FACILITY / CARDHOLDER / PLAN / INTERMEDIARY AUTHORIZATION TYPE / INTERMEDIARY AUTHORIZATION / PRIMARY CARE PROVIDER / /
Company
First DataBank / GE / Magellan Medicaid Administration Inc. / /
Currency
pence / USD / /
Facility
Pharmacy Repackaging / S FACILITY / PHARMACY PROVIDER Segment NOT REQUIRED / /
IndustryTerm
software vendors / software / any/all data elements / software/certification / /
MedicalTreatment
bypass / dialysis / /
OperatingSystem
DOS / /
Organization
European Union / /
Person
PRESCRIBER LAST / / /
Position
COB / PRODUCT/SERVICE ID QUALIFIER / COB SEGMENT / 2Ø2-B2 2Ø1-B1 SERVICE PROVIDER ID QUALIFIER SERVICE / PAYER ID QUALIFIER / PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER / ORIGINALLY PRESCRIBED PRODUCT/SERVICE ID QUALIFIER / AMOUNT CLAIMED SUBMITTED QUALIFIER / PATIENT ID QUALIFIER / /