DRA Drug Authorization

To specify a drug for which authorization is being requested

Position
Element
Name
Type
Requirement
Min
Max
Repeat
DRA-01
Description
String (AN)
Mandatory
1
80
2
A free-form description to clarify the related data elements and their content
DRA01 is the drug name. Position of data in the repeating data element conveys no significance.
DRA-02
Certification Type Code
Identifier (ID)
Optional
1
1
1
Code indicating the type of certification
DRA02 is the drug therapy type.
DRA-03
Composite Medical Procedure Identifier
Composite (composite)
Optional
2
01
Product/Service ID Qualifier
Identifier (ID)
Mandatory
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
C003-01 qualifies C003-02 and C003-08.
02
Product/Service ID
String (AN)
Mandatory
1
80
-
Identifying number for a product or service
If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs.
03
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02 and C003-08.
04
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02 and C003-08.
05
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02 and C003-08.
06
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02 and C003-08.
07
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content
C003-07 is the description of the procedure identified in C003-02.
08
Product/Service ID
String (AN)
Optional
1
80
-
Identifying number for a product or service
C003-08 represents the ending value in the range in which the code occurs.
09
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-09 modifies the value in C003-02 and C003-08.
10
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-10 modifies the value in C003-02 and C003-08.
11
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-11 modifies the value in C003-02 and C003-08.
12
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-12 modifies the value in C003-02 and C003-08.
DRA-04
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
1
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0405: If either DRA-04 or DRA-05 is present, then the other is required
DRA-05
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
DRA05 is the quantity being requested.
DRA-06
Free-form Message Text
String (AN)
Optional
1
264
1
Free-form message text
DRA06 is the Sig (The Sig is a Latin term used in the pharmacy industry that represents the instructions/directions that are printed on the drug label.)
DRA-07
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
DRA07 is the self administer indicator. A "Y" value indicates that the drug can be administered by the patient. An "N" value indicates that the drug can not be administered by the patient.
DRA-08
Yes/No Condition or Response Code
Identifier (ID)
Conditional
1
1
1
Code indicating a Yes or No condition or response
P080910: If either DRA-08, DRA-09 or DRA-10 are present, then the others are required
DRA08 is the end stage renal disease (ESRD) indicator. A "Y" value indicates that the patient has ESRD. An "N" value indicates that the patient does not have ESRD.
DRA-09
Date/Time Qualifier
Identifier (ID)
Conditional
3
3
1
Code specifying type of date or time, or both date and time
DRA-10
Date
Date (DT)
Conditional
8
8
1
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
DRA10 is the ESRD certification date.
DRA-11
Free-form Message Text
String (AN)
Optional
1
264
999
Free-form message text
DRA11 is for questions that are related to the authorization of the drug. Position of data in the repeating data element conveys no significance.
DRA-12
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
DRA12 is the number of refills requested.
DRA-13
Question and Answer
Composite (composite)
Optional
999
01
Assigned Identification
String (AN)
Mandatory
1
20
-
Alphanumeric characters assigned for differentiation within a transaction set
C060-01 is the question number from a pre-defined questionnaire.
02
Yes/No Condition or Response Code
Identifier (ID)
Mandatory
1
1
-
Code indicating a Yes or No condition or response
C060-02 is the answer to the pre-defined question. A "Y" value indicates the answer to the question is yes. A "N" value indicates the answer to the question is no.
DRA-14
Dosage Form Code
Identifier (ID)
Optional
2
2
1
Code indicating the form in which the drug is dispensed
DRA-15
Free-form Message Text
String (AN)
Optional
1
264
999
Free-form message text
DRA15 is for comments and/or instructions regarding the authorization. Position of data in the repeating data element conveys no significance.

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