Pharmaceutical Claims Data Mart (PHARMS) DATA MART - DATA DICTIONARY. Version 4.2 April 2017

Transcription

1 Pharmaceutical Claims Data Mart (PHARMS) DATA MART - DATA DICTIONARY Version 4.2

2 Pharmaceutical Claims Reproduction of material The Ministry of Health ( the Ministry ) permits the reproduction of material from this publication without prior notification, providing all the following conditions are met: the information must not be used for commercial gain, must not be distorted or changed, and the Ministry must be acknowledged as the source. Disclaimer The Ministry of Health gives no indemnity as to the correctness of the information or data supplied. The Ministry of Health shall not be liable for any loss or damage arising directly or indirectly from the supply of this publication. All care has been taken in the preparation of this publication. The data presented was deemed to be accurate at the time of publication, but may be subject to change. It is advisable to check for updates to this publication on the Ministry s web site at Publications A complete list of the Ministry s publications is available from the Ministry of Health, PO Box 5013, Wellington, or on the Ministry s web site at Any enquiries about or comments on this publication should be directed to: Analytical Services Ministry of Health PO Box 5013 Wellington Phone: (04) Fax: (04) data-enquiries@moh.govt.nz Published by Ministry of Health 2017, Ministry of Health Version 4.2 MoH 2

3 Pharmaceutical Claims Introduction Objectives Audiences Format Changes to dictionary format The objectives of the Ministry of Health ( the Ministry ) Data Dictionaries are to: describe the information available within the National Collections promote uniformity, availability and consistency across the National Collections support the use of nationally agreed protocols and standards wherever possible promote national standard definitions and make them available to users. It is hoped that the greater level of detail along with clear definitions of the business rules around each element will assist with providing and using the data. The target audiences for Data Dictionaries are data providers, software developers, and data users. All data element definitions in the Data Dictionaries are presented in a format based on the Australian Institute of Health and Welfare National Health Data Dictionary. This dictionary is based on the ISO/IEC Standard Specification and Standardization of Data Elements the international standard for defining data elements issued by the International Organization for Standardization and the International Electrotechnical Commission. The format is described in detail in the appendices of this dictionary. A more rigorous approach to recording changes in the data elements has been introduced in these dictionaries along with background material on the features of time-series data for each element. In summary, the changes to the data dictionaries include: standardisation of the element names so that, for instance, a healthcare user s NHI number is referred to as NHI number in all collections elements are listed alphabetically within each table, and the tables are organised alphabetically each table is described verification rules, historical information, and data quality information are included alternative names for the elements are listed information about how the data is collected is given related data, and references to source documents and source organisations are included an alphabetical index is included code tables are included with the element, or a reference given to the Ministry s web site (for large or dynamic code tables). Version 4.2 MoH 3

4 Pharmaceutical Claims Please note the following: This data dictionary makes references to organisations called HealthPAC and NZHIS. These organisations were disestablished in 2008 and were absorbed into the Ministry of Health. For HealthPAC or NZHIS read Ministry of Health Version 4.2 MoH 4

5 Pharmaceutical Claims Table of Contents Pharmaceutical Claims... 9 COS Code Reference table Cost of Service code Description Claimant table Claimant address Claimant address Claimant address Claimant name Claimant number Funding DHB code Funding DHB name Region Trading name Costing Flags table CHF Endorsement Flag Cost, Brand, Source of supply (CBS) flag Dispensing fee code Non Social Security (NSS) flag Rural Area Flag Dispensing Flags table Child resistant container Form type Order type Stat indicator Form Pack Subsidy table Alternate Base units Brand code Brand name Change Chemical ID Chemical name Cost, Brand, Source of supply (CBS) Distributor Effective date Expiry date Form pack business key Formulation ID Formulation name Manufacturer Multiple OP Pharmacode Presentation ID Price Product ID Quantity Specified Stamp Subsidy Therapeutic group ID Therapeutic group level 1 ID Therapeutic group level 1 name Therapeutic group level 2 ID Therapeutic group level 2 name Therapeutic group level 3 ID Therapeutic group level 3 name Therapeutic group manager ID Weight PHA Claim Fact table Version 4.2 MoH 5

6 Pharmaceutical Claims Adjustment amount Adjustment amount ex GST Catnip batch number Claim approved date Claim date Claim value Claim value ex GST Claimant number DSS count Date Suffix File type Number PHA subsidy cards Payment due date PHA Dispensing Adjustments Fact table CHF Endorsement Flag Catnip batch number Child resistant container Claim Amount Claim date Claimant number Component number Cost of Service code Cost, Brand, Source of supply (CBS) flag Cost, Brand, Source of supply (CBS) unit price Daily dose Date Suffix Date dispensed Days supply Dispensing fee value Dispensings prescribed Dose Encrypted HCU ID Form number Frequency HealthPAC Chemical ID HealthPAC Cost Ex Supplier HealthPAC Pack ID HealthPAC Pack Size HealthPAC Presentation ID HealthPAC Product ID Item number Locum identifier National adjustment Non Social Security (NSS) flag PHA Subsidy Card Indicator Patient contribution Patient flag Pharmacode Prescribed quantity Prescription number Purchase unit key Quantity dispensed Quantity prescribed Quantity units Reimbursement Cost Repeat sequence number Requirement number Requirement suffix Retail subsidy Rounding Rural Area Flag Southern patient contribution remainder Special authority number Special authority type Specialist identifier Version 4.2 MoH 6

