Report the submitter-assigned identifier as it appears in PR001 in the Product Product ID Product File. This element is used to understand PC 58 11/8/12 Text ID Link to PR001 All 100% A0 Number Identification Product and Eligibility attributes of the member / subscriber as applied to this record Lookup Report the that defines the element. Mail Order Indicator - Mail PC 59 11/8/12 - tlkpFlagIndicators int[1] EXAMPLE: 1 = Yes, pharmacy is a mail All 100% A2 pharmacy Order Option Integer order pharmacy Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Script Prescription Report the unique identifier of the PC 60 6/24/10 Text ID Claim Number All 100% B number Number prescription Report the member's PCP ID here. The Recipient Patient's PCP value in this element must have a PC 61 6/24/10 Text ID Link to PV002 All 98% B PCP ID ID Number corresponding Provider ID (PV002) in the Provider File. Lookup Report the that defines the availability Drug Source PC 62 11/8/12 Table - int[1] of the pharmaceutical. EXAMPLE: 1 = All 98% A2 Source Indicator Integer Multi-source brand Indicator Value Description 1 Multi-source brand Multi-source brand with generic 2 equivalent 3 Single source brand Single source brand with generic 4 equivalent 5 Unknown Member Street address Report the patient / member's address. PC 63 Street 11/8/12 Text Address 1 Member of the All 90% B Used to validate Unique Member ID. Address Member/Patient
PC 58 Product ID Number 11/8/12 Text ID Link to PR001 Product Identification Report the submitter-assigned identifier as it appears in PR001 in the Product File. This element is used to understand Product and Eligibility attributes of the member / subscriber as applied to this record All 100% A0 PC 59 Mail Order pharmacy 11/8/12 Lookup - Integer tlkpFlagIndicators int[1] Indicator - Mail Order Option Report the that defines the element. EXAMPLE: 1 = Yes, pharmacy is a mail order pharmacy All 100% A2 Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable PC 60 Script number 6/24/10 Text ID Claim Number Prescription Number Report the unique identifier of the prescription All 100% B PC 61 Recipient PCP ID 6/24/10 Text ID Link to PV002 Patient's PCP ID Number Report the member's PCP ID here. The value in this element must have a corresponding Provider ID (PV002) in the Provider File. All 98% B PC 62 Source Indicator 11/8/12 Lookup Table - Integer int[1] Drug Source Indicator Report the that defines the availability of the pharmaceutical. EXAMPLE: 1 = Multi-source brand All 98% A2 Value Description 1 Multi-source brand 2 Multi-source brand with generic equivalent 3 Single source brand 4 Single source brand with generic equivalent 5 Unknown PC 63 Member Street Address 11/8/12 Text Address 1 Member Street address of the Member/Patient Report the patient / member's address. Used to validate Unique Member ID. All 90% B