STANDARD DATA DICTIONARY #9002313.02 -- BPS CLAIMS FILE 3/24/25 PAGE 1
STORED IN ^BPSC( *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 1.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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Intermediate form of transmissions. Fields are stored in formatted form. Raw packet is also stored.
Most fields are in Free Text format to accommodate NCPDP Standard formatting criteria and required field lengths. Fields other
than those with decimals in the number correlate directly to the field numbers supplied in the NCPDP Data Dictionary.
While many of the fields in this file indicate coded values, they are NCPDP coded values preceded by the NCPDP field identifier to
be used in the NCPDP transmission. Example: Compound Code is either a 1 or 0. The NCPDP field identifier for 'Compound Code' is
'D6'. The field length is 3 thereby allowing the identifier for that field to be included in the data stored in that field. So,
'D61' is stored for that field.
Per VHA Directive 2004-038, this file definition should not be modified.
DD ACCESS: @
RD ACCESS: Pp
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
POINTED TO BY: BPS CLAIM field (#.01) of the BPS RESPONSES File (#9002313.03)
CLAIM field (#.03) of the BPS CERTIFICATION File (#9002313.31)
CLAIM field (#3) of the BPS LOG OF TRANSACTIONS File (#9002313.57)
REVERSAL CLAIM field (#401) of the BPS LOG OF TRANSACTIONS File (#9002313.57)
CLAIM field (#3) of the BPS TRANSACTION File (#9002313.59)
REVERSAL CLAIM field (#401) of the BPS TRANSACTION File (#9002313.59)
CROSS
REFERENCED BY: TRANSMIT FLAG(AD), TRANSMITTED ON(AE), DATE OF SERVICE(AF), DATE CLOSED(AG), CLAIM ID(B), PATIENT NAME(C)
INDEXED BY: CLOSED (AC)
LAST MODIFIED: AUG 8,2022@17:12:09
9002313.02,.01CLAIM ID 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: JUN 04, 2008
HELP-PROMPT: Answer must be 1-32 characters in length.
DESCRIPTION: External Claim ID value. This value is a concatenation of the text 'VA' along with the current
year, the pharmacy ID, the VA National Plan ID (without the alpha prefix), and a unique sequence
number. Each of the four pieces is delimited by the equal sign ("=").
CROSS-REFERENCE: 9002313.02^B^MUMPS
1)= S ^BPSC("B",$E(X,1,32),DA)=""
2)= K ^BPSC("B",$E(X,1,32),DA)
9002313.02,.02ELECTRONIC PAYER 0;2 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Enter the payer sheet for the claim
DESCRIPTION:
This is the payer sheet used by the claim
9002313.02,.04TRANSMIT FLAG 0;4 SET
'1' FOR YES (BATCH FILE);
'0' FOR NO;
'2' FOR YES (POINT OF SALE);
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Specify if this claim should be transmitted and the mode.
DESCRIPTION: Numerical code to indicate a transmit status. Current values are 0 for 'No' 1 for 'Yes' Batch and
2 for 'Yes' Point of Sale.
CROSS-REFERENCE: 9002313.02^AD
1)= S ^BPSC("AD",$E(X,1,30),DA)=""
2)= K ^BPSC("AD",$E(X,1,30),DA)
9002313.02,.05TRANSMITTED ON 0;5 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
OUTPUT TRANSFORM: S Y=$$FM2EXT^BPSOSU1(Y)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Enter Date/Time this claim was transmitted
DESCRIPTION:
Date on which the data was transmitted.
CROSS-REFERENCE: 9002313.02^AE
1)= S ^BPSC("AE",$E(X,1,30),DA)=""
2)= K ^BPSC("AE",$E(X,1,30),DA)
9002313.02,.06CREATED ON 0;6 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
OUTPUT TRANSFORM: S Y=$$FM2EXT^BPSOSU1(Y)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Enter Date/Time this claim was created
DESCRIPTION:
Date on which this record was created.
9002313.02,.07AUTO REVERSE FLAG 0;7 SET
'0' FOR NO;
'1' FOR UNRELEASED CLAIM;
'2' FOR INPATIENT CLAIM;
LAST EDITED: JAN 05, 2006
HELP-PROMPT: If auto-reversed, enter the type of auto-reversal
DESCRIPTION: This flag is marking ECME Claims that were automatically reversed because the Prescription was not
released in time or the claim was an inpatient claim.
9002313.02,.08TRANSACTION 0;8 POINTER TO BPS TRANSACTION FILE (#9002313.59)
LAST EDITED: APR 14, 2021
HELP-PROMPT: Enter the transaction for the claim.
DESCRIPTION:
This is the ECME transaction that generates the claim.
9002313.02,1.01PATIENT NAME 1;1 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<1) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: Patient name extracted from the VA patient file. This entry is free text to accommodate the NCPDP
formatting requirements.
CROSS-REFERENCE: 9002313.02^C
1)= S ^BPSC("C",$E(X,1,30),DA)=""
2)= K ^BPSC("C",$E(X,1,30),DA)
9002313.02,1.04GROUP INSURANCE PLAN 1;4 POINTER TO GROUP INSURANCE PLAN FILE (#355.3)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Enter the Group Insurance
DESCRIPTION:
Internal identifier number for the Group Insurance Record
9002313.02,101IIN NUMBER 100;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>6!($L(X)<6) X
LAST EDITED: APR 22, 2021
HELP-PROMPT: Answer must be 6 characters in length.
DESCRIPTION:
Card Issuer ID or Bank ID Number used for network routing.
9002313.02,102VERSION/RELEASE NUMBER 100;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION:
Code identifying the Enrollment Standard format of the file sent or received.
9002313.02,103TRANSACTION CODE 100;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION: Code to identify the transaction type for this claim. E1=Eligibility Verification B1=Billing
B2=Reversal B3=Rebill P1=P.A. Request & Billing P2=P.A. Reversal P3=P.A. Inquiry P4=P.A. Request
Only N1=Information Reporting N2=Information Reporting Reversal N3=Information Reporting Rebill
C1=Controlled Substance Reporting C2=Controlled Substance Reporting Reversal C3=Controlled
Substance Reporting Rebill
9002313.02,104PROCESSOR CONTROL NUMBER 100;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
MAXIMUM LENGTH: 10
LAST EDITED: JUN 14, 2017
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION:
Number which will uniquely identify the submitter of the claim. NCPDP field 104-A4.
9002313.02,109TRANSACTION COUNT 100;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
Count of transactions in the transmission. NCPDP standard field 109-A9.
TECHNICAL DESCR: A transaction count of >1 is not allowed for Eligibility and Prior Authorization transactions.
REQUEST TRANSACTION HEADER SEGMENT.
9002313.02,110SOFTWARE VENDOR/CERT ID 100;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Certification number which Identifies the patient's insurance carrier. NCPDP standard field
110-AK.
TECHNICAL DESCR:
REQUEST TRANSACTION HEADER SEGMENT.
9002313.02,114MEDICAID SUBROGATION ICN/TCN 110;4 FREE TEXT
MEDICAID SUBROGATION INTERNAL CONTROL NUMBER/TRANSACTION CONTROL NUMBER (ICN/TCN)
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: OCT 04, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 114-N4 (Medicaid Subrogation Internal Control Number/Transaction
Control Number (ICN/TCN)), which is defined as "Claim number assigned by the Medicaid Agency."
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT. RESPONSE CLAIM SEGMENT.
9002313.02,115MEDICAID ID NUMBER 110;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-20 characters.
DESCRIPTION: This is used to store NCPDP field 115-N5 (Medicaid ID Number), which is defined as "A unique member
identification number assigned by the Medicaid Agency."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.
9002313.02,116MEDICAID AGENCY NUMBER 110;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-15 characters.
DESCRIPTION: This is used to store NCPDP field 116-N6 (Medicaid Agency Number), which is defined as "Number
assigned by processor to identify the individual Medicaid Agency or representative."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.
9002313.02,201SERVICE PROVIDER ID 200;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<15) X
LAST EDITED: MAY 24, 2018
HELP-PROMPT: Answer must be 15 characters in length
DESCRIPTION:
ID assigned to a pharmacy or provider. NCPDP standard field 201-B1.
TECHNICAL DESCR:
REQUEST TRANSACTION HEADER SEGMENT. RESPONSE HEADER SEGMENT.
9002313.02,202SERV PROVIDER ID QUALIFIER 200;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION:
Qualifier indicating which ID number was used. NCPDP standard field 202-B2.
TECHNICAL DESCR:
REQUEST TRANSACTION HEADER SEGMENT. RESPONSE HEADER SEGMENT.
9002313.02,301GROUP ID 300;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
ID assigned to the cardholder group or employer group. NCPDP standard field 301-C1.
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.
9002313.02,302CARDHOLDER ID 300;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<2) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 2-20 characters in length
DESCRIPTION: Insurance ID assigned to the cardholder or identification number used by the plan. NCPDP standard
field 302-C2.
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.
9002313.02,303PERSON CODE 300;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<5) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 5 characters in length
DESCRIPTION:
Code assigned to a specific person within a family. NCPDP standard field 303-C3.
TECHNICAL DESCR: Regarding the Telecommunication Standard: REQUEST INSURANCE SEGMENT.
- - - - - - - - - - - - - - - - - - - - - - -
Enrollment Standard Examples: Examples: 001=Cardholder 002=Spouse 003-999=Dependents and Others
(including second spouses, etc.)
9002313.02,304DATE OF BIRTH 300;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
OUTPUT TRANSFORM: NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION:
Date of birth of patient. NCPDP standard field 304-C4.
TECHNICAL DESCR: Format=CCYYMMDD CC=Century YY=Year MM=Month DD=Day Examples: If a patient was born on July 27,
1970, this field would reflect: 19700727. REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT.
9002313.02,305PATIENT GENDER CODE 300;5 SET
'C50' FOR NOT SPECIFIED;
'C51' FOR MALE;
'C52' FOR FEMALE;
'C53' FOR NON-BINARY;
OUTPUT TRANSFORM: NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!
LAST EDITED: MAR 31, 2022
HELP-PROMPT: Enter the patient's gender.
DESCRIPTION: Code indicating the gender of patient.
NCPDP standard field 305-C5.
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT.
9002313.02,306PATIENT RELATIONSHIP CODE 300;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
OUTPUT TRANSFORM: S Y=$S(Y="C60":"NOT SPECIFIED",Y="C61":"CARDHOLDER",Y="C62":"SPOUSE",Y="C63":"CHILD",Y="C64":"OTHER
",1:Y)
LAST EDITED: MAR 09, 2011
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION:
Code indicating relationship of patient to cardholder. NCPDP standard field 306-C6.
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT.
9002313.02,307PLACE OF SERVICE 300;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code identifying the location of the patient when receiving pharmacy services. NCPDP standard
field 307-C7. (was PATIENT LOCATION)
�=Not Specified 1=Home 2=Inter-Care 3=Nursing Home 4=Long Term/Extended Care 5=Rest Home 6=Boarding
Home 7=Skilled Care Facility 8=Sub-Acute Care Facility 9=Acute Care Facility 1�=Outpatient
11=Hospice
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT.
9002313.02,309ELIGIBILITY CLARIFICATION CODE 300;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Code indicating that the pharmacy is clarifying eligibility based on receiving a denial. NCPDP
standard field 309-C9.
TECHNICAL DESCR: Examples: The patient has become a student but eligibility has not yet been updated. The pharmacy
can indicate "3" so that the carrier may override eligibility for this patient. REQUEST INSURANCE
SEGMENT.
9002313.02,310PATIENT FIRST NAME 300;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<14) X
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Answer must be 14 characters in length
DESCRIPTION:
First name of patient receiving the prescription. NCPDP standard field 310-CA.
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT
9002313.02,311PATIENT LAST NAME 300;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
Last Name of patient receiving the prescription. NCPDP standard field 311-CB.
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT
9002313.02,312CARDHOLDER FIRST NAME 300;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<14) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 14 characters in length
DESCRIPTION:
First name of the Cardholder/Subscriber. NCPDP standard field 312-CC.
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT
9002313.02,313CARDHOLDER LAST NAME 300;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
Last name of the cardholder/subscriber. NCPDP standard field 313-CD.
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT
9002313.02,314HOME PLAN 300;14 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<5) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 5 characters in length
DESCRIPTION: Code identifying the Blue Cross or Blue Shield plan ID which indicates where the member's coverage
has been designated. Usually where the member lives or purchased their coverage. NCPDP standard
field 314-CE.
TECHNICAL DESCR: Used for interstate processing between Blue Cross and Blue Shield plans. The Blue Cross codes are
in the range less than 600 and Blue Shield codes are greater than 599. REQUEST INSURANCE SEGMENT
9002313.02,322PATIENT STREET ADDRESS 321;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<32) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 32 characters in length
DESCRIPTION:
Free-form text for Patient address information. NCPDP standard field 322-CM.
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT
9002313.02,323PATIENT CITY ADDRESS 321;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<22) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 22 characters in length
DESCRIPTION:
Free-form text for city name. NCPDP standard field 323-CN.
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT
9002313.02,324PATIENT STATE/PROVINCE ADDRESS 321;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Standard State/Province Code as defined by appropriate government agency. NCPDP standard field
324-CO.
TECHNICAL DESCR: Standard United States and Canadian province two-letter postal service abbreviations should be
used. REQUEST PATIENT SEGMENT
9002313.02,325PATIENT ZIP/POSTAL ZONE 321;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 1-17 characters in length
DESCRIPTION: Code defining international postal zone excluding punctuation and blanks (zip code for US). NCPDP
standard field 325-CP.
TECHNICAL DESCR: This left-justified field contains the five-digit zip code, and may include the four-digit expanded
zip code in which the patient is located.
Examples: If the zip code is 98765-4321, this field would reflect: 987654321.
If the zip code is 98765, this field would reflect: 98765 left justified.
REQUEST PATIENT SEGMENT
9002313.02,326PATIENT TELEPHONE NUMBER 321;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION:
Ten-digit phone number of patient. NCPDP standard field 326-CQ.
TECHNICAL DESCR: Format=AAAEEENNNN AAA=Area Code EEE=Exchange NNNN=Number
Examples: If the phone number is (313) 555-1212, this field would reflect: 3135551212.
REQUEST PATIENT SEGMENT
9002313.02,331PATIENT ID QUALIFIER 330;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code qualifying the 'Patient ID'(332-CY). NCPDP standard field 331-CX.
Blank=Not Specified �1=Social Security Number �2=Driver's License Number �3=U.S. Military ID
99=Other
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT
9002313.02,332PATIENT ID 330;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<22) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 22 characters in length
DESCRIPTION:
ID assigned to the patient. NCPDP standard field 332-CY.