7 Pharmaceutical Claims Stat indicator Subsidy PHA Dispensing Fact table Age at dispensing CHF Endorsement Flag Catnip batch number Child resistant container Claim Amount Claim Amount ex GST Claim approved date Claim date Claimant number Community Service Card Holder Component number Cost ex supplier Cost of Service code Cost, Brand, Source of supply (CBS) flag Cost, Brand, Source of supply (CBS) unit price Cost, Brand, Source of supply (CBS) unit price ex GST DSS count Daily dose Data source Date Suffix Date dispensed Days supply Dim Requirement Key Dispensing fee code Dispensing fee value Dispensing fee value exgst Dispensings prescribed Dose Encrypted NHI number Form cost Form cost ex GST Form number Form pack business key Form type Frequency HealthPAC Chemical ID HealthPAC Cost Ex Supplier HealthPAC Cost ex Supplier ex GST HealthPAC Pack Size HealthPAC Presentation ID HealthPAC Product Pack ID High use card indicator Item number Locum identifier National adjustment National adjustment ex GST Non Social Security (NSS) flag Oncology specialty patient grouping Order type PEC form number PHA Subsidy Card Indicator Patient category Patient contribution Patient contribution ex GST Patient flag Payment authority Pharmacode Pharms provider type Prescription ID Prescription number Provider number Provider type Purchase unit key Version 4.2 MoH 7

8 Pharmaceutical Claims Quantity dispensed Quantity prescribed Quantity units Reimbursement Cost Reimbursement Cost ex GST Repeat sequence number Requirement number Requirement suffix Retail subsidy Retail subsidy ex GST Role type Rounding Rounding ex GST Rural Area Flag Southern patient contribution remainder Southern patient contribution remainder ex GST Special authority number Special authority type Stat indicator Subsidy value Subsidy value ex GST Patient Flags table Community Service Card Holder High use card indicator PHA Subsidy Card Indicator Patient category Patient flag Requirement table Base units Requirement item name Requirement number Requirement suffix Short description Appendix A: Logical to Physical Table Mapping Appendix B: List of Shared Dimensions Appendix C: List of Views Appendix D: Code Table Index Appendix E: Data Dictionary Template Appendix F: Logical Groups of Data Elements Appendix G: PHARMS Data Mart model Version 4.2 MoH 8

9 Pharmaceutical Claims Pharmaceutical Claims The Pharmaceutical Claims Data Mart (Pharms DM) is a data mart that supports the management of pharmaceutical subsidies. It is jointly owned by the Ministry of Health and Pharmac. Pharms contains claim and payment information from pharmacists for subsidised dispensings that have been processed by the General Transaction Processing System (GTPS). Version 4.2 MoH 9

10 COS Code Reference table COS Code Reference table dim_cos Primary key Business key Reference for Cost of Service code, which replaces Claimant Type. This defines the role of the pharmacy or the contract under which the pharmacy is supplying the drug. Source: HealthPAC dim_cos_key cos_code Defunct reference table. changed from September 2001 and this reference table no longer applies. It is retained for historical reasons. The unique key should be Claimant and COS code, but Claimant is not held in the table. Relational rules This dimension table is linked via its primary key dim_cos_key to the foreign key dim_cos_key in the fact_pha_dispensing table Data content Version 4.2 MoH 10

11 COS Code Reference table Cost of Service code Cost of Service code that replaces Claimant type. This defines the role of the pharmacy, or the contract under which the pharmacy is supplying the drug. cos_code dim_cos char(5) NNNNN Data domain Provides a unique link to the COS Code Reference table for claims between 1 June 2000 and September However, the link between the COS code and the actual contract it refers to is not in the Pharmhouse and needs to be obtained from HealthPAC. From 1 June 2000 to September 2001, code numbers started at '99' plus the codes from the Cost Code table. When HealthPAC transitioned to GTPS, the COS code changed to be unique to each pharmacy (for example, could be retail, wholesale, special), so from September 2001 the reference table no longer applies and is out of date. Indicates under which payment Service Contract the claim is priced, and allows a single pharmaceutical to be claimed under the correct Service Contract when a pharmacy has more than one service for the single item. The COS Code Reference table is defunct. The definition changed from September 2001 and the reference table no longer applies. It is retained for historical reasons. The unique key should be Claimant and COS code, but Claimant is not held in the table. HealthPAC Version 4.2 MoH 11

12 COS Code Reference table Description description dim_cos varchar2(30) Data domain Version 4.2 MoH 12

13 Claimant table Claimant table Primary key Business key dim_claimant Reference table for claimant (pharmacy or other institution) who is eligible to claim a pharmaceutical subsidy from HealthPAC payment office. Source: HealthPAC NZHIS Geocodes dim_claimant_key claimant_number Data updated monthly. Each record should represent a pharmacy. However, in some cases a pharmacy may have more than one Claimant number. This usually occurs if a pharmacy has more than one contract (eg, retails and wholesale contracts). The claimant address is geocoded and the record count is checked against control totals from HealthPAC. On rare occasions, the geographic DHB is not the funding DHB. Some pharmacies no longer exist but their data is retained for linking up old records. The description may include an indication that the pharmacy is no longer current. Relational rules This dimension table is linked via its primary key dim_claimant_key to the foreign key dim_claimant_key in the fact_pha_claim and fact_pha_dispensing tables. Data content Version 4.2 MoH 13

14 Claimant table Claimant address 1 The first line of the claimant's address. claimant_address1 dim_claimant varchar2(50) Free text Data domain May have been changed from the address supplied by HealthPAC, to achieve geocoding. Version 4.2 MoH 14

15 Claimant table Claimant address 2 The second line of the claimant's address. claimant_address2 dim_claimant varchar2(50) Free text Data domain May have been changed from the address supplied by HealthPAC, to achieve geocoding. Version 4.2 MoH 15

16 Claimant table Claimant address 3 The third line of the claimant's address. claimant_address3 dim_claimant varchar2(50) Free text Data domain May have been changed from the address supplied by HealthPAC, to achieve geocoding. Version 4.2 MoH 16

