Which items are required for drug claim submission (drug/script info)?

Which items are required for drug claim submission (drug/script info)?

• A. Date rx written, date dispensed, new or refill, NDC, DAW, days supply, ingredient cost, dispensing fee, deductible or copay, balance
• B. Dispensing fee
• C. Age of patient
• D. Drug name

Answer: (A)

Submitting a drug claim requires a complete set of script and pricing details so the payer can determine eligibility, price the medication, and assign patient responsibility. The essential items include the date the prescription was written and the date the medication was dispensed, which show the prescription’s validity and when the patient actually received the drug. Indicating whether this is a new fill or a refill helps enforce quantity limits and refill rules. The National Drug Code identifies the exact product, strength, and form being billed, ensuring the correct item is reimbursed. The DAW (dispense as written) code clarifies whether the patient requested brand or a substitution occurred, which can affect pricing and coverage rules. Days’ supply communicates how long the supplied quantity should last and informs eligibility windows and quantity controls. Ingredient cost and dispensing fee together reflect the pharmacy’s base drug cost and service charge used in reimbursement calculations. Deductible or copay represents the patient’s share, and the balance shows what remains the patient owes after applying those amounts. Each piece is necessary for accurate adjudication; other items like age or just the drug name don’t provide the full, required data set for proper submission.

Submitting a drug claim requires a complete set of script and pricing details so the payer can determine eligibility, price the medication, and assign patient responsibility. The essential items include the date the prescription was written and the date the medication was dispensed, which show the prescription’s validity and when the patient actually received the drug. Indicating whether this is a new fill or a refill helps enforce quantity limits and refill rules. The National Drug Code identifies the exact product, strength, and form being billed, ensuring the correct item is reimbursed. The DAW (dispense as written) code clarifies whether the patient requested brand or a substitution occurred, which can affect pricing and coverage rules. Days’ supply communicates how long the supplied quantity should last and informs eligibility windows and quantity controls. Ingredient cost and dispensing fee together reflect the pharmacy’s base drug cost and service charge used in reimbursement calculations. Deductible or copay represents the patient’s share, and the balance shows what remains the patient owes after applying those amounts. Each piece is necessary for accurate adjudication; other items like age or just the drug name don’t provide the full, required data set for proper submission.