知行 EDI 规范查询平台™
Segment
X12 EDI Release 00403
SV4Drug Service
To specify the claim service detail for prescription drugs
Elements
  • SV401127Reference Identification
    AN
    M必须(Mandatory)
    Min 1 / Max 50

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

  • SV402C003Composite Medical Procedure IdentifierO可选(Optional)
    2352341339133913391339352
    • SV40201235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

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

      Codes (505)
    • SV40202234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      Identifying number for a product or service

    • SV402031339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV402041339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV402051339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV402061339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV40207352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

      A free-form description to clarify the related data elements and their content

  • SV403127Reference Identification
    AN
    O可选(Optional)
    Min 1 / Max 50

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

  • SV4041073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • SV4051329Dispense as Written Code
    ID
    O可选(Optional)

    Code indicating whether or not the prescriber's instructions regarding generic substitution were followed

    Codes (10)
  • SV4061338Level of Service Code
    ID
    O可选(Optional)

    Code specifying the level of service rendered

    Codes (17)
  • SV4071356Prescription Origin Code
    ID
    O可选(Optional)

    Code indicating the origin of a prescription

    Codes (4)
  • SV408352Description
    AN
    O可选(Optional)
    Min 1 / Max 80

    A free-form description to clarify the related data elements and their content

  • SV4091073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • SV4101073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • SV4111370Unit Dose Code
    ID
    O可选(Optional)

    Code indicating the type of unit dose dispensing done

    Codes (10)
  • SV4121319Basis of Cost Determination Code
    ID
    O可选(Optional)

    Code indicating the method by which the ingredient cost was calculated

    Codes (10)
  • SV4131320Basis of Days Supply Determination Code
    ID
    O可选(Optional)

    Code indicating the method by which the days supply was determined

    Codes (4)
  • SV4141330Dosage Form Code
    ID
    O可选(Optional)

    Code indicating the form in which the drug is dispensed

    Codes (73)
  • SV4151327Copay Status Code
    ID
    O可选(Optional)

    Code indicating whether or not co-payment requirements were met on a line by line basis

    Codes (4)
  • SV4161384Patient Location Code
    ID
    O可选(Optional)

    Code identifying the location where patient is receiving medical treatment

    Codes (15)
  • SV4171337Level of Care Code
    ID
    O可选(Optional)

    Code specifying the level of care provided by a nursing home facility

    Codes (8)
  • SV4181357Prior Authorization Type Code
    ID
    O可选(Optional)

    Code indicating the type of prior authorization or medical certification that has occurred

    Codes (8)
知行 EDI 规范查询平台™ 2023 - 3.1.18
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