Quickscrip transmits electronic prescriptions in the new D.0 transmission format
as of 2011.
To see what fields of data are being transmitted, enter T/B at the time of
transmission (in RXFILL and Dual Billing EDIT) or Y/B (in the EDIT Screen).
Note: When searching this document by field number, be aware that insurance
companies often reverse the numeric code (Thus, field A1-101, may be called
101-A1 by an insurance customer support representative)
Segment ID Field
The Field AM-111 is the Segment identifier field. This field will apper multiple
times in a transmission, and is used to seperate transmitted data into relevant
groupings.
The transmission header contains routing information that your switch uses to
determine where the claim is sent to.
| Field Name
|
Description
|
| A1-101 |
Insurance BIN Number
|
| A2-102 |
Version Number
|
| A3-103 |
Transaction Code
|
| A4-104 |
Processor Control Number
|
| A9-109 |
Transaction Count
|
| B2-202 |
Service Provider ID
|
| D1-401 |
Date of Service
|
| AK110 |
Software Vendor Certification #
|
Insurance Info
| Field Name
|
Description
|
| C2-302 |
Cardhoder ID Number
|
| CC-312 |
Cardholder First Name
|
| CD-313 |
Cardholder Last Name
|
| CE-314 |
Home Plan
|
| FO-524 |
Plan ID
|
| C9-309 |
Eligibility Clerification Code
|
| C1-301 |
Group ID
|
| C3-303 |
Person Code
|
| C6-306 |
Relationship Code
|
| 2D-361 |
Provider Accept Assignment
|
| G2-997 |
Long Term Care Claim Submission
|
| 2B-360 |
Medicaid Indicator
|
| N5-115 |
Medicaid ID Number
|
Patient Info
| Field Name
|
Description
|
| CX-331 |
Patient ID Type
|
| CY-332 |
Patient ID
|
| C4-304 |
Date of Birth
|
| C5-305 |
Gender Code
|
| C7-307 |
Place of Service
|
| CA-310 |
Patient First name
|
| CB-311 |
Patient Last name
|
| CM-322 |
Patient Street Address
|
| CN-323 |
Patient City
|
| CO-324 |
Patient State
|
| CP-325 |
Patient Zip code
|
| CQ-326 |
Patient Phone
|
| CZ-333 |
Patient Employer ID
|
| 1C-334 |
Patient Smoker?
|
| 2C-335 |
Patient Pregnant?
|
| 4X-384 |
Patient Residence
|
| HN-350 |
Patient Email Address
|
Claim Information
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Doctor Information
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Pricing Informaction
In Quickscrip claim transmissions, numberical values end with a letter of the alphabhet
and do not include a decimal.
Thus 7462E would corrispond to $746.25.
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Coordination of Benefits
This section typically appears on secondary billing claims.
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Workers Comp Information
Workers comp fields are generated when a Date of Injury has been set on a claim.
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
DUR Information
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Coupon Information
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Compound Drug Information
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
P/A Request Information
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Clinical Information
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Additional Documantation Segment
| Field Name
|
Description
|
| Placeholder |
Placeholder
|
Older Versions
On rare occasions, an insurance may require a claim be send on an older transmission standard (RXOL51 or RXO3PI). Please contact Cost Effective Computers for these claims.