The ZE1 Specification
If the "Example Contents" has a "^", then there are 2 pieces of data required
Field #, Name of field, Example Contents
0 Segment Name ZE1
1 Sequence Number Blank or a characters:A, 1, B, 2, ...
2 Data Hub Name RXHUB, WISHARD, etc
3 PBM Code & Name P00000000020062^Argus Health Systems
4 Formulary ID FSL105
5 Alt.Formulary ID ALT111
6 COPAY COP106
7 COVERAGE COV107
8 Drug Logistics ACTIVE^INACTIVE ie:{Retail}^{Mail-Order}
9 Insure.Group Id.
and Name B000000^HONEYWELL
10 Insure.Member Id. 111111110
11 PBM Patient Id B000000%111111110%001 Note: With "%"s, This is considered a complete Pat.Id.
12 Health Plan Number & Health Plan Name
PLAN123^CARRGRPNAME Note:Health Plan Number = REF-18-02, Health Plan Name = REF-18-03
Note: Wishard does not have one.
13 Eligibility Error [Med Hub error code]^[Med Hub error text]^RIMH^[message error code]^[error text we map]^Provider
14 History Error [Med Hub error code]^[Med Hub error text]^RIMH^[message error code]^[error text we map]^Provider
Note: There are 14 fields now, before there was 13. Alt.Formulary ID was moved from Formulary field to its own field.
Field 13 Example:
PB^The PBM returned an error^RIMH^67^Patient Not Found, Resubmission Not Allowed (NM1, IL)N^RxHub
Component 1: Med Hub error code = PB
Component 2: Med Hub error text = The PBM returned an error
Component 3: Med Hub Name = RIMH
Component 4: Message error code = 67
Component 5: Error text we map = Patient Not Found, Resubmission Not Allowed (NM1, IL)N
Component 6: Provider Name = RxHub
Good Message:
0 1 2 3 4 5 6 7 8 9 10 11 12
ZE1|B|RXHUB|P00000000020062^Argus Health Systems|FSL105|ALT111|COP106|COV107|ACTIVE^INACTIVE|B000000^HONEYWELL|111111110|B000000%111111110%001|PLAN123^CARRGRPNAME
Bad Message:
111 1
0 1 23456789012 3
ZE1|1|RXHUB|||||||||||PB^The PBM returned an error^RIMH^67^Patient Not Found, Resubmission Not Allowed (NM1, IL)N^RxHub|