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Sub-Field: 9002313.0201

Package: E Claims Management Engine

BPS CLAIMS(#9002313.02)-->9002313.0201

Sub-Field: 9002313.0201


Information

Parent File Name Number Package
BPS CLAIMS(#9002313.02) TRANSACTIONS 9002313.0201 E Claims Management Engine

Details

Field # Name Loc Type Details
.01 TRANSACTION ORDER 0;1 NUMBER

  • 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)
.04 MEDICATION 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.
.05 PRESCRIPTION NUMBER 0;5 POINTER TO PRESCRIPTION FILE (#52) PRESCRIPTION(#52)

  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Enter the Prescription for this medication
  • DESCRIPTION:  
    This is the prescription associated with the claim
113 MEDICAID 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.
117 BILLING 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.
118 PAY 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.
119 PAY 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.
120 PAY 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.
121 PAY 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.
122 PAY 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.
123 PAY 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.
124 PAY 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.
125 GENERIC EQUIV PROD ID QLFR 120;5 FREE TEXT

  • 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.
126 GENERIC 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.
147 PHARMACY 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.
308 OTHER 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
315 EMPLOYER 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
316 EMPLOYER 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
317 EMPLOYER 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
318 EMPLOYER 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
319 EMPLOYER 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
320 EMPLOYER 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
321 EMPLOYER 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
327 CARRIER 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
330 ALTERNATE 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
337 COB/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.
337.01 COB OTHER PAYMENTS 337;0 Multiple #9002313.0401 9002313.0401

  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    Multiple counter to store other coordination of benefit payments.
343 DISPENSING 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.
344 QTY 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.
345 DAYS 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.
354 SUBMISSION CLARIF CODE COUNT 350;4 FREE TEXT

  • 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."
354.01 SUBMISSION CLARIFICATION MLTPL 354.01;0 Multiple #9002313.02354 9002313.02354

  • LAST EDITED:  JUL 27, 2010
  • DESCRIPTION:  
    This sub-file stores Submission Clarification values.
357 DELAY 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."
364 PRESCRIBER 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).
365 PRESCRIBER 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."
366 PRESCRIBER 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."
367 PRESCRIBER STATE/PROV ADDRESS 360;7 FREE TEXT

  • 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."
368 PRESCRIBER 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."
369 ADDITIONAL DCMNTN TYPE ID 360;9 FREE TEXT

  • 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.
370 LENGTH 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.
371 LENGTH 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.
372 PRESCRIBER/SUPPLIER DT SIGNED 370;2 FREE TEXT

  • 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.
373 REQUEST 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.
374 REQUEST 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.
375 REQ PERIOD RECERT/REVISED DT 370;5 FREE TEXT

  • 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.
376 SUPPORTING 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.
377 QUESTION 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.
377.01 QUESTION NUMBER/LETTER MLTPL 377.01;0 Multiple #9002313.023771 9002313.023771

  • DESCRIPTION:  
    This sub-file stores Question Number/Letter values.
385 FACILITY 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
386 FACILITY 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
387 FACILITY STATE/PROV ADDRESS 380;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 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.
388 FACILITY 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.
389 FACILITY 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.
390 NARRATIVE 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.
391 PATIENT 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."
402 PRESCRIPTION/SERVICE REF NO 400;2 FREE TEXT

  • 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.
403 FILL 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.
405 DAYS 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.
406 COMPOUND 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.
407 PRODUCT/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.
408 DAW 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.
409 INGREDIENT 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.
411 PRESCRIBER 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
412 DISPENSING 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.
414 DATE 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.
415 NUMBER 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.
418 LEVEL 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.
419 PRESCRIPTION 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.
421 PRIMARY 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.
423 BASIS 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.
424 DIAGNOSIS CODE 400;24 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<17) X
  • LAST EDITED:  MAR 07, 2025
  • 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.
426 USUAL 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.
427 PRESCRIBER 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.
429 SPECIAL 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.
430 GROSS 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.
431 OTHER 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.
433 PATIENT 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.
434 DATE 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.
435 CLAIM/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.
436 PRODUCT/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.
438 INCENTIVE 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.
442 QUANTITY 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.
443 OTHER 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
444 PROVIDER 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.
445 ORIG 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.
446 ORIGINALLY 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.
447 COMPOUND 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.
447.01 COMPOUND REPEATING FIELDS 447;0 Multiple #9002313.0501 9002313.0501

