Name	Value
RECORD FORMAT NAME	NJMDB1V5
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: 37 NCPDP FIELD NUMBER: 304 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 38 NCPDP FIELD NUMBER: 305 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 40 NCPDP FIELD NUMBER: 310 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 42 NCPDP FIELD NUMBER: 311 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 44 NCPDP FIELD NUMBER: 322 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 46 NCPDP FIELD NUMBER: 323 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 48 NCPDP FIELD NUMBER: 324 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 51 NCPDP FIELD NUMBER: 325 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 53 NCPDP FIELD NUMBER: 326 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 55 NCPDP FIELD NUMBER: 307 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 57 NCPDP FIELD NUMBER: 333 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 58 NCPDP FIELD NUMBER: 334 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 60 NCPDP FIELD NUMBER: 335 PROCESSING MODE: STANDARD
INSURANCE SEGMENT	INSURANCE SEGMENT ORDER: 69 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 71 NCPDP FIELD NUMBER: 302 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 74 NCPDP FIELD NUMBER: 312 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 76 NCPDP FIELD NUMBER: 313 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 78 NCPDP FIELD NUMBER: 314 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 79 NCPDP FIELD NUMBER: 524 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 80 NCPDP FIELD NUMBER: 309 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 83 NCPDP FIELD NUMBER: 336 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 84 NCPDP FIELD NUMBER: 301 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 85 NCPDP FIELD NUMBER: 303 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 89 NCPDP FIELD NUMBER: 306 PROCESSING MODE: STANDARD
CLAIM SEGMENT	CLAIM SEGMENT ORDER: 101 NCPDP FIELD NUMBER: 455 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 104 NCPDP FIELD NUMBER: 402 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 106 NCPDP FIELD NUMBER: 436 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 108 NCPDP FIELD NUMBER: 407 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 110 NCPDP FIELD NUMBER: 456 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 113 NCPDP FIELD NUMBER: 457 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 116 NCPDP FIELD NUMBER: 458 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 119 NCPDP FIELD NUMBER: 459 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 121 NCPDP FIELD NUMBER: 442 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 123 NCPDP FIELD NUMBER: 403 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 124 NCPDP FIELD NUMBER: 405 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 125 NCPDP FIELD NUMBER: 406 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 126 NCPDP FIELD NUMBER: 408 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 128 NCPDP FIELD NUMBER: 414 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 131 NCPDP FIELD NUMBER: 415 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 134 NCPDP FIELD NUMBER: 419 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 136 NCPDP FIELD NUMBER: 420 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 139 NCPDP FIELD NUMBER: 460 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 141 NCPDP FIELD NUMBER: 308 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 143 NCPDP FIELD NUMBER: 429 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 145 NCPDP FIELD NUMBER: 453 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 148 NCPDP FIELD NUMBER: 445 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 151 NCPDP FIELD NUMBER: 446 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 153 NCPDP FIELD NUMBER: 330 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 154 NCPDP FIELD NUMBER: 454 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 157 NCPDP FIELD NUMBER: 600 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 158 NCPDP FIELD NUMBER: 418 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 159 NCPDP FIELD NUMBER: 461 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 162 NCPDP FIELD NUMBER: 462 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 166 NCPDP FIELD NUMBER: 463 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 169 NCPDP FIELD NUMBER: 464 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 172 NCPDP FIELD NUMBER: 343 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 174 NCPDP FIELD NUMBER: 344 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 177 NCPDP FIELD NUMBER: 345 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 99 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD
PHARMACY PROVIDER SEGMENT	PHARMACY PROVIDER ORDER: 187 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PHARMACY PROVIDER ORDER: 189 NCPDP FIELD NUMBER: 465 PROCESSING MODE: STANDARD PHARMACY PROVIDER ORDER: 191 NCPDP FIELD NUMBER: 444 PROCESSING MODE: STANDARD
PRESCRIBER SEGMENT	PRESCRIBER SEGMENT ORDER: 199 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 201 NCPDP FIELD NUMBER: 466 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")="05" PRESCRIBER SEGMENT ORDER: 203 NCPDP FIELD NUMBER: 411 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"CAID #")) PRESCRIBER SEGMENT ORDER: 205 NCPDP FIELD NUMBER: 467 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 207 NCPDP FIELD NUMBER: 427 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 209 NCPDP FIELD NUMBER: 498 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 211 NCPDP FIELD NUMBER: 468 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 214 NCPDP FIELD NUMBER: 421 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 216 NCPDP FIELD NUMBER: 469 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 219 NCPDP FIELD NUMBER: 470 PROCESSING MODE: STANDARD
