| RECORD FORMAT NAME |
CAMDBIL5 |
| 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: 22
- NCPDP FIELD NUMBER: 401
- PROCESSING MODE: STANDARD
-
- TRANSACTION HEADER ORDER: 23
- 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: 304
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 35
- NCPDP FIELD NUMBER: 305
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 37
- NCPDP FIELD NUMBER: 307
- PROCESSING MODE: STANDARD
|
| INSURANCE SEGMENT |
-
- INSURANCE SEGMENT ORDER: 45
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 47
- NCPDP FIELD NUMBER: 302
- PROCESSING MODE: STANDARD
|
| CLAIM SEGMENT |
-
- CLAIM SEGMENT ORDER: 57
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 59
- NCPDP FIELD NUMBER: 455
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 62
- NCPDP FIELD NUMBER: 402
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 64
- NCPDP FIELD NUMBER: 436
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 66
- NCPDP FIELD NUMBER: 407
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 68
- NCPDP FIELD NUMBER: 442
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 71
- NCPDP FIELD NUMBER: 405
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 72
- NCPDP FIELD NUMBER: 406
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 74
- NCPDP FIELD NUMBER: 420
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 77
- NCPDP FIELD NUMBER: 461
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 80
- NCPDP FIELD NUMBER: 462
- PROCESSING MODE: STANDARD
|
| PRESCRIBER SEGMENT |
-
- PRESCRIBER SEGMENT ORDER: 91
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- PRESCRIBER SEGMENT ORDER: 93
- NCPDP FIELD NUMBER: 466
- PROCESSING MODE: SPECIAL
- SPECIAL CODE:
S BPS("X")="08"
-
- PRESCRIBER SEGMENT ORDER: 95
- NCPDP FIELD NUMBER: 411
- PROCESSING MODE: SPECIAL
- SPECIAL CODE:
S BPS("X")=$P($G(^VA(200,BPS("RX",BPS(9002313.0201),"Prescriber IEN"),"PS1",1,0)),"^",2)
|
| COB OTHER PAYMENTS SEGMENT |
-
- COB OTHER PAYMENTS ORDER: 104
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- COB OTHER PAYMENTS ORDER: 107
- NCPDP FIELD NUMBER: 337
- PROCESSING MODE: STANDARD
-
- COB OTHER PAYMENTS ORDER: 109
- NCPDP FIELD NUMBER: 338
- PROCESSING MODE: STANDARD
-
- COB OTHER PAYMENTS ORDER: 111
- NCPDP FIELD NUMBER: 341
- PROCESSING MODE: STANDARD
-
- COB OTHER PAYMENTS ORDER: 114
- NCPDP FIELD NUMBER: 342
- PROCESSING MODE: STANDARD
-
- COB OTHER PAYMENTS ORDER: 117
- NCPDP FIELD NUMBER: 431
- PROCESSING MODE: STANDARD
|
| DUR PPS SEGMENT |
-
- DUR PPS SEGMENT ORDER: 126
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- DUR PPS SEGMENT ORDER: 128
- NCPDP FIELD NUMBER: 473
- PROCESSING MODE: STANDARD
-
- DUR PPS SEGMENT ORDER: 132
- NCPDP FIELD NUMBER: 439
- PROCESSING MODE: STANDARD
-
- DUR PPS SEGMENT ORDER: 134
- NCPDP FIELD NUMBER: 440
- PROCESSING MODE: STANDARD
-
- DUR PPS SEGMENT ORDER: 136
- NCPDP FIELD NUMBER: 441
- PROCESSING MODE: STANDARD
|
| PRICING SEGMENT |
-
- PRICING SEGMENT ORDER: 145
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 147
- NCPDP FIELD NUMBER: 433
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 150
- NCPDP FIELD NUMBER: 430
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 151
- NCPDP FIELD NUMBER: 423
- PROCESSING MODE: STANDARD
|
| CLINICAL SEGMENT |
-
- CLINICAL SEGMENT ORDER: 160
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- CLINICAL SEGMENT ORDER: 162
- NCPDP FIELD NUMBER: 491
- PROCESSING MODE: STANDARD
-
- CLINICAL SEGMENT ORDER: 164
- NCPDP FIELD NUMBER: 492
- PROCESSING MODE: STANDARD
-
- CLINICAL SEGMENT ORDER: 166
- NCPDP FIELD NUMBER: 424
- PROCESSING MODE: STANDARD
|
