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This includes drugs such as: Nonprescription drugs Medications used for anorexia, weight loss, or gain Medications used to promote fertility Drugs used for cosmetic purposes Medications used for symptomatic relief of colds and cough Drugs when used for the treatment of sexual or erectile dysfunction Prescription vitamins and mineral products (excluding prenatal vitamins and fluoride preparations) Sometimes it can be difficult to know which drugs are excluded or restricted from coverage

Since EDI 835 ERA transaction data is the electronic transaction data from payers that provides claim payment information rather than the payer-specific negotiated charge for an item or service, we clarify that we would not expect, nor should hospitals use, EDI 835 ERA transaction data to encode their payer-specific negotiated charges

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