Prescription Routing 10.6 ACR 2013-05-01

PRESCRIPTION ROUTING 10.
6 APPLICATION CERTIFICATION
REQUIREMENTS
Date: May 1, 2013
PRESCRIPTION ROUTING 10.6 APPLICATION CERTIFICATION REQUIREMENTS

PUBLISHED BY
SURESCRIPTS, L.L.C.
920 2ND AVENUE S.
MINNEAPOLIS, MN 55402
PHONE: 866-267-9482
FAX: 651-855-3001
2800 CRYSTAL DRIVE
ARLINGTON, VA 22202
PHONE: 866-797-3239
FAX: 703-921-2191
WWW.SURESCRIPTS.COM
Copyright 2013 by Surescripts, LLC.
All rights reserved. Proprietary and Confidential.
This document and all other documents, materials, and information, transmitted or orally communicated
by Surescripts in the course of the parties dealings constitute and are hereby designated as
proprietary and confidential information of Surescripts, and may not be reproduced or distributed (in
whole or in part) without the express written consent of Surescripts.
FOR SECTIONS OF THIS PARTICIPANT IMPLEMENTATION GUIDE

PERTAINING TO NCPDP STANDARDS:
Materials Reproduced With the Consent of
National Council for Prescription Drug Programs, Inc.
NCPDP
NCPDP is a registered trademark of the National Council for Prescription Drug Programs, Inc.
Membership of NCPDP acknowledges your support and commitment to implement these standards as
specified in the standards documentation. You further acknowledge that the Councils standards
documents and their predecessors include proprietary material protected under the U.S. Copyright Law
and that all rights remain with NCPDP.
Document Change Log

The table below tracks significant changes made to the document since it was last
published.
Section #
Section Title
Change Description
N/A
The requirements were removed from the Prescription Routing

10.6 Implementation Guide and placed into this separate
document.
UTC requirements 106R-026, -075, and -126 were duplicates, so
were combined into one (106R-016).
Relates To Message ID
LAST PUBLISHED 5/1/2013
Added note that Surescripts does not support the Resupply and
RxFill messages.
COPYRIGHT 2013 BY S URESCRIPTS, LLC.

ALL RIGHTS RESERVED. PROPRIETARY AND CONFIDENTIAL.
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PAGE 4
Prescription Routing 10.6 ACR
Table of Contents
TABLE OF CONTENTS
SECTION 1
Overview .................................................................................................. 7
Document Purpose .............................................................................................................. 7

Document References ......................................................................................................... 7
SECTION 2
General Data Format Requirements........................................................... 9
Prescription Routing General ............................................................................................ 9

Drug Database .................................................................................................................... 9
Communication Rules ........................................................................................................ 10
Detailed Prescription Routing Transaction Workflow........................................................... 10
EPCS Pharmacy ................................................................................................................ 11
UTC Time Format .............................................................................................................. 11
EDIFACT Trimming............................................................................................................ 11
Numeric Representation .................................................................................................... 12
XML Escape Characters .................................................................................................... 13
SECTION 3
Message Requirements ........................................................................... 15
New Rx Prescriber .......................................................................................................... 15

NewRx Pharmacy Requirements..................................................................................... 17
Refill Renewal Prescriber Requirements ............................................................................ 17
Refill Renewal Pharmacy ................................................................................................... 19
Common Message Header/UIB.......................................................................................... 20
Relates To Message ID...................................................................................................... 20
Phone Number .................................................................................................................. 21
Interactive Message Header Segment................................................................................ 22
RES Response Segment ................................................................................................ 22
PVD Prescriber Segment ................................................................................................ 25
PVD Facility Segment ..................................................................................................... 26
PVD Pharmacy Segment ................................................................................................ 26
PTT Patient Segment...................................................................................................... 26
DRU-Drug Segment ........................................................................................................... 27
Message Linkage ........................................................................................................... 30
Refill Renewal Processing ................................................................................................. 30

PAGE 5
Table of Contents

PAGE 6
Overview
SECTION 1
OVERVIEW
DOCUMENT PURPOSE
This document presents Application Certification Requirements for Surescripts
participants. The audience for this document includes the participants
development, business analyst, product managers and implementation staff, and
representatives of the Surescripts implementation and certification staff.
The Application Certification Requirements are a set of additional requirements
above those mandated in the Surescripts Prescription Routing 10.6
Implementation Guide.
All of the application certification requirements must be met in order for a
participant to access the Surescripts production network.
DOCUMENT REFERENCES
The following documents were referenced in creating these application certification
requirements.
Document Title
Surescripts Prescription Routing 10.6 Implementation Guide.

PAGE 7
Overview

PAGE 8
SECTION 2
General Data Format Requirements
GENERAL DATA FORMAT REQUIREMENTS
PRESCRIPTION ROUTING GENERAL

2.1
The following application certification requirements apply to all prescription routing

message types.
1). Electronic transactions shall*106R-001 not be re-entered into an electronic system
in their entirety (for example, reducing to paper and rekeying into a system).
2). The application shall*106R-002 alert the user when a given field in the application
allows for more characters than the standard transaction allows for that data
element. For example some legacy applications might support a first name of
50 characters, while the NCPDP SCRIPT standard only allows for a first name
of 35 characters. The application shall*106R-003 not truncate data without user
knowledge.
3).The application shall*106R-004 provide differentiation of all new messages that
require user attention.
4). The participant shall*106R-006 be able to process incoming, syntactically valid
maximum and minimum population messages. Optional data elements (and
values therein) shall*106R-007 not cause message failure.
5). When a field is not sent, it shall*106R-155 not be defaulted to display 0.
DRUG DATABASE
1). The participant shall*106R-008 implement and maintain a comprehensive,
industry-accepted drug information source that is map-able to NDC drug codes
and updated at least monthly. Acceptable data sources include the following:
*CliniDATA (for Routing Only see Note below)

Drug Information Technologies (DIT)
First Databank
Gold Standard Drug Database (GSDD)
Lexi-Comp
Multum
Medispan
*RxNorm (for Routing Only see Note below)
Thomson Reuters Micromedex/RED BOOK
Or others as approved by Surescripts

PAGE 9
Note: Use of Routing only approved databases for Prescription Routing.

