PHIDRXB3 (278)    BPS NCPDP FORMATS (9002313.92)

Name Value
RECORD FORMAT NAME PHIDRXB3
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:   43
    NCPDP FIELD NUMBER:   322
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   45
    NCPDP FIELD NUMBER:   323
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   47
    NCPDP FIELD NUMBER:   324
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   50
    NCPDP FIELD NUMBER:   325
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   52
    NCPDP FIELD NUMBER:   326
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   54
    NCPDP FIELD NUMBER:   307
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   55
    NCPDP FIELD NUMBER:   333
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   56
    NCPDP FIELD NUMBER:   334
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   58
    NCPDP FIELD NUMBER:   335
    PROCESSING MODE:   STANDARD
INSURANCE SEGMENT
  • INSURANCE SEGMENT ORDER:   67
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   69
    NCPDP FIELD NUMBER:   302
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   71
    NCPDP FIELD NUMBER:   312
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   73
    NCPDP FIELD NUMBER:   313
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   75
    NCPDP FIELD NUMBER:   314
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   76
    NCPDP FIELD NUMBER:   524
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   77
    NCPDP FIELD NUMBER:   309
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   80
    NCPDP FIELD NUMBER:   336
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   81
    NCPDP FIELD NUMBER:   301
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   82
    NCPDP FIELD NUMBER:   303
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   83
    NCPDP FIELD NUMBER:   306
    PROCESSING MODE:   STANDARD
CLAIM SEGMENT
  • CLAIM SEGMENT ORDER:   100
    NCPDP FIELD NUMBER:   436
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   102
    NCPDP FIELD NUMBER:   407
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   104
    NCPDP FIELD NUMBER:   456
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   107
    NCPDP FIELD NUMBER:   457
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   110
    NCPDP FIELD NUMBER:   442
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   112
    NCPDP FIELD NUMBER:   403
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   113
    NCPDP FIELD NUMBER:   405
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   114
    NCPDP FIELD NUMBER:   406
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   115
    NCPDP FIELD NUMBER:   408
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   117
    NCPDP FIELD NUMBER:   414
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   120
    NCPDP FIELD NUMBER:   415
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   123
    NCPDP FIELD NUMBER:   308
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   125
    NCPDP FIELD NUMBER:   343
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   128
    NCPDP FIELD NUMBER:   344
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   131
    NCPDP FIELD NUMBER:   345
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   93
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   95
    NCPDP FIELD NUMBER:   455
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   98
    NCPDP FIELD NUMBER:   402
    PROCESSING MODE:   STANDARD
PRESCRIBER SEGMENT
  • PRESCRIBER SEGMENT ORDER:   141
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   143
    NCPDP FIELD NUMBER:   466
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   145
    NCPDP FIELD NUMBER:   411
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   146
    NCPDP FIELD NUMBER:   467
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   148
    NCPDP FIELD NUMBER:   427
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   150
    NCPDP FIELD NUMBER:   498
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   152
    NCPDP FIELD NUMBER:   468
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   155
    NCPDP FIELD NUMBER:   421
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   157
    NCPDP FIELD NUMBER:   469
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   160
    NCPDP FIELD NUMBER:   470
    PROCESSING MODE:   STANDARD
DUR PPS SEGMENT
  • DUR PPS SEGMENT ORDER:   170
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   172
    NCPDP FIELD NUMBER:   473
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   174
    NCPDP FIELD NUMBER:   439
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   176
    NCPDP FIELD NUMBER:   440
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   178
    NCPDP FIELD NUMBER:   441
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   180
    NCPDP FIELD NUMBER:   474
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   182
    NCPDP FIELD NUMBER:   475
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   184
    NCPDP FIELD NUMBER:   476
    PROCESSING MODE:   STANDARD
PRICING SEGMENT
  • PRICING SEGMENT ORDER:   192
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   194
    NCPDP FIELD NUMBER:   409
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   196
    NCPDP FIELD NUMBER:   412
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   198
    NCPDP FIELD NUMBER:   433
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   201
    NCPDP FIELD NUMBER:   426
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   204
    NCPDP FIELD NUMBER:   430
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   205
    NCPDP FIELD NUMBER:   423
    PROCESSING MODE:   STANDARD
COMPOUND SEGMENT
  • COMPOUND SEGMENT ORDER:   214
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   216
    NCPDP FIELD NUMBER:   450
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   219
    NCPDP FIELD NUMBER:   451
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   221
    NCPDP FIELD NUMBER:   452
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   223
    NCPDP FIELD NUMBER:   447
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   225
    NCPDP FIELD NUMBER:   488
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   227
    NCPDP FIELD NUMBER:   489
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   228
    NCPDP FIELD NUMBER:   448
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   230
    NCPDP FIELD NUMBER:   449
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   232
    NCPDP FIELD NUMBER:   490
    PROCESSING MODE:   STANDARD
CLINICAL SEGMENT
  • CLINICAL SEGMENT ORDER:   242
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   244
    NCPDP FIELD NUMBER:   491
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   246
    NCPDP FIELD NUMBER:   492
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   248
    NCPDP FIELD NUMBER:   424
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   249
    NCPDP FIELD NUMBER:   493
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   252
    NCPDP FIELD NUMBER:   494
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   253
    NCPDP FIELD NUMBER:   495
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   254
    NCPDP FIELD NUMBER:   496
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   256
    NCPDP FIELD NUMBER:   497
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   257
    NCPDP FIELD NUMBER:   499
    PROCESSING MODE:   STANDARD