Name	Value
RECORD FORMAT NAME	NYMDV5
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: 15 NCPDP FIELD NUMBER: 104 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 18 NCPDP FIELD NUMBER: 109 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 21 NCPDP FIELD NUMBER: 202 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")="05" TRANSACTION HEADER ORDER: 23 NCPDP FIELD NUMBER: 201 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")=BPS("Site","Medicaid Pharmacy #") TRANSACTION HEADER ORDER: 25 NCPDP FIELD NUMBER: 401 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 26 NCPDP FIELD NUMBER: 110 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 9 NCPDP FIELD NUMBER: 101 PROCESSING MODE: STANDARD
PATIENT SEGMENT	PATIENT SEGMENT ORDER: 36 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 38 NCPDP FIELD NUMBER: 304 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 39 NCPDP FIELD NUMBER: 305 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 41 NCPDP FIELD NUMBER: 335 PROCESSING MODE: STANDARD
INSURANCE SEGMENT	INSURANCE SEGMENT ORDER: 50 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 52 NCPDP FIELD NUMBER: 302 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 55 NCPDP FIELD NUMBER: 309 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 59 NCPDP FIELD NUMBER: 303 PROCESSING MODE: STANDARD
CLAIM SEGMENT	CLAIM SEGMENT ORDER: 102 NCPDP FIELD NUMBER: 462 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 69 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 71 NCPDP FIELD NUMBER: 455 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 74 NCPDP FIELD NUMBER: 402 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 76 NCPDP FIELD NUMBER: 436 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 78 NCPDP FIELD NUMBER: 407 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 80 NCPDP FIELD NUMBER: 442 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 82 NCPDP FIELD NUMBER: 403 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 83 NCPDP FIELD NUMBER: 405 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 85 NCPDP FIELD NUMBER: 406 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 86 NCPDP FIELD NUMBER: 408 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 88 NCPDP FIELD NUMBER: 414 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 91 NCPDP FIELD NUMBER: 415 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 94 NCPDP FIELD NUMBER: 420 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 97 NCPDP FIELD NUMBER: 308 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 99 NCPDP FIELD NUMBER: 461 PROCESSING MODE: STANDARD
PRESCRIBER SEGMENT	PRESCRIBER SEGMENT ORDER: 113 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 115 NCPDP FIELD NUMBER: 466 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")="05" PRESCRIBER SEGMENT ORDER: 117 NCPDP FIELD NUMBER: 411 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"CAID #")) PRESCRIBER SEGMENT ORDER: 120 NCPDP FIELD NUMBER: 468 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")="05" PRESCRIBER SEGMENT ORDER: 123 NCPDP FIELD NUMBER: 421 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"CAID #"))
COB OTHER PAYMENTS SEGMENT	COB OTHER PAYMENTS ORDER: 132 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 134 NCPDP FIELD NUMBER: 337 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 136 NCPDP FIELD NUMBER: 338 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 140 NCPDP FIELD NUMBER: 339 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 143 NCPDP FIELD NUMBER: 340 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 144 NCPDP FIELD NUMBER: 443 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 145 NCPDP FIELD NUMBER: 341 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 148 NCPDP FIELD NUMBER: 342 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 151 NCPDP FIELD NUMBER: 431 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 153 NCPDP FIELD NUMBER: 471 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 155 NCPDP FIELD NUMBER: 472 PROCESSING MODE: STANDARD
DUR PPS SEGMENT	DUR PPS SEGMENT ORDER: 164 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 166 NCPDP FIELD NUMBER: 473 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 168 NCPDP FIELD NUMBER: 439 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 170 NCPDP FIELD NUMBER: 441 PROCESSING MODE: STANDARD
PRICING SEGMENT	PRICING SEGMENT ORDER: 179 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 181 NCPDP FIELD NUMBER: 433 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 184 NCPDP FIELD NUMBER: 426 PROCESSING MODE: STANDARD
PRIOR AUTH SEGMENT	PRIOR AUTH SEGMENT ORDER: 194 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 197 NCPDP FIELD NUMBER: 498.01 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 198 NCPDP FIELD NUMBER: 498.02 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 200 NCPDP FIELD NUMBER: 498.03 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 202 NCPDP FIELD NUMBER: 498.04 PROCESSING MODE: STANDARD

NYMDV5 (164) BPS NCPDP FORMATS (9002313.92)