- Routing-only databases are Surescripts approved sources for medication description
information as defined in the item description data element of the NCPDP standard and
for NDCs for the purposes of Surescripts prescription routing implementation and
certification.
Routing-only databases do not currently contain all of the required data attributes that are
necessary for a participant to successfully meet and pass the Surescripts formulary benefit
data integration and application display certification requirements. Surescripts will not
grant any exceptions to participants on the prescription benefits requirements to support
one of the comprehensive, industry-accepted drug information sources. For drug
databases not on the Surescripts approved Drug Knowledgebase Vendor list, there is a
formal process in place to review and approve new Drug Knowledgebase Vendors. The
Surescripts Compliance department manages this process.
2). The drug name shall*106R-009 be an item that is currently available for dispensing
in the marketplace. Participants are expected to work with their drug database
vendor to satisfy this requirement.
COMMUNICATION RULES
All participants shall*106R-011 be able to accept freestanding ERROR messages
from network participants and transport down to the end users (if error requires
end user notification or action).
DETAILED PRESCRIPTION ROUTING TRANSACTION W ORKFLOW

Participants shall*106R-012 support the scenarios in section 3.4 of the Prescription
Routing guide.
Note: Where the Status transaction is used, the status type code can be either 000
Transmission successful or 010 Successfully accepted by ultimate receiver.
The 000 indicates that there could be an Error or Verify forthcoming. If an Error or
Verify is not received following a Status 000, then no assumptions should be
made on whether the message has been received successfully or not. The 010
indicates that no further transactions will follow. An Error, Status (Code 010) or
Verify shall*106R-013 always be sent to close the transaction workflow. If a
transaction workflow has already been closed and an error occurs, a message
should not be sent, rather a manual process should be followed.
An Error message shall*106R-014 never be responded to with an Error message;
this could create an endless loop.
A Status message with a code of 010 may not be responded to; it shall*106R-072 be
considered the final message (similar to the Verify).

PAGE 10
EPCS PHARMACY
Pharmacy applications shall*106R-184 incorporate a prominent visual indication to
pharmacy personnel on the pharmacy practice management system display that
the e-prescription they are viewing is either DEA compliant, Non-DEA Compliant,
or both as described below.
1). Pharmacy system informs pharmacist that the EPCS is DEA compliant and
that if seal of approval is not on the EPCS, the pharmacist knows it is nonDEA compliant.
2). Pharmacy system alerts pharmacist when an EPCS is non-DEA compliant,
3). Pharmacy system does *both* (1) and (2).
Examples of possible indications include:
A statement on the display such as: This prescription meets the

requirements of the Drug Enforcement Administrations electronic prescribing
for controlled substances rules (21 CFR Parts 1300, 1304, 1306, & 1311).
A statement on the display such as: This prescription DOES NOT meet the
requirements of the Drug Enforcement Administrations electronic prescribing
for controlled substances rules (21 CFR Parts 1300, 1304, 1306, & 1311).
A seal-of-approval icon or symbol that incorporates in its design, language
such as Authentic EPCS received via DEA-approved processes.
A seal-of-disapproval icon or symbol that incorporates in its design language
such as NON-Authentic EPCS.
Other similar, unmistakable visual indications that vendors might devise.
UTC TIME FORMAT

All date times shall*106R-015 be using Coordinated Universal Time (UTC) time.
The UTC time shall*106R-016 be synched with NIST (National Institute of Standards
and Technology). (Drift of no more than one minute will be acceptable.)
EDIFACT TRIMMING
All non-essential characters shall*106R-018 be suppressed from the message where
permissible (see EDIFACT Representation in the Prescription Routing
Implementation Guide). Non-essential characters include leading spaces, trailing
spaces, leading zeroes, and trailing zeroes where permissible (see Numeric
Representation in the Prescription Routing Implementation Guide).
The length of SCRIPT message can be optimized in several ways:
Empty segments should not be transmitted.

PAGE 11
Depending on the trading partner and the message, not all data elements
will be utilized. All data elements within a segment after the last data
element used may be dropped.
Although SCRIPT messages can be trimmed in several ways, software systems

shall*106R-019 not assume that a trading partner would always trim. The systems
shall*106R-020 be capable of properly interpreting a full-length message. If a data
element is unused, it may be omitted; however, the data element separator
character must be used to hold the place of the data element. SCRIPT messages
do not contain field identifiers; therefore, all data elements (up to the segment trim
point) must be accounted for with separator characters.
Example:
In the following example, a colon : is used to simulate a data element separator
character. A single quote represents the segment terminator. These two
characters are used for illustrative purposes only. In an actual transmission, the
terminators are unprintable characters.
Using all data elements: 771011:30:ML:456
Omitting 2 data elements: 771011:::456
Trimmed last element: 771011:30:ML
NUMERIC REPRESENTATION
The decimal point is represented by a period and shall*106R-017 be used as follows:
only when there are significant digits to the right of the decimal
when there is a digit before and after the decimal point
not with whole numbers
not to be counted towards the length total of a data element (only for
EDIFACT) This only applies to the quantity field in the DRU segment
DRU-020-02.
For example, consider the following possible values:

