In the Reports module, the Pharmacy Claims Details report provides a line‑level view of all previously submitted claims data, with each row representing an individual claim from an uploaded file. Here you can filter submitted claims based on various search filters, including date, covered entity, submission results, and more.
Use the Pharmacy Claims Details report to assess data quality, confirm whether claims are processed as expected, or identify recurring issues in your covered entity’s submission history. Whether you're troubleshooting non‑conforming claims, reviewing recent submissions for a specific manufacturer, or monitoring claim activity for a single covered entity, the report offers flexible tools to support various workflow needs.
Reviewing Pharmacy Claims Submissions in the Reports View
In the Reports module, the Pharmacy Claims Details report provides access to all previously submitted pharmacy claims data for your registered covered entities. This view is especially valuable when auditing recent submissions to confirm that claims processed as conforming, or when investigating non‑conforming patterns that may signal issues with contract pharmacy eligibility or pricing restoration workflows.
By selecting View Report, you can review claim‑level information and apply filters to focus on specific data segments or trends.
To refine your results and focus on the claims most relevant to your review, you can apply a variety of targeted search filters:
Date – Filters by date by selecting one of the predefined date ranges or by using the date picker to define a date range.
Covered Entity – Filters claims based on the covered entity associated with the submission. You can select one or multiple covered entities, or view claims across all covered entities.
Result – Filters claims based on conforming or non-conforming processing outcomes.
Issues – Filters claims based on identified validation issues, including Claim Expired, Invalid Service Provider ID, Invalid 340B ID, and Duplicate.
Manufacturers – Filters claims based on the manufacturer associated with the submission. You can select one or multiple manufacturers, or view claims across all manufacturers.
Products – Filters claims based on the product associated with the claim.
This streamlined view helps you monitor claim quality, identify patterns, and better understand submission outcomes across your pharmacy claims.
Still have questions?
If you have questions or need additional help, our team is here for you — please feel free to reach out using any of the contact options below:
Chat: Available via in-app messenger
Email: [email protected]