MSO NPI: 1841125655 (PECOS T101320260004770) · Pharmacy NPI: 1356508980 (PTAN YL505 | NCPDP 1034898) · PIC: 1346547346
| Submission ID | VITRIOL Token | Regimen | Slot-3 NPI | Live Switch & Sheet Status | Caremark F3 Auth | FHIR |
|---|---|---|---|---|---|---|
| PRX-G10-59467 | VIT-0xC35FDBC09491 |
RX0921 | 1912556077 |
LOCKED_ADJUDICATED_PAID
ANP LIVE PAID ($676.08 Paid / $676.08 Allowed | $0.00 Copay F500{) via Cigna Part D (017010 / CIMCARE / CIGPDPRX / ID:20485351901) | F3: 800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 / 553346018332004052
|
800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 / 553346018332004052 |
JSON → |
| PRX-G10-59468 | VIT-0x961741480855 |
RX0921 | 1780845834 |
LOCKED_ADJUDICATED_PAID
ANP LIVE PAID ($356.46 Paid / $366.26 Allowed | $0.00 Copay F50000000{) via SilverScript Part D (004336 / MEDDADV / ID:GA1668054) | F3: 263031291741114999 / 263031291741114999 / 263031292028145999 / 263031291892182999 / 263031292028145999
|
263031291741114999 / 263031291741114999 / 263031292028145999 / 263031291892182999 / 263031292028145999 |
JSON → |
| PRX-G10-59469 | VIT-0x89D0541B580D |
RX0921 | 1851483754 |
LOCKED_ADJUDICATED_PAID
ANP LIVE PAID ($688.88 Paid / $703.88 Allowed | $0.00 Copay F500{) via Express Scripts Part D (610014 / MEDDPRIME / ID:019930538014) | F3: 296987942332004696 / 407374908332004795 / 191792052332004169 / 559094052332004344
|
296987942332004696 / 407374908332004795 / 191792052332004169 / 559094052332004344 |
JSON → |
paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 / 553346018332004052 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 / 553346018332004052 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: UNKNOWN ·
Google Sheet polled ClaimResponse | F3= |VITRIOL=VIT-0x000000 paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
Google Sheet polled ClaimResponse | F3=296987942332004696 / 407374908332004795 / 191792052332004169 / 559094052332004344 |VITRIOL=VIT-0x89D0541B580D paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263031291741114999 / 263031291741114999 / 263031292028145999 / 263031291892182999 / 263031292028145999 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 / 553346018332004052 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 / 553346018332004052","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
Google Sheet polled ClaimResponse | F3=296987942332004696 / 407374908332004795 / 191792052332004169 / 559094052332004344 |VITRIOL=VIT-0x89D0541B580D paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263031291741114999 / 263031291741114999 / 263031292028145999 / 263031291892182999 / 263031292028145999 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
{"rowIndex":2,"submissionId":"PRX-G10-59467","drug":"pain-default","prescriberNpi":"1912556077"} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"263031291741114999 / 263031291741114999 / 263031292028145999 / 263031291892182999 / 263031292028145999","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"263031291741114999 / 263031291741114999 / 263031292028145999 / 263031291892182999 / 263031292028145999","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"263031291741114999 / 263031292028145999 / 263031291600107999 / 263031291892182999 / 263031634352145999","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