Correct:
2.515
251.5
25.15
Incorrect:
.2515
2515.
3.00
2515
0.2515

2.5
PAGE 12
XML ESCAPE CHARACTERS

Participant shall*106R-021 not send empty elements within XML messaging. The
exceptions to this rule are on response messages:
Refill Renewal Response - <Approved/> or <ApprovedWithChanges/>

Rx Change and Rx Cancel Response - <Approved/>
All non-essential characters shall*106R-018 be suppressed from the message where

permissible (see EDIFACT Representation above). Non-essential characters
include leading spaces, trailing spaces, leading zeroes, and trailing zeroes where
permissible (see Numeric Representation above).
Most symbols should be safe within most alphanumeric fields; however, XML
validation has issues with some characters, such as less than (<) and
ampersand (&); therefore, these symbols shall*106R-146 be properly escaped or unescaped. The most common escape encodings are:
ASCII Characters
XML Escape
quote (")
"
apostrophe (')
'
ampersand (&)
&
less than (<)
<
greater than (>)
>
Note: String lengths are calculated based on the un-escaped value. For example, >98 degrees
should be encoded as >98 degrees but it would only be counted as a string length of
11, not 14. The quote and apostrophe only need to be escaped if they are used within an
attribute.

PAGE 13

PAGE 14
Message Requirements
SECTION 3
MESSAGE REQUIREMENTS
NEW RX PRESCRIBER
1). For all data entry fields, (including required and optional), what the user
enters/selects throughout the prescription writing process is what shall*106R-027
be sent in the message. (Exception to this rule includes fields that require
mapping e.g. Potency unit code).
The application shall*106R-028 not default to a value equal to zero if the user
left the field blank - the field shall*106R-029 not be sent. The only exception
to this rule is the number of refills on a New Rx.
If no data is to be sent, the application shall*106R-030 not display a value
equal to zero.
2). The application shall*106R-031 allow prescriptions to be routed to the pharmacy of

the patients choice.
3). For pharmacy search features:
The application shall*106R-032 allow a pharmacy search based on pharmacy

type (mail/retail).
When the user does not specify a pharmacy type, the application
shall*106R-033 not filter out mail order pharmacy types when a pharmacy
search by geography is performed.
At a minimum, the application shall*106R-034 display the following pharmacy
information in the pharmacy search results: Pharmacy Name, Street
Address, City, State, Zip code, phone number, and pharmacy type (long
term care, mail order, retail, specialty).
4). Prescriber vendors shall*106R-035 display a summary screen in order to allow the
prescriber to review the prescription and ensure that it contains the correct
information before it is sent to the pharmacy. The prescriber shall*106R-036 be
able to edit and/or cancel the prescription after reviewing it on the summary
screen.
All of the following clinically significant fields going into the message
shall*106R-037 be displayed on the summary screen as it will be sent in the
message. Note: The code value for codified fields does not have to be
displayed, only the description.
Patient first and last name, gender and DOB. Additional information such
as address and phone number is encouraged. Drug description (Full drug
name, strength, and dosage form), quantity/Potency Unit Code
Description, directions, notes, refills value or PRN, substitution or
Dispensed as Written (DAW), and date written.

PAGE 15
Note: If creating the directions from various dropdowns, the information shall*106R-038 be
concatenated into one string of text and displayed, including any translation, exactly as it
will be sent in the message.
When the application supports these data points, the summary screen
shall*106R-039 also display: days supply, diagnosis, prior authorization
number and prior authorization status, if populated.
Pharmacy name, address, and phone
Prescriber name and phone
Some applications include internal or application specific items (i.e.
start/stop date). It shall*106R-040 be clear to the prescriber what data
elements will be sent to the pharmacy in a New Rx and what elements
are for internal/local use. Any element that is not sent with the transaction
shall*106R-041 be labelled For internal use only on the summary screen, so
the prescriber knows that information will not be sent with the message.
5). If the above content (106R-037 through 106R-041) does not fit into one
summary display, an alternative technique can be offered such that the
prescriber shall*106R-043 review all the content before sending the prescription.
6). Prescriber vendors who are utilizing or are in the process of certifying on the
Surescripts Prescription Benefits 270/271 transactions shall*106R-068 populate
the following in the New Rx transaction with information returned in a
Surescripts 271 transaction:
In the Coordination of Benefits Segment (COO), the prescriber

shall*106R-188 populate the value contained in the related 271 transactions
ISA13 field in to the New Rx (see COO-010-01) and specify that the value
is mutually defined (see COO-010-02). For patients with more than one
active coverage, the prescriber vendor shall*106R-148 only populate one
COO loop where the segment shall*106R-149 contain the benefit information
the prescriber utilized to write the prescription.
Note: The XML tag relating to COO-010-02 is <MutuallyDefined>.
In the Patient Segment, populate the patients PBM Unique Member ID

(see PTT-050-02). For patients with more than one active coverage, the
prescriber vendor shall*106R-150, when available, only use the PBM Unique
Member ID associated with the coverage that is utilized to write the
prescription.
Additionally, when the patient is eligible for pharmacy benefit:
Prescriber vendors shall*106R-147 populate, when available, the fields in the

COO segment, along with any data elements returned in the 271 that
map to corresponding data fields in the COO segment.
7). When a prescriber attempts to enter a prescription for a controlled substance

and is NOT authorized to send EPCS messages, the application shall*106R-169
direct the prescriber to a non-EDI workflow.

