RxLogic Release Notes 1.18.6 07/28/2026

RxLogic PBM Application Update

Update Type	Minor
Update Description	This version update includes stabilization and performance items and various bug fixes. Added Features: Test Member Support Drug Lookup by Manufacturer Lower of OPAP vs. OPPRA COB Option Pay To Override Field on Claim Import
Existing Feature Behavior Changes
Version Number	1.18.6.2

Production Release Date	8/11/2026
UAT Release Date	7/29/2026

New Features

The New Features section of the Release Notes is dedicated to work items that are new functionality that were not in previous versions of the application. If you have additional questions on any of the new functionalities, please reach out to your RxLogic CSM.

Claim Tab

Adjudication

Support for Test Members (31567 / 31569 / 31571 / 31572 / 31573 / 31574 / 35198) – Support for identifying members as Test was added to Adjudication, with Test Members indicated by a Cardholder ID starting with the RXTST characters, such as RXTST12345.

Test Members are excluded from the following processes:

Card Printing
Receivables Member Based Fees for Membership Fees, Monthly Coverage Fees, Per Member Per Day, MPA Fees, and Ticket Tracker fees
Surescripts Eligibility Files

Test Members can be created via File Imports or Eligibility APIs, as well as manually through the Create Cardholder and Create Dependent options. Creation of a member through the UI will also set the member to Ignore Updates from Imports automatically. During entry on Create Cardholder / Create Dependent screens, a green TEST badge appears in the CHID field if the Cardholder ID matches the criteria for a Test Member.

The Member screen itself also includes a TEST badge for any member with a CHID starting with RXTST.

Member Search and WC Member Search screens now include an Orange highlight for member’s that are treated as test.

Note: While most Pharmacies submit the Cardholder ID on a reversal, not all do. For clients performing testing with pharmacies, the RXTST Cardholder ID must be submitted on a reversal for these RXTST test transactions to reverse properly.

Reject Code List Expansion (34097) – The available NCPDP reject code selections throughout the platform were expanded by adding 108 additional reject codes. These codes are now selectable where reject code configuration is supported and will be returned with their associated descriptions in transaction responses when configured. No Specific editing was added for these rejects. The Added Codes are:

