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.