PAGE 16
Non-EDI Workflow for Controlled Substance Prescribing

Please reference local state rules and the DEAs Practitioners Manual section on
Valid Prescription Requirements, which can be found at:
http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm.
NEWRX PHARMACY REQUIREMENTS

1). When receiving a New Rx, at a minimum, the pharmacy application
shall*106R-044 display the following in its entirety to the pharmacist:
Drug name, drug strength, dosage form (as one string from the drug
description field(s)), quantity and potency unit code description,
directions, substitutions (allowed or dispensed as written), and number of
refills.
When the application receives these data points the screen shall*106R-045
also display: days supply, notes, and diagnosis, if populated.
Patient last name, first name, date of birth, and gender.
Prescriber last name, first name, NPI, and/or DEA.
2). Participant shall*106R-160 not reject incoming prescription routing messages due
to lack of appropriate entries within the participants local directories.
REFILL RENEWAL PRESCRIBER REQUIREMENTS

1). The application shall*106R-048 support each Refill Renewal Response status type
(Approved, Approved with Changes, Denied, Denied New Rx to Follow (DNTF).
The DNTF workflow is not for application limitations. Meaning, if the prescriber
application receives a Refill Renewal Request, the application shall*106R-049 not
create a DNTF because of internal workflow limitations (i.e., an optional field
like DaysSupply is not sent in the Refill Renewal Request and the application
requires it).
In a Refill Renewal Approved/Approved with Changes Response, there
shall*106R-050 be a non-zero value sent for the refill quantity. Denied and DNTF
Refill renewal response shall*106R-051 have refill quantity 0.
2). When a refill response is approved for 2 refills with qualifier A, it shall*106R-053 be
interpreted as 2 refills only (1 current dispense + 1 refill). To ensure proper refill
dispensing, prescribing vendors shall*106R-052 adhere to the following display
requirements:
The refills field as "Total number of dispensings approved: _______". In

this case the number the prescriber enters in the blank field shall*106R-055
be considered as the total number (current dispense + refills) and
shall*106R-056 be sent directly in the Refills field in the Refill Renewal
Response message.

PAGE 17
If, however, your Refill Renewal Response screen indicates the number
of refills approved (as opposed to number of dispensings) then the
display on the screen shall*106R-057 read: "total number of refills approved:
1 + _______". The '1' here indicates the current dispensing; the
prescriber will enter the additional refills approved in the blank field. In the
Refills field in your Refill Renewal Response message to the pharmacy
you will add one to the value input in the blank field and send it along.
If the screen only says "number of refills approved", then it either needs to
have clearer language, or some hint shall*106R-058 be given to the
physician so there can be no ambiguity.
3). When receiving a Refill Renewal Request, all the following fields shall*106R-059
be displayed, at a minimum, as received in its entirety to the end user to assist
in making the decision to accept or deny the request:
Patient first and last name, gender and DOB. Additional information such
as address and phone number is encouraged. Both the prescribed and
dispensed drug information as sent in the Refill Renewal request
shall*106R-060 be available for display including: Drug description (Full drug
name, strength, and dosage form), quantity/Potency Unit Code
Description, directions/sig, notes, refills value or PRN, substitution or
DAW, and date written.
When the application supports these data points, the screen shall*106R-061
also display: days supply, diagnosis, and prior authorization, if populated.
Pharmacy name, address, and phone
Prescriber name, address, and phone
If the above content does not fit into one screen view, an alternative technique can
be offered such that the prescriber shall*106R-063 have access to review all the
content before responding.
4). The prescriber order number shall*106R-064 be used as the first matching criteria
back to the original New Rx for which the Refill Renewal Request is being sent.
If the prescriber order number matches that of the original New Rx, the system
shall*106R-177 allow the user to visually confirm that the patient demographics are
accurate. The patient first name, last name, and date of birth should be used as
the second set of matching criteria back to the original New Rx for which the
Refill Renewal Request is being sent. An automatic Refill Renewal Response
for Refill Renewal Requests shall*106R-178 never be sent back to the pharmacy.
User review and approval/denial of the Refill Renewal Response shall*106R-179
always be required. Note: the exception to this requirement is for a participant
that does not support CP/SP (Compounds/Supplies).
5). Refill Renewal Response Free text cannot be modified in the DRU Segment:
All information on the Refill Renewal Request shall*106R-065 be echoed back on
the response except for fields defined in Section 6.6, RES Response Segment.

PAGE 18
6). For a controlled substance:
If the prescriber, who is NOT authorized to send EPCS messages, denies

the Refill Renewal Request for the controlled substance, the Refill
Renewal Response shall*106R-170 be sent electronically to the pharmacy
with the appropriate denial information, just like denials for any noncontrolled Refill Renewal Request.
If the prescriber, who is NOT authorized to send EPCS messages,
approves the Refill Renewal Request for the controlled substance, the
application shall*106R-171, on the back-end, send to the pharmacy a Refill
Renewal Response with a Denied New Prescription To Follow status
along with a note in the Denied Response segment (RES-040 or
<DenialReason>) stating: Prescriber system cannot transmit approved
controlled e prescription.
The application shall*106R-172 then direct the prescriber to a non-EDI
workflow. On a printed prescription there shall*106R-173 be an indication that
this is in response to an electronic refill renewal request for a controlled
substance. The appropriate RxReferenceNumber from the original Refill
Renewal Request shall*106R-174 be included on the printed prescription.
Non-EDI Workflow for Controlled Substance Prescribing

Please reference local state rules and the DEAs Practitioners Manual section on
Valid Prescription Requirements, which can be found at:
http://www.deadiversion.usdoj.gov/pubs/manuals/pract/section5.htm
REFILL RENEWAL PHARMACY