  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    Multiple to store multiple compounds in a prescription.
450 COMPOUND 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.
451 COMPOUND 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.
452 COMPOUND 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.
453 ORIG 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.
454 SCHEDULED 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.
455 PRESCRIPTION/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.
456 ASSOC PRESCRIPTION/SERV REF NO 450;6 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:  
    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.
457 ASSOC 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.
458 PROCEDURE 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.
459 PROCEDURE MODIFIER CODE 459;0 Multiple #9002313.201459 9002313.201459

  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    Multiple for storing procedure code information.
460 QUANTITY 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.
461 PRIOR 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
462 PRIOR 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.
463 INTERMEDIARY 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
464 INTERMEDIARY 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.
465 PROVIDER 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.
466 PRESCRIBER 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.
467 PRESCRIBER 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.
468 PRIMARY 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.
469 PRIM 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.
470 PRIM 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.
471 OTHER 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.
473.01 DUR PPS REPEATING FIELDS 473.01;0 Multiple #9002313.1001 9002313.1001

  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    Count of Drug Utilization sub-records.
477 PROF 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.
478 OTHER AMT CLAIMED SBMTTD COUNT 470;8 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:  
    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.
478.01 OTHER AMT CLAIMED MULTIPLE 478.01;0 Multiple #9002313.0601 9002313.0601

  • LAST EDITED:  OCT 13, 2010
  • DESCRIPTION:  
    This sub-file stores Other Amount Claimed values.
481 REGULATORY 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 $1ØØ 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.
482 PERCENT 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.
483 PERCENT 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.
484 PERCENTAGE 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.
485 COUPON 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.
486 COUPON 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.
487 COUPON 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.
491 DIAGNOSIS 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.
491.01 CLINICAL DIAGNOSIS 491.01;0 Multiple #9002313.0701 9002313.0701

  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    Diagnosis sub-records.
492 DIAGNOSIS CODE QUALIFIER 490;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<4) X
    MAXIMUM LENGTH: 4
  • LAST EDITED:  FEB 27, 2025
  • 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.
493 CLINICAL 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.
493.01 CLINICAL INFORMATION 493.01;0 Multiple #9002313.0801 9002313.0801

  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    Count of clinical information sub-records.
498.01 REQUEST 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.
498.02 REQUEST 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.
498.03 REQUEST 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.
498.04 BASIS 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.
498.05 AUTHORIZED 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.
498.06 AUTHORIZED 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.
498.07 AUTHORIZED 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.
498.08 AUTH 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.
498.09 AUTHORIZED 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.
498.11 AUTHORIZED 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.
498.12 PRESCRIBER 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.
498.13 PRIOR AUTH SUPPORTING DOCUMENT 498.13;0 WORD-PROCESSING #9002313.0901

  • 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.
498.14 PRIOR 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.
503 AUTHORIZATION 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.
579 ASSOC 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' (58Ø-XY) to which the claim/service is related.
  • TECHNICAL DESCR:  
    CLAIM SEGMENT
580 ASSOC 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
581 ASSOC 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
582 ASSOC 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
583 SERVICE 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 (2Ø1-B1).
  • TECHNICAL DESCR:  
    SERVICE PROVIDER SEGMENT
584 SERVICE 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
585 SERVICE 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
586 SERVICE 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
587 SERVICE 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
590 SELLER 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
591 PURCHASER 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
592 PURCHASER 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
593 PURCHASER 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
594 PURCHASER 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
595 PURCHASER 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
596 PURCHASER 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
597 PURCHASER 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
598 PURCHASER 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
599 PURCHASER 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
600 UNIT 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.
675 PURCHASER 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
676 PURCHASER 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
677 PURCHASER 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
678 TIME 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
679 SELLER 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
680 SELLER 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
681 SALES 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
880 TRANSACTION 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."
995 ROUTE 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."
996 COMPOUND 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."
1023 PURCHASER 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
1024 PRESCRIBER 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
1025 PRESCRIBER 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
1026 PRESCRIBER 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
1027 PRESCRIBER 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
1029 REPORTED 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
1030 RELEASED 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
1031 RELEASED 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 (A3Ø-ZT)
  • TECHNICAL DESCR:  
    PURCHASER SEGMENT
1032 COMPOUND 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
1093 SERVICE 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".
2013 AUTH 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".
2014 AUTH 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".
2015 EMPLOYER 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".
2016 EMPLOYER 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".
2017 EMPLOYER 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".
2018 EMPLOYER 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".
2019 EMPLOYER 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".
2020 FACILITY 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".
2021 FACILITY 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".
2024 PAY 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".
2025 PAY 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".
2026 PRESCRIBER 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".
2027 PRESCRIBER 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".
2028 PRESCRIBER 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".
2029 PURCHASER 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".
2030 PURCHASER 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".
2031 SERVICE 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".
2032 SERVICE 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".
2034 AUTH 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".
2035 EMPLOYER 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".
2037 FACILITY 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".
2039 PAY 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".
2040 PRES 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".
2041 PRES 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".
2042 PRESCRIBER 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".
2043 PURCHASER 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".
2044 INTERMEDIARY 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.
2044.01 INTERMEDIARY ID MULTIPLE B44;0 Multiple #9002313.022044 9002313.022044