17 Claimant table Claimant name The claimant's full name or title. claimant_name dim_claimant varchar2(50) Free text Data domain Usually the name of the pharmacy, not the pharmacist?s name. If the claimant is no longer in business, this may be indicated in this field. from HealthPAC claimant file Version 4.2 MoH 17

18 Claimant table Claimant number A number given by HealthPAC to a pharmacy or other institution authorised by the Ministry of Health and the Pharmaceutical Society to claim benefits. claimant_number dim_claimant integer Payee number NNNNNNNNNN Data domain 1 to Claimant number identifies the Contract from which payment and processing rules will be sought. HealthPAC gives each claimant a 7 character Payee number, which is converted to a 4 character Claimant number on a one-to-one mapping. In the future, it is likely that the Payee number will be reported to this field. Used as one of the keys to match form to item. Catnip batch number, Claimant number and Claim date form a unique link to the Claim table. The Claim table contains some historical Claimant numbers. Must be a valid Claimant number in the Claimant table. from HealthPAC form and HealthPAC item Version 4.2 MoH 18

19 Claimant table Funding DHB code Represents the District Health Board responsible for funding the services under the contract. funding_dhb_code dim_claimant varchar2(3) NNN Data domain A three digit code identifying the DHB that funds this claimant's claims. The Funding DHB code is to be populated with leading zeros Northland Waitemata Auckland Counties Manakau Waikato Lakes Bay of Plenty Tairawhiti Hawkes Bay Taranaki Midcentral Whanganui Capital and Coast Hutt Wairarapa Nelson Marlborough West Coast Canterbury South Canterbury Otago Southland MOH - Ministry of Health Version 4.2 MoH 19

20 Claimant table Funding DHB name The name of the DHB responsible for funding the services under this contract. funding_dhb_name dim_claimant varchar2(50) Free text Data domain funding_dhb_code Version 4.2 MoH 20

21 Claimant table Region Name of Regional Health Authority where the Claimant is located region dim_claimant varchar2(64) Free text Data domain Version 4.2 MoH 21

22 Claimant table Trading name Claimant's trading name. trading_name dim_claimant varchar2(50) Free text Data domain Usually the name of the pharmacy. If the pharmacy is no longer in business, this may be indicated in the name. from HealthPAC claimant file Version 4.2 MoH 22

23 Costing Flags table Costing Flags table dim_costing_flags Primary key Business key Relational rules The Costing Flags table is a matrix of costing flags for linking to the PHA Dispensing Fact table. dim_costing_flags_key prescriber_flag, prescription_flag, dispensing_fee_code, cbs_flag, nss_flag Each record contains five flags, this table holds every combination used for these flags. This dimension table is linked via its primary key dim_costing_flags_key to the foreign key dim_costing_flags_key in the fact_pha_dispensing table Data content Version 4.2 MoH 23

24 Costing Flags table CHF Endorsement Flag Flag to indicate that the prescription has congestive heart failure endorsement. prescription_flag dim_costing_flags varchar2(1) A Data domain Y item has congestive heart failure endorsement N or space item has not congestive heart failure endorsement From Claim approved date of April If empty, set to 'N'. Version 4.2 MoH 24

25 Costing Flags table Cost, Brand, Source of supply (CBS) flag Flag to indicate whether the item is Cost, Brand, Source of supply (CBS) as per the Pharmac schedule. cbs_flag dim_costing_flags varchar2(1) A Data domain Y item is Cost, Brand, Source of supply (CBS) as per the Pharmac schedule N or space item is not Cost, Brand, Source of supply (CBS) as per the Pharmac schedule From Claim approved date of April If empty, insert 'N'. Version 4.2 MoH 25

26 Costing Flags table Dispensing fee code Class of dispensing fee claimed. dispensing_fee_code dim_costing_flags integer Data domain N 0 to 9, null Has been supplied as null since Claim approved date of 1 August Retained for historical data. from HealthPAC item Version 4.2 MoH 26

27 Costing Flags table Non Social Security (NSS) flag Indicates whether the claim is a standard claim, credit transaction, nonclaim item or a resubmission of a previous claim. nss_flag dim_costing_flags varchar2(1) A Data domain Equivalent of the HP variable transaction category. 'O' is part of the pharmaceutical electronic claiming process. Credit line transactions are used to credit a previously submitted claim transaction. These may either be used independantly, to credit a previous transaction claimed, or as part of a resubmission. Credit line transactions need only contain the following data elements in the Transaction Record of a claim file. Transactions may be resubmitted if the transaction field contents have changed. Only items that have been submitted with incorrect data should be resubmitted. Items that have been rejected by the system do not need to be resubmitted through this procedure. If a transaction is resubmitted, the resubmission must be transferred as two transactions.pre Claim approved date of 1 August 1998: Y Not Subsidised N Subsidised space Undefined Post Claim approved date of 1 August 1998: C Credit I Invoice N Not Subsidised O Balance owing R Resubmission from HealthPAC item Version 4.2 MoH 27

28 Costing Flags table Rural Area Flag Flag field to indicate when a Practitioner's Supply Order is for use in a rural area. prescriber_flag dim_costing_flags varchar2(1) A Data domain Y item is a Practitioner's Supply Order in a rural area N space item is not a Practitioner's Supply Order in a rural area From Claim approved date of April If empty, set to 'N'. Version 4.2 MoH 28

29 Dispensing Flags table Dispensing Flags table dim_dispensing_flags Primary key Business key Relational rules The Dispensing Flags table is a matrix of dispensing flags for linking to the PHA Dispensing Fact table. dim_dispensing_flags_key order_type, child_resistant_container, stat_indicator, form_type Each record contains four dispensing flags, this table holds every combination used for these dispensing flags. This dimension table is linked via its primary key dim_dispensing_flags_key to the foreign key dim_dispensing_flags_key in the fact_pha_dispensing table Data content Version 4.2 MoH 29

