Prescribed Drugs Provider Manual - Iowa Department of Human ...

IowaDepartmentof HumanServicesProvider and ChapterPrescribed DrugsChapter III. Provider-Specific PoliciesPage100DateAugust 1, 2013FIELD NAME/DESCRIPTIONINSTRUCTIONS34 – DATE OF SERVICE MANDATORY. Enter the date the prescription wasfilled using a two-digit entry for each of thefollowing: month, day, and year. CCYYMMDD35 – SUBMISSIONCLARIFICATIONOPTIONAL.36 – PRESCRIPTION ORIGIN OPTIONAL.37 – PRODUCT/SERVICE ID MANDATORY. Enter the national drug code (NDC)found on the drug’s label. All of the numerals inthe NDC, including the package size, must becurrent and exactly match the NDC of the productactually dispensed.Be careful to copy the NDC exactly as it appears,including leading zeros. If the product number isonly three digits long, enter a leading zero.For a compound, “0” must appear in this field. Listeach ingredient, NDC, quantity, and charge in theCOMPOUND section.38 – PRODUCT/SERVICE IDQUALIFIER00 = COMPOUND03 = NDC39 – PRODUCT DESCRIPTION REQUIRED.40 – QUANTITY DISPENSED REQUIRED. Give the number of tablets, capsules,etc. or the metric measurement for liquids,creams, etc. Be sure the billed quantity, whendivided by the number of days’ supply, is anappropriate amount for that therapeutic class ofdrugs. If the quantity is a fractional amount, use adecimal point.41 – DAYS SUPPLY REQUIRED. Enter the number of days theprescription will last.42 – DAW CODE (MACOVERRIDE)43 – PRIOR AUTH #SUBMITTEDLeave blank.CONDITIONAL. Leave blank unless one of thefollowing applies:1 = 72 hour supply4 = Pregnant5 = Nursing facility vaccine7 = Mental health drugs