TECHNICAL DESCR:
Qualified by Patient Id Qualifier (331-CX). REQUEST PATIENT SEGMENT
9002313.02,333EMPLOYER ID 330;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
ID assigned to employer. NCPDP standard field 333-CZ.
TECHNICAL DESCR: The Internal Revenue Service, Department of the Treasury, assigns the Employer ID. The format of
this field is nine-digits with a hyphen, as in 00-0000000. The hyphen must be transmitted as part
of the Employer ID Number. Information on the Employer ID may be found at
http://www.irs.ustreas.gov/. REQUEST PATIENT SEGMENT
9002313.02,334SMOKER/NONSMOKER 330;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Code indicating the patient as a smoker or non-smoker. NCPDP standard field 334-1C.
Blank=Not Specified 1=Non-Smoker 2=Smoker
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT
9002313.02,335PREGNANCY INDICATOR 330;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Code indicating the patient as pregnant or non-pregnant. NCPDP standard field 335-2C.
Blank=Not Specified 1=Not pregnant 2=Pregnant
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT
9002313.02,336FACILITY ID 330;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
MAXIMUM LENGTH: 12
LAST EDITED: JUN 01, 2017
HELP-PROMPT: Answer must be 12 characters in length.
DESCRIPTION:
ID assigned to the patient's clinic/host party. NCPDP standard field 336-8C.
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT
9002313.02,350PATIENT E-MAIL ADDRESS 340;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>82!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-82 characters in length.
DESCRIPTION: This is used to store NCPDP field 350-HN (Patient E-Mail Address), which is defined as "The E-Mail
address of the patient (member)."
9002313.02,356OTHER PAYER CARDHOLDER ID 350;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 356-NU (Other Payer Cardholder ID), which is defined as
"Cardholder ID for this member that is associated with the Payer noted."
TECHNICAL DESCR:
RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT. REQUEST INSURANCE SEGMENT.
9002313.02,359MEDIGAP ID 350;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 359-2A (Medigap ID), which is defined as "Patient's ID assigned
by the Medigap Insurer."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT.
9002313.02,360MEDICAID INDICATOR 350;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: OCT 07, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 360-2B (Medicaid Indicator), which is defined as "Two character
State Postal Code indicating the state where Medicaid coverage exists."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT.
9002313.02,361PROVIDER ACCEPT ASSGNMT INDCTR 360;1 FREE TEXT
PROVIDER ACCEPT ASSIGNMENT INDICATOR
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 361-2D (Provider Accept Assignment Indicator), which is defined
as "Code indicating whether the provider accepts assignment."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT.
9002313.02,384PATIENT RESIDENCE 380;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-2 characters.
DESCRIPTION: This is used to store NCPDP field 384-4X (Patient Residence), which is defined as "Code identifying
the patient's place of residence."
9002313.02,400TRANSACTIONS 400;0 Multiple #9002313.0201 (Add New Entry without Asking)
LAST EDITED: SEP 22, 2010
9002313.0201,.01TRANSACTION ORDER 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>999999999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: MAY 16, 2018
HELP-PROMPT: Type a number between 1 and 999999999, 0 decimal digits.
DESCRIPTION: This is the numeric value to indicate the order of the transactions. This is a sequential value
starting at 1 to store multiple transactions on this request.
CROSS-REFERENCE: 9002313.0201^B
1)= S ^BPSC(DA(1),400,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(1),400,"B",$E(X,1,30),DA)
9002313.0201,.04MEDICATION NAME 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
Name of the med ordered.
9002313.0201,.05PRESCRIPTION NUMBER 0;5 POINTER TO PRESCRIPTION FILE (#52)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Enter the Prescription for this medication
DESCRIPTION:
This is the prescription associated with the claim
9002313.0201,113MEDICAID PAID AMOUNT 110;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 113-N3 (Medicaid Paid Amount), which is defined as "Amount paid
by the Medicaid Agency."
TECHNICAL DESCR:
REQUEST PRICING SEGMENT.
9002313.0201,117BILLING ENTITY TYPE INDICATOR 110;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 117-TR (Billing Entity Type Indicator), which is defined as "A
code that identifies the entity submitting the billing transaction."
TECHNICAL DESCR:
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,118PAY TO QUALIFIER 110;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 118-TS (Pay To Qualifier), which is defined as "Code qualifying
the Pay To ID (119-TT)."
TECHNICAL DESCR:
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,119PAY TO ID 110;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-17 characters.
DESCRIPTION: This is used to store NCPDP field 119-TT (Pay To ID), which is defined as "Identifying number of
the entity to receive payment for claim."
TECHNICAL DESCR:
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,120PAY TO NAME 110;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 120-TU (Pay To Name), which is defined as "Name of the entity
to receive payment for claim."
TECHNICAL DESCR:
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,121PAY TO STREET ADDRESS 120;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-32 characters.
DESCRIPTION: This is used to store NCPDP field 121-TV (Pay To Street Address), which is defined as "Street
address of the entity to receive payment for claim."
TECHNICAL DESCR:
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,122PAY TO CITY ADDRESS 120;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 122-TW (Pay To City Address), which is defined as "City of the
entity to receive payment for claim."
TECHNICAL DESCR:
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,123PAY TO STATE/PROVINCE ADDRESS 120;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION:
This is used to store NCPDP field 123-TX (Pay to State/Province Address).
TECHNICAL DESCR:
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,124PAY TO ZIP/POSTAL ZONE 120;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-17 characters.
DESCRIPTION: This is used to store NCPDP field 124-TY (Pay To Zip/Postal Zone), which is defined as "Code
defining international postal zone excluding punctuation and blanks (zip code for US)."
TECHNICAL DESCR: Examples: If the zip code is 98765-4321, this field would reflect: 987654321. If the zip code is
98765, this field would reflect: 98765 left justified. REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,125GENERIC EQUIV PROD ID QLFR 120;5 FREE TEXT
GENERIC EQUIVALENT PRODUCT ID QUALIFIER
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: APR 22, 2021
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 125-TZ (Generic Equivalent Product ID Qualifier), which is
defined as "Code qualifying the Generic Equivalent Product ID (126-UA)."
TECHNICAL DESCR: Comments: Qualifies Generic Equivalent Product ID (126-UA). REQUEST WORKERS' COMPENSATION
SEGMENT.
9002313.0201,126GENERIC EQUIVALENT PRODUCT ID 120;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>21!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-21 characters.
DESCRIPTION: This is used to store NCPDP field 126-UA (Generic Equivalent Product ID), which is defined as
"Identifies the generic equivalent of the brand product dispensed."
TECHNICAL DESCR: Comments: Qualified by Generic Equivalent Product ID Qualifier (125-TZ). Qualifier (118-TS).
REQUEST WORKERS' COMPENSATION SEGMENT.
9002313.0201,147PHARMACY SERVICE TYPE 140;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 147-U7 (Pharmacy Service Type), which is defined as "The type
of service being performed by a pharmacy when different contractual terms exist between a payer
and the pharmacy, or when benefits are based upon the type of service performed."
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,308OTHER COVERAGE CODE 300;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating whether or not the patient has other insurance coverage. NCPDP standard field
308-C8.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT
9002313.0201,315EMPLOYER NAME 310;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<32) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 32 characters in length
DESCRIPTION:
Complete name of employer. NCPDP standard field 315-CF.
TECHNICAL DESCR:
REQUEST WORKER'S COMPENSATION SEGMENT
9002313.0201,316EMPLOYER STREET ADDRESS 310;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<32) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 32 characters in length
DESCRIPTION:
The Street address of the insured's employer. NCPDP standard field 316-CG.
TECHNICAL DESCR:
REQUEST WORKER S COMPENSATION SEGMENT
9002313.0201,317EMPLOYER CITY ADDRESS 310;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<22) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 22 characters in length
DESCRIPTION:
Free-form text for city name. NCPDP standard field 317-CH.
TECHNICAL DESCR:
REQUEST WORKER'S COMPENSATION SEGMENT
9002313.0201,318EMPLOYER STATE/PROV ADDRESS 310;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Standard State/Province Code as defined by appropriate government agency. NCPDP standard field
318-CI.
TECHNICAL DESCR: Standard United States and Canadian province two-letter postal service abbreviations should be
used. REQUEST WORKER'S COMPENSATION SEGMENT
9002313.0201,319EMPLOYER ZIP/POSTAL ZONE 310;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION: Code defining international postal zone excluding punctuation and blanks (zip code for US).
NCPDP standard field 319-CJ.
TECHNICAL DESCR: This left-justified field contains the five-digit zip code and may include the four-digit
expanded zip code in which the employer is located.
Examples: If the zip code is 98765-4321, this field would reflect: 987654321.
If the zip code is 98765, this field would reflect: 98765 left justified.
REQUEST WORKER S COMPENSATION SEGMENT
9002313.0201,320EMPLOYER TELEPHONE NUMBER 310;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION:
Ten digit phone number of employer. NCPDP standard field 320-CK.
TECHNICAL DESCR: Format=AAAEEENNNN
AAA=Area Code EEE=Exchange Code NNNN=Number
Examples: A phone number of 212-555-1212 would reflect: 2125551212.
REQUEST WORKER'S COMPENSATION SEGMENT
9002313.0201,321EMPLOYER CONTACT NAME 320;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<32) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 32 characters in length
DESCRIPTION:
Employer primary contact. NCPDP standard field 321-CL.
TECHNICAL DESCR:
REQUEST WORKER'S COMPENSATION SEGMENT
9002313.0201,327CARRIER ID 320;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION:
Carrier code assigned in Worker's Compensation Program. NCPDP standard field 327-CR.
TECHNICAL DESCR:
REQUEST WORKER'S COMPENSATION SEGMENT
9002313.0201,330ALTERNATE ID 320;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<22) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 22 characters in length
DESCRIPTION: Person identifier to be used for controlled product reporting. Identifier may be that of the
patient or the person picking up the prescription as required by the governing body. NCPDP
standard field 330-CW.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT
9002313.0201,337COB/OTHER PAYMENTS COUNT 330;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
Count of other payment occurrences.
9002313.0201,337.01COB OTHER PAYMENTS 337;0 Multiple #9002313.0401 (Add New Entry without Asking)
LAST EDITED: JAN 02, 2008
DESCRIPTION:
Multiple counter to store other coordination of benefit payments.
9002313.0401,.01 COB OTHER PAYMENT COUNTER 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: JUN 04, 2008
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
This is a multiple counter field to store multiple COB payments received from other payers.
CROSS-REFERENCE: 9002313.0401^B
1)= S ^BPSC(DA(2),400,DA(1),337,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),337,"B",$E(X,1,30),DA)
9002313.0401,338 OTHER PAYER COVERAGE TYPE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION:
Code identifying the type of Other Payer ID (340-7C). NCPDP standard field 338-5C.
TECHNICAL DESCR: REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. RESPONSE COORDINATION OF
BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0401,339 OTHER PAYER ID QUALIFIER 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION:
Code qualifying the Other Payer ID (340-7C). NCPDP standard field 339-6C.
TECHNICAL DESCR: REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT. RESPONSE COORDINATION OF
BENEFITS/OTHER PAYERS SEGMENT.
9002313.0401,340 OTHER PAYER ID 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION:
ID assigned to the payer. NCPDP standard field 340-7C.
TECHNICAL DESCR: Qualified by Other Payer ID Qualifier (339-6C). REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT
SEGMENT. RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.0401,341 OTHER PAYER AMOUNT PAID COUNT 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION:
Count of the payer amount paid occurrences. NCPDP standard field 341-HB.
TECHNICAL DESCR:
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0401,342 OTHER PAYER AMT PAID QUALIFIER 1;0 Multiple #9002313.401342 (Add New Entry without Asking)
LAST EDITED: MAR 30, 2021
DESCRIPTION:
This sub-file stores Other Paid Amount Qualifier values.
TECHNICAL DESCR:
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.401342,.01 OTHER PAYER AMT PAID QUALIFIER 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JUN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION:
Code qualifying the Other Payer Amount Paid (431-DV). NCPDP standard field 342-HC.
TECHNICAL DESCR:
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
CROSS-REFERENCE: 9002313.401342^B
1)= S ^BPSC(DA(3),400,DA(2),337,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(3),400,DA(2),337,DA(1),1,"B",$E(X,1,30),DA)
9002313.401342,431 OTHER PAYER AMOUNT PAID 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Amount of any payment known by the pharmacy from other sources (including coupons). NCPDP
standard field 431-DV.
TECHNICAL DESCR: Format=s$$$$$$cc
Examples: If the other payer amount paid is $32.56, this field would reflect: 325F.
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0401,353 OTHER PAYER-PAT RESP AMT CNT 0;8 FREE TEXT
OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT COUNT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 353-NR (Other Payer-Patient Responsibility Amount Count),
which is defined as "Count of Other Payer-Patient Responsibility Amount (352-NQ) and Other
Payer-Patient Responsibility Amount Qualifier (351-NP) occurrences."
TECHNICAL DESCR:
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0401,353.01OTHER PAYER-PATIENT RESP MLTPL 3;0 Multiple #9002313.401353
DESCRIPTION:
This sub-file stores OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT values.
9002313.401353,.01 OTHER PAYER-PATIENT COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is an integer counter incremented by software.
CROSS-REFERENCE: 9002313.401353^B
1)= S ^BPSC(DA(3),400,DA(2),337,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(3),400,DA(2),337,DA(1),3,"B",$E(X,1,30),DA)
9002313.401353,351 OTHER PAYER-PAT RESP AMT QLFR 0;2 FREE TEXT
OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT QUALIFIER
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 351-NP (Other Payer-Patient Responsibility Amount
Qualifier), which is defined as "Code qualifying the Other Payer-Patient Responsibility
Amount (352-NQ)."
TECHNICAL DESCR: Comments: This field is submitted by the pharmacist for the purpose of qualifying the entry
in the Other Payer-Patient Responsibility Amount field. REQUEST COORDINATION OF
BENEFITS/OTHER PAYMENT SEGMENT.
9002313.401353,352 OTHER PAYER-PAT RESP AMOUNT 0;3 FREE TEXT
OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 352-NQ (Other Payer-Patient Responsibility Amount), which
is defined as "The patient's cost share from a previous payer."
TECHNICAL DESCR:
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0401,392 BENEFIT STAGE COUNT 0;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 392-MU (Benefit Stage Count), which is defined as "Count
of Benefit Stage Amount (394-MW) occurrences."
TECHNICAL DESCR:
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT RESPONSE PRICING SEGMENT.
9002313.0401,392.01BENEFIT STAGE MLTPL 4;0 Multiple #9002313.401392
DESCRIPTION:
This sub-file stores BENEFIT STAGE values.
9002313.401392,.01 BENEFIT STAGE COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter incremented by software.
