SV4 Drug Service
To specify the claim service detail for prescription drugs
Position
Element
Name
Type
Requirement
Min
Max
Repeat
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
SV401 is prescription number.
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
Identifying number for a product or service.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02.
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02.
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.
Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.
SV403 is new or refill number. A value of zero indicates a new prescription, any other value is the refill number of an existing prescription.
Code indicating a Yes or No condition or response.
SV404 is 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 drug name
Code indicating a Yes or No condition or response.
SV409 is 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 compound indicator. A ``Y'' indicates a compound drug. An ``N'' value indicates a non-compound drug. A ``U'' value indicates a non-specified 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