United States Health Information Knowledgebase

 

Data Elements Related to Telecommunication Standard

Name: Telecommunication Standard
Definition: Developed to provide a standard format for the electronic submission of third party drug claims and other transactions between pharmacy providers, insurance carriers, third-party administrators, and other responsible parties. The Telecommunication Standard includes transactions for eligibility verification, claim and service billing, predetermination of benefits, prior authorization, information reporting, and controlled substance (general and regulated) transaction exchanges.
Results 1-50 of 393

sort Name
sort Definition
Accumulated Deductible AmountAmount in dollars met by the patient/family in a deductible plan.
Additional Documentation Type IDUnique identifier for the data being submitted.
Additional Message InformationFree text message.
Additional Message Information ContinuityIndicates continuity of the text found in the current repetition of 'Additional Message Information' (526-FQ) with the text found in the next repetition that follows.
Additional Message Information CountCount of the 'Additional Message Information' (526-FQ) occurrences that follow.
Additional Message Information QualifierFormat qualifier of the 'Additional Message Information' (526-FQ) that follows. Each value may occur only once per transaction and values must be ordered sequentially (numeric characters precede alpha characters, i.e., 0-9, A-Z).
Adjudicated Payment TypeThe type of prescription benefit plan that adjudicated and paid the primary amount of the prescription as reported by the plan in a response.
Alternate IDPerson identifier to be used for controlled product reporting. Identifier may be that of the patient or the person picking up the prescription as required by the governing body.
Amount Applied To Periodic DeductibleAmount to be collected from a patient that is included in 'Patient Pay Amount' (505-F5) that is applied to a periodic deductible.
Amount Applied To Periodic DeductibleAmount to be collected from a patient that is included in 'Patient Pay Amount' (505-F5) that is applied to a periodic deductible.
Amount Attributed to Processor FeeAmount to be collected from the patient that is included in Patient Pay Amount (505-F5) that is due to the processing fee imposed by the processor.
Amount Attributed to Product Selection / Brand DrugAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of a Brand product.
Amount Attributed to Product Selection / Brand Non-Preferred Formulary SelectionAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of a Brand Non-Preferred Formulary product.
Amount Attributed to Product Selection / Non-Preferred Formulary SelectionAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of a Non-Preferred Formulary product.
Amount Attributed to Provider Network SelectionAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's provider network selection.
Amount Attributed To Sales TaxAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to sales tax paid.
Amount Exceeding Periodic Benefit MaximumAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient exceeding a periodic benefit maximum.
Amount of CoinsuranceAmount to be collected from the patient that is included in 'Patient Pay Amount' (5(5-F5) that is due to a per prescription coinsurance.
Amount Of CopayAmount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to a per prescription copay.
Approved Message CodeMessage code, on an approved claim/service, communicating the need for an additional follow-up.
Approved Message Code CountCount of the 'Approved Message Code' (548-6F) occurrences.
Associated Prescription/ Service DateDate of the 'Associated Prescription/Service Reference Number' (456-EN).
Associated Prescription/ Service Fill NumberRelated Fill Number to which the claim/service is associated.
Associated Prescription/ Service Provider IDRelated Service Provider ID to which the claim/service is associated.
Associated Prescription/Service Provider ID QualifierCode qualifying the 'Associated Prescription/Service Provider ID' (580-XY) to which the claim/service is related.
Associated Prescription/ Service Reference NumberRelated 'Prescription/Service Reference Number' (402-D2) to which the service is associated.
Associated Prescription/Service Reference Number QualifierCode qualifying the 'Associated Prescription/Service Reference Number ID' (456-EN) to which the claim/service is related.
Authorization NumberNumber assigned by the processor to identify an authorized transaction.
Authorized Representative City AddressFree-form text for city name.
Authorized Representative Country CodeCode of the country.
Authorized Representative First NameFirst name of the patient's authorized representative.
Authorized Representative Last NameLast name of the patient's authorized representative.
Authorized Representative State/Province AddressState/Province Code of the authorized representative.
Authorized Representative Street Address Line 1Free-form text for address line 1 information.
Authorized Representative Street Address Line 2Free-form text for address line 2 information.
Authorized Representative Zip/Postal CodeCode defining international postal code excluding punctuation of authorized representative.
Basis of Calculation - CoinsuranceCode indicating how the Coinsurance reimbursement amount was calculated for 'Patient Pay Amount' (5(5-F5).
Basis Of Calculation - CopayCode indicating how the Copay reimbursement amount was calculated for 'Patient Pay Amount' (505-F5).
Basis Of Calculation-Dispensing FeeCode indicating how the reimbursement amount was calculated for 'Dispensing Fee Paid' (507-F7).
Basis Of Calculation - Flat Sales TaxCode indicating how the reimbursement amount was calculated for 'Flat Sales Tax Amount Paid' (558-AW).
Basis Of Calculation - Percentage Sales TaxCode indicating how the reimbursement amount was calculated for 'Percentage Sales Tax Amount Paid' (559-AX).
Basis Of Cost DeterminationCode indicating the method by which 'Ingredient Cost Submitted' (Field 409-D9) was calculated.
Basis Of Reimbursement DeterminationCode identifying how the reimbursement amount was calculated for 'Ingredient Cost Paid' (506-F6).
Basis Of RequestCode describing the reason for prior authorization request.
Benefit IDAssigned by processor to identify a set of parameters, benefits, or coverage criteria used to adjudicate a claim.
Benefit Stage AmountThe amount of claim allocated to the Medicare stage identified by the 'Benefit Stage Qualifier' (393-MV).
Benefit Stage CountCount of 'Benefit Stage Amount' (394-MW) occurrences.
Benefit Stage QualifierCode qualifying the 'Benefit Stage Amount' (394-MW).
Billing Entity Type IndicatorA code that identifies the entity submitting the billing transaction.
BIN NumberCard Issuer ID or Bank ID Number used for network routing.
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