CROSS-REFERENCE: 9002313.401392^B
1)= S ^BPSC(DA(3),400,DA(2),337,DA(1),4,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(3),400,DA(2),337,DA(1),4,"B",$E(X,1,30),DA)
9002313.401392,393 BENEFIT STAGE QUALIFIER 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 393-MV (Benefit Stage Qualifier), which is defined as
"Code qualifying the Benefit Stage Amount (394-MW)."
TECHNICAL DESCR: Comments: Qualifies Benefit Stage Amount (392-MW). REQUEST COORDINATION OF
BENEFITS/OTHER PAYMENT SEGMENT.
9002313.401392,394 BENEFIT STAGE AMOUNT 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 394-MW (Benefit Stage Amount), which is defined as "The
amount of claim allocated to the Medicare stage identified by the Benefit Stage Qualifier
(393-MV)."
TECHNICAL DESCR: Format=s$$$$$$cc
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
RESPONSE PRICING SEGMENT.
9002313.0401,443 OTHER PAYER DATE 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1($E(Y,3,10))
LAST EDITED: MAR 09, 2009
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Payment or denial date of the claim submitted to the other payer. Used for coordination
of benefits.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century
YY=Year
MM=Month
DD=Day
Examples: If the other payer denial date was August 1,1999, this field would reflect:
19990801.
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0401,471 OTHER PAYER REJECT COUNT 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION:
Count of 'Other Payer Reject Code' (472) occurrences.
9002313.0401,472 OTHER PAYER REJECT CODE 2;0 Multiple #9002313.401472 (Add New Entry without Asking)
LAST EDITED: MAR 30, 2021
DESCRIPTION:
This sub-file is to store reject values received from other payers.
9002313.401472,.01 OTHER PAYER REJECT CODE 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<5) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 5 characters in length
DESCRIPTION: The error encountered by the previous "Other Payer" in Reject Code (511-FB). NCPDP
standard field 472-6E.
TECHNICAL DESCR:
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
CROSS-REFERENCE: 9002313.401472^B
1)= S ^BPSC(DA(3),400,DA(2),337,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(3),400,DA(2),337,DA(1),2,"B",$E(X,1,30),DA)
9002313.0401,993 INTERNAL CONTROL NUMBER 0;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-32 characters.
DESCRIPTION: This is used to store NCPDP field 993-A7 (Internal Control Number), which is defined as
"Number assigned by the processor to identify an adjudicated claim when supplied in
payer-to-payer coordination of benefits only."
TECHNICAL DESCR: REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
RESPONSE STATUS SEGMENT.
9002313.0401,2149 OTHER PAYER RECONCILIATION ID 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: MAY 16, 2018
HELP-PROMPT: Enter an ID between 1 and 30 characters.
DESCRIPTION: NCPDP field C49-9V - Other Payer Reconciliation ID. Reconciliation ID (B98-34) as
reported by the Other Payer for Paid/Accepted transactions OR for Information Reporting
transactions, the designated default value for reporting a previous payer's rejected
response as designated in the Other Payer Reject Code value(s) reported in the COB
claim.
9002313.0201,343DISPENSING STATUS 340;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Code indicating the quantity dispensed is a partial fill or the completion of a partial
fill. Used only in situations where inventory shortages do not allow the full quantity
to be dispensed. NCPDP standard field 343-HD.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,344QTY INTENDED TO BE DISPENSED 340;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION: Metric decimal quantity of medication that would be dispensed on original filling if
inventory were available. Used in association with a 'P' or 'C' in Dispensing Status
(343-HD). NCPDP standard field 344-HF.
TECHNICAL DESCR: Format=9999999.999
REQUEST CLAIM SEGMENT.
9002313.0201,345DAYS SUPPLY INTEND TO BE DISP 340;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<5) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 5 characters in length
DESCRIPTION: Days supply for metric decimal quantity of medication that would be dispensed on
original dispensing if inventory were available. Used in association with a 'P' or 'C'
in Dispensing Status (343-HD). NCPDP standard field 345-HG.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,354SUBMISSION CLARIF CODE COUNT 350;4 FREE TEXT
SUBMISSION CLARIFICATION CODE COUNT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 354-NX (Submission Clarification Code Count), which
is defined as "Count of the Submission Clarification Code (420-DK) occurrences."
9002313.0201,354.01SUBMISSION CLARIFICATION MLTPL 354.01;0 Multiple #9002313.02354
LAST EDITED: JUL 27, 2010
DESCRIPTION:
This sub-file stores Submission Clarification values.
9002313.02354,.01 SUBMISSION CLRFCTN CODE CNTR 0;1 NUMBER
SUBMISSION CLARIFICATION CODE COUNTER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: AUG 19, 2010
HELP-PROMPT: Type a Number between 1 and 99, 0 Decimal Digits.
DESCRIPTION:
This is a sequential counter of the Submission Clarification occurrences.
CROSS-REFERENCE: 9002313.02354^B
1)= S ^BPSC(DA(2),400,DA(1),354.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),354.01,"B",$E(X,1,30),DA)
9002313.02354,420 SUBMISSION CLARIFICATION CODE 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 24, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 420-DK (Submission Clarification Code), which is
defined as "Code indicating that the pharmacist is clarifying the submission."
TECHNICAL DESCR: Examples: Since the patient will be out of state for the next three months, they have
requested a three month supply of their medication. This situation can cause the
claim to reject, because it was refilled too soon. By indicating an 03, the processor
is made aware of the situation, and can properly adjudicate the claim.
REQUEST CLAIM SEGMENT.
9002313.0201,357DELAY REASON CODE 350;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-2 characters.
DESCRIPTION: This is used to store NCPDP field 357-NV (Delay Reason Code), which is defined as
"Code to specify the reason that submission of the transactions has been delayed."
9002313.0201,364PRESCRIBER FIRST NAME 360;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-14 characters.
DESCRIPTION:
This is used to store NCPDP field 364-2J (Prescriber First Name).
9002313.0201,365PRESCRIBER STREET ADDRESS 360;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-32 characters.
DESCRIPTION: This is used to store NCPDP field 365-2K (Prescriber Street Address), which is
defined as "Free form text for prescriber address information."
9002313.0201,366PRESCRIBER CITY ADDRESS 360;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 366-2M (Prescriber City Address), which is defined
as "Free form text for prescriber city name."
9002313.0201,367PRESCRIBER STATE/PROV ADDRESS 360;7 FREE TEXT
PRESCRIBER STATE/PROVINCE ADDRESS
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: AUG 25, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 367-2N (Prescriber State/Province Address), which
is defined as "Standard state /province code as defined by appropriate government
agency."
9002313.0201,368PRESCRIBER ZIP/POSTAL ZONE 360;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-11 characters.
DESCRIPTION: This is used to store NCPDP field 368-2P (Prescriber Zip/Postal Zone), which is
defined as "Code defining international postal zone excluding punctuation and
blanks."
9002313.0201,369ADDITIONAL DCMNTN TYPE ID 360;9 FREE TEXT
ADDITIONAL DOCUMENTATION TYPE ID
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 1-5 characters.
DESCRIPTION: This is used to store NCPDP field 369-2Q (Additional Documentation Type ID), which is
defined as "Unique identifier for the data being submitted."
TECHNICAL DESCR:
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,370LENGTH OF NEED 360;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-5 characters.
DESCRIPTION: This is used to store NCPDP field 370-2R (Length of Need), which is defined as
"Length of time the physician expects the patient to require use of the ordered item.
Qualified by Length of Need Qualifier (371-2S)."
TECHNICAL DESCR:
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,371LENGTH OF NEED QUALIFIER 370;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-5 characters.
DESCRIPTION: This is used to store NCPDP field 371-2S (Length of Need Qualifier), which is defined
as "Code qualifying the length of need."
TECHNICAL DESCR: Qualifies Length of Need (370-2R). Note: If value is 6, length of need would be 1.
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,372PRESCRIBER/SUPPLIER DT SIGNED 370;2 FREE TEXT
PRESCRIBER/SUPPLIER DATE SIGNED
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: OCT 25, 2010
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is used to store NCPDP field 372-2T (Prescriber/Supplier Date Signed), which is
defined as "The date the form was completed and signed by the ordering physician."
TECHNICAL DESCR: Format = CCYYMMDD
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,373REQUEST STATUS 370;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 373-2U (Request Status), which is defined as "Code
identifying type of request."
TECHNICAL DESCR:
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,374REQUEST PERIOD BEGIN DATE 370;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 374-2V (Request Period Begin Date), which is
defined as "The beginning date of need."
TECHNICAL DESCR: Format = CCYYMMDD
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,375REQ PERIOD RECERT/REVISED DT 370;5 FREE TEXT
REQUEST PERIOD RECERT/REVISED DATE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 375-2W (Request Period Recert/Revised Date), which
is defined as "The effective date of the revision or re-certification provided by the
certifying physician."
TECHNICAL DESCR: Format = CCYYMMDD
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,376SUPPORTING DOCUMENTATION 370;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>67!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-67 characters.
DESCRIPTION: This is used to store NCPDP field 376-2X (Supporting Documentation), which is defined
as "Free text message."
TECHNICAL DESCR:
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,377QUESTION NUMBER/LETTER COUNT 370;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 377-2Z (Question Number/Letter Count), which is
defined as "Count of Question Number/Letter occurrences."
TECHNICAL DESCR:
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,377.01QUESTION NUMBER/LETTER MLTPL 377.01;0 Multiple #9002313.023771
DESCRIPTION:
This sub-file stores Question Number/Letter values.
9002313.023771,.01QUESTION NUMBER/LETTER COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter of Question Number/Letter occurrences.
TECHNICAL DESCR: Integer counter incremented as needed by BPS* software.
Fields included in the set/logical grouping are:
Question Number/Letter (378-4B),
Question Percent Response (379-4D),
Question Date Response (380-4G),
Question Dollar Amount Response (381-4H),
Question Numeric Response (382-4J),
Question Alphanumeric Response (383-4K).
CROSS-REFERENCE: 9002313.023771^B
1)= S ^BPSC(DA(2),400,DA(1),377.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),377.01,"B",$E(X,1,30),DA)
9002313.023771,378QUESTION NUMBER/LETTER 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-5 characters.
DESCRIPTION: This is used to store NCPDP field 378-4B (Question Number/Letter), which is defined
as "Identifies the question number/letter that the question response applies to
(part of the question information)."
TECHNICAL DESCR: Values to be determined by Trading Partner Agreement. REQUEST ADDITIONAL
DOCUMENTATION SEGMENT.
9002313.023771,379QUESTION PERCENT RESPONSE 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>7!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-7 characters.
DESCRIPTION: This is used to store NCPDP field 379-4D (Question Percent Response), which is
defined as "Percent response to a question (part of the question information)."
TECHNICAL DESCR: Examples: 25.75% = 02575 or 0.5% = 0005
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.023771,380QUESTION DATE RESPONSE 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 380-4G (Question Date Response), which is defined
as "Date response to a question (part of the question information)."
TECHNICAL DESCR: Format=CCYYMMDD
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.023771,381QUESTION DOLLAR AMT RESPONSE 0;5 FREE TEXT
QUESTION DOLLAR AMOUNT RESPONSE
INPUT TRANSFORM: K:$L(X)>13!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-13 characters.
DESCRIPTION: This is used to store NCPDP field 381-4H (Question Dollar Amount Response), which
is defined as "Dollar Amount response to a question (part of the question
information)."
TECHNICAL DESCR: Format=s$$$$$$$$$cc
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.023771,382QUESTION NUMERIC RESPONSE 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-13 characters.
DESCRIPTION: This is used to store NCPDP field 382-4J (Question Numeric Response), which is
defined as "Numeric response to a question (part of the question information)."
TECHNICAL DESCR:
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.023771,383QUESTION ALPHANUMERIC RESPONSE 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-32 characters.
DESCRIPTION: This is used to store NCPDP field 383-4K (Question Alphanumeric Response), which is
defined as "Alphanumeric response to a question (part of the question
information)."
TECHNICAL DESCR:
REQUEST ADDITIONAL DOCUMENTATION SEGMENT.
9002313.0201,385FACILITY NAME 380;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-32 characters.
DESCRIPTION: This is used to store NCPDP field 385-3Q (Facility Name), which is defined as "Name
identifying the location of the service rendered."
TECHNICAL DESCR:
Note: This is not the name of the dispensing pharmacy. REQUEST FACILITY SEGMENT
9002313.0201,386FACILITY STREET ADDRESS 380;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-32 characters.
DESCRIPTION: This is used to store NCPDP field 386-3U (Facility Street Address), which is
defined as "Free form text for Facility address information."
TECHNICAL DESCR:
REQUEST FACILITY SEGMENT
9002313.0201,387FACILITY STATE/PROV ADDRESS 380;7 FREE TEXT
FACILITY STATE/PROVINCE ADDRESS
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 387-3V (Facility State/Province Address), which
is defined as "Standard state /province code as defined by appropriate government
agency."
TECHNICAL DESCR:
REQUEST FACILITY SEGMENT.
9002313.0201,388FACILITY CITY ADDRESS 380;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 388-5J (Facility City Address), which is defined
as "Free form text for facility city name."
TECHNICAL DESCR:
REQUEST FACILITY SEGMENT.
9002313.0201,389FACILITY ZIP/POSTAL ZONE 380;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>18!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-18 characters.
DESCRIPTION: This is used to store NCPDP field 389-6D (Facility Zip/Postal Zone), which is
defined as "Code defining international postal zone excluding punctuation and
blanks."
TECHNICAL DESCR:
REQUEST FACILITY SEGMENT.
9002313.0201,390NARRATIVE MESSAGE 389;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>202!($L(X)<1) X
LAST EDITED: SEP 02, 2010
HELP-PROMPT: Answer must be 1-202 characters.
DESCRIPTION: This is used to store NCPDP field 390-BM (Narrative Message), which is defined as
"Free form text."
TECHNICAL DESCR: REQUEST NARRATIVE SEGMENT.
This field is the 2nd piece of node 389 because of its length.
9002313.0201,391PATIENT ASSIGNMENT INDICATOR 390;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 391-MT (Patient Assignment Indicator (Direct
Member Reimbursement Indicator)), which is defined as "Code to indicate a patient's
choice on assignment of benefits."
9002313.0201,402PRESCRIPTION/SERVICE REF NO 400;2 FREE TEXT
PRESCRIPTION/SERVICE REFERENCE NUMBER
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
LAST EDITED: SEP 29, 2010
HELP-PROMPT: Answer must be 1-14 characters.
DESCRIPTION: This is the reference number assigned by the provider for the dispensed
drug/product and/or service provided. It is NCPDP field 402-D2. The VA uses the
Prescription IEN for this field.
