Element Details

requirement designation element attributes code description mandatory the element must be used per the specification (e g , xml schema validation) business rule if sent, the element must be used per the surescripts business rule note not all business rules reside in this table conditional the element is to be used per the conditions specified recommended surescripts recommends sending the element as a best practice note this guide only includes data elements where surescripts has specific requirements or further explains the field usage refer to the rtpb xml schema listed in document references for a complete list of fields message header elements element code comment to/primary mandatory patient’s iin it is recommended to use the iin from the newrx or any other data stored in the pharmacy system that is less than 72 hours old if the patient’s iin is not available, this should be the surescripts id (s00000000000005) to/@qualifier mandatory values iin = iin number py = payer/processor note if the surescripts id (s00000000000005) is sent in the to/primary field, py will be the qualifier to/secondary conditional patient’s pcn it is recommended to use the pcn from the newrx or any other data stored in the pharmacy system that is less than 72 hours old note this can be found in the 271 eligibility response from the pbm/payer in loop 2100a nm109 to/@qualifier mandatory value pcn = processor control number to/tertiary conditional payeridentification (surescripts assigned participant id of the pbm/payer) it is recommended to use the payeridentification from the newrx or any other data stored in the pharmacy system that is less than 72 hours old note this can be found in the 271 eligibility response from the pbm/payer in loop 2100a nm109 to/@qualifier mandatory value py = payer/processor from/primary mandatory the identification of the sender of the message this is the ncpdpid of the pharmacy sending the request from/@qualifier mandatory value p = pharmacy messageid mandatory a minimum set of standards/algorithms should be used when generating message ids to ensure uniqueness if possible, customers should utilize global unique identifiers (guids) note the messageid in the rtpbresponse will be populated in the relatestomessageid field of the newrx see messageid linkage docid\ fkjjhxgyyhkh2 k1bflyi for more details s 205 the sender shall ensure the combination of the from and messageid elements, for all messages including error, is unique for at least 18 months surescripts recommends an unformatted globally unique identifier (guid) relatestomessageid conditional this element is case sensitive populate with the messageid contained in the newrx for the prescription being queried see messageid linkage docid\ fkjjhxgyyhkh2 k1bflyi for more details s 210 customers shall support the scenarios in the message linkage section of this guide senttime mandatory date/time of initiation refer to utc time format for information on how to properly format the date/time data sendersoftwarecertificationid conditional business rule sendersoftwarecertificationid has a max length of 10 characters surescripts requires sending this field identifies the entity responsible for the software that generated the message the developer may be a software vendor or, if the software was developed “in house”, the developer is the entity sending the message (e g , a chain) the value transmitted is determined by the sender software developer messageid linkage diagram messageid linkage s 210 customers shall support the scenarios in the message linkage section of this guide the table below illustrates how the messageids and relatestomessageids in the newrx, rtpbrequest and rtpbresponse, and rxchange messages are linked in pharmacy rtpbrequest elements notes this guide only includes data elements where surescripts has specific requirements or further explains the field usage refer to the real time prescription benefit standard v13 schema listed in document references for a complete list of fields per acr s 201, customers shall ensure all messages are syntactically correct before transmission to surescripts element code comment patient mandatory name/lastname mandatory patient last name name/firstname mandatory patient first name sexandgender/ administrativegender mandatory patient gender dateofbirth mandatory date of birth of patient stateprovince mandatory patient’s state or province postalcode mandatory patient’s address postal code city extension mandatory patient’s city customers should use the following url \<extension name="city" url="http //surescripts com/extensions/rtpbrequest/patient/city”> benefitscoordination mandatory cardholderid conditional insurance id assigned to the cardholder or identification number used by the plan providing cardholderid can help with patient matching note this can be found in the 271 eligibility response from the pbm/payer in loop 2100c and is indicated when the ref01 segment is "hj" and the ref02 is not blank pbmmemberid conditional unique pbmmemberid for the patient providing pbmmemberid can help with patient matching unique pbmmemberid for the patient note the pbmmemberid can be found in the 271 eligibility response from the pbm/payer in loop 2100c nm109 requestedproduct mandatory product mandatory drugcoded/ndc mandatory ndc of the requested medication note if