DEV5 (114)    BPS NCPDP FORMATS (9002313.92)

Name Value
RECORD FORMAT NAME DEV5
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:   SPECIAL
    SPECIAL CODE:   
    S BPS("X")="05"
  • TRANSACTION HEADER ORDER:   19
    NCPDP FIELD NUMBER:   201
    PROCESSING MODE:   SPECIAL
    SPECIAL CODE:   
    S BPS("X")=BPS("Site","Medicaid Pharmacy #")
  • 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:   32
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   34
    NCPDP FIELD NUMBER:   307
    PROCESSING MODE:   STANDARD
INSURANCE SEGMENT
  • INSURANCE SEGMENT ORDER:   42
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   44
    NCPDP FIELD NUMBER:   302
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   45
    NCPDP FIELD NUMBER:   312
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   48
    NCPDP FIELD NUMBER:   313
    PROCESSING MODE:   STANDARD
CLAIM SEGMENT
  • CLAIM SEGMENT ORDER:   58
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   60
    NCPDP FIELD NUMBER:   455
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   63
    NCPDP FIELD NUMBER:   402
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   67
    NCPDP FIELD NUMBER:   436
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   69
    NCPDP FIELD NUMBER:   407
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   72
    NCPDP FIELD NUMBER:   442
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   74
    NCPDP FIELD NUMBER:   403
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   77
    NCPDP FIELD NUMBER:   405
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   78
    NCPDP FIELD NUMBER:   406
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   81
    NCPDP FIELD NUMBER:   408
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   85
    NCPDP FIELD NUMBER:   308
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   87
    NCPDP FIELD NUMBER:   462
    PROCESSING MODE:   STANDARD
PRESCRIBER SEGMENT
  • PRESCRIBER SEGMENT ORDER:   100
    NCPDP FIELD NUMBER:   466
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   104
    NCPDP FIELD NUMBER:   411
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   98
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
COB OTHER PAYMENTS SEGMENT
  • COB OTHER PAYMENTS ORDER:   114
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   117
    NCPDP FIELD NUMBER:   337
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   119
    NCPDP FIELD NUMBER:   338
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   121
    NCPDP FIELD NUMBER:   443
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   122
    NCPDP FIELD NUMBER:   341
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   125
    NCPDP FIELD NUMBER:   342
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   128
    NCPDP FIELD NUMBER:   431
    PROCESSING MODE:   STANDARD
DUR PPS SEGMENT
  • DUR PPS SEGMENT ORDER:   137
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   139
    NCPDP FIELD NUMBER:   473
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   141
    NCPDP FIELD NUMBER:   439
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   143
    NCPDP FIELD NUMBER:   440
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   145
    NCPDP FIELD NUMBER:   441
    PROCESSING MODE:   STANDARD
PRICING SEGMENT
  • PRICING SEGMENT ORDER:   154
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   156
    NCPDP FIELD NUMBER:   426
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   159
    NCPDP FIELD NUMBER:   430
    PROCESSING MODE:   STANDARD
COMPOUND SEGMENT
  • COMPOUND SEGMENT ORDER:   167
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   169
    NCPDP FIELD NUMBER:   450
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   172
    NCPDP FIELD NUMBER:   451
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   174
    NCPDP FIELD NUMBER:   452
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   176
    NCPDP FIELD NUMBER:   447
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   178
    NCPDP FIELD NUMBER:   488
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   180
    NCPDP FIELD NUMBER:   489
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   183
    NCPDP FIELD NUMBER:   448
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   185
    NCPDP FIELD NUMBER:   449
    PROCESSING MODE:   STANDARD
CLINICAL SEGMENT
  • CLINICAL SEGMENT ORDER:   194
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   196
    NCPDP FIELD NUMBER:   491
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   198
    NCPDP FIELD NUMBER:   492
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   200
    NCPDP FIELD NUMBER:   424
    PROCESSING MODE:   STANDARD