TECHNICAL DESCR: Qualified by Prescription/Service Reference Number Qualifier (455-EM). REQUEST
CLAIM SEGMENT. RESPONSE CLAIM SEGMENT.
9002313.0201,403FILL NUMBER 400;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: The fill/refill number, starting at 0 for the original fill. The code indicating
whether the prescription is an original or a refill. NCPDP standard field 403-D3.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,405DAYS SUPPLY 400;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<5) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 5 characters in length
DESCRIPTION:
Estimated number of days the prescription will last. NCPDP standard field 405-D5.
TECHNICAL DESCR: Examples: The prescription is estimated to last 30 days. This field would reflect:
30.
REQUEST CLAIM SEGMENT.
9002313.0201,406COMPOUND CODE 400;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Field indicating whether this prescription was a compound (1) or not a compound
(0).
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,407PRODUCT/SERVICE ID 400;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>21!($L(X)<21) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 21 characters in length
DESCRIPTION: ID of the product dispensed or service provided. NDC code in our case. NCPDP
standard field 407-D7.
TECHNICAL DESCR: Format=MMMMMDDDDPP
MMMMM=Manufacturer's Assigned Number DDDD=Drug ID PP=Package Size
Comments: Qualified by Product/Service ID Qualifier (436-E1) If Product Service ID
Qualifier (436-E1) is 03=NDC
REQUEST CLAIM SEGMENT.
9002313.0201,408DAW PRODUCT SELECTION CODE 400;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Code indicating whether or not the prescriber's instructions regarding generic
substitution were followed. NCPDP standard field 408-D8.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,409INGREDIENT COST SUBMITTED 400;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Submitted product component cost of the dispensed prescription. This amount is
included in the 'Gross Amount Due' (430-DU).
TECHNICAL DESCR: Format=s$$$$$$cc
Comments: This field can be further defined by using the Basis of Cost
Determination Field 423-DN.
Examples: If the ingredient cost submitted is $65.00, this field would reflect:
650{.
REQUEST PRICING SEGMENT.
9002313.0201,411PRESCRIBER ID 400;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
ID assigned to the prescriber.
TECHNICAL DESCR: Regarding the Telecommunication Standard:
Comments: Qualified by Prescriber ID Qualifier (466-EZ) for the Telecommunications
Standard.
REQUEST PRESCRIBER SEGMENT
9002313.0201,412DISPENSING FEE SUBMITTED 400;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Dispensing fee submitted by the pharmacy. This amount is included in the 'Gross
Amount Due' (430-DU). NCPDP standard field 412-DC.
TECHNICAL DESCR: Format=s$$$$$$cc
Examples: If the pharmacy submitted a $5.62 dispensing fee, this field would
reflect: 56B.
REQUEST PRICING SEGMENT.
9002313.0201,414DATE PRESCRIPTION WRITTEN 400;14 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Date prescription was written. This will be the fill/refill date for local fills,
the released date for CMOP. NCPDP standard field 414-DE.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day
Examples: For a prescription written on August 1, 1999, field would reflect:
19990801.
REQUEST CLAIM SEGMENT.
9002313.0201,415NUMBER OF REFILLS AUTHORIZED 400;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Number of refills authorized by the prescriber. The number of refills allowed that
was entered during order entry. NCPDP standard field 415-DF.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,418LEVEL OF SERVICE 400;18 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Coding indicating the type of service the provider rendered. Not utilized,
populated with DI00. NCPDP standard field 418-DI.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,419PRESCRIPTION ORIGIN CODE 400;19 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION:
Code indicating the origin of the prescription.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,421PRIMARY CARE PROVIDER ID 400;21 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION: ID assigned to the primary care provider. Used when the patient is referred to a
secondary care provider. NCPDP standard field 421-DL.
TECHNICAL DESCR: Qualified by Primary Care Provider ID Qualifier (468-2E). REQUEST PRESCRIBER
SEGMENT.
9002313.0201,423BASIS OF COST DETERMINATION 400;23 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating the method by which 'Ingredient Cost Submitted' (Field 409-D9) was
calculated. How the amount charged was determined. NCPDP standard field 423-DN.
TECHNICAL DESCR:
REQUEST PRICING SEGMENT.
9002313.0201,424DIAGNOSIS CODE 400;24 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION: Code identifying the diagnosis of the patient. Not used for third party billing as
of this date - so it is not used, but may be used in the future. NCPDP standard
field 424-DO.
TECHNICAL DESCR: Qualified by a Diagnosis Code Qualifier (492-WE). The format must adhere to the
owner's code set rules and formats. REQUEST CLINICAL SEGMENT.
9002313.0201,426USUAL AND CUSTOMARY CHARGE 400;26 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Amount charged cash customers for the prescription exclusive of sales tax or other
amounts claimed. NCPDP standard field 426-DQ.
TECHNICAL DESCR: Format=s$$$$$$cc
Examples: If the usual and customary charge is $32.56, this field would reflect:
325F.
REQUEST PRICING SEGMENT.
9002313.0201,427PRESCRIBER LAST NAME 420;27 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
Last Name of the Prescriber. NCPDP standard field 427-DR.
TECHNICAL DESCR:
REQUEST PRESCRIBER SEGMENT.
9002313.0201,429SPECIAL PACKAGING INDICATOR 400;29 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Code indicating the type of Unit Dose dispensing. NCPDP standard field 429-DT.
0=Not Specified 1=Not Unit Dose 2=Manufacturer Unit Dose 3=Pharmacy Unit Dose
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,430GROSS AMOUNT DUE 400;30 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Total price claimed from all sources. For prescription claim request, field
represents a sum of Ingredient Cost Submitted (409-D9), Dispensing Fee Submitted
(412-DC), Flat Sales Tax Amount Submitted (481-HA), Percentage Sales Tax Amount
Submitted (482-GE), Incentive Amount Submitted (438-E3), Other Amount Claimed
(480-H9). For service claim request, field represents a sum of Professional
Services Fee Submitted (477-BE), Flat Sales Tax Amount Submitted (481-HA),
Percentage Sales Tax Amount Submitted (482-GE), Other Amount Claimed (480-H9).
NCPDP standard field 430-DU.
TECHNICAL DESCR: Format=s$$$$$$cc
Examples: If the gross amount due is $14.95, this field would reflect: 149E.
REQUEST PRICING SEGMENT.
9002313.0201,431OTHER PAYER AMOUNT PAID 430;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Amount of any payment known by the pharmacy from other sources. NCPDP standard
field 431-DV.
TECHNICAL DESCR: Format=s$$$$$$cc
Examples: If the other payer amount paid is $32.56, this field would reflect: 325F.
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0201,433PATIENT PAID AMOUNT REPORTED 430;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION:
Amount the pharmacy received from the patient for the prescription dispensed.
TECHNICAL DESCR: This field is not used in coordination of benefit transactions to pass patent
liability information to a downstream payer. See Other Payer-Patient Responsibility
Amount (352-NQ).
Format=s$$$$$$cc
Examples: If the patient paid amount submitted is $10.50, this field would reflect:
105{.
REQUEST PRICING SEGMENT.
9002313.0201,434DATE OF INJURY 430;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION:
Date on which the injury occurred. NCPDP standard field 434-DY.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day
Examples: If injury occurred on July 1, 1999, field would reflect: 19990701.
REQUEST WORKER S COMPENSATION SEGMENT.
9002313.0201,435CLAIM/REFERENCE ID 430;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<32) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 32 characters in length
DESCRIPTION: Identifies the claim number assigned by Worker s Compensation Program. NCPDP
standard field 435-DZ.
TECHNICAL DESCR:
REQUEST WORKER S COMPENSATION SEGMENT.
9002313.0201,436PRODUCT/SERVICE ID QUALIFIER 430;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code qualifying the value in 'Product/Service ID' (407-D7). NCPDP standard field
436-E1.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,438INCENTIVE AMOUNT SUBMITTED 430;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Amount represents a fee that is submitted by the pharmacy for contractually agreed
upon services. This amount is included in the 'Gross Amount Due' (430-DU).
TECHNICAL DESCR: Format=s$$$$$$cc
Examples: If the incentive amount submitted is $4.50, this field would reflect:
45{.
REQUEST PRICING SEGMENT.
9002313.0201,442QUANTITY DISPENSED 440;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION:
Quantity dispensed expressed in metric decimal units. NCPDP standard field 442-E7.
TECHNICAL DESCR:
Format=9999999.999 REQUEST CLAIM SEGMENT.
9002313.0201,443OTHER PAYER DATE 440;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JUN 04, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Payment or denial date of the claim submitted to the other payer. Used for
coordination of benefits. NCPDP standard field 443-E8.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day
Examples: If the primary payer denial date was August 1,1999, this field would
reflect: 19990801.
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT
9002313.0201,444PROVIDER ID 440;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION: Unique ID assigned to the person responsible for the dispensing of the prescription
or provision of the service.
TECHNICAL DESCR:
Qualified by Provider ID Qualifier (465-EY). REQUEST PHARMACY PROVIDER SEGMENT.
9002313.0201,445ORIG PRESCRIBED PROD/SERV CODE 440;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>21!($L(X)<21) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 21 characters in length
DESCRIPTION:
Code of the initially prescribed product or service. NCPDP standard field 445-EA.
TECHNICAL DESCR: Qualified by Originally Prescribed Product/Service Code Qualifier (453-EJ).
REQUEST CLAIM SEGMENT.
9002313.0201,446ORIGINALLY PRESCRIBED QUANTITY 440;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION: Product initially prescribed amount expressed in metric decimal units. NCPDP
standard field 446-EB.
TECHNICAL DESCR:
Format=9999999.999 REQUEST CLAIM SEGMENT.
9002313.0201,447COMPOUND INGREDIENT COMP COUNT 440;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Count of compound product IDs (both active and inactive) in the compound mixture
submitted. NCPDP standard field 447-EC.
TECHNICAL DESCR:
REQUEST COMPOUND SEGMENT.
9002313.0201,447.01COMPOUND REPEATING FIELDS 447;0 Multiple #9002313.0501 (Add New Entry without Asking)
LAST EDITED: JAN 02, 2008
DESCRIPTION:
Multiple to store multiple compounds in a prescription.
9002313.0501,.01 COMPOUND REPEATING COUNT 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
Count of Compounds for this medication.
CROSS-REFERENCE: 9002313.0501^B
1)= S ^BPSC(DA(2),400,DA(1),447,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),447,"B",$E(X,1,30),DA)
9002313.0501,362 COMPOUND INGRED MOD CODE CNT 0;7 FREE TEXT
COMPOUND INGREDIENT MODIFIER CODE COUNT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 362-2G (Compound Ingredient Modifier Code
Count), which is defined as "Code indicating the number of Compound Ingredient
Modifier Code (363-2H)"
TECHNICAL DESCR:
REQUEST COMPOUND SEGMENT.
9002313.0501,362.01COMPND INGRED MDFR MLTPL 1;0 Multiple #9002313.05011
DESCRIPTION:
This sub-file stores Compound Ingredient Modifier values.
9002313.05011,.01 COMPND INGRED MDFR COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter of Compound Ingredient Modifier entries.
CROSS-REFERENCE: 9002313.05011^B
1)= S ^BPSC(DA(3),400,DA(2),447,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(3),400,DA(2),447,DA(1),1,"B",$E(X,1,30),DA)
9002313.05011,363 COMPOUND INGRED MODIFIER CODE 0;2 FREE TEXT
COMPOUND INGREDIENT MODIFIER CODE
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 363-2H (Compound Ingredient Modifier Code),
which is defined as "Identifies special circumstances related to the
dispensing/payment of the product as identified in the Compound Product ID
(498-TE)."
TECHNICAL DESCR:
REQUEST COMPOUND SEGMENT.
9002313.0501,448 COMPOUND INGREDIENT QUANTITY 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION: Amount expressed in metric decimal units of the product included in the
compound mixture. NCPDP standard field 448-ED.
TECHNICAL DESCR:
Format=9999999.999 REQUEST COMPOUND SEGMENT.
9002313.0501,449 COMPOUND INGREDIENT DRUG COST 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Ingredient cost for the metric decimal quantity of the product included in the
compound mixture indicated in Compound Ingredient Quantity (Field 448-ED).
NCPDP standard field 449-EE.
TECHNICAL DESCR:
Format=s$$$$$$cc REQUEST COMPOUND SEGMENT.
9002313.0501,488 COMPOUND PRODUCT ID QUALIFIER 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION:
Code qualifying the type of product dispensed. NCPDP standard field 488-RE.
TECHNICAL DESCR:
Qualifies Compound Product ID (489-TE). REQUEST COMPOUND SEGMENT.
9002313.0501,489 COMPOUND PRODUCT ID 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>21!($L(X)<21) X
LAST EDITED: JAN 03, 2008
HELP-PROMPT: Answer must be 21 characters in length
DESCRIPTION: Product identification of an ingredient used in a compound. NCPDP standard
field 489-TE.
TECHNICAL DESCR:
Qualified by Compound Product ID Qualifier (488-RE). REQUEST COMPOUND SEGMENT.
9002313.0501,490 COMP INGRED BASIS COST DETERM 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating the method by which the drug cost of an ingredient used in a
compound was calculated. NCPDP standard field 490-UE.
TECHNICAL DESCR:
REQUEST COMPOUND SEGMENT.
9002313.0201,450COMPOUND DOSAGE FORM DESC CODE 440;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 17 characters in length.
DESCRIPTION:
Dosage form of the complete compound mixture. NCPDP standard field 450-EF.
TECHNICAL DESCR:
REQUEST COMPOUND SEGMENT.
9002313.0201,451COMPOUND DISP UNIT FORM INDCTR 450;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION:
NCPDP standard product billing codes. NCPDP standard field 451-EG.
TECHNICAL DESCR:
REQUEST COMPOUND SEGMENT.
9002313.0201,452COMPOUND ROUTE OF ADMIN 450;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code for the route of administration of the complete compound mixture. NCPDP
standard field 452-EH.
9002313.0201,453ORIG PRESCR PROD/SERV ID QUAL 450;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code qualifying the value in 'Originally Prescribed Product/Service Code'
(Field 445-EA). NCPDP standard field 453-EJ.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,454SCHEDULED PRESCRIPTION ID NUM 450;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<14) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 14 characters in length
DESCRIPTION:
The serial number of the prescription blank/form. NCPDP standard field 454-EK.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,455PRESCRIPTION/SERV REF NO QLFR 450;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION:
Indicates the type of billing submitted. NCPDP standard field 455-EM.
TECHNICAL DESCR: Qualifies Prescription/Service Reference Number (402-D2). REQUEST CLAIM
SEGMENT. RESPONSE CLAIM SEGMENT.
