PACE

Provider Bulletin

May 6, 2005

PAYER SPECIFICATIONS NCPDP 5.1

FUTURE EDITS

REMINDER

 

The fields listed below are contained in the current version of PACE/PACENET NCPDP v5.1 Payer Specifications dated June 1, 2004.

 

PACE is monitoring these fields and is returning the paid claim with an E.O.B. (Explanation Of Benefits) message whenever Missing or Invalid Data has been entered.

 

Claims containing incorrect or invalid data in these fields will continue to be paid and returned with these EOB’s until September 27, 2005.

 

Effective September 27, 2005, claims with missing or invalid data in these fields will deny.  

 

Providers should contact their software vendors to ensure that valid data is being submitted to PACE in these data fields.

 

Field

Field  Name

Comments

 

307-C7

 

Patient Location*

 

 0= Not Specified  (This value will deny as Invalid.)

 

 Required Values

 1 = Home                                      7 = Skilled Care Facility

 2 = Inter-Care                                8 = Sub-Acute Care Facility

 3 = Nursing Home                         9 = Acute Care Facility

 4 = LongTerm / Extended Care    10 = Outpatient

 5 = Rest Home                             11 = Hospice

 6 = Boarding Home

 

 

301-C1

 

Group ID

 

Required Values

 

PACE = PACE/PACENET

CRDP = Chronic Renal Disease Program

SPBP = Special Pharmaceutical Benefits Program

CF = Cystic Fibrosis

SB = Spina Bifida

PKU = Phenylketonuria

MSUD = Maple Syrup Urine Disease

PAP = PA Lorazepam / Clorazepate Assistance Program

 

419-DJ

 

Prescription Origin Code

 

  0= Not Specified  (This value will deny as Invalid.)

 

  Required Values

       1 = Written                               3 = Electronic

       2 =Telephone                           4 = Fax

 

*Patient Location Definitions listed on back.

 

 Questions may be directed to Provider Services at 1-800-835-4080.

                     (OVER)                                                                               PPB-05-010