COMBCAZ5 (102)    BPS NCPDP FORMATS (9002313.92)

Name Value
RECORD FORMAT NAME COMBCAZ5
VERSION Version 5.1
PRODUCTION STATUS PRODUCTION
PAYER SHEET VERSION 1
TRANSACTION HEADER SEGMENT
  • TRANSACTION HEADER ORDER:   10
    NCPDP FIELD NUMBER:   102
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   12
    NCPDP FIELD NUMBER:   103
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   13
    NCPDP FIELD NUMBER:   104
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   15
    NCPDP FIELD NUMBER:   109
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   17
    NCPDP FIELD NUMBER:   202
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   19
    NCPDP FIELD NUMBER:   201
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   21
    NCPDP FIELD NUMBER:   401
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   22
    NCPDP FIELD NUMBER:   110
    PROCESSING MODE:   STANDARD
  • TRANSACTION HEADER ORDER:   9
    NCPDP FIELD NUMBER:   101
    PROCESSING MODE:   STANDARD
PATIENT SEGMENT
  • PATIENT SEGMENT ORDER:   31
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   33
    NCPDP FIELD NUMBER:   304
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   34
    NCPDP FIELD NUMBER:   305
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   36
    NCPDP FIELD NUMBER:   310
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   38
    NCPDP FIELD NUMBER:   311
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   40
    NCPDP FIELD NUMBER:   322
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   42
    NCPDP FIELD NUMBER:   323
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   44
    NCPDP FIELD NUMBER:   324
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   47
    NCPDP FIELD NUMBER:   325
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   49
    NCPDP FIELD NUMBER:   326
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   51
    NCPDP FIELD NUMBER:   307
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   52
    NCPDP FIELD NUMBER:   333
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   53
    NCPDP FIELD NUMBER:   334
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   55
    NCPDP FIELD NUMBER:   335
    PROCESSING MODE:   STANDARD
INSURANCE SEGMENT
  • INSURANCE SEGMENT ORDER:   64
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   66
    NCPDP FIELD NUMBER:   302
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   67
    NCPDP FIELD NUMBER:   312
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   69
    NCPDP FIELD NUMBER:   313
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   71
    NCPDP FIELD NUMBER:   314
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   72
    NCPDP FIELD NUMBER:   524
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   73
    NCPDP FIELD NUMBER:   309
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   76
    NCPDP FIELD NUMBER:   336
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   77
    NCPDP FIELD NUMBER:   301
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   78
    NCPDP FIELD NUMBER:   303
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   79
    NCPDP FIELD NUMBER:   306
    PROCESSING MODE:   STANDARD
CLAIM SEGMENT
  • CLAIM SEGMENT ORDER:   100
    NCPDP FIELD NUMBER:   456
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   103
    NCPDP FIELD NUMBER:   457
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   106
    NCPDP FIELD NUMBER:   458
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   109
    NCPDP FIELD NUMBER:   459
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   111
    NCPDP FIELD NUMBER:   442
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   113
    NCPDP FIELD NUMBER:   403
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   114
    NCPDP FIELD NUMBER:   405
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   115
    NCPDP FIELD NUMBER:   406
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   116
    NCPDP FIELD NUMBER:   408
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   118
    NCPDP FIELD NUMBER:   414
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   121
    NCPDP FIELD NUMBER:   415
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   124
    NCPDP FIELD NUMBER:   419
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   126
    NCPDP FIELD NUMBER:   420
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   129
    NCPDP FIELD NUMBER:   460
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   131
    NCPDP FIELD NUMBER:   308
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   133
    NCPDP FIELD NUMBER:   429
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   135
    NCPDP FIELD NUMBER:   453
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   138
    NCPDP FIELD NUMBER:   445
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   141
    NCPDP FIELD NUMBER:   446
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   143
    NCPDP FIELD NUMBER:   330
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   144
    NCPDP FIELD NUMBER:   454
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   147
    NCPDP FIELD NUMBER:   600
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   148
    NCPDP FIELD NUMBER:   418
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   149
    NCPDP FIELD NUMBER:   461
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   152
    NCPDP FIELD NUMBER:   462
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   156
    NCPDP FIELD NUMBER:   463
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   159
    NCPDP FIELD NUMBER:   464
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   162
    NCPDP FIELD NUMBER:   343
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   164
    NCPDP FIELD NUMBER:   344
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   167
    NCPDP FIELD NUMBER:   345
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   89
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   91
    NCPDP FIELD NUMBER:   455
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   94
    NCPDP FIELD NUMBER:   402
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   96
    NCPDP FIELD NUMBER:   436
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   98
    NCPDP FIELD NUMBER:   407
    PROCESSING MODE:   STANDARD
PHARMACY PROVIDER SEGMENT
  • PHARMACY PROVIDER ORDER:   177
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PHARMACY PROVIDER ORDER:   179
    NCPDP FIELD NUMBER:   465
    PROCESSING MODE:   STANDARD
  • PHARMACY PROVIDER ORDER:   181
    NCPDP FIELD NUMBER:   444
    PROCESSING MODE:   STANDARD
PRESCRIBER SEGMENT
  • PRESCRIBER SEGMENT ORDER:   189
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   191
    NCPDP FIELD NUMBER:   466
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   193
    NCPDP FIELD NUMBER:   411
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   194
    NCPDP FIELD NUMBER:   467
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   196
    NCPDP FIELD NUMBER:   427
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   198
    NCPDP FIELD NUMBER:   498
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   200
    NCPDP FIELD NUMBER:   468
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   203
    NCPDP FIELD NUMBER:   421
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   205
    NCPDP FIELD NUMBER:   469
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   208
    NCPDP FIELD NUMBER:   470
    PROCESSING MODE:   STANDARD
COB OTHER PAYMENTS SEGMENT
