Claims submitted by participating providers must include the following information:
Field | Information Required |
Carrier ID | NB |
Group Number or Code | Plan Identification Letter (see below) |
Client ID | Patient’s Plan ID number or Medicare number (see below) |
Patient Code (NB Drug Plan only) | Patient’s ID number (see below) |
Patient Name | Patient’s first and last name |
Patient DOB | Patient’s date of birth |
Prescriber ID | Prescriber’s license or registration number (see below) |
Prescriber ID Reference Code | Code identifying a prescriber’s licensing body (see below) |
DIN / PIN | Drug Identification Number / Product Identification Number |
Quantity | Quantity dispensed |
Days Supply | Number of days’ supply dispensed (see below) |
Drug Cost / Product Value | Please refer to Dispensing Fees and Drug Cost Reimbursement |
Cost Upcharge | Please refer to Dispensing Fees and Drug Cost Reimbursement |
Professional Fee | Please refer to Dispensing Fees and Drug Cost Reimbursement |