COB OTHER PAYMENTS SEGMENT	COB OTHER PAYMENTS ORDER: 229 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 231 NCPDP FIELD NUMBER: 337 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 233 NCPDP FIELD NUMBER: 338 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 235 NCPDP FIELD NUMBER: 339 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 237 NCPDP FIELD NUMBER: 340 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 238 NCPDP FIELD NUMBER: 443 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 239 NCPDP FIELD NUMBER: 341 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 242 NCPDP FIELD NUMBER: 342 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 245 NCPDP FIELD NUMBER: 431 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 247 NCPDP FIELD NUMBER: 471 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 249 NCPDP FIELD NUMBER: 472 PROCESSING MODE: STANDARD
WORKERS COMP SEGMENT	WORKERS COMP SEGMENT ORDER: 258 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 260 NCPDP FIELD NUMBER: 434 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 268 NCPDP FIELD NUMBER: 315 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 276 NCPDP FIELD NUMBER: 316 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 278 NCPDP FIELD NUMBER: 317 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 280 NCPDP FIELD NUMBER: 318 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 283 NCPDP FIELD NUMBER: 319 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 285 NCPDP FIELD NUMBER: 320 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 287 NCPDP FIELD NUMBER: 321 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 289 NCPDP FIELD NUMBER: 327 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 290 NCPDP FIELD NUMBER: 435 PROCESSING MODE: STANDARD
DUR PPS SEGMENT	DUR PPS SEGMENT ORDER: 299 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 301 NCPDP FIELD NUMBER: 473 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 303 NCPDP FIELD NUMBER: 439 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 305 NCPDP FIELD NUMBER: 440 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 307 NCPDP FIELD NUMBER: 441 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 309 NCPDP FIELD NUMBER: 474 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 311 NCPDP FIELD NUMBER: 475 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 313 NCPDP FIELD NUMBER: 476 PROCESSING MODE: STANDARD
PRICING SEGMENT	PRICING SEGMENT ORDER: 321 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 323 NCPDP FIELD NUMBER: 409 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 325 NCPDP FIELD NUMBER: 412 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 327 NCPDP FIELD NUMBER: 477 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 330 NCPDP FIELD NUMBER: 433 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 333 NCPDP FIELD NUMBER: 438 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 335 NCPDP FIELD NUMBER: 478 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 338 NCPDP FIELD NUMBER: 479 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 342 NCPDP FIELD NUMBER: 480 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 345 NCPDP FIELD NUMBER: 481 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 348 NCPDP FIELD NUMBER: 482 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 351 NCPDP FIELD NUMBER: 483 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 354 NCPDP FIELD NUMBER: 484 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 357 NCPDP FIELD NUMBER: 426 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 360 NCPDP FIELD NUMBER: 430 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 361 NCPDP FIELD NUMBER: 423 PROCESSING MODE: STANDARD
COUPON SEGMENT	COUPON SEGMENT ORDER: 370 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COUPON SEGMENT ORDER: 372 NCPDP FIELD NUMBER: 485 PROCESSING MODE: STANDARD COUPON SEGMENT ORDER: 373 NCPDP FIELD NUMBER: 486 PROCESSING MODE: STANDARD COUPON SEGMENT ORDER: 374 NCPDP FIELD NUMBER: 487 PROCESSING MODE: STANDARD
COMPOUND SEGMENT	COMPOUND SEGMENT ORDER: 383 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 385 NCPDP FIELD NUMBER: 450 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 388 NCPDP FIELD NUMBER: 451 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 390 NCPDP FIELD NUMBER: 452 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 392 NCPDP FIELD NUMBER: 447 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 394 NCPDP FIELD NUMBER: 488 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 396 NCPDP FIELD NUMBER: 489 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 397 NCPDP FIELD NUMBER: 448 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 399 NCPDP FIELD NUMBER: 449 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 401 NCPDP FIELD NUMBER: 490 PROCESSING MODE: STANDARD
PRIOR AUTH SEGMENT	PRIOR AUTH SEGMENT ORDER: 411 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 413 NCPDP FIELD NUMBER: 498.01 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 414 NCPDP FIELD NUMBER: 498.02 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 416 NCPDP FIELD NUMBER: 498.03 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 418 NCPDP FIELD NUMBER: 498.04 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 419 NCPDP FIELD NUMBER: 498.05 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 421 NCPDP FIELD NUMBER: 498.06 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 423 NCPDP FIELD NUMBER: 498.07 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 425 NCPDP FIELD NUMBER: 498.08 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 427 NCPDP FIELD NUMBER: 498.09 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 430 NCPDP FIELD NUMBER: 498.11 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 432 NCPDP FIELD NUMBER: 498.14 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 435 NCPDP FIELD NUMBER: 503 PROCESSING MODE: STANDARD PRIOR AUTH SEGMENT ORDER: 437 NCPDP FIELD NUMBER: 498.13 PROCESSING MODE: STANDARD
CLINICAL SEGMENT	CLINICAL SEGMENT ORDER: 446 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 448 NCPDP FIELD NUMBER: 491 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 450 NCPDP FIELD NUMBER: 492 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 452 NCPDP FIELD NUMBER: 424 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 453 NCPDP FIELD NUMBER: 493 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 456 NCPDP FIELD NUMBER: 494 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 457 NCPDP FIELD NUMBER: 495 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 458 NCPDP FIELD NUMBER: 496 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 460 NCPDP FIELD NUMBER: 497 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 461 NCPDP FIELD NUMBER: 499 PROCESSING MODE: STANDARD

NJMDB1V5 (172) BPS NCPDP FORMATS (9002313.92)