Claims submitted by participating providers must include the following information:
Field | Information Required |
Carrier Code | NB |
Group Number or Code | Plan Identification Letter (see below) |
Patient 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 Date of Birth |
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) |
Drug | DIN or PIN |
Drug Cost | Please refer to Dispensing Fees and Drug Cost Reimbursement |
Mark-up | Please refer to Dispensing Fees and Drug Cost Reimbursement |
Dispensing Fee | Please refer to Dispensing Fees and Drug Cost Reimbursement |