Segment
X12 EDI Release 00701
To specify a drug for which authorization is being requested
Elements
  • DRA01352Description
    AN
    M必须(Mandatory)
    Min 1 / Max 80

    A free-form description to clarify the related data elements and their content

  • DRA021322Certification Type Code
    ID
    M必须(Mandatory)

    Code indicating the type of certification

    Codes (17)
  • DRA03C003Composite Medical Procedure IdentifierO可选(Optional)
    23523413391339133913393522341339133913391339
    • DRA0301235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

      Code identifying the type/source of the descriptive number used in Product/Service ID (234)

      Codes (527)
    • DRA0302234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 80

      Identifying number for a product or service

    • DRA03031339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • DRA03041339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • DRA03051339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • DRA03061339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • DRA0307352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

      A free-form description to clarify the related data elements and their content

    • DRA0308234Product/Service ID
      AN
      O可选(Optional)
      Min 1 / Max 80

      Identifying number for a product or service

    • DRA03091339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • DRA03101339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • DRA03111339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • DRA03121339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

  • DRA04355Unit or Basis for Measurement Code
    ID
    O可选(Optional)

    Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

    Codes (903)
  • DRA05380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • DRA06933Free-form Message Text
    AN
    O可选(Optional)
    Min 1 / Max 264

    Free-form message text

  • DRA071073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • DRA081073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)
  • DRA09374Date/Time Qualifier
    ID
    O可选(Optional)

    Code specifying type of date or time, or both date and time

    Codes (1307)
  • DRA10373Date
    DT
    O可选(Optional)
    Min 8 / Max 8

    Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year

  • DRA11933Free-form Message Text
    AN
    O可选(Optional)
    Min 1 / Max 264

    Free-form message text

  • DRA12380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • DRA13C060Question and AnswerO可选(Optional)
    3501073
    • DRA1301350Assigned Identification
      AN
      M必须(Mandatory)
      Min 0 / Max 20

      Alphanumeric characters assigned for differentiation within a transaction set

    • DRA13021073Yes/No Condition or Response Code
      ID
      M必须(Mandatory)

      Code indicating a Yes or No condition or response

      Codes (4)
  • DRA141330Dosage Form Code
    ID
    O可选(Optional)

    Code indicating the form in which the drug is dispensed

    Codes (72)
  • DRA15933Free-form Message Text
    AN
    O可选(Optional)
    Min 1 / Max 264

    Free-form message text