Element Details

14 min

requirement designation \element attributes\ code description mandatory the element must be used per the specification (e g , xml schema validation) conditional the element is to be used per the conditions specified business rule if sent, the element must be used per the surescripts business rule recommended surescripts recommends sending the element as a best practice not used not used by surescripts note this guide includes data elements only where surescripts has specific requirements or further explains the field usage refer to the schema for a complete list of fields message header message header xml requirements element (message header) code comment to mandatory this field contains the identification of the receiver this field is used in conjunction with to/@qualifier, which qualifies which id was used medication history for ambulatory requests request messages from provider vendors to surescripts will contain “s00000000000001” request messages from surescripts to the data supplier will contain the data supplier's participant id medication history for reconciliation requests request messages from provider vendors to surescripts will contain “s00000000000002” request messages from surescripts to the data supplier will contain the data supplier's participant id medication history for ltpac requests request messages from provider vendors to surescripts will contain “s00000000000013” request messages from surescripts to the data supplier will contain the data supplier's participant id @qualifier conditional business rule because the to field must always be sent, the qualifier must also be sent values zzz = mutually defined from mandatory this field is used in conjunction with from/@qualifier, which qualifies which id was used medication history for ambulatory, reconciliation, and ltpac requests request messages from provider vendors to surescripts will contain the provider vendor participant id assigned by surescripts request messages from surescripts to pbm/payer will contain the provider vendor participant id assigned by surescripts responses for claim history response messages from surescripts to the provider vendor will contain either s00000000000001, s00000000000002, or s00000000000013 @qualifier conditional business rule because the from field must always be sent, the qualifier must also be sent value zzz = mutually defined messageid mandatory the sender should ensure the combination of the from and messageid elements is unique for at least 18 months surescripts recommends an unformatted globally unique identifier (guid) senttime mandatory date of the transmission please see utc time format docid\ ixyzj274gggzgxkrbu6vp section testmessage conditional when sent, allowable values must match platform that message is being sent to values 1 or true = test (required in staging environment ) all other values = live (production) it is recommended not to send this field when in production medication history request \medication history request for a patient is sent to surescripts \ rxhistoryrequest benefitscoordination element requirements note surescripts requires the benefitscoordination in the rxhistoryrequest element (rxhistoryrequest) code comment payeridentification conditional mutuallydefined conditional business rule if the eligibility request is required, the isa control number (isa13) from the 271 eligibility response must be populated in this field consent conditional patient consent indicator business rule consent field must be sent as surescripts echoes this information in the rxhistoryresponse values y = patient consents x = parent consents for child note values 'n', 'p', 'z' and 'tpo' will be treated as no consent and message will be rejected rxhistoryrequest facility element requirements note facility is required when the prescriber element is not provided for medication history for reconciliation or long term post acute care (ltpac) rxhistoryrequests element (rxhistoryrequest) code comment identification mandatory npi conditional business rule npi is required if facility element is included provider vendor should populate this field with the organizational npi note if a pharmacist is requesting medication history on behalf of a healthcare organization, the organizational npi for the healthcare organization should be sent in the rxhistoryrequest must be a valid 10 digit npi and must be associated to a valid user in the national plan and provider enumeration system (nppes) in the staging environment, the npi check digit will be validated using the luhn formula for specific information see https //www cms gov/regulations and guidance/administrative simplification/nationalprovidentstand/downloads/npicheckdigit pdf https //www cms gov/regulations and guidance/administrative simplification/nationalprovidentstand/downloads/npicheckdigit pdf note surescripts updates npi data weekly from nppes it may take up to one week for new npis to be considered valid facilityname conditional business rule facilityname is required for medication history for reconciliation if facility element is included rxhistoryrequest patient element requirements element (rxhistoryrequest) code comment nonhumanpatient not used surescripts does not support the ncpdp script elements for nonhuman patients humanpatient mandatory names mandatory name mandatory lastname mandatory aids in patient matching firstname mandatory aids in patient matching middlename recommended recommended to send to aid in patient matching address recommended recommended to send to aid in patient matching postalcode recommended recommended to send to aid in patient matching communication numbers recommended recommended to send to aid in patient matching primarytelephone mandatory if communicationnumbers is sent, primarytelephone must be sent rxhistoryrequest prescriber element requirements note surescripts requires the prescriber element for all medication history for ambulatory rxhistoryrequests and for medication history for reconciliation or long term post acute care (ltpac) rxhistoryrequests where the facility is not provided element (rxhistoryrequest) code comment veterinarian not used surescripts does not support the ncpdp script elements for veterinarian prescribers nonveterinarian mandatory identification mandatory npi mandatory provider vendor should populate this field with the individual’s npi must be a valid 10 digit npi and must be associated to a valid user in the national plan and provider enumeration system (nppes) in the staging environment, the npi check digit will be validated using the luhn formula for specific information see https //www cms gov/regulations and guidance/administrative simplification/nationalprovidentstand/downloads/npicheckdigit pdf https //www cms gov/regulations and guidance/administrative simplification/nationalprovidentstand/downloads/npicheckdigit pdf note surescripts updates npi data weekly from nppes it may take up to one week for new npis to be considered valid practicelocation conditional business rule medication history for reconciliation if the prescriber element is sent, practicelocation must be sent businessname conditional business rule medication history for reconciliation if the prescriber element is sent, businessname must be sent prescriberplaceof service recommended identifies the place where professional services are rendered resulting in medication history being pulled the cms place of service code set serves as the standard for these codes https //www cms gov/medicare/coding billing/place of service codes/code sets https //www cms