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Kentucky D.0 Payer Specification NCPDP Version D Claim Billing/Claim Re-bill Template Request Claim Billing/Claim Re-bill Payer Sheet Template **Start of Request Claim Billing/Claim Re-bill (B1/B3) Payer Sheet Template**
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Document Date: 2012-01-19 13:34:58

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File Size: 512,32 KB

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City

Medicaid / Passport / State Issued / PATIENT / Tribal / Employer Assigned / /

Company

Magellan Medicaid Administration Inc. / /

Facility

Nursing Facility / Assisted Living Facility / Homeless Shelter / Psychiatric Facility / Inpatient Psychiatric Facility / Pharmacy Unit Dose / Residential Substance Abuse Treatment Facility / Custodial Care Facility / Psychiatric Residential Treatment Facility / Skilled Nursing Facility / Comprehensive Inpatient Rehabilitation Facility / /

IndustryTerm

patient health care communications / /

Organization

6ØØ-28 UNIT OF MEASURE / European Union / regulatory / Medicare / /

/

Position

PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER / Driver / Payer Sheet Template** General Information Payer Name / 2Ø2-B2 SERVICE PROVIDER ID QUALIFIER / PRODUCT/SERVICE ID QUALIFIER / /

Product

Long-Term Care Replacement Medication / /

ProgrammingLanguage

R / /

URL

http /

SocialTag