DRA Drug Authorization

To specify a drug for which authorization is being requested

Position: DRA-01 · Element: 352 · Name: Description · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 80 · Repeat: 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.

Position: DRA-02 · Element: 1322 · Name: Certification Type Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 1 · Repeat: 1

Code indicating the type of certification

DRA02 is the drug therapy type.

DRA-03 C003 Composite Medical Procedure Identifier Composite (composite) Optional 2

Position: 01 · Element: 235 · Name: Product/Service ID Qualifier · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 2 · Repeat: -

Code identifying the type/source of the descriptive number used in Product/Service ID (234)

C003-01 qualifies C003-02 and C003-08.

Position: 02 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 48 · Repeat: -

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.

Position: 03 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: 04 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: 05 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: 06 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: 07 · Element: 352 · Name: Description · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: -

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.

Position: 08 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 48 · Repeat: -

Identifying number for a product or service

C003-08 represents the ending value in the range in which the code occurs.

Position: 09 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: 10 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: 11 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: 12 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

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.

Position: DRA-04 · Element: 355 · Name: Unit or Basis for Measurement Code · Type: Identifier (ID) · Requirement: Conditional · Min: 2 · Max: 2 · Repeat: 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

Position: DRA-05 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: 1

Numeric value of quantity

DRA05 is the quantity being requested.

Position: DRA-06 · Element: 933 · Name: Free-form Message Text · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 264 · Repeat: 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.)

Position: DRA-07 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Optional · Min: 1 · Max: 1 · Repeat: 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.

Position: DRA-08 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 1 · Repeat: 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.

Position: DRA-09 · Element: 374 · Name: Date/Time Qualifier · Type: Identifier (ID) · Requirement: Conditional · Min: 3 · Max: 3 · Repeat: 1

Code specifying type of date or time, or both date and time

Position: DRA-10 · Element: 373 · Name: Date · Type: Date (DT) · Requirement: Conditional · Min: 8 · Max: 8 · Repeat: 1

Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

DRA10 is the ESRD certification date.

Position: DRA-11 · Element: 933 · Name: Free-form Message Text · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 264 · Repeat: 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.

Position: DRA-12 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: 1

Numeric value of quantity

DRA12 is the number of refills requested.

DRA-13 C060 Question and Answer Composite (composite) Optional 999

Position: 01 · Element: 350 · Name: Assigned Identification · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 20 · Repeat: -

Alphanumeric characters assigned for differentiation within a transaction set

C060-01 is the question number from a pre-defined questionnaire.

Position: 02 · Element: 1073 · Name: Yes/No Condition or Response Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 1 · Repeat: -

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.

Position: DRA-14 · Element: 1330 · Name: Dosage Form Code · Type: Identifier (ID) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: 1

Code indicating the form in which the drug is dispensed

Position: DRA-15 · Element: 933 · Name: Free-form Message Text · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 264 · Repeat: 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.