| 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 | 
 |