Kalderos aims to provide as much information as possible to help covered entities identify a claim quickly and easily. The data provided to Kalderos comes from a multitude of stakeholders, each of which has its own IT systems and databases that may store information differently. To simplify the process for covered entities, Kalderos organizes the data we receive into a consistent set of fields, regardless of the data source.
The data elements provided to covered entities in Kalderos Review claims table are:
- Date Added: Date the claim was loaded to the Kalderos Review platform and visible to your covered entity for the first time.
- Provider Name: The name of the dispensing pharmacy is listed for retail claims, and the name of the prescriber is listed for medical claims.
- RxID/ICN: Prescription number. RxID is used for retail claims, and ICN (Internal Control Number) is used for medical claims.
- Date of Service: Date prescription was filled by the pharmacy. Note: the date may vary slightly from the date listed in your systems due to variations in how stakeholders define the date of service.
- Drug Name: Brand name of the product dispensed.
- # of Units: Quantity dispensed or administered.
- Associated Claims: Any refills or credit/rebills associated with the claim. Note: you can view the list of associated claims in the sidebar by clicking ‘View’.
- Reviewed By: Name of the user who last responded to the claim in the Kalderos Review platform.
- 340B Dispensed: Your response to whether a 340B drug was dispensed.
When you expand each row in the claims review table, you will also find:
- Claim Type: Displays if the claim billed was a medical or retail claim.
- Provider NPI: The dispensing pharmacy’s National Provider Identifier is listed for retail claims, and the prescriber’s National Provider Identifier is listed for medical claims
- Plan Type: Indicates whether the patient’s plan is Fee-for-Service (FFS) or Managed Care (MCO)
- Medicaid Agency: State Medicaid agency that was billed for the claim.
- NDC: National Drug Code; a unique 10-digit or 11-digit, 3-segment number, and a universal product identifier for human drugs in the United States.
- Manufacturer: Drug manufacturer responsible for the product dispensed. Authorization letters for Kalderos’ work with each manufacturer are available here.
- Kalderos ID: A unique identifier assigned by Kalderos for each claim on the platform.