1). The pharmacy shall*106R-066 display the following fields in the Refill Renewal
Response:
Response type Denied/Denied New Prescription to

Follow/Approved/Approved with changes
Refill Qty (except for denied)
Free Text Denial Reason or Free Text Note
Denial Reason Code Description, when present
2). When the application receives the following data points, the screen shall*106R-067
also display:
Days Supply
Diagnosis
Prescriber Agent
3). When sending a Refill Renewal Request, the pharmacy shall*106R-162 send the
Refill Renewal Request to the appropriate prescriber location when the
prescriber has more than one SPI in the Surescripts directories. Pharmacies

PAGE 19
need to use all prescriber directory information provided to match at the

appropriate location level.
4). For all data entry fields (including required and optional), what the user
enters/selects throughout the Refill Renewal process is what shall*106R-163 be
sent in the message. (Exception to this rule is fields that require mapping e.g.
Potency unit code).
The application shall*106R-028 not default to a value equal to zero if the user
left the field blank; the field shall*106R-029 not be sent.
If no data is to be sent, the application shall*106R-030 not display a value
equal to zero.
5). The Written Date shall*106R-186 be populated in the Refill Renewal Request, in
both the Medication Prescribed and Medication Dispensed loops, with the
Written Date of the New Rx.
COMMON MESSAGE HEADER/UIB

For EDIFACT users: The fields in the XML header shall*106R-023 match those in the
EDIFACT UIB Header
<MessageID>
Each message sent from a participant, including Error and Status, shall*106R-024
have a unique Message ID.
<SentTime>
The date and time the message was sent. Shall*106R-026 be sent in UTC coordinates
only.
RELATES TO MESSAGE ID
Message ID
M/C
Description/Comments
New Rx
Set by the prescriber if the New Rx is a follow-up message to a

previously sent Denied New to Follow Refill Renewal Response. The
106R-076
value shall*
be set to the MessageID of that Refill Renewal
Response. This will help the pharmacy close the business
transaction started with a Refill Renewal Request.
Refill Renewal
Request
If the Refill Renewal Request is being made for a prescription that

was previously created from an electronic transaction (could have
been a New Rx, Refill Renewal Response Approved or Approved
with Changes or Rx Change Response Approved or Approved With
106R-077
Changes), the pharmacy shall*
set the value to the
MessageID of that transaction. This will help the prescriber link the
request to a previously approved transaction.
Refill Response
Shall*
always be set to the MessageID of the corresponding
Refill Renewal Request being responded to.
106R-078

PAGE 20
Message ID
M/C
Description/Comments
Rx Change
Request
If the Rx Change Request is being made for a prescription that was

previously created from an electronic transaction (a New Rx, Refill
Renewal Request Approved or Approved with Changes or Rx
Change Response Approved or Approved With Changes), the
106R-079
pharmacy shall*
set the value to the MessageID of that
transaction. This will help the prescriber link the request to a
previously approved transaction.
Rx Change
Response
Shall*
Rx Change Request being responded to.
Rx Cancel
Request
If the Rx Cancel Request is being made for a prescription that was

previously created from an electronic transaction (a New Rx, Refill
Renewal Request Approved or Approved With Changes or Rx
Change Response Approved or Approved With Changes), the
106R-081
prescriber shall*
set the value to the MessageID of that
transaction. This will help the pharmacy link the request to a
previously approved transaction and cancel the correct prescription.
Rx Cancel
Response
Shall*
Rx Cancel Request being responded to.
RxFill
If the Rx Fill is being sent for a prescription that was previously

created from an electronic transaction (a New Rx, Refill Renewal
Request Approved or Approved With Changes or Rx Change
Response Approved or Approved With Changes), the pharmacy
106R-083
shall*
set the value to the MessageID of that transaction. This
will help the prescriber link the RxFill to a previously approved
transaction. Surescripts does not support this message.
Resupply
If the Resupply is being made for a prescription that was previously

created from an electronic transaction (a New Rx), the facility
106R-084
set the value to the MessageID of that transaction. This
shall*
will help the pharmacy link the request to a previously approved
transaction. Surescripts does not support this message.
Status
Shall*
transaction being acknowledged.
Verify
Shall*
transaction being acknowledged.
Error
Shall*
transaction being errored.
106R-080
106R-082
106R-085
106R-086
106R-087
PHONE NUMBER
PVD-090-01 Communication Number <Number>
PTT-070-01 Communication Number <Number>
Phone Number shall*106R-104 be in the format 5552223333X4444 - where 555 is the
area code, 2223333 is the main number and X4444 is the extension. Shall*106R-105
not be populated with all zeros or other default values. (Please note this extension
is just an example. Less/more than four digits is allowed).

PAGE 21
INTERACTIVE MESSAGE HEADER SEGMENT

UIH-020 Message Reference Number <RxReferenceNumber>
For a New Rx, shall*106R-088 be left blank except when creating New Rx in response
to a denied Refill Renewal Request, (i.e. Denied with New Rx to follow), prescriber
system shall*106R-089 populate New Rx with the RxReference number from the
original Refill Renewal Request.
On a Refill Renewal Response the value from the Refill Renewal Request
shall*106R-154 be echoed back.
UIH-030-01 Initiator Control reference <PrescriberOrderNumber>
Sender of New Rx, Refill Renewal Response, and Rx Change Response
shall*106R-091 populate this field with the number assigned by their system.
Senders of Refill Renewal Request, Rx Change Request, Fill Status and Cancel
Rx Response shall*106R-092 echo back the value provided by the prescribing system
on any message relating to the Rx in question.
On an Approved or Approved with Changes Refill Renewal Response, the
prescriber shall*106R-093 create a new Prescriber Order Number.
RES RESPONSE SEGMENT