9002313.0201,456ASSOC PRESCRIPTION/SERV REF NO 450;6 FREE TEXT
ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER
INPUT TRANSFORM: K:$L(X)>14!($L(X)<14) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 14 characters in length.
DESCRIPTION: This is the Related Prescription/Service Reference Number (402-D2) to which the
service is associated. It is NCPDP field 456-EN.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,457ASSOC PRESCRIPTION/SERV DATE 450;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Date of the Associated Prescription/Service Reference Number (456-EN). NCPDP
standard field 457-EP.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day
REQUEST CLAIM SEGMENT.
9002313.0201,458PROCEDURE MODIFIER CODE COUNT 450;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: OCT 04, 2010
HELP-PROMPT: Answer must be 4 characters in length.
DESCRIPTION: This is the count of the Procedure Modifier Code (459-ER) occurrences. It is
NCPDP field 458-SE.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,459PROCEDURE MODIFIER CODE 459;0 Multiple #9002313.201459 (Add New Entry without Asking)
LAST EDITED: JAN 02, 2008
DESCRIPTION:
Multiple for storing procedure code information.
9002313.201459,.01PROCEDURE MODIFIER CODE 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Identifies special circumstances related to the performance of the service.
NCPDP standard field 459-ER.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
CROSS-REFERENCE: 9002313.201459^B
1)= S ^BPSC(DA(2),400,DA(1),459,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),459,"B",$E(X,1,30),DA)
9002313.0201,460QUANTITY PRESCRIBED 450;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION: Amount expressed in metric decimal units. Quantity prescribed during order
entry. NCPDP standard field 460-ET.
TECHNICAL DESCR:
Format=9999999.999 REQUEST CLAIM SEGMENT.
9002313.0201,461PRIOR AUTHORIZATION TYPE CODE 460;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length.
DESCRIPTION: Code clarifying the Prior Authorization Number Submitted (462-EV) or
benefit/plan exemption. NCPDP standard field 461-EU.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT
9002313.0201,462PRIOR AUTH NUMBER SUBMITTED 460;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<13) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 13 characters in length.
DESCRIPTION: Number submitted by the provider to identify the prior authorization. NCPDP
standard field 462-EV.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,463INTERMEDIARY AUTH TYPE ID 460;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Value indicating that authorization occurred for intermediary processing.
NCPDP standard field 463-EW.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT
9002313.0201,464INTERMEDIARY AUTHORIZATION ID 460;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<13) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 13 characters in length
DESCRIPTION: Value indicating intermediary authorization occurred. NCPDP standard field
464-EX.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,465PROVIDER ID QUALIFIER 460;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION:
Code qualifying the Provider ID (444-E9). NCPDP standard field 465-EY.
TECHNICAL DESCR:
REQUEST PHARMACY PROVIDER SEGMENT.
9002313.0201,466PRESCRIBER ID QUALIFIER 460;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION:
Code qualifying the Prescriber ID (411-DB). NCPDP standard field 466-EZ.
TECHNICAL DESCR:
REQUEST PRESCRIBER SEGMENT.
9002313.0201,467PRESCRIBER LOCATION CODE 460;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<5) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 5 characters in length
DESCRIPTION: Location address code assigned to the prescriber as identified in the
National Provider System (NPS). NCPDP standard field 467-1E.
TECHNICAL DESCR:
REQUEST PRESCRIBER SEGMENT.
9002313.0201,468PRIMARY CARE PROVIDER ID QLFR 460;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code qualifying the Primary Care Provider ID (421-DL). NCPDP standard field
468-2E.
TECHNICAL DESCR:
REQUEST PRESCRIBER SEGMENT.
9002313.0201,469PRIM CARE PROV LOCATION CODE 460;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<5) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 5 characters in length
DESCRIPTION: Location address code assigned to the primary care provider as identified in
the National Provider System (NPS). NCPDP standard field 469-H5.
TECHNICAL DESCR:
REQUEST PRESCRIBER SEGMENT.
9002313.0201,470PRIM CARE PROVIDER LAST NAME 460;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
Last name of the Primary Care Provider. NCPDP standard field 470-4E.
TECHNICAL DESCR:
REQUEST PRESCRIBER SEGMENT.
9002313.0201,471OTHER PAYER REJECT COUNT 470;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JUN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Count of Other Payer Reject Code (472-6E) occurrences. NCPDP standard field
471-5E.
TECHNICAL DESCR: Number of reject codes identified by the previous "Other Payer" in Reject
Count (510-FA).
REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
9002313.0201,473.01DUR PPS REPEATING FIELDS 473.01;0 Multiple #9002313.1001 (Add New Entry without Asking)
LAST EDITED: JAN 02, 2008
DESCRIPTION:
Count of Drug Utilization sub-records.
9002313.1001,.01 DUR PPS CODE COUNT 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: The number of DUR messages that were returned in the response message.
NCPDP standard field 473-7E.
TECHNICAL DESCR:
REQUEST DUR/PPS SEGMENT.
CROSS-REFERENCE: 9002313.1001^B
1)= S ^BPSC(DA(2),400,DA(1),473.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),473.01,"B",$E(X,1,30),DA)
9002313.1001,439 REASON FOR SERVICE CODE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code identifying the type of utilization conflict detected or the reason
for the pharmacist's professional service. NCPDP standard field 439-E4.
TECHNICAL DESCR:
REQUEST DUR/PPS SEGMENT. RESPONSE DUR/PPS SEGMENT.
9002313.1001,440 PROFESSIONAL SERVICE CODE 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code identifying the type of utilization conflict detected or the reason
for the pharmacist's professional service. NCPDP standard field 440-E5.
TECHNICAL DESCR: If the pharmacist spoke with the patient as a result of a conflict code
being transmitted on a prescription, the field would reflect P0. REQUEST
DUR/PPS SEGMENT.
9002313.1001,441 RESULT OF SERVICE CODE 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Action taken by a pharmacist in response to a conflict or the result of a
pharmacist's professional service. NCPDP standard field 441-E6.
TECHNICAL DESCR:
REQUEST DUR/PPS SEGMENT.
9002313.1001,474 DUR/PPS LEVEL OF EFFORT 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating the level of effort as determined by the complexity of
decision making or resources utilized by a pharmacist to perform a
professional service. NCPDP standard field 474-8E.
TECHNICAL DESCR:
REQUEST DUR/PPS SEGMENT.
9002313.1001,475 DUR/DUE CO-AGENT ID QUALIFIER 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code qualifying the value in DUR Co-Agent ID (476-H6). NCPDP standard
field 475-J9.
TECHNICAL DESCR:
REQUEST DUR/PPS SEGMENT.
9002313.1001,476 DUR/DUE CO-AGENT ID 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>21!($L(X)<21) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 21 characters in length
DESCRIPTION: Identifies the co-existing agent contributing to the DUR event (drug or
disease conflicting with the prescribed drug or prompting pharmacist
professional service). NCPDP standard field 476-H6.
TECHNICAL DESCR:
Qualified by DUR Co-Agent ID Qualifier (475-J9). REQUEST DUR/PPS SEGMENT.
9002313.0201,477PROF SERVICE FEE SUBMITTED 470;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Amount submitted by the provider for professional services rendered. NCPDP
standard field 477-BE.
TECHNICAL DESCR: Format=s$$$$$$cc
Examples: If the Professional Service Fee Submitted is $7.00, this field
would reflect: 70{.
REQUEST PRICING SEGMENT.
9002313.0201,478OTHER AMT CLAIMED SBMTTD COUNT 470;8 FREE TEXT
OTHER AMOUNT CLAIMED SUBMITTED COUNT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 3 characters in length.
DESCRIPTION: This is NCPDP field 478-H7 (Other Amount Claimed Submitted Count). It is
the count of 'Other Amount Claimed Submitted' occurrences.
TECHNICAL DESCR: Fields included in the set/logical grouping are:
Other Amount Claimed Submitted Qualifier (479-H8),
Other Amount Claim Submitted (480-H9).
REQUEST PRICING SEGMENT.
9002313.0201,478.01OTHER AMT CLAIMED MULTIPLE 478.01;0 Multiple #9002313.0601 (Add New Entry without Asking)
LAST EDITED: OCT 13, 2010
DESCRIPTION:
This sub-file stores Other Amount Claimed values.
9002313.0601,.01 OTHER AMT CLAIMED COUNTER 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: OCT 13, 2010
HELP-PROMPT: Answer must be 1-2 characters.
DESCRIPTION: This is the number of other claimed amount entries in the sub-file. It
is used for coordination of benefits.
TECHNICAL DESCR:
Sequential counter of Other Amount Claimed occurrences.
CROSS-REFERENCE: 9002313.0601^B
1)= S ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),478.01,"B",$E(X,1,30),DA)
9002313.0601,479 OTHER AMT CLAIMED SUBM QLFR 0;2 FREE TEXT
OTHER AMOUNT CLAIMED SUBMITTED QUALIFIER
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length.
DESCRIPTION: This is the code identifying the additional incurred cost claimed in
Other Amount Claimed Submitted (480-H9). It is NCPDP field 479-H8.
TECHNICAL DESCR:
REQUEST PRICING SEGMENT.
9002313.0601,480 OTHER AMT CLAIMED SUBMITTED 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: This is the amount representing the additional incurred costs for a
dispensed prescription or service. It is NCPDP field 480-H9.
TECHNICAL DESCR: Format=s$$$$$$cc
Qualified by Other Amount Claimed Submitted Qualifier (479-H8).
Examples: If the other amount claimed submitted is $12.55, this field
would reflect: 125E.
REQUEST PRICING SEGMENT.
9002313.0201,481REGULATORY FEE AMT SUBMITTED 480;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Flat sales tax submitted for prescription. This amount is included in
the Gross Amount Due (430-DU). NCPDP standard field 481-HA.
TECHNICAL DESCR: Format=s$$$$$$cc
The submission of sales tax is governed by regulatory agencies (state,
local, parish, etc). If the sales tax reported is a flat rate, then it is
a fixed amount for a certain dollar value (for example for $xxx it is a
certain amount). For example, for $1�� the flat rate is $1.99. This flat
rate is then reported in Flat Sales Tax Amount Submitted (481-HA).
Examples: If the flat sales tax amount submitted is $3.08, this field
would reflect: 30H.
REQUEST PRICING SEGMENT.
9002313.0201,482PERCENT TAX AMT SUBMITTED 480;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION:
Percentage sales tax submitted. NCPDP standard field 482-GE.
TECHNICAL DESCR: Format=s$$$$$$cc
Comments: The submission of sales tax is governed by regulatory agencies
(state, local, parish, etc)..
Examples: If the percentage sales tax amount submitted is $4.47, this
field would reflect: 44G.
REQUEST PRICING SEGMENT.
9002313.0201,483PERCENT TAX RATE SUBMITTED 480;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>9!($L(X)<9) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 9 characters in length
DESCRIPTION: Percentage sales tax rate used to calculate Percentage Sales Tax Amount
Submitted (482-GE). NCPDP standard field 483-HE.
TECHNICAL DESCR: The submission of sales tax is governed by regulatory agencies (state,
local, parish, etc).
Format=s999.9999
REQUEST PRICING SEGMENT.
9002313.0201,484PERCENTAGE TAX BASIS SBMTTD 480;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating the basis for percentage sales tax. NCPDP standard field
484-JE.
TECHNICAL DESCR: The submission of sales tax is governed by regulatory agencies (state,
local, parish, etc).
REQUEST PRICING SEGMENT.
9002313.0201,485COUPON TYPE 480;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating the type of coupon being used. NCPDP standard field
485-KE.
TECHNICAL DESCR:
REQUEST COUPON SEGMENT.
9002313.0201,486COUPON NUMBER 480;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION: Unique serial number assigned to the prescription coupons. NCPDP
standard field 486-ME.
TECHNICAL DESCR:
REQUEST COUPON SEGMENT.
9002313.0201,487COUPON VALUE AMOUNT 480;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION:
Value of the coupon. NCPDP standard field 487-NE.
TECHNICAL DESCR: Format=s$$$$$$vcc
Examples: If the coupon value amount is $10.00, this field would reflect:
100{.
REQUEST COUPON SEGMENT.
9002313.0201,491DIAGNOSIS CODE COUNT 490;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION:
Count of diagnosis occurrences. NCPDP standard field 491-VE.
TECHNICAL DESCR: Fields included in the set/logical grouping are:
Diagnosis Code Qualifier (492-WE)
Diagnosis Code (424-DO) REQUEST CLINICAL SEGMENT.
9002313.0201,491.01CLINICAL DIAGNOSIS 491.01;0 Multiple #9002313.0701 (Add New Entry without Asking)
LAST EDITED: JAN 02, 2008
DESCRIPTION:
Diagnosis sub-records.
9002313.0701,.01 DIAGNOSIS COUNTER 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
The number of diagnosis codes defined for this medication order.
CROSS-REFERENCE: 9002313.0701^B
1)= S ^BPSC(DA(2),400,DA(1),491.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),491.01,"B",$E(X,1,30),DA)
9002313.0701,424 DIAGNOSIS CODE 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION: Code identifying the diagnosis of the patient. NCPDP standard field
424-DO.
TECHNICAL DESCR: Qualified by a Diagnosis Code Qualifier (492-WE). The format must
adhere to the owner's code set rules and formats. REQUEST CLINICAL
SEGMENT.
9002313.0701,492 DIAGNOSIS CODE QUALIFIER 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code qualifying the Diagnosis Code (424-DO). NCPDP standard field
492-WE.
TECHNICAL DESCR:
REQUEST CLINICAL SEGMENT.
9002313.0201,493CLINICAL INFORMATION COUNTER 493;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Counter number of clinical information measurement set/logical
grouping. NCPDP standard field 493-XE.
TECHNICAL DESCR:
REQUEST CLINICAL SEGMENT.
9002313.0201,493.01CLINICAL INFORMATION 493.01;0 Multiple #9002313.0801 (Add New Entry without Asking)
LAST EDITED: JAN 02, 2008
DESCRIPTION:
Count of clinical information sub-records.
9002313.0801,.01 CLINICAL INFORMATION COUNT 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
The number of clinical indicator records for the medication order.
CROSS-REFERENCE: 9002313.0801^B
1)= S ^BPSC(DA(2),400,DA(1),493.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),493.01,"B",$E(X,1,30),DA)
9002313.0801,494 MEASUREMENT DATE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Date clinical information was collected or measured. NCPDP standard
field 494-ZE.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day
REQUEST CLINICAL SEGMENT.
9002313.0801,495 MEASUREMENT TIME 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>6!($L(X)<6) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 6 characters in length
DESCRIPTION: Time clinical information was collected or measured. NCPDP standard
field 495-H1.
