Pharmacy Claims Report

Description and Important Notes:

The pharmacy claims report is where you can find the most detailed reporting on a group's pharmacy (prescription drug) claims. The pharmacy claims report is found on the "reports" page of the portal and is designed to include more information than the summary view shown on the "claims" page.

A few important notes:

The pharmacy claims report shows adjudicated claims. Claims still in process can be viewed on the "claims" page.
This report is a snapshot in time. In order to get up-to-date information, regenerate the claims report on a regular basis.
This report will be generated as a .csv file and will include a raw data view of all adjudicated pharmacy claims.
This report contains Personal Health Information, it may be anonymized or redacted based on your access.

If you are unable to download the report, try normal troubleshooting steps. If you’re still unable to access, email partners@yuzu.health.

Interpretation Guide:

1. Each row is one prescription fill. Unlike the medical claims report, pharmacy claims are not split into individual lines for each service: one row is one claim, and every claimNumber appears once. You can sum a dollar column without double counting. Keep in mind that the same patient will appear on many rows, since each fill and refill is its own claim.

2. Start with the claim status. claimStatus tells you whether the claim was approved or denied. remarkCodes and remarkCodeDescriptions add plain-language processing notes when they apply; they are blank on most rows and appear mainly when a claim adjusts a previously processed claim.

3. Know who the row is about. The patient is the person who received the medication; the subscriber is the employee who holds the coverage. This report has no relationship column, so compare the names, or compare memberId to employeeId: both are built from the same member number base, with a person code that identifies the individual. When the two IDs match, the patient is the employee.

4. Follow the money. billedAmount is what the pharmacy charged and allowedAmount is the price the plan recognizes; at the pharmacy these are usually the same. The allowed amount is split between the plan (planPaidAmount) and the patient, whose share is broken into deductibleAmount, copayAmount, and coinsuranceAmount. patientPaidAmount is the sum of those three pieces, and the plan share plus the patient share always adds back to the allowed amount.

5. Use the cost components to see what makes up the price. ingredientCost, dispensingFee, and salesTax break the drug's price into its parts, and together they generally account for the allowed amount. administrativeFee belongs to the same breakdown and shows "UNKNOWN" when the value is unavailable.

6. Check whether payment has gone out. paidDate shows the date the plan's payment was issued and is blank when no paid date is recorded. Blank is common, most often because the patient's copay or deductible covered the full cost and no plan payment applied; it can also mean a plan payment has not been issued yet. Open the claim for payment detail.

7. Use the drug fields to identify the medication. drugName carries the full product name, including strength and form (for example, "Pravastatin Sodium Oral Tablet 10 MG"), so it is the most reliable field for identifying what was dispensed. ndcCode gives the National Drug Code, genericOrFormulary shows whether the drug is generic or a formulary brand, and therapeuticClass groups drugs by what they treat. daysSupply and quantity show how much was dispensed. Some fields (dosage, medicationForm, isSpecialty, prescribedDate) show "UNKNOWN" or are blank when the pharmacy data doesn't include them; when dosage or medicationForm is unavailable, drugName still carries the strength and form.

8. Mind the dates. fillDate is when the prescription was filled; paidDate follows later, if a plan payment applies. A fill from one month may not be paid until a later month, so recent months in the report are usually incomplete.

9. Open the claim for full detail. Every row includes a linkToClaim that takes you to the claim in the Yuzu app, where you can see documents, history, and payment detail beyond what fits in the report.

For column-by-column definitions, see the data dictionary below.

Data Definitions:

This section explains each field, its format, any applicable calculations, and a basic definition.

Member and Employee Information

Column	Format	Calculation (if applicable)	What it means
memberId	String	Member number base + person code of the patient's coverage	Unique identifier for the patient (the person who received the medication).
employeeId	String	Member number base + person code of the subscriber's coverage	Identifier for the employee (subscriber) whose plan covers the patient.
subscriberFirstName	String	—	Employee's (subscriber's) first name.
subscriberLastName	String	—	Employee's (subscriber's) last name.
employeeLocation	String (optional)	Subscriber's assigned location tag	Employee's assigned location, if applicable. Blank when no location is assigned.
groupName	String	—	Name of the sponsoring employer group.
groupNumber	String	—	Group policy number for the employee's plan.

Patient Information

Column	Format	Calculation (if applicable)	What it means
patientDob	MM/DD/YYYY	—	Patient's date of birth.
patientFirstName	String	—	Patient's first name.
patientLastName	String	—	Patient's last name.

