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Segment
in
X12 Release 008010

DRA Drug Authorization

To specify a drug for which authorization is being requested
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
352
Description
String (AN)
Mandatory
1
80
2
A free-form description to clarify the related data elements and their content
DRA01 is the drug name. Position of data in the repeating data element conveys no significance.
02
Certification Type Code
Identifier (ID)
Optional
1
1
1
Code indicating the type of certification
DRA02 is the drug therapy type.
Codes (17)
03
Composite Medical Procedure Identifier
Composite (composite)
Optional
2
01
Product/Service ID Qualifier
Identifier (ID)
Mandatory
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
C003-01 qualifies C003-02 and C003-08.
Codes (544)
02
Product/Service ID
String (AN)
Mandatory
1
80
-
Identifying number for a product or service
If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs.
03
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02 and C003-08.
04
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02 and C003-08.
05
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02 and C003-08.
06
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02 and C003-08.
07
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content
C003-07 is the description of the procedure identified in C003-02.
08
Product/Service ID
String (AN)
Optional
1
80
-
Identifying number for a product or service
C003-08 represents the ending value in the range in which the code occurs.
09
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-09 modifies the value in C003-02 and C003-08.
10
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-10 modifies the value in C003-02 and C003-08.
11
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-11 modifies the value in C003-02 and C003-08.
12
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-12 modifies the value in C003-02 and C003-08.
04
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
1
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0405
Codes (925)
05
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
DRA05 is the quantity being requested.
06
Free-form Message Text
String (AN)
Optional
1
264
1
Free-form message text
DRA06 is the Sig (The Sig is a Latin term used in the pharmacy industry that represents the instructions/directions that are printed on the drug label.)
07
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
1
Code indicating a Yes or No condition or response
DRA07 is the self administer indicator. A "Y" value indicates that the drug can be administered by the patient. An "N" value indicates that the drug can not be administered by the patient.
Codes (9)
08
Yes/No Condition or Response Code
Identifier (ID)
Conditional
1
1
1
Code indicating a Yes or No condition or response
P080910
DRA08 is the end stage renal disease (ESRD) indicator. A "Y" value indicates that the patient has ESRD. An "N" value indicates that the patient does not have ESRD.
Codes (9)
09
Date/Time Qualifier
Identifier (ID)
Conditional
3
3
1
Code specifying type of date or time, or both date and time
Codes (1343)
10
Date
Date (DT)
Conditional
8
8
1
Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year
DRA10 is the ESRD certification date.
11
Free-form Message Text
String (AN)
Optional
1
264
99
Free-form message text
DRA11 is for questions that are related to the authorization of the drug. Position of data in the repeating data element conveys no significance.
12
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
DRA12 is the number of refills requested.
13
Question and Answer
Composite (composite)
Optional
99
01
Assigned Identification
String (AN)
Mandatory
1
20
-
Alphanumeric characters assigned for differentiation within a transaction set
C060-01 is the question number from a pre-defined questionnaire.
02
Yes/No Condition or Response Code
Identifier (ID)
Mandatory
1
1
-
Code indicating a Yes or No condition or response
C060-02 is the answer to the pre-defined question. A "Y" value indicates the answer to the question is yes. A "N" value indicates the answer to the question is no.
Codes (9)
14
Dosage Form Code
Identifier (ID)
Optional
2
2
1
Code indicating the form in which the drug is dispensed
Codes (72)
15
Free-form Message Text
String (AN)
Optional
1
264
99
Free-form message text
DRA15 is for comments and/or instructions regarding the authorization. Position of data in the repeating data element conveys no significance.
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.