SV7 Drug Adjudication

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

Position: SV7-01 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

SV701 is an internal processing identification number.

Position: SV7-02 · Element: 127 · Name: Reference Identification · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

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.

Position: SV7-03 · Element: 1355 · Name: Prescription Denial Override Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

Code indicating that a pharmacist has overridden the denial of a prescription

Position: SV7-04 · Element: 1207 · Name: Coverage Level Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 3 · Max: 3 · Repeat: -

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.

Position: SV7-05 · Element: 750 · Name: Product/Process Characteristic Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 3 · Repeat: -

Code identifying the general class of a product or process characteristic

SV705 describes the legal status (characteristic) of the drug being dispensed.

Position: SV7-06 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: -

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 occured but no alert was issued.