BCBSNM Medicaid D.0 Pharmacy Payer Sheet - Prime Therapeutics
BCBSNM Medicaid D.0 Pharmacy Payer Sheet - Prime Therapeutics
BCBSNM Medicaid D.0 Pharmacy Payer Sheet - Prime Therapeutics
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Clinical Segment Questions<br />
This Segment is situational<br />
Check<br />
X<br />
Claim Billing/Claim Rebill<br />
If Situational, <strong>Payer</strong> Situation<br />
Clinical Segment<br />
Segment Identification<br />
(111-AM) = “13”<br />
Claim<br />
Billing/Claim<br />
Rebill<br />
Field # NCPDP Field Name Value <strong>Payer</strong> Usage <strong>Payer</strong> Situation<br />
491-VE DIAGNOSIS CODE COUNT Maximum<br />
count of 5<br />
RW<br />
<strong>Payer</strong> Requirement:<br />
Required When<br />
instructed by POS<br />
Messaging<br />
492-WE DIAGNOSIS CODE QUALIFIER RW <strong>Payer</strong> Requirement:<br />
Required When<br />
instructed by POS<br />
Messaging<br />
424-DO DIAGNOSIS CODE RW <strong>Payer</strong> Requirement<br />
Required When<br />
instructed by POS<br />
Messaging<br />
Materials reproduced with the consent of © National Council for Prescription Drug Programs, Inc.<br />
3851-D <strong>Payer</strong> Specification <strong>Sheet</strong> for <strong>BCBSNM</strong> BlueSalud! <strong>Medicaid</strong> © <strong>Prime</strong> <strong>Therapeutics</strong> LLC 07/11<br />
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