Google Sheet polled ClaimResponse | F3=296987942332004696 / 407374908332004795 / 191792052332004169 / 559094052332004344 |VITRIOL=VIT-0x89D0541B580D paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263031291600107999 / 263031291741114999 / 263031291892182999 / 263031292028145999 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"296987942332004696 / 407374908332004795 / 191792052332004169 / 559094052332004344","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"263031291600107999 / 263031291741114999 / 263031291892182999 / 263031292028145999","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"800569908332004292 / 149931018332004098 / 151133018332004169 / 636484018332004603","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263027276642331997 / 263028191371325999 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=258850331232004169 / 451304331232004496 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
Google Sheet polled ClaimResponse | F3=859908331232004274 / 934661431232004262 |VITRIOL=VIT-0x89D0541B580D paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"submissionId":"PRX-G10-59468","vitriolToken":"VIT-0x961741480855","drug":"pain-default","regimenCode":"RX0921","prescriberNpi":"1780845834","status":"LOCKED_ADJUDICATED_PAID","f3Auth":"263027276642331997 / 263028191371325999","parsed":{"status":"P","f4Message":"ANP LIVE PAID ($11.94 MAC | $0.00 Copay F50000000{) via SilverScript Part D (004336 / MEDDADV / ID:GA1668054) | F3: 263027276642331997 & 263028191371325999"}} paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
Google Sheet polled ClaimResponse | F3=859908331232004274 / 934661431232004262 |VITRIOL=VIT-0x89D0541B580D paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263027276642331997 / 263028191371325999 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=258850331232004169 / 451304331232004496 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: UNKNOWN ·
Google Sheet polled ClaimResponse | F3= |VITRIOL=VIT-0x000000 paul.smith@bhg.llc ·
Target: UNKNOWN ·
Google Sheet polled ClaimResponse | F3= |VITRIOL=VIT-0x000000 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=258850331232004169 / 451304331232004496 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263027276642331997 / 263028191371325999 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"859908331232004274 / 934661431232004262","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"263027276642331997 / 263028191371325999","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
{"status":"LOCKED_ADJUDICATED_PAID","f3Auth":"258850331232004169 / 451304331232004496","sheetHttp":200} paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
Google Sheet polled ClaimResponse | F3=737467585132004496 |VITRIOL=VIT-0x89D0541B580D paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263027552944110998 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=263027051656185998 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
Google Sheet polled ClaimResponse | F3=737467585132004496 |VITRIOL=VIT-0x89D0541B580D paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263027552944110998 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=263027051656185998 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
{"rowIndex":4,"submissionId":"PRX-G10-59469","vitriolToken":"VIT-0x89D0541B580D","f3Auth":"737467585132004496","status":"LOCKED_SUBMITTED_R","drug":"pain-default","prescriberNpi":"1851483754","partner":"G10","rep":"FTR"} paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
{"meta":{"tx":"B1-LIVE","submissionId":"PRX-G10-59469","rowIndex":4,"drug":"pain-default","picSignoff":"1346547346"},"parsed":{"headerEcho":"D0B11A011356508980 2","status":"R","statusLabel":"REJECTED (R)","f4Message":"","fqMessage":"","f3AuthNum":"737467585132004496","rejects":["21","E2"],"e1Bin":"","e1Pcn":"","e1Group":"","e1Cardholder":"","e1Contract":"","e1HelpDesk":"","rawLength":147,"httpCode":200}} paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
