Field Mapping Reference

🟪 audience pbms/payers + provider/ehr vendors this content applies to both trading partner types and includes requirements or workflows shared across both sides of the transaction the following tables explains the use of the formulary ids and the corresponding ref segments in the 2100c/d loops of the x12 271 (this is new do we want this?) how the two tables relate in v60, every legacy v3 0 ref segment carries two identifiers the original v3 0 value in element 2 (ref02) for v3 0 ehrs, plus one additional v60 file id in element 3 (ref03) the four v60 file types carried in ref03 are step therapy products (st), prior authorization (pa), product exclusion (pe), and pharmacy networks (pn) all other v60 file types are carried in their own msg segments (second table) the two tables together cover the complete v60 file set; no file type appears in both located in x12 271 2110c1 loop (ref segment) segment element 1 element 2 element 3 ref 18 plan id ref 6p group number group name ref fo drug formulary number id (formulary status id) product exclusion (pe) ref cli coverage list id prior authorization file (pa) ref ig copay id pharmacy network (pn) ref als alternatives(v3)/alt trigger file (at) step therapy products (st) ref n6 bin (iin) pcn located in x12 271 2110c1 loop (msg segment) segment element 1 (msg01 type code prefix) element 2 (v60 file) msg ag alternative product groups msg al age limit coverage file msg ps copay product specific file msg gl gender limit coverage file msg gm general message file (gm) msg me message file (me) msg pc pharmacy chain file msg ql quantity limit coverage file msg sp specialty products file msg sm step therapy product groups notes data must be included in fields marked with an asterisk ( ), if fields are sent for legacy files (e g , files that exist in v3 0 and continue in v60+), use the same file ids for the lists that were previously grouped together for example, these files will all use the same file id individually the prior authorization file id, quantity limit file id, age limit file id, etc for more information, see eligibility response message details and full eligibility message example identifier requirements all related files in formulary version 60, such as age limit, gender limit, prior authorization, step therapy, alternatives, and alternative product groups, must share the same identifiers consistent ids ensure smooth translation between older versions (e g , v3 0) and v60 without this alignment, ehrs and pbms cannot accurately map legacy data to the new structure version 3 0 list type version 60 file equivalent formulary status (fs) formulary status (fs) alternatives list (alt) alternatives list alternative product triggers (apt) alternative product groups (apg) coverage lists benefit coverage files prior authorization (pa) prior authorization (pa) quantity limits (ql) quantity limits (ql) age limits (al) age limits (al) gender limits (gl) gender limits (gl) drug exclusion (de) product exclusion (pe) step therapy (st) step therapy products (st) step medication (sm) step therapy product groups (stpg) specialty products (sp) messaging text message (tm) general message (gm) resource links (web) message (me) copay copay copay product specific (ps) copay product specific (cp) pharmacy networks pharmacy network (pn) pharmacy chain (pc) the example below details how an eligibility response can vary with version 60 fields version 3 0 version 60 ref 6p groupid groupname ref als \<font color="#9400d3">alt pl50\</font> ref cli \<font color="#4682b4">cov pl50\</font> ref fo \<font color="#9400d3">fsl pl50\</font> ref ig \<font color="#4682b4">cop pl50\</font> ref n6 004655 pcnnumber dtp 291 rd8 20250701 20991231 ref 6p groupid groupname ref als \<font color="#9400d3">alt pl50\</font> \<font color="#008000">cov pl50\</font> ref cli \<font color="#4682b4">cov pl50\</font> \<font color="#008000">cov pl50\</font> ref fo \<font color="#9400d3">fsl pl50\</font> \<font color="#008000">cov pl50\</font> ref ig \<font color="#4682b4">cop pl50\</font> \<font color="#008000">pn67890ut hg\</font> ref n6 004655 pcnnumber dtp 291 rd8 20250701 20991231 msg \<font color="#008000">agalt pl50\</font> msg \<font color="#008000">alcov pl50\</font> msg \<font color="#008000">pscop pl50\</font> msg \<font color="#008000">glcov pl50\</font> msg \<font color="#008000">gmcov pl50\</font> msg \<font color="#008000">mecov pl50\</font> msg \<font color="#008000">pc234567890fs\</font> msg \<font color="#008000">qlcov pl50\</font> msg \<font color="#008000">sp234567890fs\</font> msg \<font color="#008000">smcov pl50\</font> note max values for all per version 60 are 40 characters key (used for) \<font color="#4682b4">v3 0\</font> \<font color="#9400d3">v3 0 and v60\</font> \<font color="#008000">v60 only\</font> for a complete eligibility transaction example, see full eligibility message example field mapping best practices in order to successfully use existing formulary file ids, other ref03 fields, and msg field (msg01) found in the “message text” segment within the 2110c loop in the eligibility (x12 271) response include the first two characters to clearly identify the file type (e g , for age limits, an example value for the msg segment would be al234g567890) must be unique across all files of the specified type valid characters are (a z, a z, numeral 0 9, period “ ”, and a dash “ “) formulary status & alternatives product triggers can be reused to ensure support across both standards note this enables surescripts to support translation from version 60+ down to version 3 how to read an msg segment unlike ref (where the file is identified by position — ref02 vs ref03), an msg segment carries everything in a single element, msg01 the first two characters are the file type code; the rest is the file id msg al cov pl50 │ └──────── file id = "cov pl50" └─────────── type code = "al" (age limits) so msg alcov pl50 means "the age limits file is cov pl50 " the type code ( al ) and the file id's own prefix (e g , cov , cop , fsl ) are independent the type code tells the receiver which v60 file this is; the file id is whatever value you assigned to that file clarification on file type identification in the 271 for formulary v60, coverage list id and copay list id are used only for formulary v3 0, where a single identifier may represent multiple files \<font color="#b91c1c"> \</font> for v60, individual formulary files are identified as follows ref03 values in the 2110c loop are used for step therapy products (st) prior authorization (pa) product exclusion (pe) pharmacy networks (pn) msg segments in the 2110c loop (msg01) are used for all other formulary coverage file types example for msg alcov pl50, the age limit file name is "cov pl50" note the current version (v3 0) limit on formulary status id (fo) and alternatives id (al) is 10 characters, v60+ customers will need to also limit these to 10 characters to support translation all other file ids can be 40 characters in length