Insurance Transmission Fields - Revision history

Cecswiki: /* Doctor Information (AM-111 03) */

2021-05-04T19:25:27Z

Doctor Information (AM-111 03)

← Older revision		Revision as of 19:25, 4 May 2021
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	\|width="300pt"\|'''Description'''		\|width="300pt"\|'''Description'''
	\|-		\|-
	\|EZ-466\|\| Prescriber ID type		\|EZ-466\|\| [https://www.quickscrip.net/wiki/PrescriberID Prescriber ID type]
	\|-		\|-
	\|DB-411\|\| Prescriber ID		\|DB-411\|\| [https://www.quickscrip.net/wiki/PrescriberID Prescriber ID]
	\|-		\|-
	\|DR-427\|\| Prescriber Last Name		\|DR-427\|\| Prescriber Last Name

2018-05-15T18:24:56Z

Prescription Information (AM-111 07)

← Older revision		Revision as of 18:24, 15 May 2018
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	\|HG-345\|\| Days Supply intended		\|HG-345\|\| Days Supply intended
	\|-		\|-
	\|NV-357\|\| Delay Reason Code		\|NV-357\|\| [http://www.quickrx.net/wiki/Delay_Reason_Code Delay Reason Code]
	\|-		\|-
	\|MT-391\|\| Patient Assignment Indicator		\|MT-391\|\| Patient Assignment Indicator

2016-11-02T14:43:07Z

Workers Comp Information (AM-111 06)

← Older revision		Revision as of 14:43, 2 November 2016
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	==Workers Comp Information (AM-111 06)==		==Workers Comp Information (AM-111 06)==
	Workers comp fields are generated when a '''Date of Injury''' (/IY) has been ~~set on~~ a claim.		Workers comp fields are generated when a '''Date of Injury''' (/IY) has been attached to a claim.
	{\| border="1" cellpadding="2"		{\| border="1" cellpadding="2"
	\|-		\|-

2016-09-16T16:23:00Z

Patient Info (AM-111 01)

← Older revision		Revision as of 16:23, 16 September 2016
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	\|CB-311 \|\| Patient Last name		\|CB-311 \|\| Patient Last name
	\|-		\|-
	\|CM-322 \|\| Patient Street Address		\|CM-322 \|\| [http://quickrx.net/wiki/Workers_Comp_Claims Patient Street Address]
	\|-		\|-
	\|CN-323 \|\| Patient City		\|CN-323 \|\| [http://quickrx.net/wiki/Workers_Comp_Claims Patient City]
	\|-		\|-
	\|CO-324 \|\| Patient State		\|CO-324 \|\| [http://quickrx.net/wiki/Workers_Comp_Claims Patient State]
	\|-		\|-
	\|CP-325 \|\| Patient Zip code		\|CP-325 \|\| [http://quickrx.net/wiki/Workers_Comp_Claims Patient Zip code]
	\|-		\|-
	\|CQ-326 \|\| Patient Phone		\|CQ-326 \|\| Patient Phone

2016-09-16T16:22:14Z

Workers Comp Information (AM-111 06)

← Older revision		Revision as of 16:22, 16 September 2016
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	\|width="300pt"\|'''Description'''		\|width="300pt"\|'''Description'''
	\|-		\|-
	\|DY-434\|\| Date of injury		\|DY-434\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Date of injury]
	\|-		\|-
	\|CF-315\|\| Employer Name		\|CF-315\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Employer Name]
	\|-		\|-
	\|CG-316\|\| Employer street address		\|CG-316\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Employer street address]
	\|-		\|-
	\|CH-317\|\| Employer City		\|CH-317\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Employer City]
	\|-		\|-
	\|CI-318\|\| Employer State		\|CI-318\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Employer State]
	\|-		\|-
	\|CJ-319\|\| Employer Zip		\|CJ-319\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Employer Zip]
	\|-		\|-
	\|CK-320\|\| Employer Phone		\|CK-320\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Employer Phone]
	\|-		\|-
	\|CL-321\|\| Employer Contact Name		\|CL-321\|\| [http://quickrx.net/wiki/Workers_Comp_Claims Employer Contact Name]
	\|-		\|-
	\|CR-327\|\| Carrier ID		\|CR-327\|\| Carrier ID

2016-01-12T18:45:52Z

Insurance Info (AM-111 04)

