Loop ID Reference Name Codes Notes/Comments Category 2400 PS1 CONTRACT INFORMATION Purchased diagnostic tests 4 – Segment (PDT) require that the Rule purchased amounts be submitted at the detail line level (Loop 2400). Claims which contain a purchased service provider (QB) but that do not contain the PS1 segment data will be rejected. 2400 LIN02 PURCHASED SERVICE LIN02 must be qualifier 1 PROVIDER IDENTIFIER value Submission of “N4”. any other value will cause your claim to reject. 2410 CTP04 National Drug Unit Count The max value for 4 international units (qualifier F2), in the CTP segment, cannot exceed seven bytes numeric with three decimal places. Claims for drugs that exceed this value will be rejected. 2410 REF PRESCRIPTION OR If modifier J1 is used to 2 – Segment COMPOUND DRUG bill the claim, this Rule ASSOCIATION NUMBER segment must be submitted. 2410 REF PRESCRIPTION OR Must not be present (non- 1 – Segment COMPOUND DRUG VA contractors). Rule ASSOCIATION NUMBER Submission of this segment will cause your claim to reject. 2420A REF 4 RENDERING PROVIDER Must not be present (non- – Segment SECONDARY VA contractors). Rule IDENTIFICATION Submission of this segment will cause your claim to reject.
Loop ID Reference Name Codes Notes/Comments Category 2400 PS1 – Segment Rule CONTRACT INFORMATION Purchased diagnostic tests (PDT) require that the purchased amounts be submitted at the detail line level (Loop 2400). Claims which contain a purchased service provider (QB) but that do not contain the PS1 segment data will be rejected. 4 2400 LIN02 PURCHASED SERVICE PROVIDER IDENTIFIER LIN02 must be qualifier value “N4”. Submission of any other value will cause your claim to reject. 1 2410 CTP04 National Drug Unit Count The max value for international units (qualifier F2), in the CTP segment, cannot exceed seven bytes numeric with three decimal places. Claims for drugs that exceed this value will be rejected. 4 2410 REF – Segment Rule PRESCRIPTION OR COMPOUND DRUG ASSOCIATION NUMBER If modifier J1 is used to bill the claim, this segment must be submitted. 2 2410 REF – Segment Rule PRESCRIPTION OR COMPOUND DRUG ASSOCIATION NUMBER Must not be present (non- VA contractors). Submission of this segment will cause your claim to reject. 1 2420A REF – Segment Rule RENDERING PROVIDER SECONDARY IDENTIFICATION Must not be present (non- VA contractors). Submission of this segment will cause your claim to reject. 4