Insurance Transmission Fields: Difference between revisions
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| | |EM-455|| Rx number type | ||
|- | |||
|D2-402|| Rx# | |||
|- | |||
|E1-436|| Prod/Service ID type | |||
|- | |||
|D7-407|| NDC# (Prod/Service ID) | |||
|- | |||
|E7-442|| Quantity dispensed | |||
|- | |||
|D3-403|| Refill# | |||
|- | |||
|D5-405|| Days Supply | |||
|- | |||
|D6-406|| Compound Code | |||
|- | |||
|D8-408|| DAW code | |||
|- | |||
|DE-414|| Date Rx written | |||
|- | |||
|DF-415|| # of Refills authorized | |||
|- | |||
|U7-147|| Pharmacy Service Type | |||
|- | |||
|DJ-419|| Rx origin code | |||
|- | |||
|NX-354|| Submission Clarify count | |||
|- | |||
|DK-420|| Submission clarify code | |||
|- | |||
|DI-418|| Level of Service | |||
|- | |||
|C8-308|| Other coverage code | |||
|- | |||
|EN-456|| Associated Rx/service ref # | |||
|- | |||
|EP-457|| Associated Rx/service date | |||
|- | |||
|SE-458|| Procedure modifier count MAX | |||
|- | |||
|ER-459|| Procedure modifier code | |||
|- | |||
|ET-460|| Quantity prescribed | |||
|- | |||
|DT-429|| Special Packaging Indicator | |||
|- | |||
|EJ-453|| Orig Rxd item ID type | |||
|- | |||
|EA-445|| Orig Rxd item ID | |||
|- | |||
|EB-446|| Orig Rxd quantity | |||
|- | |||
|CW-330|| Alternate ID | |||
|- | |||
|EK-454|| Scheduled Rx ID number | |||
|- | |||
|28-600|| Unit of Measure | |||
|- | |||
|EU-461|| P/A type code | |||
|- | |||
|EV-462|| P/A AUTH # | |||
|- | |||
|EW-463|| Intermediary Auth type | |||
|- | |||
|EX-464|| Intermediary Auth ID | |||
|- | |||
|HD-343|| Dispensing status | |||
|- | |||
|HF-344|| Qty intended to dispense | |||
|- | |||
|HG-345|| Days Supply intended | |||
|- | |||
|NV-357|| Delay Reason Code | |||
|- | |||
|MT-391|| Patient Assignment Indicator | |||
|- | |||
|E2-995|| Route of Administration | |||
|- | |||
|G1-996|| Compound Type | |||
|- | |- | ||
|} | |} | ||
Revision as of 18:29, 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 |
| EM-455 | Rx number type |
| D2-402 | Rx# |
| E1-436 | Prod/Service ID type |
| D7-407 | NDC# (Prod/Service ID) |
| E7-442 | Quantity dispensed |
| D3-403 | Refill# |
| D5-405 | Days Supply |
| D6-406 | Compound Code |
| D8-408 | DAW code |
| DE-414 | Date Rx written |
| DF-415 | # of Refills authorized |
| U7-147 | Pharmacy Service Type |
| DJ-419 | Rx origin code |
| NX-354 | Submission Clarify count |
| DK-420 | Submission clarify code |
| DI-418 | Level of Service |
| C8-308 | Other coverage code |
| EN-456 | Associated Rx/service ref # |
| EP-457 | Associated Rx/service date |
| SE-458 | Procedure modifier count MAX |
| ER-459 | Procedure modifier code |
| ET-460 | Quantity prescribed |
| DT-429 | Special Packaging Indicator |
| EJ-453 | Orig Rxd item ID type |
| EA-445 | Orig Rxd item ID |
| EB-446 | Orig Rxd quantity |
| CW-330 | Alternate ID |
| EK-454 | Scheduled Rx ID number |
| 28-600 | Unit of Measure |
| EU-461 | P/A type code |
| EV-462 | P/A AUTH # |
| EW-463 | Intermediary Auth type |
| EX-464 | Intermediary Auth ID |
| HD-343 | Dispensing status |
| HF-344 | Qty intended to dispense |
| HG-345 | Days Supply intended |
| NV-357 | Delay Reason Code |
| MT-391 | Patient Assignment Indicator |
| E2-995 | Route of Administration |
| G1-996 | Compound Type |
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.