Crosswalk - Instructions

2017 (old version)	2019 (new version)	Type of Change	Reason for Change	Burden Change
Introduction - The adjusment and dispute codes found in Appendix C are used for both the ROSI and the PQAS.	Introduction - The adjustment and dispute codes found in the Adjustment and Dispute Codes for CMS 304/304a document are used for both the ROSI and the PQAS.	Rev	To remove the reference to "Appendix C", which is no longer applicable.	N/A
Labeler Name: Name of labeler as it appears on the signed rebate agreement. Alpha-numeric, first 25 letters of labeler name, left-justified, blank-filled.	Labeler Name: Name of labeler as it appears on the signed rebate agreement. Alpha-numeric; first 25 letters of labeler name; left-justified; blank-filled.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Labeler Code: The first segment of the national drug code (NDC 1) as assigned by the FDA. Numeric only, 5 positions, right-justified, zero-filled.	Labeler Code: The first segment of the National Drug Code (NDC) that identifies the labeler. Numeric values; 5-digit field; right-justified; zero-padded.	Rev	To align verbiage with PRA packages 0938-0582 and 0938-0578	N/A
Quarter Covered: Current quarter and year. Numeric, 5-digit field, QYYYY, no blanks. Valid values for Q: 1 = January 1 - March 31 2 = April 1 - June 30 3 = July 1 - September 30 4 = October 1 - December 31 Valid values for YYYY: Four-digit calendar year covered.	Period Covered: Current quarter and year. Numeric values; 5-digit field; format: QYYYY; no blanks. Valid values for Q: 1 = January 1 - March 31 2 = April 1 - June 30 3 = July 1 - September 30 4 = October 1 - December 31 Valid values for YYYY: 4-digit calendar year equal to 1991 or later.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Labeler Contact: Labeler’s Invoice contact. Alphabetic, 20-character field, left-justified, first name and last name separated by 1 blank.	Labeler Contact: Labeler’s Invoice contact. Alphabetic values; 20-character field; left-justified; first name and last name separated by 1 blank.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Phone: Labeler’s Invoice contact phone number. Numeric, 14-digit field, 10-digit area code and phone number, and 4-digit extension or blanks.	Phone: Labeler’s Invoice contact phone number. Numeric values; 14-digit field; 10-digit area code and phone number; 4-digit extension or blanks.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Fax: Labeler’s Invoice contact fax number. Numeric, 10-digit field, area code and fax number.	Fax: Labeler’s Invoice contact fax number. Numeric values; 10-digit field; area code and fax number.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
State: State postal abbreviation. Alphabetic, 2-character field, no blanks.	State Code: State postal abbreviation. Alphabetic values; 2-character field; no blanks.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Invoice Number: If no invoice number, blank-filled. Alpha-numeric, 10-digit field, right-justified.	Invoice Number: If no invoice number, blank-filled. Alpha-numeric values; 10-digit field; right-justified.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Date: Date ROSI was generated. Numeric only, 8-digit field, MMDDYYYY, no blanks.	Date: Date ROSI was generated. Numeric values; 8-digit field, format: MMDDYYYY; no blanks.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Product/Package Code (Column A): The second and third segments of the NDC. Alpha-numeric, 6-digit field, right-justified, zero-filled.	Product Code/Package (Column A): The second and third segments of the NDC. Alpha-numeric values; 6-digit field; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Product Name (Column B): First 10 characters of product name as approved by and/or listed with the FDA. Alpha-numeric, 10-digit field, left-justified, blank-filled.	FDA Product Name (Column B): First 10 characters of product name as approved by and/or listed with the FDA. Alpha-numeric values; 10-digit field; left-justified; blank-filled.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
FSS/MCO Record ID (Column C): Constant of “FFSU” or “MCOU”: The FFSU Record ID indicates that the information for this NDC represents a Fee-For-Service record. The MCOU Record ID indicates that the information for this NDC represents a Managed Care Organization record. 4-digit field, no blanks, valid values: FFSU or MCOU.	FFS/MCO Record ID (Column C): Constant of “FFSU” or “MCOU”: The FFSU Record ID indicates that the information for this NDC represents a Fee-For-Service record. The MCOU Record ID indicates that the information for this NDC represents a Managed Care Organization record. Valid Values: Within or earlier than 4Q2009 = Constant Record ID of FFSU Within or later than 1Q2010 = FFSU & MCOU	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Original Rebate Per Unit (Column D: CMS-calculated unit rebate amount (URA) as shown on the original state invoice. Numeric, 11-digit field: 5 whole numbers and 6 decimals or zero-filled per invoice, right-justified.	Original Unit Rebate Amount (URA) (Column D): CMS-calculated URA as shown on the original state invoice. Numeric values; 11-digit field: 5 whole numbers and 6 decimal places; zero-padded; right-justified.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Current Rebate Per Unit (Column E): The adjusted/current URA. Numeric, 11-digit field: 5 whole numbers and 6 decimals or blank-filled if not applicable, right-justified.	Current Unit Rebate Amount (URA) (Column E): The adjusted/current URA. Numeric values; 11-digit field: 5 whole numbers and 6 decimal places; right-justified; blank-filled if not applicable.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Orignal Units Invoiced (Column F): The number of units reported on the original invoice. Numeric, 12-digit field: 9 whole numbers and 3 decimals, right-justified, zero-filled.	