RES-010 RESPONSE TYPE <Approved><Denied>,
<DeniedNewPrescriptionToFollow>, <ApprovedWithChanges>
The pharmacy shall*106R-096 accept the code sent in a Refill Renewal Response
and display its translation along with any denial reason when presenting the Refill
Renewal Response to the pharmacist. See Section 5.2.9 Refill Renewal Pharmacy
Certification Requirements for more information.
When sending a Refill Renewal Response, the prescriber shall*106R-095 follow the
rules below to determine the type of response as Approved, Approved with
Changes, Denied, or Denied New to Follow. These rules apply to both the
prescribed and dispensed medication segments. Items not listed here are
expected to be echoed back in REFRES; e.g. phone numbers, Prior Auth Status.
This rule does exclude items that are mentioned in the common message header,
UIH and UIB per the guide.
On an EPCS Refill Renewal Response transaction, either the Digital Signature
block in the Common Message Header area or SI drug coverage status code
indicator (DRU-110) shall*106R-181 be included.

PAGE 22
A = Approved
The only fields that can be updated on an approved status type Refill
Renewal Response are:
Refills Qualifier (DRU-060-01) Update from P to A.
Number of refills (DRU-60-02) - When a refill value is not specified in the
Refill Renewal Request the number must be updated to a value of 1 or
more. Otherwise, return the exact value that was in Refill Renewal
Request.
Date Written (DRU-040) Update the Written Date per requirement
106R-125.
Since the structured SIG segment is optionally supported, if sent on a Refill

Renewal Request it does not need to be sent back on a Refill Renewal Response.
The pharmacy will instead use the Directions (DRU-030) from the medication
segment.
Since the facility segment is optionally supported, if sent on a Refill Renewal
Request, it does not need to be sent back on a Refill Renewal Response.
If any other items need to be added or changed, the Approved with Changes or
the Denied New to Follow status type Refill Renewal Response should be used
instead. See Approved with Changes or the Denied New to Follow status types for
more information.
C = Approved With Changes
The only fields that can be added or updated on an Approved with Changes status
type Refill Renewal Response are:
Prescriber NPI (PVD-020-01) Add or update value when appropriate.

DEA# or SSN (only one or the other may be used on a EPCS per the
DEA IFR):
DEA# (PVD-020-01) Add or update value when appropriate.
SSN (PVD-020-01) with the military specialty ID (PVD-040-03) - Add or
update values when appropriate.
Prescribing Agent (PVD-100) Add or update composite when
appropriate. (The composite is defined as the sub elements under the
parent element (PVD-100)).
Prescriber Address (PVD-080) Add or update composite when
appropriate.
Supervisor Segment (PVD SU) Add or update segment when
appropriate.
Number of refills (DRU-060-02) Change to a non-zero value that differs
from the value that was sent in Refill Renewal Request. Otherwise, return
the exact value that was in Refill Renewal Request.

PAGE 23
Date Written (DRU-040) - Update the Written Date per requirement

106R-125.
NDC# (DRU-010-03) - When value specified in Refill Renewal Request is
not a NDC-11 formatted value or value is not present, add or update
value to a NDC-11. Otherwise, return the exact value that was in Refill
Renewal Request. (This is required for translations from older versions.)
Diagnosis (DRU-070) Add or update composite to prescriber inferred
information when appropriate.
Prior Authorization (DRU-080) Add or update composite when
appropriate.
Drug Use Evaluation (DRU-100) Add or update composite when
appropriate.
Observation Segment (OBS) add or update segment when appropriate.
Since the structured SIG segment is optionally supported, if sent on a Refill

The pharmacy will instead use the Directions (DRU-030) from the medication
segment.
If any other items need to be added or updated, the Denied New To Follow status
type Refill Renewal Response shall*106R-097 be used, where edits will be conveyed
to the pharmacy via the separate New Rx prescription.
D = Denied and N = New Prescription To Follow
The only fields that can be added or updated on a Denied or Denied New
Prescription To Follow status type Refill Renewal Response are:
Required to be updated:

Number of refills (DRU-60-02) Add or update to zero per requirement
106R-132
.
Optional to update:
Prescriber NPI (PVD-020-01) Add or update value when appropriate.

DEA# or SSN (only one or the other may be used on a EPCS per the
DEA IFR):
o DEA# (PVD-020-01) Add or update value when appropriate.
o SSN (PVD-020-01) with the military specialty ID (PVD-040-03) - Add
or update values when appropriate.
Prescribing Agent (PVD-100) Add or update composite when
appropriate.

PAGE 24
Prescriber Address (PVD-080) Add or update composite when

appropriate.
Supervisor Segment (PVD-010 value: SU) Add or update segment
when appropriate.
Date Written (DRU-040) - Update the Written Date is permitted.
NDC# (DRU-010-03) - When value specified in Refill Renewal Request is
not an NDC-11 formatted value or value is not present, add or update
value to a NDC-11. Otherwise, return the exact value that was in Refill
Renewal Request. (This is required for translations from older versions.)
Diagnosis (DRU-070) Add or update composite to prescriber inferred
information when appropriate.
Prior Authorization (DRU-080) Add or update composite when
appropriate.
Drug Use Evaluation (DRU-100) Add or update composite when
appropriate.
Observation Segment (OBS) add or update segment when appropriate.
Since the structured SIG segment is optionally supported if sent on a Refill