← Older revision		Revision as of 18:45, 12 January 2016
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	\|C2-302\|\| [http://www.quickrx.net/wiki/Cardholder_ID Cardhoder ID Number]		\|C2-302\|\| [http://www.quickrx.net/wiki/Cardholder_ID Cardhoder ID Number]
	\|-		\|-
	\|CC-312\|\| Cardholder First Name		\|CC-312\|\| [http://www.quickrx.net/wiki/Cardholder_Name Cardholder First Name]
	\|-		\|-
	\|CD-313\|\| Cardholder Last Name		\|CD-313\|\| [http://www.quickrx.net/wiki/Cardholder_Name Cardholder Last Name]
	\|-		\|-
	\|CE-314\|\| Home Plan		\|CE-314\|\| Home Plan
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	\|FO-524\|\| Plan ID		\|FO-524\|\| Plan ID
	\|-		\|-
	\|C9-309\|\| Eligibility ~~Clerification~~ Code		\|C9-309\|\| Eligibility Clarification Code
	\|-		\|-
	\|C1-301\|\| Group ID		\|C1-301\|\| Group ID

2016-01-12T18:44:35Z

← Older revision		Revision as of 18:44, 12 January 2016
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	\|width="300pt"\|'''Description'''		\|width="300pt"\|'''Description'''
	\|-		\|-
	\|C2-302\|\| Cardhoder ID Number		\|C2-302\|\| [http://www.quickrx.net/wiki/Cardholder_ID Cardhoder ID Number]
	\|-		\|-
	\|CC-312\|\| Cardholder First Name		\|CC-312\|\| Cardholder First Name

2016-01-08T19:53:45Z

Group Separator

← Older revision		Revision as of 19:53, 8 January 2016
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	\|width="300pt"\|'''Description'''		\|width="300pt"\|'''Description'''
	\|-		\|-
	\|GS-029\|\| Group Separator		\|GS-029\|\| [http://www.quickrx.net/wiki/Transaction_Count Group Separator]
	\|-		\|-
	\|}		\|}

2016-01-08T19:35:29Z

Transmission Header

← Older revision		Revision as of 19:35, 8 January 2016
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	\|width="300pt"\|'''Description'''		\|width="300pt"\|'''Description'''
	\|-		\|-
	\|A1-101\|\| Insurance ~~BIN~~ Number		\|A1-101\|\| [http://www.quickrx.net/wiki/Insurance_Bin Insurance Bin Number]
	\|-		\|-
	\|A2-102\|\| Version Number		\|A2-102\|\| [http://www.quickrx.net/wiki/Version_Number Transmission Format Version Number]
	\|-		\|-
	\|A3-103\|\| Transaction Code		\|A3-103\|\| [http://www.quickrx.net/wiki/Transaction_Count Transaction Code]
	\|-		\|-
	\|A4-104\|\| Processor Control Number		\|A4-104\|\| [http://www.quickrx.net/wiki/Processor_Control_Number Processor Control Number]
	\|-		\|-
	\|A9-109\|\| Transaction Count		\|A9-109\|\| [http://www.quickrx.net/wiki/Transaction_Count Transaction Count]
	\|-		\|-
	\|B2-202\|\| Service Provider ID		\|B2-202\|\| [http://www.quickrx.net/wiki/Service_Provider_ID Service Provider ID Type]
	\|-		\|-
	\|D1-~~401~~\|\| ~~Date of~~ Service		\|B1-201\|\| [http://www.quickrx.net/wiki/Service_Provider_ID Service Provider ID]
	\|-		\|-
	\|AK110\|\| Software Vendor Certification #		\|D1-401\|\| [http://www.quickrx.net/wiki/Date_of_Service Date of Service]
			\|-
			\|AK110\|\| [http://www.quickrx.net/wiki/Software_Vendor_Certification Software Vendor Certification #]
	\|}		\|}

2016-01-08T19:19:49Z

Workers Comp Information (AM-111 06)

← Older revision		Revision as of 19:19, 8 January 2016
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	==Workers Comp Information (AM-111 06)==		==Workers Comp Information (AM-111 06)==
	Workers comp fields are generated when a '''Date of Injury''' has been set on a claim.		Workers comp fields are generated when a '''Date of Injury''' (/IY) has been set on a claim.
	{\| border="1" cellpadding="2"		{\| border="1" cellpadding="2"
	\|-		\|-