Claim Details

Column	Format	Calculation (if applicable)	What it means
claimNumber	String	—	The claim's unique reference number. Each row is one claim; claim numbers are not repeated.
claimStatus	Enum (claim status)	—	Where the claim stands in adjudication (e.g., approved, denied).
linkToClaim	URL	—	Direct link to view the claim in the Yuzu app.

Payment Information

Column	Format	Calculation (if applicable)	What it means
paidDate	MM/DD/YYYY or blank	The claim's paid date; if unavailable, the most recent payment ledger date; blank if neither exists	Date the claim was paid. Blank when no paid date is recorded, which is common when the patient's share covered the full cost.

Dollar Amounts

All amounts below apply to the individual claim.

Column	Format	Calculation (if applicable)	What it means
billedAmount	Dollars	—	The amount the pharmacy charged for the claim.
allowedAmount	Dollars	—	The maximum amount the plan allows for the claim. At the pharmacy this usually equals the billed amount.
deductibleAmount	Dollars	—	The portion applied to the patient's deductible.
copayAmount	Dollars	—	The patient's copay for the fill.
coinsuranceAmount	Dollars	—	The patient's coinsurance share of the cost.
patientPaidAmount	Dollars	—	The total amount the patient paid out of pocket (deductible + copay + coinsurance).
planPaidAmount	Dollars	—	The amount the health plan paid. The plan share plus the patient share equals the allowed amount.
ingredientCost	Dollars, or "UNKNOWN"	—	The cost of the drug itself, before fees and tax.
dispensingFee	Dollars, or "UNKNOWN"	—	The fee the pharmacy charges to dispense the prescription.
administrativeFee	Dollars, or "UNKNOWN"	—	Administrative fee on the claim. Shows "UNKNOWN" when the value is unavailable.
salesTax	Dollars, or "UNKNOWN"	—	Sales tax on the claim.
awp	Dollars, or "UNKNOWN"	—	The drug's average wholesale price, a standard pricing benchmark.

Prescription and Drug Information

Column	Format	Calculation (if applicable)	What it means
fillDate	MM/DD/YYYY, or "UNKNOWN"	—	Date the prescription was filled.
prescribedDate	MM/DD/YYYY, or "UNKNOWN"	—	Date the prescription was written. Shows "UNKNOWN" when the value is unavailable.
drugName	String, or "UNKNOWN"	—	Name of the dispensed drug. Includes strength and form (e.g., "Lisinopril Oral Tablet 10 MG").
dosage	String, or "UNKNOWN"	—	Drug strength/dosage. When unavailable, shows "UNKNOWN"; `drugName` also carries the strength.
medicationForm	String (optional)	—	Form of the medication (e.g., tablet, capsule). When unavailable, this field is blank; `drugName` also carries the form.
daysSupply	Number, or "UNKNOWN"	—	Number of days the dispensed supply covers.
quantity	Number, or "UNKNOWN"	—	Quantity of drug dispensed.
genericOrFormulary	String	"generic" if the drug is generic; otherwise "formulary" if the drug is on the formulary; otherwise "UNKNOWN"	Whether the drug is generic or a formulary brand.
ndcCode	String, or "UNKNOWN"	—	National Drug Code identifying the exact medication.
therapeuticClass	String, or "UNKNOWN"	—	Therapeutic classification of the drug (e.g., Antihyperlipidemic, Vaccines).
isSpecialty	Boolean, or "UNKNOWN"	—	Whether the drug is a specialty medication. Shows "UNKNOWN" when the value is unavailable.
daw	String ("true"/"false", optional)	—	Dispensed-as-written indicator: "true" means the pharmacist dispensed the drug exactly as the prescriber wrote it, without substitution.

Pharmacy Information

Column	Format	Calculation (if applicable)	What it means
nabpNumber	String (optional)	—	The dispensing pharmacy's NABP number, a national identifier for pharmacies.

Benefits and Processing Notes

Column	Format	Calculation (if applicable)	What it means
remarkCodes	String (","-joined, optional)	Combined claim-level and line-level remark codes	Processing remark codes explaining how the claim was handled. Blank on most rows; appears mainly for adjustments to previously processed claims.
remarkCodeDescriptions	String (","-joined, optional)	—	Plain-language explanations of the remark codes.

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