Insurance Transmission Fields: Difference between revisions
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|width="300pt"|'''Description''' | |width="300pt"|'''Description''' | ||
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| | |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 | |||
|- | |- | ||
|} | |} | ||
Revision as of 18:20, 29 May 2015
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.
Transmission Header
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.