STAR Health Pharmacy Claims Submission
Pharmacy claims using the DFPS number must be submitted with the values identified below. Refer to the Claims Billing (B1) Transaction for instructions and payer sheets.
| Field Name | Field Number | Submitted Value |
|---|---|---|
|
BIN Number |
101-A1 |
610084 |
|
Processor Control Number |
104-A4 |
DRTXPROD |
|
Group ID |
301-C1 |
MEDICAID |
|
Cardholder ID |
302-C2 |
16-digit DFPS number |
|
Prior Authorization Type Code |
461-EU |
8 |
|
Prior Authorization Number Submitted |
462-EV |
1027 |