Parent File | Name | Number | Package |
---|---|---|---|
3P CLAIM DATA(#9002274.3) | Pharmacy | 9002274.3023 | Third Party Billing |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | MEDICATION | 0;1 | POINTER TO DRUG FILE (#50) | DRUG(#50)
|
.02 | REVENUE CODE | 0;2 | POINTER TO REVENUE CODES FILE (#9999999.72) | REVENUE CODES(#9999999.72)
|
.03 | UNITS | 0;3 | NUMBER | ************************REQUIRED FIELD************************
|
.04 | UNIT COST | 0;4 | NUMBER | ************************REQUIRED FIELD************************
|
.05 | DISPENSE FEE | 0;5 | NUMBER |
|
.06 | PRESCRIPTION | 0;6 | FREE TEXT |
|
.07 | IV ADDITIVE | 0;7 | POINTER TO IV ADDITIVES FILE (#52.6) | IV ADDITIVES(#52.6)
|
.08 | IV SOLUTION | 0;8 | POINTER TO IV SOLUTIONS FILE (#52.7) | IV SOLUTIONS(#52.7)
|
.09 | IV NARRATIVE | 0;9 | FREE TEXT |
|
.1 | *NON-RX PROVIDER | 0;10 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
.11 | NON-RX DAYS SUPPLY | 0;11 | NUMBER |
|
.12 | NON-RX REFILL NUMBER | 0;12 | NUMBER |
|
.13 | CORRESPONDING DIAGNOSIS | 0;13 | FREE TEXT |
|
.14 | SERVICE FROM DATE/TIME | 0;14 | DATE |
|
.15 | IV TYPE | 0;15 | SET |
|
.16 | TIMES DISPENSED | 0;16 | NUMBER |
|
.17 | DATA SOURCE | 0;17 | FREE TEXT |
|
.18 | SERVICE LINE PROVIDER | P;0 | POINTER Multiple #9002274.302318 | 9002274.302318
|
.19 | NEW/REFILL CODE | 0;19 | NUMBER |
|
.2 | DAYS SUPPLY | 0;20 | NUMBER |
|
.21 | NON-RX PHARMACIST | 0;21 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
.22 | RX FILE POINTER | 0;22 | POINTER TO PRESCRIPTION FILE (#52) | PRESCRIPTION(#52)
|
.23 | *PRESCRIBER | 0;23 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
.24 | NDC | 0;24 | FREE TEXT |
|
.25 | DATE WRITTEN | 0;25 | DATE |
|
.26 | DATE DISCONTINUED | 0;26 | DATE |
|
.27 | RETURNED TO STOCK | 0;27 | DATE |
|
.28 | SERVICE TO DATE/TIME | 0;28 | DATE |
|
.29 | CPT CODE | 0;29 | POINTER TO CPT FILE (#81) | CPT(#81)
|
.3 | PRINT ORDER | 0;30 | NUMBER |
|
.31 | MODIFIER | 2;3 | FREE TEXT |
|
.32 | SECOND MODIFIER | 2;4 | FREE TEXT |
|
.33 | THIRD MODIFIER | 2;5 | FREE TEXT |
|
22 | CPT NARRATIVE | 3;2 | FREE TEXT |
|