Original Units Invoiced (Column F): The number of units reported on the original invoice. Numeric values; 12-digit field: 9 whole numbers and 3 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Current Units to Date (Column G): The number of units agreed upon by the labeler and state, as adjusted from the original invoice. Numeric, 12-digit field: 9 whole numbers and 3 decimals, right-justified, zero-filled.	Current Units to Date (Column G): The number of units agreed upon by the labeler and state, as adjusted from the original invoice. Numeric values; 12-digit field: 9 whole numbers and 3 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Prior Units Paid (Column H): The total units previously paid from the original invoice. Numeric, 12-digit field: 9 whole numbers and 3 decimals, right-justified, zero-filled.	Prior Units Paid (Column H): The total units previously paid from the original invoice. Numeric values; 12-digit field: 9 whole numbers and 3 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Current Units Paid to Date (Column I): The total units paid for this NDC with this PQAS. Numeric, 12-digit field: 9 whole numbers and 3 decimals, right-justified, zero-filled.	Current Units Paid to Date (Column I): The total units paid for this NDC with this PQAS. Numeric values; 12-digit field: 9 whole numbers and 3 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Prior Units Disputed (Column J): The total units previously disputed from the original invoice. Numeric, 12-digit field: 9 whole numbers and 3 decimals, right-justified, zero-filled.	Prior Units Disputed (Column J): The total units previously disputed from the original invoice. Numeric values; 12-digit field: 9 whole numbers and 3 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Current Units Disputed to Date (Column K): The total units disputed for this NDC, with this PQAS. Numeric, 12-digit field: 9 whole numbers and 3 decimals, right-justified, zero-filled.	Current Units Disputed to Date (Column K): The total units disputed for this NDC, with this PQAS. Numeric values; 12-digit field: 9 whole numbers and 3 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Original Amount Invoiced (Column L): The total rebate amount originally invoiced for this NDC. Numeric, 9-digit field: 7 whole numbers and 2 decimals, right-justified, zero-filled.	Original Amount Invoiced (Column L): The total rebate amount originally invoiced for this NDC. Numeric values; 9-digit field: 7 whole numbers and 2 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Revised Invoice Amount (Column M): The total rebate amount as adjusted (where applicable) by this PQAS for this NDC. Numeric, 9-digit field: 7 whole numbers and 2 decimals, right-justified, zero-filled.	Revised Invoice Amount (Column M): The total rebate amount as adjusted (where applicable) by this PQAS for this NDC. Numeric values; 9-digit field: 7 whole numbers and 2 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Prior Amount Paid (Column N): The total amount previously paid for this NDC from the original invoice. Numeric, 9-digit field: 7 whole numbers and 2 decimals, right-justified, zero-filled.	Prior Amount Paid (Column N): The total amount previously paid for this NDC from the original invoice. Numeric values; 9-digit field: 7 whole numbers and 2 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Current Amount Paid to Date (Column O): The total amount paid for this NDC, including payments made via this PQAS. Numeric, 9-digit field: 7 whole numbers and 2 decimals, right-justified, zero-filled.	Current Amount Paid to Date (Column O): The total amount paid for this NDC, including payments made via this PQAS. Numeric values; 9-digit field: 7 whole numbers and 2 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Amount Paid This Transaction (Column P): The difference between columns M and N (the result may be a positive or negative number). Numeric, 9-digit field: 7 whole numbers and 2 decimals, right-justified, zero-filled.	Amount Paid This Transaction (Column P): The difference between columns M and N (the result may be a positive or negative number). Numeric values; 9-digit field: 7 whole numbers and 2 decimal places; right-justified; zero-filled.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Adjustment Code(s) (Column Q): Adjustment explanation(s). Alphabetic, 3-character field. Valid values per attached list of codes. Up to 3 Adjustment Codes per NDC; blanks for fewer than 3 codes.	Adjustment Code(s) (Column Q): Adjustment explanation(s). Alphabetic values; 3-character field. Valid values per attached list of codes. Up to 3 Adjustment Codes per NDC; blanks for fewer than 3 codes.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Dispute Code(s) (Column R): Dispute explanation. Alphabetic only, 3-character field. Valid values per attached list of codes. Up to 3 Adjustment Codes per NDC; blanks for fewer than 3 codes.	Dispute Code(s) (Column R): Dispute explanation(s). Alphabetic values; 3-character field. Valid values per attached list of codes. Up to 3 Dispute Codes per NDC; blanks for fewer than 3 codes.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Plus Interest Payment: Total amount of interest paid with this PQAS. Numeric, 8-digit field: 6 whole numbers and 2 decimal places, right-justified, zero-filled.	Plus Interest Payment: Total amount of interest paid with this PQAS. Numeric values; 8-digit field: 6 whole numbers and 2 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A
Total Remittance: Total rebate amount paid on this PQAS for all NDCs, including any interest payment. Numeric, 10-digit field: 8 whole numbers and 2 decimals, right-justified, zero-filled.	Total Remittance: Total rebate amount paid on this PQAS for all NDCs, including any interest payment. Numeric values; 10-digit field: 8 whole numbers and 2 decimal places; right-justified; zero-padded.	Rev	To align verbiage with other Medicaid Drug Rebate Program documentation.	N/A