COMGHCB1 (210)    BPS NCPDP FORMATS (9002313.92)

Name Value
RECORD FORMAT NAME COMGHCB1
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:   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:   331
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   35
    NCPDP FIELD NUMBER:   332
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   36
    NCPDP FIELD NUMBER:   304
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   37
    NCPDP FIELD NUMBER:   305
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   39
    NCPDP FIELD NUMBER:   310
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   41
    NCPDP FIELD NUMBER:   311
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   44
    NCPDP FIELD NUMBER:   322
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   47
    NCPDP FIELD NUMBER:   323
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   50
    NCPDP FIELD NUMBER:   324
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   53
    NCPDP FIELD NUMBER:   325
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   56
    NCPDP FIELD NUMBER:   326
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   59
    NCPDP FIELD NUMBER:   307
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   62
    NCPDP FIELD NUMBER:   333
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   65
    NCPDP FIELD NUMBER:   334
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   68
    NCPDP FIELD NUMBER:   335
    PROCESSING MODE:   STANDARD
INSURANCE SEGMENT
  • INSURANCE SEGMENT ORDER:   100
    NCPDP FIELD NUMBER:   303
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   101
    NCPDP FIELD NUMBER:   306
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   78
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   80
    NCPDP FIELD NUMBER:   302
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   81
    NCPDP FIELD NUMBER:   312
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   84
    NCPDP FIELD NUMBER:   313
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   87
    NCPDP FIELD NUMBER:   314
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   90
    NCPDP FIELD NUMBER:   524
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   93
    NCPDP FIELD NUMBER:   309
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   96
    NCPDP FIELD NUMBER:   336
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   99
    NCPDP FIELD NUMBER:   301
    PROCESSING MODE:   STANDARD
CLAIM SEGMENT
  • CLAIM SEGMENT ORDER:   111
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   113
    NCPDP FIELD NUMBER:   455
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   116
    NCPDP FIELD NUMBER:   402
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   118
    NCPDP FIELD NUMBER:   436
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   120
    NCPDP FIELD NUMBER:   407
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   122
    NCPDP FIELD NUMBER:   456
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   125
    NCPDP FIELD NUMBER:   457
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   128
    NCPDP FIELD NUMBER:   458
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   131
    NCPDP FIELD NUMBER:   459
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   133
    NCPDP FIELD NUMBER:   442
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   135
    NCPDP FIELD NUMBER:   403
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   136
    NCPDP FIELD NUMBER:   405
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   137
    NCPDP FIELD NUMBER:   406
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   138
    NCPDP FIELD NUMBER:   408
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   140
    NCPDP FIELD NUMBER:   414
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   143
    NCPDP FIELD NUMBER:   415
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   146
    NCPDP FIELD NUMBER:   419
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   149
    NCPDP FIELD NUMBER:   420
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   153
    NCPDP FIELD NUMBER:   308
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   155
    NCPDP FIELD NUMBER:   429
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   157
    NCPDP FIELD NUMBER:   330
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   158
    NCPDP FIELD NUMBER:   454
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   161
    NCPDP FIELD NUMBER:   600
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   162
    NCPDP FIELD NUMBER:   418
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   163
    NCPDP FIELD NUMBER:   461
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   166
    NCPDP FIELD NUMBER:   462
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   170
    NCPDP FIELD NUMBER:   463
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   173
    NCPDP FIELD NUMBER:   464
    PROCESSING MODE:   STANDARD
PHARMACY PROVIDER SEGMENT
  • PHARMACY PROVIDER ORDER:   183
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PHARMACY PROVIDER ORDER:   185
    NCPDP FIELD NUMBER:   465
    PROCESSING MODE:   STANDARD
  • PHARMACY PROVIDER ORDER:   188
    NCPDP FIELD NUMBER:   444
    PROCESSING MODE:   STANDARD
PRESCRIBER SEGMENT
  • PRESCRIBER SEGMENT ORDER:   198
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   200
    NCPDP FIELD NUMBER:   466
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   202
    NCPDP FIELD NUMBER:   411
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   203
    NCPDP FIELD NUMBER:   467
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   206
    NCPDP FIELD NUMBER:   427
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   209
    NCPDP FIELD NUMBER:   498
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   212
    NCPDP FIELD NUMBER:   468
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   215
    NCPDP FIELD NUMBER:   421
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   225
    NCPDP FIELD NUMBER:   469
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   235
    NCPDP FIELD NUMBER:   470
    PROCESSING MODE:   STANDARD
