Pharmacy Companion Guide
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
 Pharmacy Companion Guide (314 KB PDF)
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| Description | This guide details the HIPAA ASC X12N 004010 format structure for 835 Pharmacy Remittance Advice and provides information regarding electronic billing to the department via Provider Express billing (PEB) | |
| Detail | ||
| Form number | F245-400-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | 835, 835 Payment Advice, 835 Remittance Advice, Pharmacy Remittance Advice, Remittance Advice | |
| Languages | English | |
| Valid dates | 03-2007 | |
| Contact information |
Electronic Billing
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| Web pages | Electronic Billing | |
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