RXACDAB1 (279)    BPS NCPDP FORMATS (9002313.92)

Name Value
RECORD FORMAT NAME RXACDAB1
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:   322
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   42
    NCPDP FIELD NUMBER:   323
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   44
    NCPDP FIELD NUMBER:   324
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   47
    NCPDP FIELD NUMBER:   325
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   49
    NCPDP FIELD NUMBER:   326
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   51
    NCPDP FIELD NUMBER:   334
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   53
    NCPDP FIELD NUMBER:   335
    PROCESSING MODE:   STANDARD
INSURANCE SEGMENT
  • INSURANCE SEGMENT ORDER:   62
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   64
    NCPDP FIELD NUMBER:   302
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   65
    NCPDP FIELD NUMBER:   312
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   67
    NCPDP FIELD NUMBER:   313
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   69
    NCPDP FIELD NUMBER:   301
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   70
    NCPDP FIELD NUMBER:   303
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   71
    NCPDP FIELD NUMBER:   306
    PROCESSING MODE:   STANDARD
CLAIM SEGMENT
  • CLAIM SEGMENT ORDER:   102
    NCPDP FIELD NUMBER:   420
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   105
    NCPDP FIELD NUMBER:   308
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   107
    NCPDP FIELD NUMBER:   343
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   109
    NCPDP FIELD NUMBER:   344
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   112
    NCPDP FIELD NUMBER:   345
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   81
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   83
    NCPDP FIELD NUMBER:   455
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   86
    NCPDP FIELD NUMBER:   402
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   88
    NCPDP FIELD NUMBER:   436
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   90
    NCPDP FIELD NUMBER:   407
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   92
    NCPDP FIELD NUMBER:   442
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   94
    NCPDP FIELD NUMBER:   403
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   95
    NCPDP FIELD NUMBER:   405
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   96
    NCPDP FIELD NUMBER:   406
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   97
    NCPDP FIELD NUMBER:   408
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   99
    NCPDP FIELD NUMBER:   414
    PROCESSING MODE:   STANDARD
PRESCRIBER SEGMENT
  • PRESCRIBER SEGMENT ORDER:   122
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   124
    NCPDP FIELD NUMBER:   466
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   126
    NCPDP FIELD NUMBER:   411
    PROCESSING MODE:   STANDARD
WORKERS COMP SEGMENT
  • WORKERS COMP SEGMENT ORDER:   134
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   137
    NCPDP FIELD NUMBER:   434
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   138
    NCPDP FIELD NUMBER:   315
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   139
    NCPDP FIELD NUMBER:   316
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   141
    NCPDP FIELD NUMBER:   317
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   143
    NCPDP FIELD NUMBER:   318
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   146
    NCPDP FIELD NUMBER:   319
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   148
    NCPDP FIELD NUMBER:   320
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   150
    NCPDP FIELD NUMBER:   321
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   152
    NCPDP FIELD NUMBER:   327
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   153
    NCPDP FIELD NUMBER:   435
    PROCESSING MODE:   STANDARD
PRICING SEGMENT
  • PRICING SEGMENT ORDER:   162
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   164
    NCPDP FIELD NUMBER:   409
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   166
    NCPDP FIELD NUMBER:   412
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   168
    NCPDP FIELD NUMBER:   481
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   171
    NCPDP FIELD NUMBER:   482
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   174
    NCPDP FIELD NUMBER:   426
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   177
    NCPDP FIELD NUMBER:   430
    PROCESSING MODE:   STANDARD