If the prescriber is sending a Denied New Prescription To Follow Refill Request
Response, the following New Rx shall*106R-168 be sent to the same pharmacy that
initiated the request. If the pharmacy needs to be changed, the prescriber
shall*106R-182 send a Denied Refill Request Response and send a new NewRx to
the desired pharmacy.
C = Approved with changes. This code shall*106R-099 not be utilized for a prior
authorization or generic substitution of an Rx Change Request. The fields
listed above for approved with changes on a Refill Renewal Response may
also need to be added for the Rx Change Response for a controlled
substance.
PVD PRESCRIBER SEGMENT

PVD-020 REFERENCE NUMBER <Identification>
For all other message types except the RxFill the prescriber NPI shall*106R-100 be
sent if available.
The DEA number shall*106R-101 be formatted as a 9 character field if the suffix is
also sent it must be preceded by a dash. Only one DEA number for the location
where the prescriber is located should be sent.

PAGE 25
If used, the Drug Abuse Treatment ID shall*106R-102 be placed in the Drug Notes
field.
PVD-080 ADDRESS <Address>
For New Rx, this address shall*106R-176 match what is in the directory for this
prescriber.
PVD-080-01 Street and Number/PO Box <AddressLine1>
PO Box information shall*106R-103 not be sent in this field.
(See Phone Numbers above for Communication Number requirement.)
PVD FACILITY SEGMENT

PVD-080-01 Street and Number/PO Box <AddressLine1>
(See Phone Numbers section above for Communication Number requirement.)
PVD PHARMACY SEGMENT

PVD-020-02 Reference Qualifier
For the pharmacy-initiated messages (Renewal Request, Change Request, and
RxFIll), the pharmacy NPI is required. For all other message types, the pharmacy
NPI shall*106R-109 be sent if available.
PVD-080-01 Street and Number/PO Box <Address>
(See Phone Number section above for Communication Number requirement.)
PTT PATIENT SEGMENT

PTT-050-01 Reference Number <Identification>
If the PBM Unique Member ID is greater than 35 characters, then the first loop of
the PTT-050-01 shall*106R-166 contain the first 35 characters and the second loop
shall contain the remaining characters.
(See Phone Number section above for Communication Number requirement.)

PAGE 26
DRU-DRUG SEGMENT
DRU-010-02 Item Description <DrugDescription>
The item or drug description field shall*106R-116 include the full drug name, strength
and form (in that exact sequence).
Shall*106R-117 communicate 1 and only 1 medication unless this is a compound.
If the data for single medications as well as compounds does not fit within the drug
description field, the prescription shall*106R-161 not be sent electronically.
When entering a prescription that is free text, such as a compound, the prescriber
shall* 106R-185 be prompted to confirm that the prescription is not for a controlled
substance.
DRU-010-03 Item Number <DrugCoded.ProductCode>
When sending, the NDC must be an 11 digit NDC in the 5-4-2 format. Dashes
shall*106R-118 not be used and leading zeros shall*106R-119 NOT be suppressed.
Example: 12345123412. If this is not a compound or supply as indicated in (DRU110), then the NDC is required when sending 10.6; however, receivers of 10.6
messages cannot expect this information to always be present due to translation
from lower SCRIPT versions on the network.
For New Rx, a representative NDC shall*106R-120 be sent if the product has an NDC.
For Refill Renewal Requests and other outbound pharmacy messages to
prescribers, the NDC shall*106R-156 be sent if the product has an NDC. NDC (and
qualifier; see 010-04) shall*106R-157 be echoed back in Refill Renewal Response.
The exception to this rule is if the NDC in the request is not an NDC11. See
section on approved with changes RES-010.
DRU-010-06 Free Text <DrugCoded.Strength>
If either or both the Drug Coded Strength (DRU-010-06) and the Strength Code
(DRU-010-16) are sent they shall* 106R-152 match the Drug Strength in the Drug
Name Description field (DRU-010-02). Example of improper use: The drug name
description is Amoxicillin 500 mg oral capsule and the drug coded strength field
contains the value of 250 instead of 500.
DRU-010-14 Item Form Code <FormCode>
If sent, the Form Code shall*106R-153 match the drug form in the Drug Description
field. Example of improper use: The drug description is Amoxicillin 500 mg oral
capsule and the strength code field contains the value of C42998 for tablet
instead of C25158 for capsule.

PAGE 27
DRU-010-16 Item Strength Code <StrengthCode>

If either or both the Drug Coded Strength (DRU-010-06) and the Strength Code
(DRU-010-16) are sent, they shall*106R-152 match the Drug Strength in the Drug
Name Description field (DRU-010-02). Example of improper use: The drug name
description is Amoxicillin 500 mg oral capsule and the Strength Code contains
C28254 Milliliter instead of C28253 Milligram.
DRU-010-17 DEA Schedule <DEASchedule>
If a compound drug is sent and one of the ingredients is a known controlled
substance, this field shall*106R-183 be sent.
For non-fillable messages (Renewal Request, Change Request, Cancel, RxFill), if
the medication is categorized as a controlled substance by the DEA, this field
shall*106R-167 be sent.
DRU-020-02 Quantity <Value>
Medication quantity shall*106R-121 not be zero unless the message is for Long Term
Care.
On the New Rx and Refill Renewal Request medication quantity field, the
application shall*106R-122 support a decimal point and up to at least 3 digits to the
right of decimal.
DRU-020-05 Potency Unit Code <PotencyUnitCode>
Potency Unit/Quantity Qualifiers shall*106R-158 be correctly associated with drug
descriptions.
DRU-030-02 Dosage <Directions>
If the SIG is over 140 characters the end users shall*106R-151 send the prescription
to the pharmacy by another means such as fax or printing the prescription out and
handing to the patient; rather than populating the additional SIG information in the
Free Text/Notes field.
DRU-040-01 Date/Time period qualifier <DaysSupply>, <WrittenDate>,
<LastFillDate>, <ExpirationDate>, <EffictiveDate>, <PeriodEnd>,
<DeliveredOnDate>, <DateValidated>, <SoldDate>
The Written Date shall*106R-125 be populated in the approved Refill Renewal
Response with the date of approval, i.e. date of response, on the drug prescribed
and dispensed.
DRU-050 PRODUCT/SERVICE SUBSTITUTION, CODED <Substitutions>
The application shall*106R-127 not default the substitution code to DAW (code of 1).
Rather, the prescriber shall*106R-128 take action to set the substitution code to DAW
(code of 1).

