SV7 Drug Adjudication

Opt

AtMax 1

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

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
2	127	Reference Identification	Opt	Alphanumeric	1/80	AtMax 1
3	1355	Prescription Denial Override Code	Opt	ID	2/2	AtMax 1
4	1207	Coverage Level Code	Mandatory	ID	3/3	AtMax 1
5	750	Product/Process Characteristic Code	Mandatory	ID	2/3	AtMax 1
6	1073	Yes/No Condition or Response Code	Opt	ID	1/1	AtMax 1
C059Drug Use Review (DUR)Opt AtMax 6

ID127

NameReference Identification

LengthMin 1 / Max 80

Position1

RequirementOpt