The table below describes each of the fields on the Utilization Manager screen for a Covered Entity. Scroll to the right to see all of the fields.
| Field |
Description |
| Status |
Account under which the script qualified: 340B, GPO, or WAC. |
| Service Date |
Date when the patient received a diagnosis after a covered entity visit. |
| MRN |
Patient’s medical record number |
| Visit |
Visit Number |
| Rx Number |
Prescription Number |
| Patient Type |
Patient type at the time of charge |
| CDM |
Charge Description Master. A CDM is a unique charge code assigned by a covered entity to a particular drug for billing purposes. |
| CDM Description |
Description of the CDM. Each covered entity may have its own charge code descriptions. |
| Quantity |
Number of pills or tablets in the prescriptions. |
| Amount |
Dollar amount, including copay, dispense fee, and revenue. |
| Primary Payor |
The first entity that pays for the claim. |
| Secondary Payor |
The second entity that pays for the claim. |
| Tertiary Payor |
The third entity that pays for the claim. |
| NDC |
National Drug Code. An NDC is a unique 11-digit, 3-segment numeric identifier required for each drug by the Food and Drug Administration. The first segment, the labeler code, is used to identify the firm that manufactures the drug. The second segment, the product code identifies a specific strength, dosage form, and formulation for a particular firm. The third segment, the package code identifies package forms and sizes. |
| NDC Description |
Description of the drug as provided by the FDA |
| MHI BUPP |
Billing Unit Per Package in 340B Architect |
| MHI Pkgs. |
The number of packages for that drug as listed in 340B Architect. The number of pills dispensed over the BUPP. The number of packages you can buy. |
| MHI Date Match |
Y – Script is within Pharmacy effective date N – Script fell outside Pharmacy effective date (not eligible for 340B testing) |
| MHI Inpatient |
If this drug qualifies as an Inpatient, you will see a Y for Yes. Otherwise, you will see an N for No. Otherwise, you will see an N for No. |
| MHI Medicaid |
340B test results confirming whether or not a claim was qualified or disqualified based on having a Medicaid payor. If the CP is Carving-In, MH will not test or disqualify on Medicaid payor type. The Pharmacy Setting in 340B Architect in this scenario will be Test Medicaid (PID) and Test Medicaid (MHI) = No. The MHI Medicaid column in Utilization Manager will always contain an “N”. If the CP is Carving-Out, MH will test and disqualify on Medicaid payor type. In this scenario, the MHI Medicaid column in the Utilization Manager can contain a “Y” or “N”. Y indicates the claim has a Medicaid payor, which will disqualify it from the 340B program. N indicates NO, the claim did not have a Medicaid payor; therefore it does qualify for the 340B program (assuming it passes all other testing). |
| MHI Orphan |
340B test results Orphan drug eligibility Orphan Drug Exclusion policy states that:
N – Indicates No, the NDC is not an orphan drug; may qualify for 340B. X – Indicates that the NDC is an orphan drug and the diagnosis received for the patient was not orphan related, therefore, this claim may qualify for 340B. Y – Indicates Yes, the NDC is an orphan drug and MH has not received the diagnosis for the patient to confirm whether or not it was orphan related. Claims with a Y indicator are in the non-340B account status (GPO) until the diagnosis information is received. Z – Indicates that the NDC is an orphan drug and the diagnosis received for the patient is orphan related. Drugs with a Z indicator are not eligible for 340B and will have non-340B status. |
| MHI 340B Drug |
340B test results confirming if a 340B price exists in the customer’s drug catalog. Y indicates Yes, drug catalog price exists; may qualify for 340B. N indicates No, a drug catalog price is not present; does not qualify for 340B. |
| MHI Drug Exclude |
340B test results indicating if an applied Qualification Filter qualified or disqualified a specific NDC. Y indicates a qualification rule was applied; does not qualify for 340B based on this test N indicates a qualification rule was not applied; does qualify for 340B based on this test |
| MHI IsPatient |
If the CE sends to Macro Helix a list of patients whose prescriptions are to be tested for 340B eligibility, then this flag is set to Y (yes). If N (No), no patient prescriptions are tested. The IsPatient means this patient IS an inpatient. |
| MHI Is Employee |
If the CE sends to Macro Helix a list of employees whose prescriptions are to be tested for 340B eligibility, then this flag is set to Y (yes). If N (No), no employees prescriptions are tested. |
| MHI Locked |
Indicates if a script is Frozen. Y – Script is frozen and will not be tested for 340B eligibility N – not frozen and will be tested for 340B eligibility |
| Filename |
Name of the data file individual claim was included in. |
| Import Date |
Date that data was imported into 340B Architect. These were put in place initially for billing purposes. |
| Qualified Date |
The date a claim qualifies for 340B. |
| Disqual Date |
The date a claim changes status from 340B to GPO/WAC/RTL. These were put in place initially for billing purposes. |
| ID |
A unique Macro Helix code auto generated by the database. It incremented by one when new script is received. |
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