Download:
pdf |
pdf2019 (old version)
2020 (new version)
Type of Change
Reason for Change
Burden Change
Header:
MEDICAID DRUG REBATE
PRIOR QUARTER ADJUSTMENT STATEMENT (PQAS) CMS‐304a
ELECTRONIC FORMAT
Header:
MEDICAID DRUG REBATE PROGRAM
PRIOR QUARTER ADJUSTMENT STATEMENT (PQAS)
Form CMS‐304a
ELECTRONIC FILE FORMAT
Effective: July 1, 2021
Rev
To align Header with other Medicaid Drug
Rebate Program documentation.
N/A
New File Format Column:
Ordinal Position
Corresponding Rows 1‐10 for Record 1
Corresponding Rows 1‐20 for Record 2
Corresponding Rows 1‐15 for Record 3
Add
To update File Format to include .CSV Ordinal N/A
Numbering Column
Column Name Update:
Field
Column Name Update:
Field Name (.TXT)
Header Row (.CSV
Rev
To include .CSV Header Row in additon to the N/A
.TXT Field Name
N/A
New File Format Column:
Position
Positions 1‐141 for Record 1
Positions 1‐239 for Record 2
Positions 1‐209 for Record 3
Add
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Record ID ‐ Record 1
Size: 1
Remarks: Constant of “1”
Record ID ‐ Record 1
Size: 2
Remarks: Constant of “P1” for PQAS 1
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Phone‐ Record 1
Remarks: Area Code/Phone No./Ext. of Contact
Phone‐ Record 1
Remarks: Area Code/Phone No./Ext. of Invoice Contact
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Fax ‐ Record 1
Size: 10
Remarks: Labeler’s Contact Fax Number
Email ‐ Record 1
Size: 50
Remarks: Labeler’s Invoice Contact Email Address
Rev
The Fax Field is no longer relevant so it is
being replaced with an Email Field
N/A
Record ID ‐ Record 2
Size: 1
Remarks: Constant of “2”
Record ID ‐ Record 2
Size: 2
Remarks: Constant of “P2” for PQAS 2
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Original Unit Rebate Amount ‐ Record 2
Size: 11
Remarks: 99999V999999
Original Unit Rebate Amount ‐ Record 2
Size: 15
Remarks: 99999999.999999
Rev
Updated field size from 11 to 15 digits
N/A
Current Unit Rebate Amount ‐ Record 2
Size: 11
Remarks: 99999V999999
Current Unit Rebate Amount ‐ Record 2
Size: 15
Remarks: 99999999.999999
Rev
Updated field size from 11 to 15 digits
N/A
Original Units Invoiced ‐ Record 2
Size: 12
Remarks: 999999999V999
Original Units Invoiced ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Current Units to Date ‐ Record 2
Size: 12
Remarks: 999999999V999
Current Units to Date ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
N/A
2019 (old version)
2020 (new version)
Type of Change
Reason for Change
Burden Change
Prior Units Paid ‐ Record 2
Size: 12
Remarks: 999999999V999
Prior Units Paid ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Current Units Paid to Date ‐ Record 2
Size: 12
Remarks: 999999999V999
Current Units Paid to Date ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Prior Units Disputed ‐ Record 2
Size: 12
Remarks: 999999999V999
Prior Units Disputed ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Current Units Disputed to Date ‐ Record 2
Size: 12
Remarks: 999999999V999
Current Units Disputed to Date ‐ Record 2
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Original Amount Invoiced ‐ Record 2
Size: 9
Remarks: 9999999V99
Original Amount Invoiced ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Revised Invoice Amount ‐ Record 2
Size: 9
Remarks: 9999999V99
Revised Invoice Amount ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Prior Amount Paid ‐ Record 2
Size: 9
Remarks: 9999999V99
Prior Amount Paid ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Current Amount Paid to Date ‐ Record 2
Size: 9
Remarks: 9999999V99
Current Amount Paid to Date ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Amount Paid This Transaction ‐ Record 2
Size: 9
Remarks: 9999999V99
Amount Paid This Transaction ‐ Record 2
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 9 to 16 digits
N/A
Record ID ‐ Record 3
Size: 1
Remarks: Constant of “3”
Record ID ‐ Record 3
Size: 2
Remarks: Constant of “P3” for PQAS 3
Rev
To align verbiage with other Medicaid Drug
Rebate Program documentation.
N/A
Total Original Units Invoiced ‐ Record 3
Size: 12
Remarks: 999999999V999
Total Original Units Invoiced ‐ Record 3
Size: 16
Remarks: 99999999.999999
Rev
Updated field size from 12 to 16 digits
N/A
Total Current Units to Date ‐ Record 3
Size: 12
Remarks: 999999999V999
Total Current Units to Date ‐ Record 3
Size: 16
Remarks: 99999999.999999
Rev
Updated field size from 12 to 16 digits
N/A
Total Prior Units Paid ‐ Record 3
Size: 12
Remarks: 999999999V999
Total Prior Units Paid ‐ Record 3
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
2019 (old version)
2020 (new version)
Type of Change
Reason for Change
Burden Change
Total Current Units Paid to Date ‐ Record 3
Size: 12
Remarks: 999999999V999
Total Current Units Paid to Date ‐ Record 3
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Total Prior Units Disputed ‐ Record 3
Size: 12
Remark: 999999999V999
Total Prior Units Disputed ‐ Record 3
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Total Current Units Disputed to Date ‐ Record 3
Size: 12
Remarks: 999999999V999
Total Current Units Disputed to Date ‐ Record 3
Size: 16
Remarks: 999999999999.999
Rev
Updated field size from 12 to 16 digits
N/A
Total Original Amount Invoiced ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Original Amount Invoiced ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Total Revised Invoice Amount ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Revised Invoice Amount ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Total Prior Amount Paid ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Prior Amount Paid ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Total Current Amount Paid to Date ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Current Amount Paid to Date ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Total Amount Paid This Transaction ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Amount Paid This Transaction ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Plus Interest Payment ‐ Record 3
Size: 8
Remarks: 999999V99
Plus Interest Payment ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 8 to 16 digits
N/A
Total Remittance ‐ Record 3
Size: 10
Remarks: 99999999V99
Total Remittance ‐ Record 3
Size: 16
Remarks: 9999999999999.99
Rev
Updated field size from 10 to 16 digits
N/A
Type of Change: Rev = Revision, Del = Deletion, Add = Addition, and Red = Redesgnation.
| File Type | application/pdf |
| File Title | CMS Form-304a Prior Quarter Adjustment Statement (PQAS)_Electronic Format_Crosswalk_07.2021.xlsx |
| Author | LOKG |
| File Modified | 2020-11-03 |
| File Created | 2020-11-03 |