30 Dispensing Flags table Child resistant container Flag field to indicate the medication has a safety cap on the container. child_resistant_container dim_dispensing_flags varchar2(1) A Data domain Y child resistant container fee claimed. N, X, or space child resistant container fee not claimed. The list of applicable medications is in the Pharmac Schedule. The Child resistant container has not been populated since from HealthPAC item Version 4.2 MoH 30

31 Dispensing Flags table Form type The type of the prescription form for claims. form_type dim_dispensing_flags integer NN Data domain Order type should be used instead as HealthPAC derives the Form type from the Order type 1 Pharmacy prescription 2 Practitioner's supply order 3 Controlled drug 4 Controlled practitioner's supply order 5 Hospital prescription 6 Wholesales supply order 7 Bulk supply order 8 Controlled bulk supply order 9 Allergy treatment set Invalid codes assume 1 from HealthPAC form Version 4.2 MoH 31

32 Dispensing Flags table Order type Indicates the type of prescription or order. order_type dim_dispensing_flags integer N Data domain 1 Prescription 3 Practitioner's supply order (MPSO) 4 Bulk supply order (BSO) 5 Wholesale supply order (WSO) 6 Nicotene replacement therapy (NRT) 7 Oncology Medicines From Claim approved date of April Since electronic claiming used to work out the Form Type. Version 4.2 MoH 32

33 Dispensing Flags table Stat indicator Whether or not more than 30 days of the prescribed medication can be given to the patient at one time. stat_indicator dim_dispensing_flags varchar2(1) A Data domain Y extended supply N or space not extended supply Access exemption criteria (described in the Pharmac schedule) have to be met. from HealthPAC item Version 4.2 MoH 33

34 Form Pack Subsidy table Form Pack Subsidy table dim_form_pack_subsidy Primary key Business key Relational rules This table maintains hierarchical relationships between chemical, therapeutic group, formulation,brand, pack (pharmacode), and subsidies dim_form_pack_subsidy_key form_pack_bk Data updated monthly This dimension table is linked via its primary key dim_form_pack_subsidy_key to the foreign key dim_form_pack_subsidy_key in the fact_pha_dispensing table. Data content Version 4.2 MoH 34

35 Form Pack Subsidy table Alternate A higher subsidy value sometimes available on special authority. alternate dim_form_pack_subsidy number(10,2) NNNNNNNN.NN Data domain Version 4.2 MoH 35

36 Form Pack Subsidy table Base units The unit of measure for dispensing and measuring dose (PEC specifications 2.29 'unit dispensed' and 'unit claimed'). base_units dim_form_pack_subsidy varchar2(5) Units of measure Free text Data domain Examples include tablets, pills, capsules, milligrams. Should agree with the NZ Pharmacy Guild's Generic unit of measure. With the move from Pronet to the GTPS system, units of measure of numerous drugs have been changed. For example, instead of one inhaler being prescribed (which has 200 doses) there are now 200 doses of the inhaler prescribed. Version 4.2 MoH 36

37 Form Pack Subsidy table Brand code Pharmac identifier for each product. brand_code dim_form_pack_subsidy integer NNNNNNNN Data domain to digit Chemical Code plus 2-digit Presentation ID (also known as Formulation Suffix) and 2-digit Brand Suffix. Version 4.2 MoH 37

38 Form Pack Subsidy table Brand name The trade name of the product given by the manufacturer. brand_name dim_form_pack_subsidy varchar2(40) Free text Data domain Should match the Medsafe registered name for registered medicines. Version 4.2 MoH 38

39 Form Pack Subsidy table Change Indicates record type e.g. New Listing, Subsidy Change or Delisting etc. change dim_form_pack_subsidy varchar2(50) Free Text Data domain Version 4.2 MoH 39

40 Form Pack Subsidy table Chemical ID Pharmac identifier of primary active chemical ingredient. chemical_id dim_form_pack_subsidy integer NNNN Data domain 0 to 9999 If Chemical ID does not exist then the HPAC Chemical ID is used if it is present. All historical data was remapped in October Chemical ID and Presentation ID combine to form Formulation ID. The Chemical Reference table is created by Pharmac from their SiMPle database for Pharmhs. It is updated monthly, before the Dispensings load process runs. Set to zero if the Pharmacode has a bad check digit. Formulation ID Pharmac Version 4.2 MoH 40

41 Form Pack Subsidy table Chemical name Chemical (generic) name of the active chemical ingredient. chemical_name dim_form_pack_subsidy varchar2(220) Free text Data domain Combined names exist for formulations with multiple active ingredients. Version 4.2 MoH 41

42 Form Pack Subsidy table Cost, Brand, Source of supply (CBS) Flag to indicate whether the item is Cost, Brand, Source of supply (CBS) as per the Pharmac schedule. cbs dim_form_pack_subsidy varchar2(1) 'Cost Brand Source' - no price currently available for this pack; to be supplied bu the claimant. A Data domain Y item is Cost, Brand, Source of supply (CBS) as per the Pharmac schedule N or space item is not Cost, Brand, Source of supply (CBS) as per the Pharmac schedule From Claim approved date of April If empty, insert 'N'. Version 4.2 MoH 42

43 Form Pack Subsidy table Distributor Pharmac identifier for a pharmaceutical supply company. distributor dim_form_pack_subsidy integer NNN Data domain 1 to 999 Version 4.2 MoH 43

44 Form Pack Subsidy table Effective date The date this record becomes effective. effective dim_form_pack_subsidy date Data domain Oracle datetime field Valid dates Version 4.2 MoH 44

