Benefits Coordination (R.304)
Overview
This section holds the application certification requirements located in the Benefits Coordination ElementsBenefits Coordination section in the guide.
R.304
R.304: Prescribing vendors who are utilizing the Surescripts Eligibility 270/271 messages shall populate the first BenefitsCoordination element with the associated information returned in a Surescripts 271 message. If more than one active coverage is returned, only the single coverage information utilized to write the prescription is sent. Subsequent BenefitsCoordination elements should be used for coupon/discount information. Prescribing vendors who are not utilizing the Surescripts Eligibility 270/271 messages should use the first BenefitsCoordination element for coupon/discount information. The 271 message’s ISA13 control number shall be populated in the BenefitsCoordination/InterchangeControlNumber field in all instances including scenarios where there’s no active coverage.
Identifier | 271 | X12 Data Type | Benefits Coordination | SCRIPT 2023011 Schema |
|---|---|---|---|---|
Interchange Control Number | ISA 13 | n 9/9 | Interchange ControlNumber | n 9 |
PBM Participant ID | 2100A/NM1/09 | an 2/80 | Payer Identification/ PayerID | an 1..80 |
PCN | 2110C1/REF/03 when REF/01 = “N6” | an 1/80 | Payer Identification/ Processor Identification Number | an 1..35 |
PBM/Payer Name | 2100A/NM1/03 | an 1/60 | PayerName | an 1..70 |
PBM Member ID | 2100C/NM1/09 | an 2/80 | PBMMemberID | an 1..80 |
Cardholder ID | 2100C/REF/01 when REF/01 = "HJ" | an 1/50 | CardholderID | an 1..35 |
BIN | 2110C1/REF/02 when REF/01 = “N6” | an 1/50 | Payer Identification/ IINNumber | an 1..35 |
Group Number | 2110C1/REF/02 when REF/01 = “6P” | an 1/50 | GroupID | an 1..35 |
Group Name | 2100C1/REF/03 when REF01 = "6P" | an 1/80 | GroupName | an 1..70 |
Note: There are differences between the field lengths in the Eligibility and SCRIPT schemas that could result in data being truncated.