Examples of Insurance Segment in a sentence
They are the Transaction Header Segment and the Insurance Segment.
The segments include the Transaction Header Segment, Patient Segment, Insurance Segment, Claim Segment, Prescriber Segment, COB/Other Payments Segment, DUR/PPS Segment, Pricing Segment, and Prior Authorization Segment.
Details concerning these fields can be found on page 2.10.6. For submission of a Nursing Home Override the provider must resubmit the original transaction with an entry in the Eligibility Clarification Code (309-C9) field on the Insurance Segment.
For multiple claims, all segments repeat for each claim up to a maximum of four claims except for the Transaction Header Segment, Patient Segment and Insurance Segment.
Details concerning these fields can be found on page 2.10.8. For submission of an excess income/spenddown override, the provider must resubmit the original transaction with an entry in the Eligibility Clarification Code (309-C9) field on the Insurance Segment and the Patient Paid Amount (433-DX) field on the Pricing Segment.
The rest of the segments in the request (such as Patient Segment, Insurance Segment, Claim Segment, Response Status Segment, Response Claim Segment, Etc.) are variable segments with variable fields (where applicable) and variable field lengths.
Retail pharmacies that wish to trigger claim-based crossovers to Medigap when billing in the NCPDP format should enter the Medigap claim-based COBA ID in the 301-C1 (Group ID) portion of the Transmission Insurance Segment in the NCPDP format version D.0. The beneficiary’s Medigap policy number is reported in the 359-2A (Medigap ID) portion of the Insurance Segment of the NCPDP format version D.0. It should be noted that no development for missing or incomplete information will be done by the DME MAC.
The NCPDP D.0 has added a provider accept assignment indicator field as element 361-2D in the Transmission Insurance Segment.
The following lists the segments available in a Reversal Transaction (transaction code B2) for version D.0 Reversal Transaction Header Segment: Mandatory in all cases Reversal Insurance Segment: Optional Reversal Claim Segment: Mandatory Field #NCPDP Field NameValue M/O/R/S 111-AMSegment Identification07M455-EMPrescription/Service Reference Number Qualifier M402-D2Prescription/Service Reference Number M436-E1Product/Service ID Qualifier M407-D7Product/Service ID M456-ENAssociated Prescription/Service Ref.
Transaction Header Segment – Mandatory Insurance Segment – MandatoryPatient Segment – Required*For Emergency/Natural Disaster claims, enter the current ZIP code of displaced patient in conjunction with Prior Authorization Type Code (461-EU) and Prior Auth ID Submitted (462-EV) field.