45 Form Pack Subsidy table Expiry date The date this record expires. expiry dim_form_pack_subsidy date Data domain Oracle datetime field Valid dates Version 4.2 MoH 45

46 Form Pack Subsidy table Form pack business key The form_pack_bk is generated to provide a business key to form/pack/subsidy relationships. This allows a link between the Form Pack Subsidy table and the Dispensing table. form_pack_bk dim_form_pack_subsidy varchar2(50) Free text Data domain If there is a Pharmacode present the Form Pack BK will be prefixed by with the character P, if not the Form Pack BK will be prefixed with the character F. NZHIS datamart generated object. Version 4.2 MoH 46

47 Form Pack Subsidy table Formulation ID Pharmac Identifier for each Formulation classification of a drug. formulation_id dim_form_pack_subsidy integer NNNNNN Data domain 0 to Comprises 4 digit Chemical ID and a 2 digit Presentation ID (also known as Formulation Suffix). Chemical ID Presentation ID Version 4.2 MoH 47

48 Form Pack Subsidy table Formulation name The name of the formulation that usually describes the form and strength. Can also include the flavour or quality reference such as 'BP', but should not include Chemical, Brand or Pack attributes. formulation_name dim_form_pack_subsidy varchar2(200) Free text Data domain A combination of the Chemical name and the Presentation name, for example, 'aspirin tablets'. Version 4.2 MoH 48

49 Form Pack Subsidy table Manufacturer Pharmac identifier for a pharmaceutical manufacturing company. manufacturer dim_form_pack_subsidy integer NNN Data domain 1 to 999 Version 4.2 MoH 49

50 Form Pack Subsidy table Multiple The smallest quantity that can be dispensed expressed in [Formulation].[ Units] multiple dim_form_pack_subsidy number(13,2) NNNNNNNNNNN.NN Data domain 0.00 to Null OK Version 4.2 MoH 50

51 Form Pack Subsidy table OP 'Original Pack' - this drug must be dispensed in whole packs. op dim_form_pack_subsidy varchar2(1) N Data domain Version 4.2 MoH 51

52 Form Pack Subsidy table Pharmacode NZ Pharmacy Guild identifier of retail pack indicating the pharmaceutical dispensed. pharmacode dim_form_pack_subsidy integer Claim code NNNNNNN Data domain 0 to HealthPAC sends the 13 digit bar code and NZHIS loads only the 6 or 7 digit portion relating to the drug. A 6 or 7 digit integer with a mod 11 check-digit. First supplied by HealthPAC from Claim approved date 17 December Expanded from 6 digits to 7 digits Claim approved date 1 October If not PCODE and not 'S' (and not CMPND unless value is ' ') set to empty. The 'Pharmacode' currently administered by the Pharmacy Guild of New Zealand is currently the only valid code to be used. Version 4.2 MoH 52

53 Form Pack Subsidy table Presentation ID Pharmac identifier of presentation. Part of formulation for a chemical. presentation_id dim_form_pack_subsidy integer Formulation suffix NN Data domain 0 to 99 Part of the chemical formulation equation, which describes the form and strength of the chemical. Mapped from Process Mapping table. If mapping does not exist then the HBL Presentation ID is used when it exists. All historical data remapped in October Part of the major key for the Dispensings table. Set to zero if the check digit is bad. Look up in Process Mapping and, if not found and CMPND or MCODE, use HBL presentation ID if a combination of Chemical ID and Presentation ID exists in the Augmented Formulation table. Version 4.2 MoH 53

54 Form Pack Subsidy table Price The supplier price for this pack. price dim_form_pack_subsidy number(10,2) NNNNNNNN.NN Data domain Version 4.2 MoH 54

55 Form Pack Subsidy table Product ID Pharmac identifier for a product (the brand suffix of a pharmaceutical). product_id dim_form_pack_subsidy integer Brand code suffix NN Data domain 0 to 99 This is always zero before 17 December The last two digits from Brand code from the Pharmac schedule. Set to zero if badcheckdigit, look up in Process_Mapping if PCODE or S if no code exists the use HBL_Product_ID if result is null set to zero. Version 4.2 MoH 55

56 Form Pack Subsidy table Quantity The quantity per market Pack expressed in [Formulation].[Units] quantity dim_form_pack_subsidy number(13,2) NNNNNNNNNNN.NN Data domain 0 to 1 Often reported as '0'. If the provided value is '0', set to '1'. Else store as reported. Version 4.2 MoH 56

57 Form Pack Subsidy table Specified Identifies pack size for unit pricing and inclusion in the printed schedule. specified dim_form_pack_subsidy varchar2(1) A Data domain Y include pack size in the printed schedule N exclude pack size in the printed schedule Version 4.2 MoH 57

58 Form Pack Subsidy table Stamp Sequential number generated for every new record or edit to facilitate change control. stamp dim_form_pack_subsidy varchar2(50) Free text Data domain Version 4.2 MoH 58

59 Form Pack Subsidy table Subsidy Maximum amount that the government will pay contractors for a pharmaceutical dispensed to a person eligible for benefits. It is different to the cost to the government of subsidising the pharmaceutical (Subsidy value). subsidy dim_form_pack_subsidy number(10,2) nnnnnnnn.nn Data domain Version 4.2 MoH 59

60 Form Pack Subsidy table Therapeutic group ID Pharmac identifier for each group of Anatomical, Therapeutic and Chemical properties. tg_id dim_form_pack_subsidy integer NNNNNN Data domain 0 to Used to be known as Therapeutic Group. This is the international pharmaceutical standard way of grouping drugs. Some drugs are in more than one group. Pharmac uses Therapeutic Groups for administration. Structured 5 or 6 digit integer comprising TG level 1 ID, TG level 2 ID and TG level 3 ID. (Made up of 2 digits for each level, with no leading zero on TG level 1.) The Therapeutic Group Reference table is created by Pharmac for Pharmhouse. It is updated monthly, before the Dispensings load process runs. TG level 1 ID TG level 2 ID TG level 3 ID Pharmac Version 4.2 MoH 60