12 - M/I Place of Service
14 - M/I Eligibility Clarification Code
1C - M/I Smoker/Non-Smoker Code
1K - M/I Patient Country Code
1R - Version/Release Value Not Supported
1S - Transaction Code/Type Value Not Supported
1T - PCN Must Contain Processor/Payer Assigned Value
2G - M/I Compound Ingredient Modifier Code Count
2H - M/I Compound Ingredient Modifier Code
2J - M/I Prescriber First Name
2K - M/I Prescriber Street Address
2M - M/I Prescriber City Address
2N - M/I Prescriber State/Province Address
2P - M/I Prescriber Zip/Postal Zone
26 - M/I Unit Of Measure
3M - M/I Prescriber Phone Number
30 - Reversal Request Outside Processor Reversal Window
31 - No Matching Paid Claim Found For Reversal Request
33 - M/I Prescription Origin Code
35 - M/I Primary Care Provider ID
4E - M/I Primary Care Provider Last Name
4M - Compound Ingredient Modifier Code Count Does Not Match Number Of Repetitions
463 - Pharmacy Not Contracted In Assisted Living Network
5E - M/I Other Payer Reject Count
51 - Non-Matched Group ID
53 - Non-Matched Person Code
55 - Non-Matched Product Package Size
58 - Non-Matched Primary Prescriber
505 - Other Payer Coverage Type Value Not Supported
512 - Compound Code Value Not Supported
513 - Compound Dispensing Unit Form Indicator Value Not Supported
514 - Compound Ingredient Basis Of Cost Determination Value Not Supported
515 - Compound Product ID Qualifier Value Not Supported
516 - Compound Type Value Not Supported
560 - Pharmacy Not Contracted In Retail Network
562 - Pharmacy Not Contracted In Hospice Network
563 - Pharmacy Not Contracted In Veterans Administration Network
564 - Pharmacy Not Contracted In Military Network
565 - Patient Country Code Value Not Supported
583 - Provider ID Not Covered
585 - Fill Number Value Not Supported
598 - More Than One Patient Found
599 - Cardholder ID Matched But Last Name Did Not
62 - Patient/Card Holder ID Name Mismatch
63 - Product/Service ID Not Covered For Institutionalized Patient
600 - Coverage Outside Submitted Date Of Service
619 - Prescriber Type 1 NPI Required
645 - Repackaged Product Is Not Covered By The Contract
7D - Non-Matched DOB
7H - Non-Matched Gender Code
7K - Discrepancy Between Other Coverage Code And Other Payer Amount
7M - Discrepancy Between Other Coverage Code And Other Coverage Information On File
7N - Patient ID Qualifier Value Not Supported
7W - Number Of Refills Authorized Exceed Allowable Refills
7Y - Compounds Not Covered
7Z - Compound Requires Two Or More Ingredients
72 - Primary Prescriber Is Not Covered
73 - Additional Fills Are Not Covered
8H - Product/Service Only Covered On Compound Claim
8K - DAW Code Value Not Supported
8N - Future Date Prescription Written Not Allowed
8Q - Excessive Refills Authorized
8R - Submission Clarification Code Value Not Supported
8T - U&C Must Be Greater Than Zero
8U - GAD Must Be Greater Than Zero
8Z - Product/Service ID Qualifier Value Not Supported
82 - Claim Is Post-Dated
834 - M/I Provider First Name
835 - M/I Provider Last Name
891 - Days Supply Is Less Than Plan Minimum
9R - Prescription/Service Reference Number Qualifier Submitted Not Covered
9U - Provider ID Qualifier Submitted Not Covered
9V - Prescriber ID Qualifier Submitted Not Covered
943 - DUR Reject - Pharmacy Override Using DUR/PPS Not Allowed
AK - M/I Software Vendor/Certification ID
A7 - M/I Internal Control Number
A9 - M/I Transaction Count
CX - M/I Patient ID Qualifier
CY - M/I Patient ID
CZ - M/I Employer ID
DA8 - M/I Patient Street Address Line 1
DA9 - M/I Patient Street Address Line 2
DC - M/I Dispensing Fee Submitted
EE - M/I Compound Ingredient Drug Cost
EF - M/I Compound Dosage Form Description Code
EG - M/I Compound Dispensing Unit Form Indicator
EM - M/I Prescription/Service Reference Number Qualifier
ET - M/I Quantity Prescribed
EV - M/I Prior Authorization ID Submitted
EY - M/I Provider ID Qualifier
E2 - M/I Route Of Administration
E4 - M/I Reason For Service Code
E6 - M/I Result Of Service Code
E8 - M/I Other Payer Date
G8 - Pharmacy Not Contracted In Long Term Care Network
HA - M/I Flat Sales Tax Amount Submitted
HB - M/I Other Payer Amount Paid Count
HC - M/I Other Payer Amount Paid Qualifier
HN - M/I Patient E-Mail Address
NP - M/I Other Payer-Patient Responsibility Amount Qualifier
NR - M/I Other Payer-Patient Responsibility Amount Count
P6 - Date Of Service Prior To Date Of Birth
UU - DAW 0 Cannot Be Submitted On A Multi-source Drug With Available Generics
YK - M/I Service Provider Name
YM - M/I Service Provider Street Address
YN - M/I Service Provider City Address
YP - M/I Service Provider State/Province Code Address
YQ - M/I Service Provider ZIP/Postal Code

F6 Updates For Request Parsing (33280/ 33282 / 33482 / 33378 / 33386 / 33456 / 33460 / 33461 / 33461 / 33463 / 33465 / 33469 / 33470 / 33471) – As RxLogic prepares for full support of version F6, the following changes were made:

F6 Transactions are now viewable in Claim Processing, Transaction Detail, Claim Activity, and Transmission Log screens. At this time, F6 transactions cannot be submitted via the UI.
The adjudicator and UI were updated for the F6 Header, including the change of length and position of the BIN/IIN.
The Patient Segment was updated by:
- Fields Added:
  - 618-RR – Patient ID Count (Looped field F6 - up to 9 occurrences)
  - B08-7A - Patient Street Address Line 1
  - B09-7B - Patient Street Address Line 2
  - A43-1K – Patient Country Code
  - E06-S8 – Species (SNOMED Codes)
- Fields Removed
  - 322-CM – Patient Street Address
The Pharmacy Provider Segment was updated by:
- Fields Added:
  - B96-4A – Provider First Name
  - B97-4M – Provider Last Name
The Insurance Segment was updated by:
- Fields Removed:
  - 314-CE – Home Plan
  - 990-MG – Other Payer BIN Number
  - 991-MH – Other Payer Processor Control Number
  - 356-NU – Other Payer Cardholder ID
  - 992-MU – Other Payer Group ID
The Claim Segment was updated by:
- Fields Added:
  - B98-34 – Reconciliation ID
  - 581-XZ – Associated Prescription/Service Reference Number Qualifier
  - D16-KZ – Submission Type Code Count
  - D17-K8 – Submission Type Code
  - D21-M3 – Multiple Prescription/Service Order Group ID
  - D22-M4 – Multiple Prescription/Service Order Group Reason Code
  - D02-KW – Total Prescribed Quantity Remaining
  - C99-KU – Preparation Environment Type
  - C98-KT – Preparation Environment Event Code
  - 579-XX – Associated Prescription/Service Provider ID Qualifier
  - 580-XY – Associated Prescription/Service Provider ID
  - A29-ZS – Reported Adjudicated Program Type
  - C02-4P – Original Manufacturer Product ID Qualifier
  - C01-4N – Original Manufacturer Product ID
  - C91-KK, – LTPAC Dispense Frequency
  - C90-KH – LTPAC Billing Methodology
  - C92-KM – Number of LTPAC Dispensing Events
  - D18-K9, –Do Not Dispense Before Date
- Fields Removed:
  - 463-EW – Intermediary Authorization Type ID
  - 464-EX – Intermediary Authorization ID
  - 880-K5 – Transaction Reference Number
  - 114-N4 – Medicaid Subrogation Internal Control Number/Transaction Control Number (ICN/TCN)
- Fields Renamed
  - 462-EV – Prior Authorization ID Submitted
The Prescriber Segment was updated by:
- Fields Added:
  - B26-7T – Prescriber Telephone Number Extension
  - B27-7U – Prescriber Street Address Line 1
  - B28-7V – Prescriber Street Address Line 2
  - B42-3C – Prescriber Country Code
  - D01-KV – Prescriber DEA Number
  - D57-RG – Prescriber Place of Service
- Fields Removed:
  - 365-2K – Prescriber Street Address
The COB Segment was updated by:
- Fields Added:
  - C47-9T – Other Payer Adjudicated Program Type
  - C49-9V – Other Payer Reconciliation ID
  - D51-P7 – Other Payer Percentage Tax Exempt Indicator
  - D53-P9 – Other Payer Regulatory Fee Type Count
  - D63-RN – Other Payer Regulatory Fee Type Code
  - D52-P8 – Other Payer Regulatory Fee Exempt Indicator
  - C50-9W – Benefit Stage Indicator Count
  - C51-9X – Benefit Stage Indicator
- Fields Removed:
  - 392-MU – Benefit Stage Count
  - 393-MV – Benefit Stage Qualifier
  - 394-MW – Benefit Stage Amount
The Worker’s Compensation Segment was updated by:
- Fields Added:
  - B15-8D – Employer Street Address Line 1
  - B16-7G – Employer Street Address Line 2
  - B35-1V – Employer Country Code
  - B19-7K – Employer Telephone Number Extension
  - B17-7H – Employer Contact First Name
  - B18-7J – Employer Contact Last Name
  - B24-7R – Pay To Street Address Line 1
  - B25-7S – Pay To Street Address Line 2
  - B39-1Z – Pay To Country Code
- Fields Removed:
  - 316-CG – Employer Street Address
  - 321-CL – Employer Contact Name
The DUR/PPS Segment was updated by:
- Fields Renamed:
  - 475-J9 – DUR/DUE Co-Agent ID Qualifier
  - 476-H6 – DUR/DUE Co-Agent ID
The Pricing Segment was updated by:
- Fields Added:
  - D60-RK – Regulatory Fee Count
  - D61-RL – Regulatory Fee Type Code
  - D14-KX – Subrogation Amount Requested
- Fields Removed:
  - 113-N3 – Medicaid Paid Amount
- Fields Renamed:
  - 481-HA – Regulatory Fee Amount Submitted
The Coupon Segment was removed completely in F6.
The Compound Segment was updated by:
- Fields Renamed:
  - C60-AG – Compound Level of Complexity

These updates are the foundation work required to parse and display F6 transactions, and no new functionality related to the new F6 fields were added.