  • COB OTHER PAYMENTS ORDER:   218
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   220
    NCPDP FIELD NUMBER:   337
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   222
    NCPDP FIELD NUMBER:   338
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   224
    NCPDP FIELD NUMBER:   339
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   226
    NCPDP FIELD NUMBER:   340
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   227
    NCPDP FIELD NUMBER:   443
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   228
    NCPDP FIELD NUMBER:   341
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   231
    NCPDP FIELD NUMBER:   342
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   234
    NCPDP FIELD NUMBER:   431
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   236
    NCPDP FIELD NUMBER:   471
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   238
    NCPDP FIELD NUMBER:   472
    PROCESSING MODE:   STANDARD
WORKERS COMP SEGMENT
  • WORKERS COMP SEGMENT ORDER:   247
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   250
    NCPDP FIELD NUMBER:   434
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   251
    NCPDP FIELD NUMBER:   315
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   252
    NCPDP FIELD NUMBER:   316
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   254
    NCPDP FIELD NUMBER:   317
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   256
    NCPDP FIELD NUMBER:   318
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   259
    NCPDP FIELD NUMBER:   319
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   261
    NCPDP FIELD NUMBER:   320
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   263
    NCPDP FIELD NUMBER:   321
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   265
    NCPDP FIELD NUMBER:   327
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   266
    NCPDP FIELD NUMBER:   435
    PROCESSING MODE:   STANDARD
DUR PPS SEGMENT
  • DUR PPS SEGMENT ORDER:   275
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   277
    NCPDP FIELD NUMBER:   473
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   279
    NCPDP FIELD NUMBER:   439
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   281
    NCPDP FIELD NUMBER:   440
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   283
    NCPDP FIELD NUMBER:   441
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   285
    NCPDP FIELD NUMBER:   474
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   287
    NCPDP FIELD NUMBER:   475
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   289
    NCPDP FIELD NUMBER:   476
    PROCESSING MODE:   STANDARD
PRICING SEGMENT
  • PRICING SEGMENT ORDER:   297
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   299
    NCPDP FIELD NUMBER:   409
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   301
    NCPDP FIELD NUMBER:   412
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   303
    NCPDP FIELD NUMBER:   477
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   306
    NCPDP FIELD NUMBER:   433
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   309
    NCPDP FIELD NUMBER:   438
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   311
    NCPDP FIELD NUMBER:   478
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   314
    NCPDP FIELD NUMBER:   479
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   318
    NCPDP FIELD NUMBER:   480
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   321
    NCPDP FIELD NUMBER:   481
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   324
    NCPDP FIELD NUMBER:   482
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   327
    NCPDP FIELD NUMBER:   483
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   330
    NCPDP FIELD NUMBER:   484
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   333
    NCPDP FIELD NUMBER:   426
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   336
    NCPDP FIELD NUMBER:   430
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   337
    NCPDP FIELD NUMBER:   423
    PROCESSING MODE:   STANDARD
COUPON SEGMENT
  • COUPON SEGMENT ORDER:   346
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COUPON SEGMENT ORDER:   348
    NCPDP FIELD NUMBER:   485
    PROCESSING MODE:   STANDARD
  • COUPON SEGMENT ORDER:   349
    NCPDP FIELD NUMBER:   486
    PROCESSING MODE:   STANDARD
  • COUPON SEGMENT ORDER:   350
    NCPDP FIELD NUMBER:   487
    PROCESSING MODE:   STANDARD
COMPOUND SEGMENT
  • COMPOUND SEGMENT ORDER:   359
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   361
    NCPDP FIELD NUMBER:   450
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   364
    NCPDP FIELD NUMBER:   451
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   366
    NCPDP FIELD NUMBER:   452
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   368
    NCPDP FIELD NUMBER:   447
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   370
    NCPDP FIELD NUMBER:   488
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   372
    NCPDP FIELD NUMBER:   489
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   373
    NCPDP FIELD NUMBER:   448
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   375
    NCPDP FIELD NUMBER:   449
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   377
    NCPDP FIELD NUMBER:   490
    PROCESSING MODE:   STANDARD
PRIOR AUTH SEGMENT
  • PRIOR AUTH SEGMENT ORDER:   387
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   390
    NCPDP FIELD NUMBER:   498.01
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   391
    NCPDP FIELD NUMBER:   498.02
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   393
    NCPDP FIELD NUMBER:   498.03
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   395
    NCPDP FIELD NUMBER:   498.04
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   396
    NCPDP FIELD NUMBER:   498.05
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   398
    NCPDP FIELD NUMBER:   498.06
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   400
    NCPDP FIELD NUMBER:   498.07
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   402
    NCPDP FIELD NUMBER:   498.08
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   404
    NCPDP FIELD NUMBER:   498.09
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   407
    NCPDP FIELD NUMBER:   498.11
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   409
    NCPDP FIELD NUMBER:   498.14
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   412
    NCPDP FIELD NUMBER:   503
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   414
    NCPDP FIELD NUMBER:   498.13
    PROCESSING MODE:   STANDARD
CLINICAL SEGMENT
  • CLINICAL SEGMENT ORDER:   423
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   425
    NCPDP FIELD NUMBER:   491
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   427
    NCPDP FIELD NUMBER:   492
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   429
    NCPDP FIELD NUMBER:   424
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   430
    NCPDP FIELD NUMBER:   493
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   433
    NCPDP FIELD NUMBER:   494
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   434
    NCPDP FIELD NUMBER:   495
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   435
    NCPDP FIELD NUMBER:   496
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   437
    NCPDP FIELD NUMBER:   497
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   438
    NCPDP FIELD NUMBER:   499
    PROCESSING MODE:   STANDARD