Name	Value
RECORD FORMAT NAME	NCBFV5
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: 31 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 33 NCPDP FIELD NUMBER: 310 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 35 NCPDP FIELD NUMBER: 311 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 INSURANCE SEGMENT ORDER: 48 NCPDP FIELD NUMBER: 309 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 51 NCPDP FIELD NUMBER: 336 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 52 NCPDP FIELD NUMBER: 301 PROCESSING MODE: STANDARD
CLAIM SEGMENT	CLAIM SEGMENT ORDER: 60 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 62 NCPDP FIELD NUMBER: 455 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 65 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: 71 NCPDP FIELD NUMBER: 442 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 73 NCPDP FIELD NUMBER: 403 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 74 NCPDP FIELD NUMBER: 405 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 75 NCPDP FIELD NUMBER: 406 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 76 NCPDP FIELD NUMBER: 408 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 78 NCPDP FIELD NUMBER: 414 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 81 NCPDP FIELD NUMBER: 420 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 84 NCPDP FIELD NUMBER: 429 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 86 NCPDP FIELD NUMBER: 461 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 89 NCPDP FIELD NUMBER: 343 PROCESSING MODE: STANDARD
PHARMACY PROVIDER SEGMENT	PHARMACY PROVIDER ORDER: 100 NCPDP FIELD NUMBER: 465 PROCESSING MODE: STANDARD PHARMACY PROVIDER ORDER: 102 NCPDP FIELD NUMBER: 444 PROCESSING MODE: STANDARD PHARMACY PROVIDER ORDER: 98 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD
PRESCRIBER SEGMENT	PRESCRIBER SEGMENT ORDER: 110 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 112 NCPDP FIELD NUMBER: 466 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 114 NCPDP FIELD NUMBER: 411 PROCESSING MODE: STANDARD
COB OTHER PAYMENTS SEGMENT	COB OTHER PAYMENTS ORDER: 122 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 124 NCPDP FIELD NUMBER: 337 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 126 NCPDP FIELD NUMBER: 338 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 128 NCPDP FIELD NUMBER: 341 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 131 NCPDP FIELD NUMBER: 342 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 134 NCPDP FIELD NUMBER: 431 PROCESSING MODE: STANDARD
WORKERS COMP SEGMENT	WORKERS COMP SEGMENT ORDER: 143 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 145 NCPDP FIELD NUMBER: 434 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 146 NCPDP FIELD NUMBER: 315 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 147 NCPDP FIELD NUMBER: 316 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 149 NCPDP FIELD NUMBER: 317 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 151 NCPDP FIELD NUMBER: 318 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 154 NCPDP FIELD NUMBER: 319 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 156 NCPDP FIELD NUMBER: 320 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 158 NCPDP FIELD NUMBER: 321 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 160 NCPDP FIELD NUMBER: 327 PROCESSING MODE: STANDARD WORKERS COMP SEGMENT ORDER: 161 NCPDP FIELD NUMBER: 435 PROCESSING MODE: STANDARD
DUR PPS SEGMENT	DUR PPS SEGMENT ORDER: 170 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 172 NCPDP FIELD NUMBER: 473 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 174 NCPDP FIELD NUMBER: 439 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 176 NCPDP FIELD NUMBER: 440 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 178 NCPDP FIELD NUMBER: 441 PROCESSING MODE: STANDARD
PRICING SEGMENT	PRICING SEGMENT ORDER: 187 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 189 NCPDP FIELD NUMBER: 433 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 192 NCPDP FIELD NUMBER: 426 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 195 NCPDP FIELD NUMBER: 430 PROCESSING MODE: STANDARD
COUPON SEGMENT	COUPON SEGMENT ORDER: 203 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COUPON SEGMENT ORDER: 205 NCPDP FIELD NUMBER: 485 PROCESSING MODE: STANDARD COUPON SEGMENT ORDER: 206 NCPDP FIELD NUMBER: 486 PROCESSING MODE: STANDARD COUPON SEGMENT ORDER: 207 NCPDP FIELD NUMBER: 487 PROCESSING MODE: STANDARD
COMPOUND SEGMENT	COMPOUND SEGMENT ORDER: 216 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 218 NCPDP FIELD NUMBER: 450 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 221 NCPDP FIELD NUMBER: 451 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 223 NCPDP FIELD NUMBER: 452 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 225 NCPDP FIELD NUMBER: 447 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 227 NCPDP FIELD NUMBER: 488 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 229 NCPDP FIELD NUMBER: 489 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 230 NCPDP FIELD NUMBER: 448 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 232 NCPDP FIELD NUMBER: 449 PROCESSING MODE: STANDARD
CLINICAL SEGMENT	CLINICAL SEGMENT ORDER: 241 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 243 NCPDP FIELD NUMBER: 424 PROCESSING MODE: STANDARD

NCBFV5 (179) BPS NCPDP FORMATS (9002313.92)