Name	Value
RECORD FORMAT NAME	IDMEDV5
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: 331 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 36 NCPDP FIELD NUMBER: 332 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 38 NCPDP FIELD NUMBER: 307 PROCESSING MODE: STANDARD
INSURANCE SEGMENT	INSURANCE SEGMENT ORDER: 46 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 48 NCPDP FIELD NUMBER: 302 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 51 NCPDP FIELD NUMBER: 312 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 53 NCPDP FIELD NUMBER: 313 PROCESSING MODE: STANDARD
CLAIM SEGMENT	CLAIM SEGMENT ORDER: 62 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 64 NCPDP FIELD NUMBER: 455 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 67 NCPDP FIELD NUMBER: 402 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 69 NCPDP FIELD NUMBER: 436 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 71 NCPDP FIELD NUMBER: 407 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 73 NCPDP FIELD NUMBER: 442 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 75 NCPDP FIELD NUMBER: 403 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 78 NCPDP FIELD NUMBER: 405 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 79 NCPDP FIELD NUMBER: 406 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 80 NCPDP FIELD NUMBER: 408 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 82 NCPDP FIELD NUMBER: 420 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 85 NCPDP FIELD NUMBER: 308 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 87 NCPDP FIELD NUMBER: 429 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 89 NCPDP FIELD NUMBER: 600 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 90 NCPDP FIELD NUMBER: 462 PROCESSING MODE: STANDARD
PRESCRIBER SEGMENT	PRESCRIBER SEGMENT ORDER: 101 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 103 NCPDP FIELD NUMBER: 466 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")="08" PRESCRIBER SEGMENT ORDER: 105 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: 114 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 117 NCPDP FIELD NUMBER: 337 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 120 NCPDP FIELD NUMBER: 338 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 122 NCPDP FIELD NUMBER: 339 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 124 NCPDP FIELD NUMBER: 340 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 125 NCPDP FIELD NUMBER: 341 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 128 NCPDP FIELD NUMBER: 342 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 131 NCPDP FIELD NUMBER: 431 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 133 NCPDP FIELD NUMBER: 471 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 135 NCPDP FIELD NUMBER: 472 PROCESSING MODE: STANDARD
DUR PPS SEGMENT	DUR PPS SEGMENT ORDER: 144 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 146 NCPDP FIELD NUMBER: 473 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 148 NCPDP FIELD NUMBER: 439 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 150 NCPDP FIELD NUMBER: 440 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 152 NCPDP FIELD NUMBER: 441 PROCESSING MODE: STANDARD
PRICING SEGMENT	PRICING SEGMENT ORDER: 161 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 163 NCPDP FIELD NUMBER: 433 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 166 NCPDP FIELD NUMBER: 426 PROCESSING MODE: STANDARD
COMPOUND SEGMENT	COMPOUND SEGMENT ORDER: 176 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 178 NCPDP FIELD NUMBER: 450 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 181 NCPDP FIELD NUMBER: 451 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 183 NCPDP FIELD NUMBER: 452 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 185 NCPDP FIELD NUMBER: 447 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 187 NCPDP FIELD NUMBER: 488 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 189 NCPDP FIELD NUMBER: 489 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 190 NCPDP FIELD NUMBER: 448 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 192 NCPDP FIELD NUMBER: 449 PROCESSING MODE: STANDARD

IDMEDV5 (167) BPS NCPDP FORMATS (9002313.92)