SV4 Drug Service

To specify the claim service detail for prescription drugs

Position
Element
Name
Type
Requirement
Min
Max
Repeat
SV401
Reference Number
String (AN)
Mandatory
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
SV401 is prescription number.
SV402
Product/Service ID Qualifier
Identifier (ID)
Conditional
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
P0203: If either SV4-02 or SV4-03 is present, then the other is required
SV403
Product/Service ID
String (AN)
Conditional
1
30
-
Identifying number for a product or service.
SV403 is national drug code (NDC).
SV404
Reference Number
String (AN)
Optional
1
30
-
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
SV404 is new or refill number. A value of zero indicates a new prescription. Any other value is the refill number of an existing prescription.
SV405
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV405 is generic indicator. A ``Y'' value indicates a generic drug. An ``N'' value indicates a branded drug.
SV406
Dispense as Written Code
Identifier (ID)
Optional
1
1
-
Code indicating whether or not the prescriber's instructions regarding generic substitution were followed
SV407
Level of Service Code
Identifier (ID)
Optional
1
3
-
Code specifying the level of service rendered
SV408
Prescription Origin Code
Identifier (ID)
Optional
1
1
-
Code indicating the origin of a prescription
SV409
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content.
SV409 is drug name.
SV410
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV410 is multi-source indicator. A ``Y'' value indicates drug is available from more than one manufacturer. A ``N'' value indicates drug is available from one manufacturer.
SV411
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response.
SV411 is compound indicator. A ``Y'' value indicates a compound drug. An ``N'' value indicates a non-compound drug. A ``U'' value indicates a non-specified drug compound.
SV412
Unit Dose Code
Identifier (ID)
Optional
1
1
-
Code indicating the type of unit dose dispensing done
SV413
Basis of Cost Determination Code
Identifier (ID)
Optional
1
2
-
Code indicating the method by which the ingredient cost was calculated
SV414
Basis of Days Supply Determination Code
Identifier (ID)
Optional
1
1
-
Code indicating the method by which the days supply was determined
SV415
Dosage Form Code
Identifier (ID)
Optional
2
2
-
Code indicating the form in which the drug is dispensed
SV416
Copay Status Code
Identifier (ID)
Optional
1
1
-
Code indicating whether or not co-payment requirements were met on a line by line basis
SV417
Patient Location Code
Identifier (ID)
Optional
1
1
-
Code identifying the location where patient is receiving medical treatment
SV418
Level of Care Code
Identifier (ID)
Optional
1
1
-
Code specifying the level of care provided by a nursing home facility
SV419
Prior Authorization Type Code
Identifier (ID)
Optional
1
1
-
Code indicating the type of prior authorization or medical certification that has occurred

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