  • DESCRIPTION:  
    This multiple is used to hold the NCPDP values for the Intermediary ID repeating group.
2056 LAST 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".
2057 LAST 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".
2058 LAST 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".
2059 LAST 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".
2060 YEAR 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".
2061 MONTH 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".
2095 FACILITY 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
2096 PROVIDER 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
2097 PROVIDER 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
2101 ORIG 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
2102 ORIG MANUFACTURER PROD ID QUAL C00;2 SET

  • 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
2147 OTHER PAYER PROGRAM TYPE C40;7 POINTER TO BPS NCPDP OTHER PAYER PROGRAM TYPE FILE (#9002313.38) BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)

  • 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.
2149 OTHER 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.
2150 BENEFIT 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.
2151 BENEFIT STAGE INDICATOR C50;1 POINTER TO BPS NCPDP BENEFIT STAGE INDICATOR FILE (#9002313.35) BPS NCPDP BENEFIT STAGE INDICATOR(#9002313.35)

  • 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.
2160 COMPOUND LEVEL OF COMPLEXITY C50;10 SET

  • 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.
2190 LTPAC BILLING METHODOLOGY C80;10 SET

  • LAST EDITED:  MAY 21, 2018
  • HELP-PROMPT:  Enter billing methodology 1, 2 or 3.
  • DESCRIPTION:  
    Code indicating the billing methodology used for the claim.
2191 LTPAC DISPENSE FREQUENCY C90;1 POINTER TO BPS NCPDP LTPAC DISPENSE FREQUENCY FILE (#9002313.36) BPS NCPDP LTPAC DISPENSE FREQUENCY(#9002313.36)

  • 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.
2192 NUMBER LTPAC DISPENSING EVENTS C90;2 NUMBER

  • 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.
2198 PREPARATION ENVIRONMENT CODE C90;8 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a preparation environment code.
  • DESCRIPTION:  
    Event which required a special preparation environment.
2199 PREPARATION ENVIRONMENT TYPE C90;9 SET

  • 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.
2201 PRESCRIBER 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.
2202 TOTAL 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.
2214 SUBROGATION 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.
2216 SUBMISSION 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.
2217 SUBMISSION TYPE CODE D10;7 SET

  • 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.
2218 DO 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.
2221 MULTIPLE 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.
2222 MULT RX/SVC GROUP REASON CODE D20;2 SET

  • 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.
2251 OTHER PAYR TAX EXEMPT INDICATR D50;1 SET

  • 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.
2252 OTHER PAYR FEE EXMPT INDICATR D50;2 SET

  • 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.
2253 OTHER 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.
2257 PRESCRIBER PLACE OF SERVICE D50;7 POINTER TO BPS NCPDP PRESCRIBER PLACE OF SERVICE FILE (#9002313.34) BPS NCPDP PRESCRIBER PLACE OF SERVICE(#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.
2260 REGULATORY 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).
2261 REGULATORY FEE TYPE CODE D60;1 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the code identifying the regulatory fee type.
  • DESCRIPTION:  
    Code identifying the type of regulatory fee.
2263 OTHER PAYER FEE TYPE CODE D60;3 SET

  • 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.
2312 PRESCRIBER 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.
2432 SEX ASSIGNED AT BIRTH F30;2 SET

  • 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.
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