To specify the claim service detail for prescription drugs
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
SV401 is a prescription number.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
SV403 is a new or refill number. A value of zero indicates a new prescription, any other value is the refill number of an existing prescription.
Code indicating a Yes or No condition or response
SV404 is the generic indicator. A "Y" value indicates a generic drug; an "N" value indicates a branded drug.
Code indicating whether or not the prescriber's instructions regarding generic substitution were followed
Code specifying the level of service rendered
Code indicating the origin of a prescription
A free-form description to clarify the related data elements and their content
SV408 is the drug name.
Code indicating a Yes or No condition or response
SV409 is the multisource indicator. A "Y" indicates drug is available from more than one manufacturer; an "N" value indicates drug is available from one manufacturer.
Code indicating a Yes or No condition or response
SV410 is the compound indicator. A "Y" indicates a compound drug; an "N" value indicates a noncompound drug. A "U" value indicates a nonspecified drug compound.
Code indicating the type of unit dose dispensing done
Code indicating the method by which the ingredient cost was calculated
Code indicating the method by which the days supply was determined
Code indicating the form in which the drug is dispensed
Code indicating whether or not co-payment requirements were met on a line by line basis
Code identifying the location where patient is receiving medical treatment
Code specifying the level of care provided by a nursing home facility
Code indicating the type of prior authorization or medical certification that has occurred