EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4010

SV4

SV4 Drug Service

Batch

To specify the claim service detail for prescription drugs

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	127	Reference Identification	Mandatory	Alphanumeric	1/30	1
C003Composite Medical Procedure IdentifierOpt 1
3	127	Reference Identification	Opt	Alphanumeric	1/30	1
4	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
5	1329	Dispense as Written Code	Opt	ID	1/1	1
6	1338	Level of Service Code	Opt	ID	1/3	1
7	1356	Prescription Origin Code	Opt	ID	1/1	1
8	352	Description	Opt	Alphanumeric	1/80	1
9	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
10	1073	Yes/No Condition or Response Code	Opt	ID	1/1	1
11	1370	Unit Dose Code	Opt	ID	1/1	1
12	1319	Basis of Cost Determination Code	Opt	ID	1/2	1
13	1320	Basis of Days Supply Determination Code	Opt	ID	1/1	1
14	1330	Dosage Form Code	Opt	ID	2/2	1
15	1327	Copay Status Code	Opt	ID	1/1	1
16	1384	Patient Location Code	Opt	ID	1/1	1
17	1337	Level of Care Code	Opt	ID	1/1	1
18	1357	Prior Authorization Type Code	Opt	ID	1/1	1

Element Details

ID127

NameReference Identification

LengthMin 1 / Max 30

Position1

RequirementMandatory