gov/medicare/coding billing/place of service codes/code sets rxhistoryrequest requesteddates element requirements element (rxhistoryrequest) code comment startdate mandatory startdate is the beginning date for the desired history (up to one year ago from today’s date) if the rxhistoryresponse indicates more medications are available (response/approved/reasoncode = ‘aq’) and the requester desires to make a subsequent request for additional medications within the dates of the original request, a new rxhistoryrequest will need to be sent with the startdate equal to the original startdate enddate mandatory enddate is the end date for the desired history (e g , today’s date) enddate must be after the startdate if the rxhistoryresponse indicates more medications are available (response/approved/reasoncode = ‘aq’) and the requester desires to make a subsequent request for additional medications within the dates of the original request, a new rxhistoryrequest will need to be sent with the enddate equal to the lastfilldate of the oldest medication returned in the rxhistoryresponse note it is recommended to send the enddate in utc date format while the timestamp is not required, the date should reflect the correct day in utc medication history response \this response is sent from surescripts back to the provider vendor and includes the patient’s medication history \ note for alphanumeric (non codified) elements, all characters sent in the response should be displayed and truncation should not be used rxhistoryresponse response element requirements element (rxhistoryresponse) code comment approved mandatory surescripts only sends approved responses reasoncode conditional aq (more history available) is sent to indicate that another rxhistoryrequest is needed to obtain additional available medication history if the original requester would like to receive the additional medications within that given timeframe, the original requester will need to send a subsequent rxhistoryrequest with the requesteddates/startdate = \[startdate of the original request] requesteddates/enddate = \[filldate of oldest medication returned in rxhistoryresponse] dj no data found sent to indicate that no medications are returned in the rxhistoryresponse dm error sent to indicate that an error was encountered in the processing of the message where additional medications may be available if the original requester would like to attempt to retrieve the medication records that were unavailable within the request due to the error, the original requester will need to send a subsequent rxhistoryrequest with the same requesteddates retrying messages should be limited to a finite number of attempts and over a limited period, such as 3 5 attempts over a 30 minute time frame establishing time parameters for when retries are appropriate can help prevent retries from entering into an endless loop note conditional the note field may be used for approved responses rxhistoryresponse medicationdispensed element requirements note medicationprescribed and medicationdispensedadministered are not used for surescripts medication history element (rxhistoryresponse) code comment drugdescription mandatory the item or drug description field should include the standardized drug name including strength and form from a surescripts approved drug compendia product conditional within the product element, one instance of drugcoded, compoundinformation, or nondrugcoded will be sent drugcoded is used exclusively for medications and includes an ndc nondrugcoded is used for non medication products that may have an ndc, supplies, durable medical equipment and digital therapeutics if the product has an ndc and is included by the data supplier then it should be included compoundinformation is used to send a compound prescription all active ingredients provided by the data supplier will be included drugcoded mandatory the elements under drugcoded are in part of a choice group in the ncpdp schema for these elements, one of the following elements must be sent if product is sent drugcoded compoundinformation nondrugcoded ndc mandatory an 11 digit ndc in the 5 4 2 format is required; no dashes and no suppression of leading zeros the drug description of the product must match the description of the drug identifier (e g , ndc, rxnorm) example 00143314250 compoundinformation mandatory nondrugcoded mandatory productcode conditional code mandatory if the nondrugcoded/productcode/qualifier contains “up”, this field will contain universal product codes (upcs) from pharmacy fill data quantity mandatory quanityunitofmeasure mandatory code mandatory see codified field usage for federal medication terminologies (fmt) codes docid\ ypwxbigrhqavoflcg255g for details writtendate conditional the original prescribed date lastfilldate mandatory the date on which the prescription was last adjudicated to a pbm/payer or processed as a cash transaction note this differs from “solddate” which is found under othermedicationdates diagnosis conditional include an icd 10 diagnosis code when possible the first occurrence of the diagnosis element should align to the primary diagnosis transmit the diagnosis code without the decimal sig conditional the sig field will provide patient directions in addition, structure and codification will occur here if enabled sigtext mandatory free text patient directions (structuredsig elements) conditional sig iq will be applied here if enabled structured elements supporting the sigtext the codes and their textual representations will semantically match with the string in the sigtext reference ncpdp script structured and codified sig format implementation guide refillsremaining conditional the number of refills remaining on the prescription historyprescriber ordernumber conditional if sent, this is the prescriber order number (pon) from the prescription historysource conditional source mandatory sourcedescription conditional data supplier participant name sourcequalifier mandatory qualifies the source description values payer pharmacy sourcereference conditional prescription number associated to medication history record if the submitter chooses to send this field and sourcequalifier is “pharmacy”, then it should be populated with the pharmacy prescription number if the submitter chooses to send this field and sourcequalifier is “payer”, then it should be populated with prescription number from pbm/payer system from claims processing fillnumber conditional defines the dispensing episode as an initial fill or an authorized refill if this field is sent for fill data, it will contain the fill number from the pharmacy if this field is sent for claim data, it will contain pharmacy’s fill number from the pbm/payer system from claims processing values 00 = initial fill 01 = first refill 02 = second refill, etc allowed values 00 thru 99 paymenttype conditional indicates how the patient paid for the medication values 1 = self pay (cash) 2 = medicaid 3 = medicare 4 = commercial insurance 5 = veterans health administration (va) 6 = workers compensation 7 = indian health services 99 = other (any other types not covered by definitions above) othermedicationdates conditional this field will only be sent if other medication dates are applicable othermedicationdate mandatory othermedication datequalifier mandatory qualification of othermedicationdate/date field example qualifiers solddate the date that the product was sold to the patient effectivedate the date after which the prescription can be dispensed (i e , do not fill before date) as authorized by the prescriber