SV4 Drug Service
To specify the claim service detail for prescription drugs
Position
Element
Name
Type
Requirement
Min
Max
Repeat
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
SV401 is a prescription number.
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
C003-01 qualifies C003-02 and C003-08.
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.
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.
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.
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.
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.
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.
Identifying number for a product or service
C003-08 represents the ending value in the range in which the code occurs.
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.
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.
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.
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.
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
SV403 indicates whether the prescription is an original or a refill. A value of zero indicates a new prescription; any other value is the subsequent fill 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
Code indicating that the pharmacist is clarifying the submission
Code indicating whether or not the patient has other insurance coverage
Code indicating the route of administration of the complete compound mixture
Code indicating the basis for percentage tax
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
SV423 is the submitted drug tax rate used to calculate the submitted drug tax amount.
Monetary amount
SV424 is the submitted drug tax amount.