HTW Pharmacy Claims Submission
The pharmacy must submit claims with the values identified below. Refer to the Claims Billing (B1) Transaction payer sheets for specific transaction, segment, and field requirements.
| Field Name | Field Number | Submitted Value |
|---|---|---|
|
BIN Number |
101-A1 |
610084 |
|
Processor Control Number |
104-A4 |
DRTXPROD |
| Group ID | 301-C1 | MEDICAID |