TECHNICAL DESCR: Format: HHMM
HH=Hour MM=Minute
Examples: Reported in military time. Two o'clock P.M.=1400.
REQUEST CLINICAL SEGMENT.
9002313.0801,496 MEASUREMENT DIMENSION 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating the clinical domain of the observed value in
Measurement Value (499-H4). NCPDP standard field 496-H2.
TECHNICAL DESCR:
REQUEST CLINICAL SEGMENT.
9002313.0801,497 MEASUREMENT UNIT 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code indicating the metric or English units used with the clinical
information. NCPDP standard field 497-H3.
TECHNICAL DESCR:
REQUEST CLINICAL SEGMENT.
9002313.0801,499 MEASUREMENT VALUE 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
Actual value of clinical information. NCPDP standard field 499-H4.
TECHNICAL DESCR: Blood pressure entered in XXX/YYY format in which XXX=systolic,
/=divider, and YYY is diastolic. Temperature entered in XXX.X format
always including decimal point. REQUEST CLINICAL SEGMENT.
9002313.0201,498.01REQUEST TYPE 498;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<3) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 3 characters in length
DESCRIPTION: Code identifying type of prior authorization request. NCPDP standard
field 498-PA.
TECHNICAL DESCR: Used by processor to distinguish reason for prior authorization
request. REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.02REQUEST PERIOD DATE-BEGIN 498;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Beginning date for a prior authorization request. NCPDP standard
field 498-PB.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day
Used by processor to determine starting date of a prior authorization
request.
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.03REQUEST PERIOD DATE-END 498;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: End date for a prior authorization request. NCPDP standard field
498-PC.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day Used by processor to determine the
ending date for a prior authorization request.
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.04BASIS OF REQUEST 498;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION: Code describing the reason for prior authorization request. NCPDP
standard field 498-PD.
TECHNICAL DESCR: Used by processor to determine appropriate modules and editing for
the prior authorization transaction. REQUEST PRIOR AUTHORIZATION
SEGMENT.
9002313.0201,498.05AUTHORIZED REP FIRST NAME 498;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<14) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 14 characters in length
DESCRIPTION: First name of the patients authorized representative. NCPDP standard
field 498-PE.
TECHNICAL DESCR:
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.06AUTHORIZED REP LAST NAME 498;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION: Last name of the patients authorized representative. NCPDP standard
field 498-PF.
TECHNICAL DESCR:
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.07AUTHORIZED REP STREET ADDRESS 498;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<32) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 32 characters in length
DESCRIPTION:
Free-form text for address information. NCPDP standard field 498-PG.
TECHNICAL DESCR:
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.08AUTH REP CITY ADDRESS 498;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<22) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 22 characters in length
DESCRIPTION:
Free-form text for city name. NCPDP standard field 498-PH.
TECHNICAL DESCR:
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.09AUTHORIZED REP STATE/PROV ADDR 498;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 4 characters in length
DESCRIPTION:
Authorized Rep's State or Province. NCPDP standard field 498-PJ.
TECHNICAL DESCR:
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.11AUTHORIZED REP ZIP/POSTAL ZONE 498;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<17) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 17 characters in length
DESCRIPTION:
Authorized Rep's Zip Code. NCPDP standard field 498-PK.
TECHNICAL DESCR: This left-justified field contains the five-digit zip code, and may
include the four-digit expanded zip code in which the patient's
authorized representative is located. REQUEST PRIOR AUTHORIZATION
SEGMENT.
9002313.0201,498.12PRESCRIBER TELEPHONE NUMBER 498;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<12) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 12 characters in length
DESCRIPTION: Ten digit phone number of the prescriber. NCPDP standard field
498-PM.
TECHNICAL DESCR: Format=AAAEEENNNN
AAA=Area Code EEE=Exchange Code NNNN=Number
Examples: This field would reflect the telephone number of (414)
555-1212 as 4145551212.
REQUEST PRESCRIBER SEGMENT.
9002313.0201,498.13PRIOR AUTH SUPPORTING DOCUMENT 498.13;0 WORD-PROCESSING #9002313.0901 (NOWRAP)
LAST EDITED: MAR 30, 2021
TECHNICAL DESCR: Could be used, if applicable, to supply information not already
included in NCPDP data fields that may be required to process a prior
authorization transaction. REQUEST PRIOR AUTHORIZATION SEGMENT.
PRIOR AUTHORIZATION SUPPORTING DOCUMENTATION
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter free text any prior authorization supporting information.
DESCRIPTION: This is used to store NCPDP field 498-PP (Prior Authorization
Supporting Documentation).
TECHNICAL DESCR: Could be used, if applicable, to supply information not already
included in NCPDP data fields that may be required to process a
prior authorization transaction.
REQUEST PRIOR AUTHORIZATION SEGMENT.
9002313.0201,498.14PRIOR AUTH NUMBER-ASSIGNED 498;14 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<13) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 13 characters in length
DESCRIPTION: Unique number identifying the prior authorization assigned by the
processor. NCPDP standard field 498-PY.
TECHNICAL DESCR: Provided to the pharmacy by the processor to be used by the
pharmacy for billing, and if applicable, reversal purposes.
REQUEST PRIOR AUTHORIZATION SEGMENT. RESPONSE PRIOR AUTHORIZATION
SEGMENT.
9002313.0201,503AUTHORIZATION NUMBER 500;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<22) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 22 characters in length
DESCRIPTION: Unique number identifying the prior authorization assigned by the
processor. NCPDP standard field 503-F3.
TECHNICAL DESCR:
REQUEST PRIOR AUTHORIZATION SEGMENT. RESPONSE STATUS SEGMENT.
9002313.0201,579ASSOC RX/SERVICE PROV ID QUAL 570;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 579-XX
Code qualifying the 'Associated Prescription/Service Provider ID'
(58�-XY) to which the claim/service is related.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,580ASSOC RX/SERVICE PROVIDER ID 570;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: NCPDP Standard field 580-XY
Related Service Provider ID to which the claim/service is
associated.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,581ASSOC RX/SERVICE REF NUM QUAL 580;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 581-XZ
Code qualifying the 'Associated Prescription/Service Reference
Number ID' (456-EN) to which the claim/service is related.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,582ASSOC RX/SERVICE FILL NUMBER 580;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 582-X0
Related Fill Number to which the claim/service is associated.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,583SERVICE PROVIDER NAME 580;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-32 characters in length.
DESCRIPTION: NCPDP Standard field 583-YK
The name of the service provider business associated to the service
provider ID (2�1-B1).
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,584SERVICE PROVIDER STREET 580;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-32 characters in length.
DESCRIPTION: NCPCP Standard field 584-YM
The street address of the service provider.
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,585SERVICE PROVIDER CITY 580;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-22 characters in length.
DESCRIPTION: NCPDP Standard field 585-YN
Code uniquely identifying the transmission syntax and corresponding
Data Dictionary.
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,586SERVICE PROVIDE STATE/PROVINCE 580;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 586-YP
The state/province code of the address of the service provider.
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,587SERVICE PROVIDER ZIP/POST CODE 580;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: NCPDP Standard field number 587-YQ
The postal code of the address of the service provider.
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,590SELLER INITIALS 580;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-5 characters in length.
DESCRIPTION: NCPDP Standard field 590-YT
The initials of the person responsible for dispensing the
prescription or provision of service.
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,591PURCHASER ID QUALIFIER 590;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 591-YU
Code indicating the type of ID used in the Purchaser ID field.
Qualifies Purchaser ID (592-YV).
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,592PURCHASER ID 590;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-22 characters in length.
DESCRIPTION: NCPDP Standard field 592-YV
The ID number used to identify the purchaser of the
product/service. Qualified by Purchaser ID Qualifier.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,593PURCHASER ID STATE/PROVINCE 590;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 593-YW
The postal state code abbreviation that is used in conjunction with
the Purchaser ID Qualifier and Purchaser ID fields to identify what
state the identification is from.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,594PURCHASER DATE OF BIRTH 590;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: NCPDP Standard field 594-YX
The Date of Birth of the purchaser of the product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,595PURCHASER GENDER CODE 590;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION: NCPDP Standard field 595-YY
The Gender of the purchaser of the product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,596PURCHASER FIRST NAME 590;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-14 characters in length.
DESCRIPTION: NCPDP Standard field 596-YZ
The First Name of the purchaser of the product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,597PURCHASER LAST NAME 590;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: NCPDP Standard field 597-Y0
The Last Name of the purchaser of the product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,598PURCHASER STREET ADDRESS 590;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-32 characters in length.
DESCRIPTION: NCPDP Standard field 598-Y1
Free-form text for address information.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,599PURCHASER CITY ADDRESS 590;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-22 characters in length.
DESCRIPTION: NCPDP Standard field 599-Y2
The City name associated to the address of the purchaser of the
product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,600UNIT OF MEASURE 600;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<4) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Enter the Unit of Measure (4 characters)
DESCRIPTION:
Unit of measure of the prescription. NCPDP standard field 600-28.
TECHNICAL DESCR:
REQUEST CLAIM SEGMENT.
9002313.0201,675PURCHASER STATE/PROVINCE CODE 670;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 675-Y3
The Postal State/province code associated to the address of the
purchaser of the product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,676PURCHASER ZIP/POSTAL CODE 670;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: NCPDP Standard field 676-Y4
The associated postal code of the address of the purchaser of the
product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,677PURCHASER COUNTRY CODE 670;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 677-Y5
The associated Postal country code of the purchaser of the
product/service.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,678TIME OF SERVICE 670;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-8 characters in length.
DESCRIPTION: NCPDP Standard field 678-Y6
The time at which the service is performed as local time that will
correspond with the actual date of service.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,679SELLER ID 670;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>72!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-72 characters in length.
DESCRIPTION: NCPDP Standard field 679-Y9
The identification of the person responsible for dispensing the
prescription or provision of the service.
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,680SELLER ID QUALIFIER 670;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 22, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field 680-ZB
Code indicating the type of ID used in the Seller Identification
(xxx-xx).
TECHNICAL DESCR:
SERVICE PROVIDER SEGMENT
9002313.0201,681SALES TRANSACTION ID 680;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>82!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-82 characters in length.
DESCRIPTION: NCPDP Standard field 681-ZF
A reference identifier assigned to the sale transaction as assigned
by the merchant.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,880TRANSACTION REFERENCE NUMBER 870;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 880-K5 (Transaction Reference
Number), which is defined as "A reference number assigned by the
provider to each of the data records in the batch or real-time
transactions. The purpose of this number is to facilitate the
process of matching the transaction response to the transaction.
The transaction reference number assigned should be returned in the
response."
9002313.0201,995ROUTE OF ADMINISTRATION 990;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-11 characters.
DESCRIPTION: This is used to store NCPDP field 995-E2 (Route of Administration),
which is defined as "This is an override to the default route
referenced for the product. For a multi-ingredient compound, it is
the route of the complete compound mixture."
9002313.0201,996COMPOUND TYPE 990;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUL 27, 2010
HELP-PROMPT: Answer must be 1-2 characters.
DESCRIPTION: This is used to store NCPDP field 996-G1 (Compound Type), which is
defined as "Clarifies the type of compound."
9002313.0201,1023PURCHASER RELATIONSHIP CODE A20;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field A23-YS
Code indicating the relationship from purchaser to patient.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,1024PRESCRIBER ID STATE/PROVINCE A20;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field A24-ZK
The postal state code abbreviation that is used in conjunction with
the Prescriber ID Qualifier and the Prescriber ID fields to
identify what state the identification is from.
TECHNICAL DESCR:
PRESCRIBER SEGMENT
9002313.0201,1025PRESCRIBER ALTERNATE ID QUAL A20;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field A25-ZM
A code qualifying the Prescriber Alternate ID (A26-ZP)
TECHNICAL DESCR:
PRESCRIBER SEGMENT
9002313.0201,1026PRESCRIBER ALTERNATE ID A20;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: NCPDP Standard field A26-ZP
An alternate ID assigned to the prescriber.
TECHNICAL DESCR:
PRESCRIBER SEGMENT
9002313.0201,1027PRESCRIBER ALTERNATE STATE A20;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field A27-ZQ
The postal state code abbreviation that is used in conjunction with
the Prescriber Alternate ID Qualifier and the Prescriber Alternate
ID fields to identify what state the identification is from.
TECHNICAL DESCR:
PRESCRIBER SEGMENT
9002313.0201,1029REPORTED ADJUDICATED PROG TYPE A20;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field A29-ZS
The type of prescription benefit plan that adjudicated and paid for
the prescription.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,1030RELEASED DATE A20;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: NCPDP Standard field A30-ZT
Identifies the date the prescription was relinquished from the
dispensing facility to the patient or purchaser.
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,1031RELEASED TIME A30;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-8 characters in length.
DESCRIPTION: NCPDP Standard field A31-ZU
Indicates the time the prescription was relinquished from the
dispensing facility to the patient or purchaser. This is the local
time that corresponds with the Released Date (A3�-ZT)
TECHNICAL DESCR:
PURCHASER SEGMENT
9002313.0201,1032COMPOUND PREPARATION TIME A30;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>6!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-6 characters in length.
DESCRIPTION: NCPDP Standard field A32-ZW
Measurement in minutes for the preparation of the compound.
TECHNICAL DESCR:
COMPOUND SEGMENT
9002313.0201,1093SERVICE PROVIDER COUNTRY CODE A90;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to hold NCPDP file A93-IT (Service Provider Country
Code), which is defined as "Indicates the country of the provider".
9002313.0201,2013AUTH REP STREET ADDRESS LINE 1 B11;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B13-7D (Authorized Representative
Street Address Line 1), which is defined as "Free-form text for
address line 1 information".
9002313.0201,2014AUTH REP STREET ADDRESS LINE 2 B11;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B14-8B (Authorized Representative
Street Address Line 2), which is defined as "Free-form text for
address line 2 information".
9002313.0201,2015EMPLOYER STREET ADDRESS LINE 1 B10;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B15-8D (Employer Street Address
Line 1), which is defined as "Free-form text for address line1
information".
9002313.0201,2016EMPLOYER STREET ADDRESS LINE 2 B10;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B16-7G (Employer Street Address
Line 2), which is defined as "Free-form text for address line 2
information".
9002313.0201,2017EMPLOYER CONTACT FIRST NAME B10;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>37!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-37 characters in length.
DESCRIPTION: This is used to store NCPDP field B17-7H (Employer Contact First
Name), which is defined as "First name of the employer's primary
contact".
9002313.0201,2018EMPLOYER CONTACT LAST NAME B10;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>37!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-37 characters in length.
DESCRIPTION: This is used to store NCPDP field B18-7J (Employer Contact Last
Name), which is defined as "Last name of the employer's primary
contact".
