| RECORD FORMAT NAME |
DATFCJB1 |
| 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
|
| INSURANCE SEGMENT |
-
- INSURANCE SEGMENT ORDER: 50
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 52
- NCPDP FIELD NUMBER: 302
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 53
- NCPDP FIELD NUMBER: 301
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 54
- NCPDP FIELD NUMBER: 303
- PROCESSING MODE: STANDARD
|
| CLAIM SEGMENT |
-
- CLAIM SEGMENT ORDER: 62
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 64
- NCPDP FIELD NUMBER: 455
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 67
- NCPDP FIELD NUMBER: 402
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 69
- NCPDP FIELD NUMBER: 436
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 71
- NCPDP FIELD NUMBER: 407
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 73
- NCPDP FIELD NUMBER: 442
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 75
- NCPDP FIELD NUMBER: 403
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 76
- NCPDP FIELD NUMBER: 405
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 77
- NCPDP FIELD NUMBER: 406
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 78
- NCPDP FIELD NUMBER: 408
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 80
- NCPDP FIELD NUMBER: 414
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 83
- NCPDP FIELD NUMBER: 415
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 86
- NCPDP FIELD NUMBER: 461
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 89
- NCPDP FIELD NUMBER: 462
- PROCESSING MODE: STANDARD
|
| PRESCRIBER SEGMENT |
-
- PRESCRIBER SEGMENT ORDER: 100
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- PRESCRIBER SEGMENT ORDER: 102
- NCPDP FIELD NUMBER: 466
- PROCESSING MODE: STANDARD
-
- PRESCRIBER SEGMENT ORDER: 104
- NCPDP FIELD NUMBER: 411
- PROCESSING MODE: STANDARD
|
| PRICING SEGMENT |
-
- PRICING SEGMENT ORDER: 112
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 114
- NCPDP FIELD NUMBER: 409
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 116
- NCPDP FIELD NUMBER: 412
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 118
- NCPDP FIELD NUMBER: 426
- PROCESSING MODE: STANDARD
-
- PRICING SEGMENT ORDER: 121
- NCPDP FIELD NUMBER: 430
- PROCESSING MODE: STANDARD
|