Drug Tab

Drug Lookup

Active/Inactive Enhancements for Show Drug (29572 / 29573 / 29574 / 29575) – The Show Drug option allows a view into if a drug is used within edits across the system. Enhancements were made to the Step Therapy, Process Rules, MAC List, and MPA Lists lookup to allow for filtering of Active vs. Inactive items.

Search by Manufacturer (34589) – Manufacturer was added as a new search option, as well as a selectable results grid column. Typing in the Search field brings up a list of potential matches that can be clicked on to perform the search. The Manufacturer search filter was also added to other screens that include Drug Searches, including Formulary Manager, MAC Manager, MPA Manager, Claim Processing, and Process Rules.

Additional Filter Setting for Manual Indicator (34591 / 35189) – The ability to set a Default User Setting for the Manual Indicator was added. Defaulting to show both Manual and non Manual drugs, the setting can be changed on the Additional Filter screen accessible via the Settings button. This setting also applies to other Drug Search based screens, including Formulary Manager, MAC Manager, MPA Manager, Claim Processing, and Process Rules.

Member Tab

MPA Manager

Reason Column Populated in Export (33957) –The MPA Manager search results and export functionality now displays the Reason associated with Approved or Denied MPAs. When the Reason column is selected, the approval or denial reason is displayed giving context for the decision.

Member Search

Status Improvements for Member Merge (33685 / 33686) – Improvements were made to the Member Merge process to include a new status popup indicating the step of the Merge that is occurring.

Once the Merge process is complete, a popup confirmation is displayed.

As a part of this process, UI based Member Merges are now logged to a Job Run logs and can be reviewed after the fact.

Rules & Calculators Tab

COB Rule

New Lower of OPAP Vs. OPPRA Formula (34567) – A new LowerOfOPAPVsOPPRA Payment Formula option was added. When this option is selected, the Total Buy Side Pricing minus the Other Payer Amount Paid (OPAP) is compared to the Other Payer Patient Responsibility Amount (OPPRA), and the lower of the two is used for the Buy Side pricing. If either the OPPRA or OPAP is not submitted, the other submitted option wins by default with the caveat that OPPRA will not be used if it exceeds the Total Buy Side Pricing.

Files and Jobs Tab

Job Manager

ClaimImport – Addition of PayToOverride Field (34175) – The Claim History Import process now includes an optional Pay-To Override field as column 73. This allows payment of imported claims to be directed to a designated payment center when needed. Clients using older versions of the Claim Import do not need to update the new 73 column layout unless they want to take advantage of the new field.

User Administration Tab

User Management

Account Locked Email to Include Environment and Client (22315) – Information about the Environment and Client were added to the Locked Email notification.

Administration Tab

Global Defaults

F6 - Add Global Default Adjudication Settings for versions F6 and D.0 (34066) – New global default settings were added to control adjudication behavior for Version F6 and Version D.0 transactions.

Adjudication – Reject Version F6 Transactions
- When set to True: Version F6 transactions are rejected with 1R – Version/Release Value Not Supported.
- When set to False/Default: Version F6 transactions are accepted.

Adjudication – Reject Version D0 Transactions
- When set to True: Version D.0 transactions are rejected with 1R – Version/Release Value Not Supported.
- When set to False/Default: Version D.0 transactions are accepted normally.

Date evaluations for both options are based off the DOS of the transaction.

Help & Support

Release History

Added 1.18.5 Release Notes (34375) – Release Notes for 1.18.5 were added.

