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Plan-specific contract number

PC008, Oregon

Versions: September 27, 2011 - v2011.1.1• June 25, 2012 - v2013.0.0• June 27, 2013 - v2014.0.0• 2015.0.1Compare Versions


Name:Plan-specific contract number
Data Element ID:PC008
Description:Plan-specific contract number
State:Oregon
Data Type:Text
Length:30
Threshold:TBD
Required:Yes
NCPDP Field:246
NCPDP Source:P
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File Specification for Multiple versionsPharmacy Claims File Submission - September 27, 2011 - v2011.1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsPC001 Payer type Not Provided Text 1
Multiple versionsPC008 Plan-specific contract number Plan-specific contract number Text 30
Multiple versionsPC010 Patient ID Unique identifier for member Text 20
Multiple versionsPC003 Insurance type/ product code Not Provided Text 6
Multiple versionsPC021 Pharmacy NPI The pharmacy's National Provider Identifier (NPI) Text 15
Multiple versionsPC021A Pharmacy alternate identifier The pharmacy's alternate identifier as assigned by the payer; required if NPI is not available Text 15
Multiple versionsPC020 Pharmacy Name Not Provided Text 35
Multiple versionsPC022 Pharmacy city Not Provided Text 30
Multiple versionsPC023 Pharmacy state Not Provided Text 2
Multiple versionsPC024 Pharmacy ZIP Not Provided Text 15
Multiple versionsPC048 Prescribing provider NPI Identifier for the provider who prescribed the medication as assigned by the reporting entity Text 15
Multiple versionsPC047 Prescribing provider DEA number Required if available. DEA number of the provider who prescribed the medication. Text 12
Multiple versionsPC025 Claim status Was claim paid, denied, or encounter only? Text 3
Multiple versionsPC026 NDC National Drug Code (NDC) Text 11
Multiple versionsPC032 Date filled Date the prescription was filled. example: 20090624 Text CCYYMMDD 8
Multiple versionsPC017 Payment date example: 20090624 Date CCYYMMDD 8
Multiple versionsPC033 Quantity dispensed Not Provided Numeric 10
Multiple versionsPC028A Alternate refill number Required if PC028 (calculated refill number) is not available Numeric 2
Multiple versionsPC034 Days supply Days supply of the prescription Numeric 3
Multiple versionsPC030 Dispense as written code Not Provided Text 1
Multiple versionsPC028 Calculated refill number Processor's calculated refill number. If the processor is not able to calculate, the alternate refill number (PC028A) is to be used. Numeric 2
Multiple versionsPC031 Compound drug indicator Indicates if this is a compound drug. Numeric 1
Multiple versionsPC004 Claim ID Payer's unique claim control number Text 30
Multiple versionsPC036 Payment Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC035 Charges Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC037 Ingredient cost/list price Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC039 Dispensing fee paid Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC040 Co-pay Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC041 Coinsurance Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC042 Deductible Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12
Multiple versionsPC043 Patient pay amount Required if any of PC040, PC041, or PC042 are missing. Two explicit decimal places. Enter 0 if amount equals zero. Leave blank if missing. Example: 15102.00 Numeric 12

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