COB OTHER PAYMENTS SEGMENT
  • COB OTHER PAYMENTS ORDER:   245
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   247
    NCPDP FIELD NUMBER:   337
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   249
    NCPDP FIELD NUMBER:   338
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   251
    NCPDP FIELD NUMBER:   339
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   253
    NCPDP FIELD NUMBER:   340
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   254
    NCPDP FIELD NUMBER:   443
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   255
    NCPDP FIELD NUMBER:   341
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   258
    NCPDP FIELD NUMBER:   342
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   261
    NCPDP FIELD NUMBER:   431
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   263
    NCPDP FIELD NUMBER:   471
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   265
    NCPDP FIELD NUMBER:   472
    PROCESSING MODE:   STANDARD
WORKERS COMP SEGMENT
  • WORKERS COMP SEGMENT ORDER:   274
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   277
    NCPDP FIELD NUMBER:   434
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   278
    NCPDP FIELD NUMBER:   315
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   279
    NCPDP FIELD NUMBER:   316
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   281
    NCPDP FIELD NUMBER:   317
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   283
    NCPDP FIELD NUMBER:   318
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   286
    NCPDP FIELD NUMBER:   319
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   288
    NCPDP FIELD NUMBER:   320
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   290
    NCPDP FIELD NUMBER:   321
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   292
    NCPDP FIELD NUMBER:   327
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   293
    NCPDP FIELD NUMBER:   435
    PROCESSING MODE:   STANDARD
DUR PPS SEGMENT
  • DUR PPS SEGMENT ORDER:   302
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   304
    NCPDP FIELD NUMBER:   473
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   306
    NCPDP FIELD NUMBER:   439
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   308
    NCPDP FIELD NUMBER:   440
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   310
    NCPDP FIELD NUMBER:   441
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   312
    NCPDP FIELD NUMBER:   474
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   314
    NCPDP FIELD NUMBER:   475
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   316
    NCPDP FIELD NUMBER:   476
    PROCESSING MODE:   STANDARD
PRICING SEGMENT
  • PRICING SEGMENT ORDER:   326
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   328
    NCPDP FIELD NUMBER:   409
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   330
    NCPDP FIELD NUMBER:   412
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   332
    NCPDP FIELD NUMBER:   477
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   335
    NCPDP FIELD NUMBER:   433
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   338
    NCPDP FIELD NUMBER:   438
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   340
    NCPDP FIELD NUMBER:   478
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   343
    NCPDP FIELD NUMBER:   479
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   347
    NCPDP FIELD NUMBER:   480
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   350
    NCPDP FIELD NUMBER:   481
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   353
    NCPDP FIELD NUMBER:   482
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   356
    NCPDP FIELD NUMBER:   483
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   359
    NCPDP FIELD NUMBER:   484
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   362
    NCPDP FIELD NUMBER:   426
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   365
    NCPDP FIELD NUMBER:   430
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   366
    NCPDP FIELD NUMBER:   423
    PROCESSING MODE:   STANDARD
COUPON SEGMENT
  • COUPON SEGMENT ORDER:   375
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COUPON SEGMENT ORDER:   377
    NCPDP FIELD NUMBER:   485
    PROCESSING MODE:   STANDARD
  • COUPON SEGMENT ORDER:   378
    NCPDP FIELD NUMBER:   486
    PROCESSING MODE:   STANDARD
  • COUPON SEGMENT ORDER:   379
    NCPDP FIELD NUMBER:   487
    PROCESSING MODE:   STANDARD
PRIOR AUTH SEGMENT
  • PRIOR AUTH SEGMENT ORDER:   388
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   391
    NCPDP FIELD NUMBER:   498.01
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   392
    NCPDP FIELD NUMBER:   498.02
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   394
    NCPDP FIELD NUMBER:   498.03
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   396
    NCPDP FIELD NUMBER:   498.04
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   397
    NCPDP FIELD NUMBER:   498.05
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   399
    NCPDP FIELD NUMBER:   498.06
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   401
    NCPDP FIELD NUMBER:   498.07
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   403
    NCPDP FIELD NUMBER:   498.08
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   405
    NCPDP FIELD NUMBER:   498.09
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   408
    NCPDP FIELD NUMBER:   498.11
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   410
    NCPDP FIELD NUMBER:   498.14
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   413
    NCPDP FIELD NUMBER:   503
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   415
    NCPDP FIELD NUMBER:   498.13
    PROCESSING MODE:   STANDARD
CLINICAL SEGMENT
  • CLINICAL SEGMENT ORDER:   424
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   426
    NCPDP FIELD NUMBER:   491
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   428
    NCPDP FIELD NUMBER:   492
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   431
    NCPDP FIELD NUMBER:   424
    PROCESSING MODE:   STANDARD