surescripts identifies a more representative ndc, surescripts may replace the ndc that was sent with the more representative ndc to ensure a successful rtpbresponse ndc must be an 11 digit numeric in the 5 4 2 format dashes shall not be used and leading zeros shall not be suppressed ndc should be representative do not send repackaged, obsolete, private label or unit dose ndc unless it is the only ndc available to identify the medication concept quantity mandatory value mandatory quantity for the requested medication to ensure successful message processing, dayssupply and quantity should be a numeric value and greater than zero (0) codelistqualifier mandatory quantity codelistqualifier for the requested medication value 38 = original quantity quantityunitof measure/code mandatory the quantityunitcode should reflect the ncit code if the ncit code is not sent, the provider vendor may not be able to translate the quantityunitcode and the response may result in an error example value c48542 = tablet for a list of ncit codes, go to http //evs nci nih gov/ftp1/ncpdp/about html http //evs nci nih gov/ftp1/ncpdp/about html this list should be updated monthly use the ncpdp quantityunitofmeasure terminology rows from the downloaded data pm 200 quantityunitofmeasure code qualifiers shall be correctly associated with medication descriptions dayssupply mandatory business rule dayssupply must be sent for accurate pricing dayssupply is the estimated number of days the prescription will last excluding refills, based upon the prescribed quantity and directions it is the prescribed quantity divided by the daily doses while this is typically system calculated, the prescriber retains responsibility for the value dayssupply and quantity must be a numeric value and greater than zero (0) diagnosis conditional include icd 10 diagnosis if populated on newrx code mandatory @qualifier mandatory value abf = icd10 prescriber mandatory identification/npi mandatory npi for the pharmacy npi will be validated against the check digit routine business rule npi in the prescriber segment must match the npi in the pharmacy segment lastname mandatory value unknown pharmacy mandatory business rule pharmacy must be sent for accurate pricing identification/ncpdpid conditional business rule the ncpdpid for the pharmacy must be sent in the rtpbrequest identification/npi conditional business rule the npi (national provider id) for pharmacy must be sent in the rtpbrequest npi will be validated against the check digit routine 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 businessname mandatory store name primarytelephonenumber mandatory store phone number rtpbresponse elements notes this guide only includes data elements where surescripts has specific requirements or further explains the field usage refer to the ncpdp rtpb xml schema listed in document references for a complete list of fields per acr s 200, customers shall be able to receive syntactically valid maximum and minimum populated messages optional data elements (and values therein) shall not cause message failure element code comment response mandatory processed mandatory processed should only be sent in instances where benefit information is provided please reach out to your surescripts representative for additional information note conditional recommended to send if needed to aid in message processing notprocessed mandatory note conditional additional free text information about the rejectcode strongly recommended to send to further explain why message was rejected responseproduct conditional product mandatory contains the information on the requested medication drugdescription mandatory the drug name, strength, and form associated with the ndc pricingandcoverages mandatory there may be up to 6 pricingandcoverages returned per responseproduct and responsealternativeproduct pm 204 coverage restrictions for all \<pricingandcoverages> elements for medication combinations returned (including alternatives) this concession is allowed an indicator that coverage restriction(s) apply to a specific combination user action on this indicator presents all coverage restrictions in their entirety estimatedcombined planandpatientsavings conditional provides additional patient and/or health plan savings information that may assist with medication selection estimatednetplancost conditional provides additional health plan cost information that may assist with medication selection responsealternative product conditional clinically appropriate alternatives are provided here this would include information for an alternative medication (if provided) similar to what is supplied in the responseproduct element pm 205 all available appropriate alternatives displayed together if all alternatives cannot be shown together, this concession is allowed an indicator that alternative medications are available user interaction on this indicator presents all alternative medications together pricingandcoverages/ pricingandcoverage/ coveragestatusmessage conditional additional free text information about the coverage status may be used to communicate non benefit coverage types as well as coverage restrictions pricingandcoverages/ pricingandcoverage/ drugstatus extension conditional additional free text information about the drug may be used to communicate drug and pricing specifics