Purchase summary

Specialty Pharmacy Data Feed Health

FIELD NAME MANDATORY / RECOMMENDED

 

ENTERPRISE MASTER PATIENT INDEX R

PATIENT ID M

HUB PROGRAM ID R

ENCOUNTER ID R

DATE OF BIRTH M

GENDER M

RACE R

ETHNICITY R

ADDRESS 1 M

ADDRESS 2 R

CITY R

STATE R

ZIP CODE M

PHONE R

FAX R

EMAIL R

ICD-9-CM PRIMARY DIAGNOSIS RELATED TO CURRENT PRESCRIPTION ORDER M BEFORE 10/1/2015

ICD-9-CM sECONDARY DIAGNOSIS RELATED TO CURRENT PRESCRIPTION ORDER M BEFORE 10/1/2015

ICD-10-CM PRIMARY DIAGNOSIS RELATED TO CURRENT PRESCRIPTION ORDER M AFTER 9/30/2015

ICD-10-CM SECONDARY DIAGNOSIS RELATED TO CURRENT PRESCRIPTION ORDER R AFTER 9/30/2015

HOSPITAL ASSIGNED PRESCRIBER ID M

PHARMACY NPI NUMBER M

PRESCRIPTION NDC M

FULL PRODUCT GENERIC NAME M

PRESCRIPTION NUMBER M

PRESCRIPTION WRITTEN DATE R

TOTAL PRESCRIPTION REFILLS ALLOWED M

REFILL REMAINING M

PRESCRIPTION TRANSFERRED TO R

PRESCRIPTION TRANSFERRED FROM R

DIRECTIONS M

REMS MEDICATION GUIDE PROVIDED M

REFERRAL DATE R

REFERRAL RECEIPT DATE R

REFERRAL COMPLETED DATE R

REFERRAL NUMBER R

REFERRAL STATUS CODE R

REFERRAL STATUS DATE R

TRANSACTION NUMBER RETIRED v3

PHARMACY RECEIPT DATE R

PRESCRIPTION TYPE M

DISPENSE STATUS M

DISPENSE STATUS DATE M

DISPENSE QUANTITY M

DAYS SUPPLY M

PRIOR AUTHORIZATION REQUIRED M

PRIOR AUTHORIZATION OBTAINED M

PRIOR AUTHORIZATION NUMBER R

SHIPPING DATE R

SHIPPING ADDRESS 1 R

SHIPPING ADDRESS 2 R

SHIPPING CITY R

SHIPPING STATE R

SHIPPING ZIP CODE R

SHIPPING CARRIER R

SHIPPING CARRIER TRACKING NUMBER R

PRIMARY PHARMACY PAYOR ID CODE M

PRIMARY PHARMACY PAYOR PLAN PATIENT ID M

PRIMARY PHARMACY PAYOR PERSON CODE M

PRIMARY PHARMACY PAYOR BIN M

PRIMARY PHARMACY PAYOR PCN M

PRIMARY PHARMACY PAYOR GROUP NUMBER M

PRIMARY PHARMACY PAYOR COPAY M

PRIMARY PHARMACY PAYOR OUT OF POCKET (OOP) MAXIMUM M

PRIMARY PHARMACY PAYOR OUT OF POCKET (OOP) AMOUNT PAID M

SECONDARY PHARMACY PAYOR ID CODE R

SECONDARY PHARMACY PAYOR PLAN PATIENT ID R

SECONDARY PHARMACY PAYOR PERSON CODE R

SECONDARY PHARMACY PAYOR BIN R

SECONDARY PHARMACY PAYOR PCN R

SECONDARY PHARMACY PAYOR GROUP NUMBER R

SECONDARY PHARMACY PAYOR COPAY M

SECONDARY PHARMACY PAYOR OUT OF POCKET (OOP) MAXIMUM M

SECONDARY PHARMACY PAYOR OUT OF POCKET (OOP) AMOUNT PAID M

PATIENT ASSISTANCE PROGRAM M

PATIENT ASSISTANCE SOURCE R

PATIENT ASSISTANCE AMOUNT M

PRIMARY MEDICAL PAYOR PLAN CODE R

PRIMARY MEDICAL PAYOR PLAN PATIENT ID R

PRIMARY MEDICAL PAYOR PERSON CODE R

PRIMARY MEDICAL PAYOR GROUP NUMBER R

PRIOR AUTHORIZATION EFFECTIVE DATE R

PRIOR AUTHORIZATION EXPIRATION DATE R

PRESCRIPTION TRANSFER DATE M

LAST UPDATE DATE R

LAST RECORDED PATIENT HEIGHT RELATED TO CURRENT PRESCRIPTION ORDER R

LAST RECORDED PATIENT WEIGHT RELATED TO CURRENT PRESCRIPTION ORDER R

 

HOSPITAL ASSIGNED PRESCRIBER ID M

PRESCRIBER NPI NUMBER M

PRESCRIBER DEA R

PRESCRIBER HUB ID R

PRESCRIBER LAST NAME R

PRESCRIBER FIRST NAME R

PRESCRIBER MIDDLE NAME R

PRESCRIBER SUFFIX R

GROUP PRACTICE ID R

PRESCRIBER PRACTICE LOCATION NAME R

PRESCRIBER LOCATION ADDRESS 1 R

PRESCRIBER LOCATION ADDRESS 2 R

PRESCRIBER CITY R

PRESCRIBER STATE R

PRESCRIBER ZIP CODE R

PRESCRIBER PHONE R

PRESCRIBER FAX R

 

PHARMACY NPI NUMBER M

DISPENSING PHARMACY NAME M

DISPENSING PHARMACY SUB_NAME R

DISPENSING PHARMACY NUMBER R

PHARMACY NCPDP R

PHARMACY ADDRESS 1 R

PHARMACY ADDRESS 2 R

PHARMACY CITY R

PHARMACY STATE R

PHARMACY ZIP CODE M

PHARMACY PHONE R

PHARMACY FAX R

 

 PAYOR ID CODE M

 PAYOR PLAN NAME M

 PAYOR PLAN SEGMENT M

 PAYOR PLAN PRODUCT LINE M

PAYOR TYPE PLAN CODE M

 

ENCOUNTER ID R

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