After Medical claims data is submitted, 340B ESP performs a series of back-end validations checks to ensure data quality on submitted claims. Once submitted, registered users can review claims submission data using the Medical Claims Submissions module.
Review medical claims submissions in 340B ESP to gain insight into claim processing status, identify validation issues, and view claim-level details.
Before You Begin
To review submitted claims data, your user account must be registered to the covered entity whose claims you want to review. Claims submitted to covered entities to which you are not registered will not appear in the Medical Submissions module.
Note: Claims submitted by a Third-Party Administrator (TPA) using the 340B ESP SDK submission method are not displayed in the Medical Claims Submissions module and can instead be reviewed through the Medical Claims Details report in the Reports module.
Reviewing Your Medical Claim Submissions
In the Medical Submissions module, you can access all submitted medical claims data for the covered entities to which you are registered. Using the submission list and Non-Conforming Claims Issues Summary, you can easily track and review the submitted claims statuses and validation outcomes.
Each row in the table represents a submitted medical claims file and includes a high-level summary of each submission, which can be used to easily scan for submissions based on a number of fields, including:
Status – Indicates the current processing state of a claim submission in 340B ESP.
Processing: The system is performing back-end validation checks.
Complete: All validation checks are finished, and the submission has received its final outcome.
Claims – The total number of claims included in the submission.
% Conforming – Percentage of conforming claims by total claims submitted
Conforming: Claims with zero issues listed and do qualify under the manufacturer’s 340B ESP policy.
Non-conforming: Claims with one or more issues listed in 340B ESP.
Date – Date the claims file was submitted to 340B ESP.
For a full report of conforming and non-conforming claims with issues, select a submission from the dropdown to access additional details, including the Non-Conforming Claims Issue Summary.
Note: After a file has been submitted to 340B ESP, the submission file name is automatically generated using the standard 340B ESP naming format (340B_ESP_YYYY-MM-DD.csv). The file can be located in the Medical Submissions module, where you can review the claims data submitted to 340B ESP.
Non-Conforming Claims Issue Summary
Within the expanded submission details, review the assessment results for each individual claim. Claims may appear in any of the six available statuses and can be counted under multiple Issue Types, so the Count values are discrete and will not sum to a single total. Percentages reflect the share of claims associated with each Issue Type relative to the overall set of reviewed claims — not a cumulative percentage.
Non-Conforming Claim Issue Types include:
Invalid Service Provider ID – The service provider ID cannot be linked to an in-house pharmacy or contract pharmacy for the associated 340B ID.
Invalid Unit of Measure – HCPCS code is populated on claim, but is not associated with that NDC or the incorrect NCPDP UOM is provided.
Claim Expired – The date of the dispense falls outside the manufacturer's lookback period.
Invalid 340B ID – The 340B ID does not match a covered entity listed in HRSA OPAIS.
Aberrant Quantity – Total units of the drug is outside an acceptable range, as listed in the 340B ESP Medical NDCs Units of Measure.
Duplicate – The claim was identified as duplicative of a previously submitted claim.
Additionally, for a more in-depth report of all claims listed on the submission with listed issue types for each individual claim, you can download the submission file linked to the submission row.
Use these details to investigate validation failures, identify patterns or recurring issues across submissions, and track claim outcomes over time. Reviewing claim details such as these help you better understand submission eligibility for a specific claim and determine whether correction or resubmission is needed.
Tip: For more information on back-end validations, the different types of back-end validations, and how they work, check out Back-end Validations.
Still have questions?
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