,
"SelfPay": false,
"UserName": "jhilltester@rxlogic.com",
"TestClaim": false
}'
/* Enter your code */
Sample Response
TransmissionId is the GUID assigned on system if 0s sent, or echoes back the value provided on the request . Response is the NCPDP response.
RuleTracker is a JSON object of all rules fired during the adjudication process showing the same data that is shown on the Tx Rules page within the application. As this data can be lengthy, it has been truncated for this response example, breaking the JSON object overall.
{
"TransmissionId": "af7f3e53-975f-4970-b51b-ce1456ff7079",
"Response":"D0B21A011285003384 20230918 AM20 AM21ANAUF01UH01FQCLAIM WAS REVERSEDF3583661 AM22EM1D2202309260003",
"RuleTracker": "{\"StageExecutionDetails\":[{\"ConstraintExecutionDetails\":null,\"StageId\":1,\"StageName\":\"Initialization\",\"RuleExecutionDetails\":[{\"ConstraintExecutionDetails\":null,\"RuleId\":1,\"RuleName\":\"Down For Maintenance\",\"Status\":6,\"TimeIn\":\"2023-09-27T09:04:52.9167869-04:00\",\"TimeOut\":\"2023-09-27T09:04:52.9167869-04:00\",\"Events\":[]},{\"ConstraintExecutionDetails\":null,\"RuleId\":11,\"RuleName\":\"FlagTestTransaction\",\"Status\":0,\"TimeIn\":\"2023-09-27T09:04:52.9167869-04:00\",\"TimeOut\":\"2023-09-27T09:04:52.9167869-04:00\",\"Events\":[]},{\"ConstraintExecutionDetails\":null,\"RuleId\":64,\"RuleName\":\"AddClaimLocks\",\"Status\":0,\"TimeIn\":\"2023-09-27T09:04:52.9167869-04:00\",\"TimeOut\":\"2023-09-27T09:04:52.9167869-04:00\",\"Events\":[{\"Type\":null,\"Message\":null,\"Detail\":\"Creating ClaimLock TxClaim_DISPFEECOB at 9/27/2023 9:04:52 AM\",\"Timestamp\":\"09/27/2023 09:04:52:916\"}]},{\"ConstraintExecutionDetails\":null,\"RuleId\":80,\"RuleName\":\"AddSleep\",\"Status\":6,\"TimeIn\":\"2023-09-27T09:04:52.9167869-04:00\",\"TimeOut\":\"2023-09-27T09:04:52.9167869-04:00\",\"Events\":[]},{\"ConstraintExecutionDetails\":null,\"RuleId\":2,\"RuleName\":\"Force Reject\",\"Status\":2,\"TimeIn\":\"2023-09-27T09:04:52.9167869-04:00\",\"TimeOut\":\"2023-09-27T09:04:52.9167869-04:00\",\"Events\":[]},{\"ConstraintExecutionDetails\":null,\"RuleId\":6,\"RuleName\":\"Validate DOS\",\"Status\":0,\"TimeIn\":\"2023-09-27T09:04:52.9167869-04:00\",\"TimeOut\":\"2023-09-27T09:04:52.9167869-04:00\"}]}"
}