PAGE 28
DRU-060-02 Quantity <Value>

No quantity is required for PRN. Quantity shall*106R-129 not be sent if PRN is used. If
P qualifier is used, refill quantity shall*106R-130 not be 0.
On a Refill Renewal Response with a Denied or Denied New prescription To
Follow, this value shall*106R-132 be set to 0.
For CS-II only one dispense event is permitted per the DEA IFR. This means on a
New Rx for a CS-II the refill value shall*106R-180 be equal to zero (0) and on an
Approved or Approved with Changes status type Refill Renewal Response for a
CS-II, the refill value shall*106R-164 be one (1).
Since there are no restrictions upon what a pharmacy may set this value to in a
Refill Renewal Request, prescriber vendors shall*106R-165 direct users to take the
following action on an Approved or Approved With Changes status type Refill
Renewal Response for a CS-II:
On the Refill Renewal Response, set the refill value to one (1).
If needed, direct the prescriber to send additional subsequent New Rx

prescription(s) where the refill value will be set to zero (0) and an effective
date will be set 30 days, 60, days, 90 days, etc. in the future.
DRU-090 FREE TEXT <Note>

For Refill Renewal Requests, if the GHB reason or NADEAN number need to be
sent to the pharmacy because they were not on the Refill Renewal Request, the
Refill Renewal Request shall*106R-133 be denied using the Denied New To Follow
response code. Then the following New Rx should contain the GHB reason or
NADEAN number in this field.
On a New Rx, the notes going into the message shall*106R-134 be labelled as Notes
to Pharmacist or something similar on the user screen. It shall*106R-187 be clear that
data passed in the 210 character Notes field will not be shared with the patient.
Prescription information that has a designated, standardized data field within the
NCPDP script standard shall*106R-175 not be entered into the Notes to Pharmacist
field. Some Examples: SIG, Effective Date, Drug Name, Strength, or Quantity.
Refill Qualifiers
A = Additional Refills Authorized
A implies no Original Dispensing in addition to the quantity specified in DRU-06002.
Example: If DRU-060-01 = A and DRU-060-02 = 3, the prescriber is authorizing
three dispensings. This value will appear in medication dispensed and prescribed
segment of the Refill Renewal Response messages. See Note, below.

PAGE 29
P = Pharmacy Requested Refills

Because DRU-060 is not mandatory, a pharmacy may submit a Refill Renewal
Request without requesting a particular number of refills by omitting DRU-060. If a
pharmacy wishes to request a specific number of refills, it shall*106R-135 submit "P"
and the desired number of refills in field DRU-060-02 Quantity. If the pharmacy
wishes to request additional refills without specifying how many, composite data
element DRU-060 shall*106R-136 be omitted completely. If "P" is used, the number of
refills requested shall*106R-137 not be zero.
Example: If DRU-060-01 = P and DRU-060-02 = 3, the pharmacy is requesting
three dispensings.
Note: A pharmacy receiving a Refill Renewal Response may implement the dispensings
authorized pursuant to the Refill Renewal Response in accordance with applicable laws
and regulations, and its own practices. Thus, if a Refill Renewal Response authorizes four
dispensings, the pharmacy may:
- Generate a new prescription with an original dispensing and three refills
Or
- Add four refills to an existing prescription
Using Long Drug Names

If the 35 characters are not sufficient for the drug name, strength, and dosage
form, elements 10-12 are to be used sequentially. The three fields shall*106R-138
result in the concatenation of the full drug name, strength, and dosage form, using
as many of the bytes necessary of the 35 times 3 fields. DRU-010-02 should
contain the first 35 characters of the long drug name. The information shall* 106R-139
begin in elements 010-10 Item Description and continue to 010-11 Item
Description for as many bytes are needed and if necessary continue to 010-12
Item Description for as many bytes are needed up to the 35 length.
MESSAGE LINKAGE
The Message Linkage of the Routing Guide shall*106R-144 be followed by all
participants. Please refer to the Message Linkage section in the Surescripts
Prescription Routing Implementation Guide for examples.
REFILL RENEWAL PROCESSING

On the Refill Renewal Response the prescriber shall*106R-145 use both the
prescribed and dispensed medication loops to indicate the number of refills
approved.

PAGE 30

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PRESCRIPTION ROUTING 10.

Date: May 1, 2013

PRESCRIPTION ROUTING 10.6 APPLICATION CERTIFICATION REQUIREMENTS

FOR SECTIONS OF THIS PARTICIPANT IMPLEMENTATION GUIDE

Document Change Log

The requirements were removed from the Prescription Routing

LAST PUBLISHED 5/1/2013

COPYRIGHT 2013 BY S URESCRIPTS, LLC.

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LAST PUBLISHED 5/1/2013

COPYRIGHT 2013 BY S URESCRIPTS, LLC.