| RECORD FORMAT NAME |
AETNABI5 |
| 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: STANDARD
-
- TRANSACTION HEADER ORDER: 19
- NCPDP FIELD NUMBER: 201
- PROCESSING MODE: STANDARD
-
- TRANSACTION HEADER ORDER: 22
- NCPDP FIELD NUMBER: 401
- PROCESSING MODE: STANDARD
-
- TRANSACTION HEADER ORDER: 5
- NCPDP FIELD NUMBER: 101
- PROCESSING MODE: STANDARD
|
| PATIENT SEGMENT |
-
- PATIENT SEGMENT ORDER: 30
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 32
- NCPDP FIELD NUMBER: 304
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 33
- NCPDP FIELD NUMBER: 305
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 35
- NCPDP FIELD NUMBER: 310
- 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: 306
- PROCESSING MODE: STANDARD
|
| CLAIM SEGMENT |
-
- CLAIM SEGMENT ORDER: 58
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 60
- NCPDP FIELD NUMBER: 455
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 63
- NCPDP FIELD NUMBER: 402
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 65
- NCPDP FIELD NUMBER: 436
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 67
- NCPDP FIELD NUMBER: 407
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 69
- NCPDP FIELD NUMBER: 442
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 71
- NCPDP FIELD NUMBER: 403
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 72
- NCPDP FIELD NUMBER: 405
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 73
- NCPDP FIELD NUMBER: 406
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 74
- NCPDP FIELD NUMBER: 408
- PROCESSING MODE: STANDARD
|
| PRESCRIBER SEGMENT |
-
- PRESCRIBER SEGMENT ORDER: 83
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- PRESCRIBER SEGMENT ORDER: 85
- NCPDP FIELD NUMBER: 466
- PROCESSING MODE: STANDARD
-
- PRESCRIBER SEGMENT ORDER: 88
- NCPDP FIELD NUMBER: 411
- PROCESSING MODE: STANDARD
|
| PRICING SEGMENT |
-
- PRICING SEGMENT ORDER: 100
- NCPDP FIELD NUMBER: 409
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 102
- NCPDP FIELD NUMBER: 482
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 98
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
|
| PRIOR AUTH SEGMENT |
-
- PRIOR AUTH SEGMENT ORDER: 112
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- PRIOR AUTH SEGMENT ORDER: 115
- NCPDP FIELD NUMBER: 498.01
- PROCESSING MODE: STANDARD
-
- PRIOR AUTH SEGMENT ORDER: 116
- NCPDP FIELD NUMBER: 498.02
- PROCESSING MODE: STANDARD
-
- PRIOR AUTH SEGMENT ORDER: 118
- NCPDP FIELD NUMBER: 498.03
- PROCESSING MODE: STANDARD
-
- PRIOR AUTH SEGMENT ORDER: 120
- NCPDP FIELD NUMBER: 498.04
- PROCESSING MODE: STANDARD
|