{"meta":{"tx":"B1-VERIFY","submissionId":"PRX-G10-59469","rowIndex":4,"drug":"pain-default"},"parsed":{"headerEcho":"D0B11A011356508980 2","status":"R","statusLabel":"REJECTED (R)","f4Message":"","fqMessage":"","f3AuthNum":"972438085132004274","rejects":["21","E2","23","23","EE"],"e1Bin":"","e1Pcn":"","e1Group":"","e1Cardholder":"","e1Contract":"","e1HelpDesk":"","rawLength":178,"httpCode":200}} paul.smith@bhg.llc ·
Target: PRX-G10-59469 ·
{"meta":{"tx":"E1","submissionId":"PRX-G10-59469","rowIndex":4},"parsed":{"headerEcho":"D0E11A011356508980 2","status":"A","statusLabel":"ACCEPTED (A)","f4Message":"LISLVL: ;LISEFF: ;LISTERM: ;PLAN:PDP ;MBI:5A17W30EH46;ED:20170520;QMB:N;QED: ;QTERM: ;","fqMessage":"","f3AuthNum":"","rejects":[],"e1Bin":"610014","e1Pcn":"MEDDPRIME","e1Group":"HNGRETX","e1Cardholder":"019930538014","e1Contract":"S5660-801","e1HelpDesk":"8009221557","rawLength":323,"httpCode":200}} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
Google Sheet polled ClaimResponse | F3=263027552944110998 |VITRIOL=VIT-0x961741480855 paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"rowIndex":3,"submissionId":"PRX-G10-59468","vitriolToken":"VIT-0x961741480855","f3Auth":"263027552944110998","status":"LOCKED_SUBMITTED_R","drug":"pain-default","prescriberNpi":"1780845834","partner":"G10","rep":"FTR"} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"meta":{"tx":"B1-LIVE","submissionId":"PRX-G10-59468","rowIndex":3,"drug":"pain-default","picSignoff":"1346547346"},"parsed":{"headerEcho":"D0B11A011356508980 2","status":"R","statusLabel":"REJECTED (R)","f4Message":"CHECK CARD - VERIFY ID, BIN, PCN & RXGRP","fqMessage":"CHECK CARD - VERIFY ID, BIN, PCN & RXGRP","f3AuthNum":"263027552944110998","rejects":["52","06"],"e1Bin":"","e1Pcn":"","e1Group":"","e1Cardholder":"","e1Contract":"","e1HelpDesk":"","rawLength":211,"httpCode":200}} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"meta":{"tx":"B1-VERIFY","submissionId":"PRX-G10-59468","rowIndex":3,"drug":"pain-default"},"parsed":{"headerEcho":"D0B11A011356508980 2","status":"R","statusLabel":"REJECTED (R)","f4Message":"COMPOUND INGR COSTS SBM CANNOT ALL BE $0","fqMessage":"COMPOUND INGR COSTS SBM CANNOT ALL BE $0","f3AuthNum":"263027552944110999","rejects":["23","23"],"e1Bin":"","e1Pcn":"","e1Group":"","e1Cardholder":"","e1Contract":"","e1HelpDesk":"","rawLength":194,"httpCode":200}} paul.smith@bhg.llc ·
Target: PRX-G10-59468 ·
{"meta":{"tx":"E1","submissionId":"PRX-G10-59468","rowIndex":3},"parsed":{"headerEcho":"D0E11A011356508980 2","status":"A","statusLabel":"ACCEPTED (A)","f4Message":"LISLVL: ;LISEFF: ;LISTERM: ;PLAN:PDP ;MBI:7V36TK1FV30;ED:20170520;QMB:N;QED: ;QTERM: ;","fqMessage":"","f3AuthNum":"","rejects":[],"e1Bin":"004336","e1Pcn":"MEDDADV","e1Group":"RXCVSD","e1Cardholder":"GA1668054","e1Contract":"S5601-811","e1HelpDesk":"8002386279","rawLength":314,"httpCode":200}} paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=263027051656185998 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=263027051656185998 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
Google Sheet polled ClaimResponse | F3=263027051656185998 |VITRIOL=VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
15-Minute Trigger Installed & Synced Row #2 FHIR Lifecycle State (8:43:46 PM EDT) paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
PIC 1346547346 Sign-Off Verified | Row #2 Locked | Caremark F3 Auth: 263027051656185998 | VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
AN:R | Rejects: 23, 23 ($0.00 FB23 Verifier Brake Confirmed — Slot-3 NPI 1912556077 & ANDA NDCs 51672136307/51672300805 PASS) paul.smith@bhg.llc ·
Target: PRX-G10-59467 ·
E1_A: ACCEPTED (A) | LISLVL:3;LISEFF:20260501;LISTERM:20261231;PLAN:PDP;MBI:7CG2A22KY03 | VIT-0xC35FDBC09491 paul.smith@bhg.llc ·
Target: _BHCP_USERS_MANIFEST ·
Seeded 6 Google OAuth RBAC roles (paul.smith@bhg.llc, frank@bhcp.llc, jmoliere@phytogenics.com, ops@bhcp.health, partner.g10, rep.ftr)