Database

Existing Field Updates

The following new fields were added as part of this release:

NCPDP F6 Standard - Extend IIN (BIN) In Database (17227) – Instances of the BIN fields in the database were expanded from a max size of 6 to 8 to prepare for support of 8 length IINs in the F6 standard.

New Fields

The following new fields were added as part of this release:

Database	Table	Field	Data Type	Length
Enrollment	StandardClaimHistoryStaging	PayToOverride	NVARCHAR	6

Bug Fixes and Minor Enhancements

Claim Tab

Adjudication

Fixed an issue where the Other Amount Claimed Rule, and COB Rule were not properly stored on a transaction. (33935)
Resolved an issue where compound claims could incorrectly reject when using the Capture All Rejects for Non Compounds setting in combination with a compound MPA configurations on closed Formulary Groups. (34506)
Fixed an issue where the Paid Claim Status box on the Transaction Details screen was missing cell borders. The status box now displays the borders correctly, restoring the expected layout and readability. (33804)

Transaction Details

Fixed an issue where the Paid Claim Status box on the Transaction Details screen was missing cell borders. The status box now displays the borders correctly, restoring the expected layout and readability. (33804)

Claim Processing

Fixed an issue where an MPA without a termination date was incorrectly displayed as Inactive in the MPA Details popup accessed from Claim Activity, Claim Processing, and Transaction Details screens. The MPA status is now displayed consistently as Active across all application areas when no termination date is present. (33679)

Drug Tab

Manual Drug

Fixed an issue that prevented Manual Drug details from being opened. (35184)

MAC Manager

Improved logging related to Adds, Changes, and Removals of items from MAC Lists via the Import. This information is captured in database level auditing tables. While this information is visible via the timeline for MACs, additional filtering and performance issues around this view will be addressed in a future sprint. (22637)

Member Tab

MPA Manager

Fixed an issue that returned an error when attempting to delete an MPA. (33681)

Member Search

Fixed an issue where manually updating a Member right after they were imported would prevent a Card Print job that includes new members from including the Member. (34359)

Pharmacy Tab

Pharmacy Manager

Resolved an issue where the Pharmacy Provider Relationship Import failed to complete despite indicating a successful run. The import process now successfully applies valid file updates and provides an appropriate import status. (34292)

Pharmacy Tab

Group Manager

Updated the Save logic to display a warning message if a Satisfaction is defined for the Deductible, OOP, or Benefit Cap without a corresponding dollar amount. (32821)

Location Manager

Improved the Bulk Deletion processes to avoid timeouts after 100 seconds when many Location Codes were being deleted. (33843)

Files and Jobs Tab

Job Manager

AccumImport – Added validation on the Processed Date column to error records missing the Processed Date value. The -Det file will include an error detail of “Missing Processed Date”. (32773)
Accumulator Export - Fixed an issue where the CHID column was null for Members with termed Cardholder Eligibility. The CHID value is now populated correctly. (34003)
Eligibility Import – Fixed an issue for the Full type where if a member has Ignore Updates from Imports set to True, their CH elig, Group Elig, or Subgroup Elig periods could have been removed if the data on the file was different than what was on system. (20150)
Pharmacy Relationship File Import - Updated the job to no longer require entry of a Client parameter. (28818)

Billing & Fee Mgmt Tab

Payables Manager

Fixed an issue that caused the DOS value to be one day less than the actual DOS value for transaction on the Claims, and Voucher Claim Details grids. (33920 / 33933)
Fixed an issue where the Carryovers report contained multiple records for the same Voucher if the batch was related to multiple Billing Cycles. (34172)

Administration Tab

ApiKey Management

Fixed an issue where the API Key Refresh endpoint did not consistently refresh API keys when triggered through the API Key Management UI. (20998)

APIs

PricingRequest

Fixed an issue where a Deductible value was incorrectly returned in the response when a member had a Deductible accumulation, but their Group had no Deductible configured. Now, when there is no Deductible setup for the group, a 0 is returned for the Deductible field. (34013)
Improved compatibility of the request by allowing for the Gender and IgnoreAccumulators fields to support null values instead of resulting in an error. (33932)

ClaimSummary

Fixed an issue where the HasBeenMet fields for Deductible, OOP, and Benefit Cap were always showing false even when the Member had met the related limit. (29007)

HotFixes

The HotFixes section includes both Enhancement and Bug related information applied to an earlier version after the publication of their Release Notes.

