SV7 Drug Adjudication

To specify the claim service detail for drug services that have been adjudicated

Position
Element
Name
Type
Requirement
Min
Max
Repeat
SV701
Reference Identification
String (AN)
Optional
1
50
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
SV701 is an internal processing identification number.
SV702
Reference Identification
String (AN)
Optional
1
50
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
SV702 is the number assigned to the doctor who wrote the prescription.
SV703
Prescription Denial Override Code
Identifier (ID)
Optional
2
2
1
Code indicating that a pharmacist has overridden the denial of a prescription
SV704
Coverage Level Code
Identifier (ID)
Mandatory
3
3
1
Code indicating the level of coverage being provided for this insured
This code is used to indicate or verify the patient's benefit coverage level at the time the claim was adjudicated.
SV705
Product/Process Characteristic Code
Identifier (ID)
Mandatory
2
3
1
Code identifying the general class of a product or process characteristic
SV705 describes the legal status (characteristic) of the drug being dispensed.
SV706
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
SV706 is the Drug Utilization Review (DUR) alert indicator. A "Y" indicates a DUR alert was issued; an "N" indicates DUR processing occurred but no alert was issued.

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