61 Form Pack Subsidy table Therapeutic group level 1 ID Identifier for ATC 1st level - anatomical main group. tg_level1_id dim_form_pack_subsidy integer Refer to Therapeutic Group ID for further details. NN Data domain 0 to 99 Version 4.2 MoH 61

62 Form Pack Subsidy table Therapeutic group level 1 name Description for ATC 1st level - anatomical main group. tg_name1 dim_form_pack_subsidy varchar2(80) Refer to Therapeutic Group ID for further details. Free text Data domain Version 4.2 MoH 62

63 Form Pack Subsidy table Therapeutic group level 2 ID Identifier for ATC 2nd level - therapeutic main group. tg_level2_id dim_form_pack_subsidy integer Refer to Therapeutic Group ID for further details. NN Data domain 0 to 99 Version 4.2 MoH 63

64 Form Pack Subsidy table Therapeutic group level 2 name Description for ATC 2nd level - therapeutic main group. tg_name2 dim_form_pack_subsidy varchar2(80) Refer to Therapeutic Group ID for further details. Free text Data domain Version 4.2 MoH 64

65 Form Pack Subsidy table Therapeutic group level 3 ID Identifier for ATC 3rd level - therapeutic/pharmacological subgroup. tg_level3_id dim_form_pack_subsidy integer Refer to Therapeutic Group ID for further details. NN Data domain 0 to 99 Version 4.2 MoH 65

66 Form Pack Subsidy table Therapeutic group level 3 name Description for ATC 3rd level - therapeutic/pharmacological subgroup. tg_name3 dim_form_pack_subsidy varchar2(80) Refer to Therapeutic Group ID for further details. Free text Data domain Version 4.2 MoH 66

67 Form Pack Subsidy table Therapeutic group manager ID Therapeutic Group Manager Identifier, ie, the person at Pharmac responsible for that Therapeutic Group. tgm_id dim_form_pack_subsidy varchar2(10) Free text Data domain Version 4.2 MoH 67

68 Form Pack Subsidy table Weight The amount of the active ingredient in the formulation. weight dim_form_pack_subsidy number(12,4) Refer to Therapeutic Group ID for further details. NNNNNNNNNNN.NN Data domain to NULL values indicate that the 30-day dispensing rule need not apply. Version 4.2 MoH 68

69 PHA Claim Fact table PHA Claim Fact table fact_pha_claim A claim for pharmaceutical subsidy against dispensings from HealthPAC's payments office. Primary key Business key claimant_number, claim_date, catnip_batch_number Data for the PHA Claim Fact table is updated on a monthly basis. This table contains 400,000 rows as at June There are 25,000 rows added per month. Limit the number of joins to speed up queries. Relational rules The Fact table has several foreign keys to dimension and fact tables. These are: KEY LINKED TO dim_claim_pay_due_date_key fact_pha_dispensing dim_claim_date_key Data content Version 4.2 MoH 69

70 PHA Claim Fact table Adjustment amount Adjustments accruing to earlier claim(s) for this claimant. adjustment_amount fact_pha_claim number(13,2) NNNNNNNNNNN.NN Data domain to Includes negative values. Before Claim approved date of August 1998 includes Agency fee, Other value, Safety net cards value and Collection rate adjustment. Version 4.2 MoH 70

71 PHA Claim Fact table Adjustment amount ex GST Adjustments accruing to earlier claim(s) for this claimant. Exclusive of GST. adjustment_amount_exgst fact_pha_claim number(13,2) nnnnnnnn.nn Data domain Includes negative values. Before Claim approved date of August 1998 includes Agency fee, Other value, Safety net cards value and Collection rate adjustment. Version 4.2 MoH 71

72 PHA Claim Fact table Catnip batch number A unique number for a batch of claims for a given claimant on a given claim date. catnip_batch_number fact_pha_claim varchar2(7) Data domain From Claim approved date of 1 July 2000, Catnip batch number is used as one of the keys to match form and item. Before that only Claimant, Claim date and Form number were required. Catnip batch number, Claimant number and Claim date form a unique link to the Claim table. Version 4.2 MoH 72

73 PHA Claim Fact table Claim approved date Date HealthPAC approved the claim for payment. claim_approved_date fact_pha_claim date Data domain Oracle datetime field Valid dates Also the date on which HealthPAC extract data and NZHIS load it into the Pharmhouse. Each load of data to the Dispensings table is for a complete month of Claim approved date. It is the most important field when it comes to loading. Derived using the key Claimant number, Claim date and Catnip batch number. Dates range from 1 July Look up in Claim table using Claimant number, Claim date and Catnip batch number. Print warning if date invalid. Claim approved date month Claim approved date year Claimant number Claim date Catnip batch number from HealthPAC Claim Version 4.2 MoH 73

74 PHA Claim Fact table Claim date End date of claim period given by payments office of HealthPAC. Usually the 15th or the last day of the month. claim_date fact_pha_claim date Data domain Oracle datetime field Valid dates Used as one of the keys to match form to item. Dates range from 15 March Catnip batch number, Claimant number and Claim date form a unique link to the Claim table. Claim date month Claim date year from HealthPAC item and form Version 4.2 MoH 74

75 PHA Claim Fact table Claim value Total value of the claim not including adjustments. claim_value fact_pha_claim number(13,2) NNNNNNNNNNN.NN Data domain 0.00 to Each pharmacy makes a claim twice a month, so this is a useful high level grouping. Version 4.2 MoH 75

