RECORD FORMAT NAME |
COMGHCB3 |
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
|