9002313.0201,2019EMPLOYER PHONE NUMBER EXT B10;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is used to store NCPDP field B19-7K (Employer Telephone Number
Extension), which is defined as "Extension of the telephone
number".
9002313.0201,2020FACILITY STREET ADDRESS LINE 1 B11;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B20-7M (Facility Street Address
Line 1), which is defined as "Free form text for Facility address
line 1 information".
9002313.0201,2021FACILITY STREET ADDRESS LINE 2 B20;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B21-7N (Facility Street Address
Line 2), which is defined as "Free form text for Facility address
line 2 information".
9002313.0201,2024PAY TO STREET ADDRESS LINE 1 B20;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B24-7R (Pay To Street Address
Line 1), which is defined as "Line 1 of street address of the
entity to receive payment for claim".
9002313.0201,2025PAY TO STREET ADDRESS LINE 2 B20;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B25-7S (Pay to Street Address
Line 2), which is defined as "Line 2 of street address of the
entity to receive payment for claim".
9002313.0201,2026PRESCRIBER PHONE NUMBER EXT B20;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is used to store NCPDP field B26-7T (Prescriber Telephone
Number Extension), which is defined as "Extension of the telephone
number".
9002313.0201,2027PRESCRIBER STREET ADDR LINE 1 B20;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B27-7U (Prescriber Street Address
Line 1), which is defined as "Free form text for prescriber address
line 1 information".
9002313.0201,2028PRESCRIBER STREET ADDR LINE 2 B20;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B28-7V (Prescriber Street Address
Line 2), which is defined as "Free form text for prescriber address
line 2 information".
9002313.0201,2029PURCHASER STREET ADDRESS LINE1 B21;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B29-7W (Purchaser Street Address
Line 1), which is defined as "Free-form text for address line 1
information".
9002313.0201,2030PURCHASER STREET ADDRESS LINE2 B21;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B30-7X (Purchaser Street Address
Line 2), which is defined as "Free-form text for address line 2
information".
9002313.0201,2031SERVICE PROV STREET ADD LINE 1 B30;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B31-7Y (Service Provider Street
Address Line 1), which is defined as "Line 1 of the street address
of the service provider".
9002313.0201,2032SERVICE PROV STREET ADD LINE 2 B30;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B32-7Z (Service Provider Street
Address Line 2), which is defined as "Line 2 of the street address
of the service provider".
9002313.0201,2034AUTH REP COUNTRY CODE B30;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B34-1U (Authorized Representative
Country Code), which is defined as "Indicates the county of the
pharmacy".
9002313.0201,2035EMPLOYER COUNTRY CODE B30;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B35-1V (Employer Country Code),
which is defined as "Employer Country Code".
9002313.0201,2037FACILITY COUNTRY CODE B30;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B37-1X (Facility Country Code),
which is defined as "Code of the country".
9002313.0201,2039PAY TO COUNTRY CODE B30;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B39-1Z (Pay to Country Code),
which is defined as "Code of the country".
9002313.0201,2040PRES ALT ID ASSOC COUNTRY CODE B30;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B40-3A (Prescriber Alternate ID
Associated Country Code), which is defined as "Code of the
country".
9002313.0201,2041PRES ID ASSOC COUNTRY CODE B40;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B41-3B (Prescriber ID Associated
Country Code), which is defined as "Code of the country".
9002313.0201,2042PRESCRIBER COUNTRY CODE B40;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 23, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B42-3C (Prescriber Country Code),
which is defined as "Code of the country".
9002313.0201,2043PURCHASER ID ASSOC COUNTRY CD B40;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B43-3D (Purchaser ID Associated
Country Code), which is defined as "Code of the country".
9002313.0201,2044INTERMEDIARY ID COUNT B40;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION: This is used to store NCPDP field B44-8G (Intermediary ID Count),
which is defined as "Count of Intermediary ID Type Code (B45-8H),
Intermediary Type Entity (B46-8J), Intermediary ID Qualifier
(B47-8K), Intermediary ID (B48-8M), Intermediary ID State/Province
Address (B49-8N) and Intermediary ID Relationship Code (B50-8P)
occurrence". These other NCPDP fields are stored in the
Intermediary ID multiple.
9002313.0201,2044.01INTERMEDIARY ID MULTIPLE B44;0 Multiple #9002313.022044
DESCRIPTION: This multiple is used to hold the NCPDP values for the Intermediary
ID repeating group.
9002313.022044,.01INTERMEDIARY ID COUNTER 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter of Intermediary ID occurrences.
CROSS-REFERENCE: 9002313.022044^B
1)= S ^BPSC(DA(2),400,DA(1),"B44","B",$E(X,1,30),DA)=""
2)= K ^BPSC(DA(2),400,DA(1),"B44","B",$E(X,1,30),DA)
9002313.022044,2045INTERMEDIARY ID TYPE CODE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B45-8H (Intermediary ID Type
Code), which is defined as "Code identifying the type of
Intermediary ID (B48-8M)".
9002313.022044,2046INTERMEDIARY ID TYPE ENTITY 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B46-8J (Intermediary ID Type
Entity), which is defined as "Code Identifying the type of entity
associated with the Intermediary ID (B48-8M)".
9002313.022044,2047INTERMEDIARY ID QUALIFIER 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B47-8K (Intermediary ID
Qualifier), which is defined as "Code qualifying the
'Intermediary ID' (B48-8M)".
9002313.022044,2048INTERMEDIARY ID 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-22 characters in length.
DESCRIPTION: This is used to store NCPDP field B48-8M (Intermediary ID), which
is defined as "Intermediary ID assigned to the type entity".
9002313.022044,2049INTERMEDIARY ID STATE/PROV ADD 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B49-8N (Intermediary ID
State/Province Address), which is defined as "The postal state
code abbreviation that is used in conjunction with the
Intermediary ID Qualifier and the Intermediary ID fields to
identify what state the identification is from".
9002313.022044,2050INTERMEDIARY ID RELATION CODE 0;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION: This is used to store NCPDP field B50-8P (Intermediary ID
Relationship Code), which is defined as "Code indicating the
relationship to the patient".
9002313.022044,2055INTERMEDIARY ID COUNTRY CODE 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B55-8U (Intermediary ID Country
Code), which is defined as "The associated Postal country code of
the associated Intermediary ID".
9002313.0201,2056LAST KNOWN IIN NUMBER B50;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
LAST EDITED: APR 29, 2021
HELP-PROMPT: Answer must be 1-8 characters in length.
DESCRIPTION: This is used to store NCPDP field B56-3E (Last Known IIN Number),
which is defined as "Last known Card Issuer ID or Bank ID Number
used for network routing used on a previous claim".
9002313.0201,2057LAST KNOWN PROCESSOR CNTRL NUM B50;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-12 characters in length.
DESCRIPTION: This is used to store NCPDP field B57-3F (Last Known Processor
Control Number), which is defined as "Last known number assigned
by the processor used on a previous claim".
9002313.0201,2058LAST KNOWN GROUP ID B50;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: This is used to store NCPDP field B58-3G (Last Known Group ID),
which is defined as "Last known ID assigned to the cardholder
group or employer group used on a previous claim".
9002313.0201,2059LAST KNOWN CARDHOLDER ID B50;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: DEC 30, 2014
HELP-PROMPT: Answer must be 1-22 characters in length.
DESCRIPTION: This is used to store NCPDP field B59-3H (Last Known Cardholder
ID), which is defined as "Last known insurance ID assigned to the
cardholder or identification number used by the plan used on a
previous claim".
9002313.0201,2060YEAR OF LAST PAID CLAIM B50;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>6!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-6 characters in length.
DESCRIPTION: This is used to store NCPDP field B60-3J (Year of Last Paid
Claim), which is defined as "Identifies the year used on a
previous claim".
9002313.0201,2061MONTH OF LAST PAID CLAIM B60;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B61-3K (Month of Last Paid
Claim), which is defined as "Identifies the month used on a
previous claim".
9002313.0201,2095FACILITY ID QUALIFIER B90;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
MAXIMUM LENGTH: 2
LAST EDITED: MAY 30, 2017
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION: Code qualifying the 'Facility ID' (336-8C). NCPDP standard field
B95-3Z. Blank=Not Specified, 1=Facility Type 2 NPI, 2= Other
9002313.0201,2096PROVIDER FIRST NAME B90;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: MAR 01, 2017
HELP-PROMPT: Enter a first name 1-35 characters in length.
DESCRIPTION: The First Name of the provider of the product/service. NCPDP
standard field B96-4A.
TECHNICAL DESCR:
PHARMACY PROVIDER SEGMENT
9002313.0201,2097PROVIDER LAST NAME B90;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: MAR 01, 2017
HELP-PROMPT: Enter a last name 1-35 characters in length.
DESCRIPTION: The Last Name of the provider of the product/service. NCPDP
standard field B97-4M.
TECHNICAL DESCR:
PHARMACY PROVIDER SEGMENT
9002313.0201,2101ORIG MANUFACTURER PRODUCT ID C00;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>19!($L(X)<1) X
MAXIMUM LENGTH: 19
LAST EDITED: MAR 01, 2017
HELP-PROMPT: Enter a value 1-19 characters in length.
DESCRIPTION: ID assigned to the original manufacturer of the product. NCPDP
standard field C01-4N.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,2102ORIG MANUFACTURER PROD ID QUAL C00;2 SET
'3' FOR NDC-Nation Drug code;
LAST EDITED: MAR 01, 2017
HELP-PROMPT: Enter '3' or leave blank if the Product ID is empty.
DESCRIPTION: Qualifies Original Manufacturer Product ID C01-4N. NCPDP
standard field C02-4P.
TECHNICAL DESCR:
CLAIM SEGMENT
9002313.0201,2147OTHER PAYER PROGRAM TYPE C40;7 POINTER TO BPS NCPDP OTHER PAYER PROGRAM TYPE FILE (#9
002313.38)
LAST EDITED: MAY 21, 2018
HELP-PROMPT: Enter the value of the Other Payer Adjudicated Program Type.
DESCRIPTION: The type of prescription benefit plan/program associated with the
Other Payer.
9002313.0201,2149OTHER PAYER RECONCILIATION ID C40;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the Other Payer Reconciliation ID, 1 to 10 characters in
length.
DESCRIPTION: Reconciliation ID (B98-34) as reported by the Other Payer for
Paid/Accepted transactions OR for Information Reporting
transactions, the designated default value for reporting a
previous payer's rejected response as designated in the Other
Payer Reject Code value(s) reported in the COB claim.
9002313.0201,2150BENEFIT STAGE INDICATOR COUNT C40;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 21, 2018
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of Benefit Stage Indicator (C51-9X) occurrences.
9002313.0201,2151BENEFIT STAGE INDICATOR C50;1 POINTER TO BPS NCPDP BENEFIT STAGE INDICATOR FILE (#90
02313.35)
LAST EDITED: MAY 14, 2018
HELP-PROMPT: Enter a Benefit Stage Indicator.
DESCRIPTION: Code identifying the Benefit Stage(s) which applied to the claim
at the time of adjudication.
9002313.0201,2160COMPOUND LEVEL OF COMPLEXITY C50;10 SET
'1' FOR LOW LEVEL COMPLEXITY;
'10' FOR MID-LEVEL COMP NON-HAZARDOUS;
'20' FOR MID-LEVEL COMP HAZARDOUS;
'31' FOR HIGH LEVEL NON-HAZARDOUS STERILE;
'41' FOR HIGH LEVEL HAZARDOUS STERILE;
'51' FOR HIGH LEVEL NON-HAZARDOUS;
'61' FOR HIGH LEVEL HAZARDOUS;
LAST EDITED: JUL 23, 2020
HELP-PROMPT: Select a value used by the pharmacy to indicate the complexity
involved in the preparation of the compounded prescription.
DESCRIPTION: This is the value used by the pharmacy to indicate the complexity
involved in the preparation of the compounded prescription.
9002313.0201,2190LTPAC BILLING METHODOLOGY C80;10 SET
'1' FOR FULL QUANTITY;
'2' FOR POST-CONSUMPTION;
'3' FOR PRE-CONSUMPTION;
LAST EDITED: MAY 21, 2018
HELP-PROMPT: Enter billing methodology 1, 2 or 3.
DESCRIPTION:
Code indicating the billing methodology used for the claim.
9002313.0201,2191LTPAC DISPENSE FREQUENCY C90;1 POINTER TO BPS NCPDP LTPAC DISPENSE FREQUENCY FILE (#9
002313.36)
LAST EDITED: MAY 15, 2018
HELP-PROMPT: Enter a LTPAC Dispense Frequency code.
DESCRIPTION: Code indicating the frequency of dispensing medication to a LTPAC
patient.
9002313.0201,2192NUMBER LTPAC DISPENSING EVENTS C90;2 NUMBER
NUMBER OF LTPAC DISPENSING EVENTS
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a number between 0 and 999, 0 decimal digits.
DESCRIPTION: Value indicating the number of times pharmacy dispensed product
or service for the claim period requested.
9002313.0201,2198PREPARATION ENVIRONMENT CODE C90;8 SET
'1' FOR PILL SPLITTING;
'2' FOR OTHER;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a preparation environment code.
DESCRIPTION:
Event which required a special preparation environment.
9002313.0201,2199PREPARATION ENVIRONMENT TYPE C90;9 SET
'1' FOR SPECIFIC PRESSURE ENV NOT REQ/NOT USED;
'2' FOR POSITIVE PRESSURE NON-STERILE/NON-HAZARDOUS;
'3' FOR NEGATIVE PRESSURE NON-STERILE/HAZARDOUS;
'4' FOR POSITIVE PRESSURE STERILE/NON-HAZARDOUS;
'5' FOR NEGATIVE PRESSURE STERILE/HAZARDOUS;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the code identifying the environment in which the
medication was prepared.
DESCRIPTION: Code identifying the environment in which the medication was
prepared.
9002313.0201,2201PRESCRIBER DEA NUMBER D00;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<15) X
MAXIMUM LENGTH: 15
LAST EDITED: MAY 24, 2018
HELP-PROMPT: Answer must be 15 characters in length.
DESCRIPTION: ID assigned to a health care provider (e.g. Practitioner,
Hospital, Manufacturer, etc.) by the US Drug Enforcement
Administration, allowing them to distribute, dispense,
administer, or conduct research with respect to controlled
substances in the course of professional practice or research.
9002313.0201,2202TOTAL PRESCRIBED QTY REMAINING D00;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a value between 1 and 9999999999, 0 decimal digits.
DESCRIPTION: Accumulated Total Prescribed Quantity Remaining as of the date of
service. Calculated value based on: (Prescribed Quantity
(460-ET)) * (Number Of Refills Authorized (415-DF) + 1) -
Accumulated Quantity Dispensed (442-E7) for each previous fill.