76 PHA Claim Fact table Claim value ex GST Total value of the claim not including adjustments. Exclusive of GST. claim_value_exgst fact_pha_claim number(13,2) nnnnnnnn.nn Data domain Each pharmacy makes a claim twice a month, so this is a useful high level grouping. Version 4.2 MoH 76

77 PHA Claim Fact table Claimant number A number given by HealthPAC to a pharmacy or other institution authorised by the Ministry of Health and the Pharmaceutical Society to claim benefits. claimant_number fact_pha_claim integer Payee number NNNNNNNNNN Data domain 1 to Claimant number identifies the Contract from which payment and processing rules will be sought. HealthPAC gives each claimant a 7 character Payee number, which is converted to a 4 character Claimant number on a one-to-one mapping. In the future, it is likely that the Payee number will be reported to this field. Used as one of the keys to match form to item. Catnip batch number, Claimant number and Claim date form a unique link to the Claim table. The Claim table contains some historical Claimant numbers. Must be a valid Claimant number in the Claimant table. from HealthPAC form and HealthPAC item Version 4.2 MoH 77

78 PHA Claim Fact table DSS count dss_count fact_pha_claim integer Data domain Version 4.2 MoH 78

79 PHA Claim Fact table Date Suffix This is the date suffix of the extract files supplied by the external provider. date_suffix fact_pha_claim varchar2(8) YYMMDDA Data domain Format is: YYMMDDA Used to identify when records were loaded to the data mart. It contains the month and year the load file was extracted from the systems at HealthPAC. For records migrated from Sybase to Oracle in 2006, the letter 'M' is appended and the dispensing month and year was used to populate this field. Version 4.2 MoH 79

80 PHA Claim Fact table File type The source HealthPAC system. file_type fact_pha_claim varchar2(5) NNNNN Data domain Made up of how the claim is processed and the version and release of the data specification. For example, '19300' is made up of 19 which relates to pharmacy processing and 300 which is the Version and Release of this data specification. Identifies whether the claim is manual, or the version of the electronic claim. Some manual claims are still made. 90 percent of claims are made in PEC (Pharmaceutical Electronic Claiming). Data supplied since Claim approved date of 1 October PEC Version PEC Version PEC Version Pronet (previously known as GTPS) WinCAPP (Manual Data Capture Application) (Early pharmacy specification) Manual Claiming Electronic Version 1.5 (transition from manual to electronic) Uses the key Claimant number, Claim date and Catnip batch number. from HealthPAC Claim file Version 4.2 MoH 80

81 PHA Claim Fact table Number PHA subsidy cards Number of Pharmaceutical Subsidy Cards issued. number_pha_subsidy_cards fact_pha_claim integer NNNNNNNN Data domain 1 to Number of Pharmaceutical Subsidy Cards issued by the claimant over the period of this claim. Version 4.2 MoH 81

82 PHA Claim Fact table Payment due date Date the payment is due to be made to the pharmacy by HealthPAC. payment_due_date fact_pha_claim date Data domain Oracle datetime field Valid dates Version 4.2 MoH 82

83 PHA Dispensing Adjustments Fact table PHA Dispensing Adjustments Fact table fact_pha_disp_adjustments Table to hold the Itex records. Source: HealthPAC Primary key Business key This table holds all credits and resubmissions of the Items (dispensings). These have never been applied to the Dispensings table. Itex records have been supplied by HealthPAC from April 2000 and represent a NSS Flag value of C for credits and R for Resubmissions. Relational rules None Data content Version 4.2 MoH 83

84 PHA Dispensing Adjustments Fact table CHF Endorsement Flag Flag to indicate that the prescription has congestive heart failure endorsement. prescription_flag fact_pha_disp_adjustments varchar2(1) A Data domain Y item has congestive heart failure endorsement N or space item has not congestive heart failure endorsement From Claim approved date of April If empty, set to 'N'. Version 4.2 MoH 84

85 PHA Dispensing Adjustments Fact table Catnip batch number A unique number for a batch of claims for a given claimant on a given claim date. catnip_batch_number fact_pha_disp_adjustments varchar2(10) Data domain From Claim approved date of 1 July 2000, Catnip batch number is used as one of the keys to match form and item. Before that only Claimant, Claim date and Form number were required. Catnip batch number, Claimant number and Claim date form a unique link to the Claim table. Version 4.2 MoH 85

86 PHA Dispensing Adjustments Fact table Child resistant container Flag field to indicate the medication has a safety cap on the container. child_resistant_container fact_pha_disp_adjustments varchar2(1) A Data domain Y child resistant container fee claimed. N, X, or space child resistant container fee not claimed. The list of applicable medications is in the Pharmac Schedule. The Child resistant container has not been populated since from HealthPAC item Version 4.2 MoH 86

87 PHA Dispensing Adjustments Fact table Claim Amount For electronic claims since August 1998, this field is what was claimed by the pharmacy as payment for this item, ie, the subsidy amount. claim_amount fact_pha_disp_adjustments number(10,2) Data domain Includes the payment to be made by the DHB for the pharmaceutical, all fees and GST. Excludes patient co-payment. Where the item is compounded, only the first item should contain the subsidy amount. Subsidy amount = Pharmaceutical subsidy + Mark-ups + GST + Dispensing fee - Patient contribution Mark-ups, and Dispensing fees may differ by each pharmacy contract. Before August 1998 this field held the patient charge carried over to second or later repeats, if any. Now inaccurately named. There have been no container fees since from HealthPAC item Version 4.2 MoH 87

