What are Pharmacy Claims with Encounter Data?
Pharmacy claims with encounter data include standard pharmacy claim information along with additional encounter-level details required by certain manufacturers.
Submit pharmacy claims with encounter data when the drug or NDC is supported for pharmacy claims submission in 340B ESP and the applicable manufacturer requires encounter data as part of its claims submission requirements.
Before submitting, confirm that the NDC is included in the pharmacy NDC list and review the applicable manufacturer requirements to determine whether encounter data is required.
Pharmacy Claims with Encounter Data Field Requirements
The following fields are collected when submitting Pharmacy + Encounter data to 340B ESP™. Fields required for all claim submissions are indicated with a single asterisk (*). Additional fields may be required based on manufacturer-specific claim data submission requirements. Please review the manufacturer policies in the Resources page to learn more.
Field | Data Type | Description |
Contracted Entity ID* | Alphanumeric 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. |
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. |
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. |
Wholesaler Invoice Number | Numeric | The invoice number assigned by the wholesaler for the replenishment order made by the 340B covered entity. |
Payer BIN | Alphanumeric, may contain leading zeros | The bank identification number of the primary payer on the prescription. |
Payer PCN | Alphanumeric, 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 | Alphanumeric | 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. |
Encounter Billing Service Provider ID* | Alphanumeric | A unique, public ID for the healthcare entity that billed for the patient's healthcare encounter. |
Encounter Date of Service* | Date | Date on which the patient was seen by a healthcare provider and received a healthcare service. |
Encounter Rendering Physician ID* | Alphanumeric | A unique, public ID for the physician that provided the healthcare service to the patient. |
Encounter HCPCS Code* | Alphanumeric | The five digit HCPCS code corresponding to the health service performed on the encounter claim. |
Encounter HCPCS Code Modifier(s) | Alphanumeric | Modifier to the HCPCS code. Up to four modifier codes may be entered for the same claim line. |
Primary Encounter Diagnosis Code* | Alphanumeric | ICD-10 diagnosis code assigned as the primary diagnosis for the healthcare encounter. |
Supplemental Encounter Diagnosis Code(s) | Alphanumeric | ICD-10 diagnosis code assigned as the supplemental diagnosis for the healthcare encounter. |
Encounter Place of Service Code* | Numeric | Two-digit code indicating the facility type where the healthcare encounter occurred. |
* Indicates a required field.
Still have questions?
If you have questions or need additional help, our team is here for you — please feel free to reach out using any of the contact options below:
Chat: Available via in-app messenger
Email: [email protected]