9002313.0201,2214SUBROGATION AMOUNT REQUESTED D10;4 NUMBER
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<1)!(X?.E1"."3
.N) X
LAST EDITED: MAY 21, 2018
HELP-PROMPT:Enter a dollar amount between 1 and 99999999, 2 decimal digits.
DESCRIPTION:
Amount paid by the plan to the pharmacy.
9002313.0201,2216SUBMISSION TYPE CODE COUNT D10;6 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 10, 2018
HELP-PROMPT:Enter a count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of the Submission Type Code (D17-K8) occurrences.
9002313.0201,2217SUBMISSION TYPE CODE D10;7 SET
'AA' FOR 340B;
'AB' FOR SPLIT BILLING;
'AC' FOR ENCOUNTER;
'AD' FOR NOMINAL PRICE;
'AE' FOR FEDERAL SUPPLY SCHEDULE;
'AF' FOR SYNCHRONIZATION FILL;
'AG' FOR TRIAL FILL - SHORTENED DAYS SUPPLY;
LAST EDITED: JUN 02, 2020
HELP-PROMPT:Enter a code identifying the type of submission.
DESCRIPTION:
Code identifying the type of submission as needed for appropriate transaction processing. NCPDP
Field D17-K8.
9002313.0201,2218DO NOT DISPENSE BEFORE DATE D10;8 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUL 16, 2018
HELP-PROMPT:Enter the earliest date the drug can be dispensed.
DESCRIPTION:
The earliest date the prescriber indicates a prescribed drug can be dispensed.
9002313.0201,2221MULTIPLE RX/SVC GROUP ID D20;1 FREE TEXT
INPUT TRANSFORM:K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: MAY 21, 2018
HELP-PROMPT:Enter a ID, must be 1-35 characters in length.
DESCRIPTION:
Unique ID assigned by the prescriber or pharmacy system to link multiple product orders together.
9002313.0201,2222MULT RX/SVC GROUP REASON CODE D20;2 SET
'1' FOR INJECTABLE THERAPY;
'2' FOR LOADING QTY;
'3' FOR MAINTENANCE QTY;
'4' FOR UNBREAKABLE PKG MUTL LOCATIONS;
'5' FOR TRIAL FILL;
'6' FOR NON-COMM AVAILABLE DOSE;
'7' FOR BUNDLED HEALTH CARE SERVICE;
LAST EDITED: MAR 30, 2021
HELP-PROMPT:Enter the reason of the grouped prescriptions code from 1-7.
DESCRIPTION:
Indicates the reason for the quantity dispensed and/or days supply as a result of the prescriber
issuing grouped prescriptions.
9002313.0201,2251OTHER PAYR TAX EXEMPT INDICATR D50;1 SET
'1' FOR OTHER PAYER/PLAN IS TAX EXEMPT;
'2' FOR OTHER PAYER RELIGIOUS ORGANIZATION;
'3' FOR OTHER PAYER TAX EXEMPT CERTIFICATE;
LAST EDITED: MAR 31, 2021
HELP-PROMPT:Enter a code indicating the source of the tax-exempt status.
DESCRIPTION:
Code indicating the source of the percentage tax exempt status of the other payer's claim.
9002313.0201,2252OTHER PAYR FEE EXMPT INDICATR D50;2 SET
'1' FOR OTHER PAYER/PLAN IS REG FEE EXEMPT;
'2' FOR OTHER PAYER RELIGIOUS ORGANIZATION;
'3' FOR OTHER PAYER REG FEE EXEMPT CERTIFICATE;
LAST EDITED: JUL 16, 2018
HELP-PROMPT:Enter a code indicating the source of the regulatory fee exempt status.
DESCRIPTION:
Code Indicating the source of the regulatory fee exempt status of the other payer's claim.
9002313.0201,2253OTHER PAYR FEE TYPE COUNT D50;3 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 21, 2018
HELP-PROMPT:Enter a count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of Other Payer Regulatory Fee Type Code.
9002313.0201,2257PRESCRIBER PLACE OF SERVICE D50;7 POINTER TO BPS NCPDP PRESCRIBER PLACE OF SERVICE FILE (#9002313.34)
LAST EDITED: MAY 14, 2018
HELP-PROMPT:Enter a two digit code between 01 and 99.
DESCRIPTION:
Code identifying the place where the patient encounter occurred as reported by the prescriber.
9002313.0201,2260REGULATORY FEE COUNT D50;10 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 11, 2018
HELP-PROMPT:Enter a count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of Regulatory Fee Type Code (D61-RL).
9002313.0201,2261REGULATORY FEE TYPE CODE D60;1 SET
'AA' FOR LA RS 46 2625;
'AB' FOR OTHER;
LAST EDITED: JUL 16, 2018
HELP-PROMPT:Enter the code identifying the regulatory fee type.
DESCRIPTION:
Code identifying the type of regulatory fee.
9002313.0201,2263OTHER PAYER FEE TYPE CODE D60;3 SET
'AA' FOR LA RS 46 2625;
'AB' FOR OTHER;
LAST EDITED: JUL 16, 2018
HELP-PROMPT:Enter the code identifying the other payer fee type.
DESCRIPTION:
Code identifying the type of Regulatory Fee reported by the other payer.
9002313.0201,2312PRESCRIBER MIDDLE NAME E10;2 FREE TEXT
INPUT TRANSFORM:K:$L(X)>25!($L(X)<1) X
MAXIMUM LENGTH: 25
LAST EDITED: OCT 08, 2019
HELP-PROMPT:Answer must be 1-25 characters in length.
DESCRIPTION:
Prescriber middle name. NCPDP standard field E12-0F.
9002313.0201,2432SEX ASSIGNED AT BIRTH F30;2 SET
'0' FOR UNKNOWN;
'1' FOR MALE;
'2' FOR FEMALE;
'4' FOR INTERSEX;
LAST EDITED: JAN 27, 2022
HELP-PROMPT:Select the sex that was assigned at birth.
DESCRIPTION:
This field contains one of four values to indicate the patient's sex assigned at birth. Possible
value:
0 - UNKNOWN, 1 - MALE, 2 - FEMALE, 4 - INTERSEX
TECHNICAL DESCR:
NCPDP standard field F32-W8.
9002313.02,401DATE OF SERVICE 401;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
LAST EDITED: JUN 04, 2008
HELP-PROMPT: Answer must be 8 characters in length
DESCRIPTION:
Date prescription was dispensed. NCPDP standard field 401-D1.
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century YY=Year MM=Month DD=Day
Examples: If the prescription was dispensed on April 22, 2000, this field would reflect 20000422.
REQUEST TRANSACTION HEADER SEGMENT. RESPONSE HEADER SEGMENT.
CROSS-REFERENCE: 9002313.02^AF
1)= S ^BPSC("AF",$E(X,1,30),DA)=""
2)= K ^BPSC("AF",$E(X,1,30),DA)
9002313.02,524PLAN ID 520;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Answer must be 10 characters in length
DESCRIPTION: Assigned by the processor to identify a set of parameters, benefit, or coverage criteria used to
adjudicate a claim. NCPDP standard field 524-FO.
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.
9002313.02,618PATIENT ID COUNT 610;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of patient ID occurrences. NCPDP standard field 618-RR.
9002313.02,901CLOSED 900;1 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: FEB 14, 2019
HELP-PROMPT: Enter if this claim is closed or not.
DESCRIPTION:
Specify if the claim has been closed (no longer needed for followup) or not.
FIELD INDEX: AC (#1706) MUMPS IR ACTION
Short Descr: MCCF EDI TAS Progress
Set Logic: D CLOSE^BPSRPC03(.DA)
Kill Logic: D CLOSE^BPSRPC03(.DA)
Whole Kill: Q
X(1): CLOSED (9002313.02,901) (forwards)
9002313.02,902DATE CLOSED 900;2 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:X<1 X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Enter the date this claim was closed.
DESCRIPTION:
This is automatically populated with the date a claim was closed.
CROSS-REFERENCE: 9002313.02^AG
1)= S ^BPSC("AG",$E(X,1,30),DA)=""
2)= K ^BPSC("AG",$E(X,1,30),DA)
9002313.02,903CLOSED BY 900;3 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Enter the person who closed this claim.
DESCRIPTION:
This is automatically populated with the user who closed the claim.
9002313.02,904CLOSED REASON 900;4 POINTER TO CLAIMS TRACKING NON-BILLABLE REASONS FILE (#356.8)
INPUT TRANSFORM: S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Enter the Claim Close Reason.
DESCRIPTION:
The ECME-supported non-billable reason entered by the user or defaulted by the system.
SCREEN: S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)"
EXPLANATION: Only ECME-supported non-billable reasons can be entered.
9002313.02,905DROP TO PAPER 900;5 SET
'D' FOR DROP TO PAPER;
'N' FOR NON-BILLABLE;
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Enter D if this claim should be billed on a paper claim.
DESCRIPTION: If close reason is 90 DAY RX FILL NOT COVERED or NOT A CONTRACTED PROVIDER then user will be
prompted: Treat as (N)on-Billable Episode or (D)rop Bill to Paper? the answer is stored in this
field and sent to IB
9002313.02,906DATE REOPENED 900;6 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 04, 2008
HELP-PROMPT: Enter the date and time when the claim was re-opened
DESCRIPTION:
Date and time when the claim was re-opened.
9002313.02,907REOPENED BY 900;7 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 14, 2006
HELP-PROMPT: Enter the user who re-opened the claim
DESCRIPTION:
The system user who re-opened the claim.
9002313.02,908REOPENED COMMENT 900;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: JUN 14, 2006
HELP-PROMPT: Enter the reason for the re-opening of the claim
DESCRIPTION:
User comments for the re-opening of the claim.
9002313.02,990OTHER PAYER BIN NUMBER 980;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 990-MG (Other Payer BIN Number), which is defined as "The
secondary, tertiary, etc. card issuer or bank ID number used for network routing."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT.
9002313.02,991OTHER PAYER PROC CONTROL NUM 990;1 FREE TEXT
OTHER PAYER PROCESSOR CONTROL NUMBER
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 991-MH (Other Payer Processor Control Number), which is defined
as "A number that uniquely identifies the secondary, tertiary, etc. payer to the processor."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT. RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.02,992OTHER PAYER GROUP ID 990;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-17 characters.
DESCRIPTION: This is used to store NCPDP field 992-MJ (Other Payer Group ID), which is defined as "ID assigned
to the cardholder group or employer group by the secondary, tertiary, etc. payer."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT. RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.02,997CMS PART D DEFND QLFD FACILITY 990;7 FREE TEXT
CMS PART D DEFINED QUALIFIED FACILITY
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: MAR 29, 2021
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 997-G2 (CMS Part D Defined Qualified Facility), which is defined
as "Indicates that the patient resides in a facility that qualifies for the CMS Part D benefit."
TECHNICAL DESCR:
REQUEST INSURANCE SEGMENT.
9002313.02,1022PATIENT ID STATE/PROVINCE A20;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field A22-YR
The postal state code abbreviation that is used in conjunction with the Patient ID Qualifier and
the Patient ID fields to identify what state the identification is from.
TECHNICAL DESCR:
PATIENT SEGMENT
9002313.02,1043PATIENT COUNTRY CODE A40;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: NCPDP Standard field A43-1K
The country of the patient's permanent residence.
TECHNICAL DESCR:
PATIENT SEGMENT
9002313.02,1045VETERINARY USE INDICATOR A40;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: MAR 01, 2013
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION: NCPDP Standard field A45-1R
To indicate that the prescription was dispensed for use on something other than human.
TECHNICAL DESCR:
PATIENT SEGMENT
9002313.02,2008PATIENT STREET ADDRESS LINE 1 B00;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: FEB 28, 2017
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B08-7A (Patient Street Address Line 1), which is defined as
"Free-form text for address line 1 information".
9002313.02,2009PATIENT STREET ADDRESS LINE 2 B00;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>42!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-42 characters in length.
DESCRIPTION: This is used to store NCPDP field B09-7B (Patient Street Address Line 2), which is defined as
"Free-form text for address line 2 information".
9002313.02,2038PATIENT ID ASSOC COUNTRY CODE B30;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: This is used to store NCPDP field B38-1Y (Patient ID Associated Country Code), which is defined as
"Code of the country".
9002313.02,2306SPECIES E00;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>9!($L(X)<1) X
MAXIMUM LENGTH: 9
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Answer must be 1-9 characters in length.
DESCRIPTION:
Species. Not used for humans. NCPDP standard field E06-S8.
9002313.02,2309PATIENT MIDDLE NAME E00;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>25!($L(X)<1) X
MAXIMUM LENGTH: 25
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Answer must be 1-25 characters in length.
DESCRIPTION:
Patient middle name. NCPDP standard field E09-0C.
9002313.02,2310PATIENT NAME PREFIX E00;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
Patient name prefix. NCPDP standard field E10-0D.
9002313.02,2311PATIENT NAME SUFFIX E10;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: OCT 08, 2019
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
Patient name suffix. NCPDP standard field E11-0E.
9002313.02,9999RAW DATA SENT M;0 WORD-PROCESSING #9002313.29999 (NOWRAP)
HELP-PROMPT: Enter the Raw data transmitted to the payer.
DESCRIPTION:
An exact copy of the record sent via the communications protocol.
LAST EDITED: NOV 24, 2003
DESCRIPTION: A copy of the raw packet is saved here. It's intended to be of help in times of dispute. This
field could be winnowed before the rest of the 9002313.02 is winnowed. For instance, it might
make sense to only keep a month of these around.
FILES POINTED TO FIELDS
BPS NCPDP BENEFIT STAGE INDICA
(#9002313.35) TRANSACTIONS:BENEFIT STAGE INDICATOR (#2151)
BPS NCPDP FORMATS (#9002313.92) ELECTRONIC PAYER (#.02)
BPS NCPDP LTPAC DISPENSE FREQU
(#9002313.36) TRANSACTIONS:LTPAC DISPENSE FREQUENCY (#2191)
BPS NCPDP OTHER PAYER PROGRAM
(#9002313.38) TRANSACTIONS:OTHER PAYER PROGRAM TYPE (#2147)
BPS NCPDP PRESCRIBER PLACE OF
(#9002313.34) TRANSACTIONS:PRESCRIBER PLACE OF SERVICE (#2257)
BPS TRANSACTION (#9002313.59) TRANSACTION (#.08)
CLAIMS TRACKING NON-BILLABLE R
(#356.8) CLOSED REASON (#904)
GROUP INSURANCE PLAN (#355.3) GROUP INSURANCE PLAN (#1.04)
NEW PERSON (#200) CLOSED BY (#903)
REOPENED BY (#907)
PRESCRIPTION (#52) TRANSACTIONS:PRESCRIPTION NUMBER (#.05)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):