88 PHA Dispensing Adjustments Fact table Claim date End date of claim period given by payments office of HealthPAC. Usually the 15th or the last day of the month. claim_date fact_pha_disp_adjustments date Data domain Oracle datetime field Valid dates Used as one of the keys to match form to item. Dates range from 15 March Catnip batch number, Claimant number and Claim date form a unique link to the Claim table. Claim date month Claim date year from HealthPAC item and form Version 4.2 MoH 88

89 PHA Dispensing Adjustments Fact table Claimant number A number given by HealthPAC to a pharmacy or other institution authorised by the Ministry of Health and the Pharmaceutical Society to claim benefits. claimant_number fact_pha_disp_adjustments integer Payee number NNNNNNNNNN Data domain 1 to Claimant number identifies the Contract from which payment and processing rules will be sought. HealthPAC gives each claimant a 7 character Payee number, which is converted to a 4 character Claimant number on a one-to-one mapping. In the future, it is likely that the Payee number will be reported to this field. Used as one of the keys to match form to item. Catnip batch number, Claimant number and Claim date form a unique link to the Claim table. The Claim table contains some historical Claimant numbers. Must be a valid Claimant number in the Claimant table. from HealthPAC form and HealthPAC item Version 4.2 MoH 89

90 PHA Dispensing Adjustments Fact table Component number A sequential number indicating the components that make up a dispensing, for example, component '1' is line one of a group of transactions, component '2' is line two, etc. component_number fact_pha_disp_adjustments integer Mixture or compound components. NN Data domain 0 to 99 Pre Claim approved date of 10 August 1998: 0: not a mixture 1: aggregate of a mixture 2+: mixture component Post Claim approved date of 10 August 1998: 0: For all items (including aggregate of compound). 1+: compound components Before Claim approved date of 10 August 1998, the first record of a dispensing would have a Component number of '0' if not a mixture or '1' if a mixture (ie, first record would contain aggregate of dispensing). Subsequent records would be sent for each component in the aggregate (if a mixture), and a sequential Component number given for each record. After Claim approved date of 10 August 1998, compounds are identified by Data source 'C'. Reimbursement cost, dispensing fee, patient co-pay and mark-ups only included on aggregate compound record (with Component number of '0'). When extracting data, use either records with '0' or the aggregate of records with '1' to 'X'. Part of the major key of the Dispensings table. The first line transaction of a compound (Compound number '0') includes all the data fields required for a line transaction, including the quantity amount for the compound. Subsequent line transactions of a compound (Compound numbers '1', '2', etc) only supply the data required for that component. from HealthPAC item Version 4.2 MoH 90

91 PHA Dispensing Adjustments Fact table Cost of Service code Cost of Service code that replaces Claimant type. This defines the role of the pharmacy, or the contract under which the pharmacy is supplying the drug. cos_code fact_pha_disp_adjustments varchar2(5) NNNNN Data domain Provides a unique link to the COS Code Reference table for claims between 1 June 2000 and September However, the link between the COS code and the actual contract it refers to is not in the Pharmhouse and needs to be obtained from HealthPAC. From 1 June 2000 to September 2001, code numbers started at '99' plus the codes from the Cost Code table. When HealthPAC transitioned to GTPS, the COS code changed to be unique to each pharmacy (for example, could be retail, wholesale, special), so from September 2001 the reference table no longer applies and is out of date. Indicates under which payment Service Contract the claim is priced, and allows a single pharmaceutical to be claimed under the correct Service Contract when a pharmacy has more than one service for the single item. The COS Code Reference table is defunct. The definition changed from September 2001 and the reference table no longer applies. It is retained for historical reasons. The unique key should be Claimant and COS code, but Claimant is not held in the table. HealthPAC Version 4.2 MoH 91

92 PHA Dispensing Adjustments Fact table Cost, Brand, Source of supply (CBS) flag Flag to indicate whether the item is Cost, Brand, Source of supply (CBS) as per the Pharmac schedule. cbs_flag fact_pha_disp_adjustments varchar2(1) A Data domain Y item is Cost, Brand, Source of supply (CBS) as per the Pharmac schedule N or space item is not Cost, Brand, Source of supply (CBS) as per the Pharmac schedule From Claim approved date of April If empty, insert 'N'. Version 4.2 MoH 92

93 PHA Dispensing Adjustments Fact table Cost, Brand, Source of supply (CBS) unit price The item is eligible for subsidy on the pharmacy's annotated purchase price, brand and source of supply. cbs_unit_price fact_pha_disp_adjustments number(10,2) $$$$$$$$.$$ Data domain 0.00 to There is no set manufacturer's price and it will be subsidised at the price at which it is obtained by the pharmacy as long as it is flagged CBS in the schedule. Version 4.2 MoH 93

94 PHA Dispensing Adjustments Fact table Daily dose The amount of base units prescribed to be used per day in the dose unit of measure defined by Pharmac. daily_dose fact_pha_disp_adjustments number(10,2) NNNNNNNN.NN Data domain 0.00 to Supplied from HealthPAC item since Claim approved date of 1 May From June 2001 missing data mapped by multiplying dose by frequency if they exist. Not always an integer because, if not provided, the value is derived. If the Daily dose is unable to be expressed (eg, 'Take as needed'), this field should be set to '0'. If the field is set to '0', the Dose flag should be set to 'Y'. If the number of units is a range, the higher amount is used. If it is greater than zero insert value, else if Dose and Frequency > 0 then Daily_Dose = Dose x Frequency. If the units are spread over alternate days, eg, every other day, or Monday, Wednesday and Friday, the value should represent this: For example, one unit every other day will equate to 0.5 of a unit. For example, Monday, Wednesday, and Friday will equate to As this field requires data expressed to 4 decimal places with no decimal points, 0.5 of a unit would appear in the data file as 5000, and would appear as Frequency Quantity Days Supply Dose from HealthPAC item Version 4.2 MoH 94