What are Pharmacy Claims?
Pharmacy claims are records for prescription drugs dispensed through a pharmacy and submitted to 340B ESP to meet applicable manufacturer claims data requirements.
Submit pharmacy claims when the drug or NDC is supported for pharmacy claims submission in 340B ESP and the applicable manufacturer requires claims data for the covered entity or pharmacy relationship.
Before submitting, confirm that the NDC is included in the pharmacy NDC list and review any applicable manufacturer requirements.
Pharmacy Claim Field Requirements
The following fields are collected when submitting pharmacy claims data to 340B ESP. Required fields are indicated with an asterisk. Any additional data elements included in a data file selected for upload will automatically be removed prior to data submission.
Download the Pharmacy Claims Data Template here:
Field | Data Type | Description |
Contracted Entity ID* | Alpha numeric ID that may contain dashes-- starts with 2 or 3 letters | The 340B ID of the covered entity where the prescription originated. If the 340B ID contains a suffix, this must be included. |
Date of Service* | Standard Date Formats | The date the patient filled their prescription. Please include only the date, as time stamps will flag an error. |
Date Prescribed* | Standard Date Formats | The date the prescriber wrote the prescription. Please include only the date, as time stamps will flag an error |
NDC* | Numeric, 11 digits, may contain up to 4 leading zeros | The 11-digit National Drug Code which indicates the manufacturer, product, and commercial package size - note that this field must have 11 digits so please include zero padding. |
Prescriber ID** | Numeric, 10 digits, never starts with a leading zero | The unique public ID for the prescribing physician. Accepted IDs include the NPI and DEA ID. |
Prescriber ID Qualifier** | Numeric | Indicates the type of unique ID provided. A value of "01" indicates NPI, "12" indicates DEA. |
Quantity* | Numeric | The number of units in the prescription. |
Rx Number* | Numeric, may contain leading zeros | The native (unmodified) prescription number for the prescription as generated by the pharmacy. |
Service Provider ID* | Numeric, 10 digits, never starts with a leading zero | The unique public ID for the dispensing pharmacy. Accepted IDs include the NPI, DEA, NCPDP, and Medicaid ID. |
Service Provider ID Qualifier** | Numeric | The type of unique ID provider. "01" for NPI, "05" for Medicaid, "07" for NCPDP, and "12" for DEA. |
Wholesaler Invoice Number | Numeric | The invoice number assigned by the wholesaler for the replenishment order made by the 340B covered entity. For claims with multiple invoice numbers, submit each invoice number as a separate claim line. |
Payer BIN** | Alpha numeric, may contain leading zeros | The bank identification number of the primary payer on the prescription. |
Payer PCN** | Alpha numeric, may contain leading zeros | Processor Control Number. Identifier used to determine which processor will handle a prescription drug claim. |
Ship to Date | Standard Date Formats | Date when the drug was shipped to the Ship To location. |
Ship to Location | Numeric | NPI, DEA, or NCPDP of the pharmacy where the drug was physically shipped. |
340B Account Number | Alpha numeric | Account number assigned by the wholesaler and used for the purchase. |
Product Serialization Number | Numeric | Unique ID assigned to the package shipped from the manufacturer to the wholesaler. |
Fill Number | Numeric | Indicates the number of times the prescription has been filled as of the current fill. For example, a value of 2 indicates that the prescription has been filled twice and the current fill is the second one. |
*Indicates a required field for all 340B ESP submissions regardless of NDC.
**Indicates a field that may be required depending on the manufacturer. Please review the manufacturer policies in the Resources page to learn more.
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