| RECORD FORMAT NAME |
PRCRREV5 |
| 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: 304
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 34
- NCPDP FIELD NUMBER: 305
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 36
- NCPDP FIELD NUMBER: 310
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 38
- NCPDP FIELD NUMBER: 311
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 40
- NCPDP FIELD NUMBER: 334
- PROCESSING MODE: STANDARD
-
- PATIENT SEGMENT ORDER: 42
- NCPDP FIELD NUMBER: 335
- PROCESSING MODE: STANDARD
|
| INSURANCE SEGMENT |
-
- INSURANCE SEGMENT ORDER: 51
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 53
- NCPDP FIELD NUMBER: 302
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 54
- NCPDP FIELD NUMBER: 524
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 57
- NCPDP FIELD NUMBER: 303
- PROCESSING MODE: STANDARD
-
- INSURANCE SEGMENT ORDER: 58
- NCPDP FIELD NUMBER: 306
- PROCESSING MODE: STANDARD
|
| CLAIM SEGMENT |
-
- CLAIM SEGMENT ORDER: 68
- NCPDP FIELD NUMBER: 111
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 70
- NCPDP FIELD NUMBER: 455
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 73
- NCPDP FIELD NUMBER: 402
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 75
- NCPDP FIELD NUMBER: 436
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 77
- NCPDP FIELD NUMBER: 407
- PROCESSING MODE: STANDARD
-
- CLAIM SEGMENT ORDER: 79
- NCPDP FIELD NUMBER: 462
- PROCESSING MODE: STANDARD
|