Claim Tab

Adjudication

1.18.5.2 – Resolved a regression issue that prevented Maximum Out-of-Pocket (MOOP) accumulators from updating correctly during claim processing in certain scenarios. MOOP accumulator amounts will now calculate and accumulate as expected. (34575)
1.18.5.2 - Resolved a regression issue where claims that met Maximum Out-of-Pocket (MOOP) requirements could continue using the plan’s default copay calculation instead of the configured post-MOOP copay rule. Claims will now correctly apply the copay calculation associated with MOOP satisfaction when applicable. (34600)
1.18.5.2 - Resolved a regression issue that could cause a transaction to reject with a 92 error if an MPA with the Ignore All SDCs option was used. (34823)
1.18.5.2 - Resolved an issue that could cause the incorrect network process rule configuration to be selected when the same network was attached to a plan multiple times with different process rules. (35035)

Transaction Details

1.18.5.2 - Resolved a regression issue where the Claim History popup detail could not be seen for a user with a restricted User Group. (34480)

Claim Processing

1.18.5.2 - Fixed an issue that showed the Request information under the Tx Response tab after submission of a transaction. (35006)

Member Tab

MPA Manager

1.18.5.2 – Fixed a regression issue where existing MPAs could not be updated. (34471)

Member Search

1.18.5.2 – Fixed a regression issue where existing MPAs could not be updated. (34471)

1.18.5.2 - Fixed an issue where clicking the Notes Summary on the Interactions tab would result in an error preventing loading of the summary. (35032)

Rules & Calculators Tab

Bill Cost Calculator

1.18.5.2 – Removed a %/$ field that erroneously appeared next to the Copy To options on a few tabs. (34809)
1.18.5.2 - Fixed an issue where the winning result from Formula1 or 2 in an attached cost calculator would set the sell side cost basis and dispensing fee even if it lost to a lower of comparison against the U&C, Total Submitted Price from Pharmacy, or other lessor of options. (35295)

Files and Jobs Tab

Job Manager

1.18.4.2 – Claim Import – Fixed an issue where a member ID would not get linked to an imported transaction if the member had more than one record on the import and one of the records had an incorrect name and no Location Code, while another record for the same member had a correct name and a Location Code. (34100)
1.18.5.2 – Eligibility Import – Increased a timeout for the Partial file type process to avoid failures during the part of the process that resolves conflicting Group enrollments. (34609)
1.18.5.2 – Repricing Import – Fixed an exception that was occurring when gathering drug information for preparation of the output report. (35005)
1.18.5.2 – Medispan History Import – Fixed an issue where the process would show as failed on days when no new Medispan File was available. (35082)
1.18.5.2 – Invoice Payments Import - Resolved an issue that caused the job to report a failure and prevent output files from being generated. (35197)
1.18.5.2 – Turned off unnecessary behind the scenes logging for the Accumulator Export, Accumulator Import, Surescripts Monthly Totals, Invoice Payments Import, Billing Cycle File Export, and Billing Cycle File Import. This logging could have a negative impact on performance on larger files (35201 / 35202 / 35203 / 35204 / 35205 / 35206)

Reporting Tab

Report Manager

1.18.5.2 – Removed additional behind the scenes system logging that could result in job slowdowns. (34976 / 35151)
1.18.5.2 – Fixed an issue that resulted in License error text displaying in output files. (35081)

Billing & Fee Mgmt Tab

Payables Manager

1.18.5.2 – Fixed a regression issue where files generated during the Batch process were placed in two different date folders. (34876)
1.18.5.2 - Fixed an issue that caused certain columns to be repeated in the combined claims and adjustment report giving the appearance of duplicate records. (35147)

APIs

Blob

1.18.5.2 - Fixed an issue where the API/Blob path was returning 404 errors for API. (34555)

ClaimHistory

1.18.4.2 – Fixed an issue where URL Encoded requests were received a 415 Unsupported Media Type response. (34478)