FHTNB2V5 (294)    BPS NCPDP FORMATS (9002313.92)

Name Value
RECORD FORMAT NAME FHTNB2V5
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:   32
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   34
    NCPDP FIELD NUMBER:   331
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   36
    NCPDP FIELD NUMBER:   332
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   37
    NCPDP FIELD NUMBER:   304
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   38
    NCPDP FIELD NUMBER:   305
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   40
    NCPDP FIELD NUMBER:   310
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   42
    NCPDP FIELD NUMBER:   311
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   44
    NCPDP FIELD NUMBER:   322
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   46
    NCPDP FIELD NUMBER:   323
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   48
    NCPDP FIELD NUMBER:   324
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   51
    NCPDP FIELD NUMBER:   325
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   53
    NCPDP FIELD NUMBER:   326
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   55
    NCPDP FIELD NUMBER:   307
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   56
    NCPDP FIELD NUMBER:   333
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   57
    NCPDP FIELD NUMBER:   334
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   59
    NCPDP FIELD NUMBER:   335
    PROCESSING MODE:   STANDARD
INSURANCE SEGMENT
  • INSURANCE SEGMENT ORDER:   68
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   70
    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:   458
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   113
    NCPDP FIELD NUMBER:   459
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   115
    NCPDP FIELD NUMBER:   442
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   117
    NCPDP FIELD NUMBER:   403
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   118
    NCPDP FIELD NUMBER:   405
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   119
    NCPDP FIELD NUMBER:   406
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   120
    NCPDP FIELD NUMBER:   408
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   122
    NCPDP FIELD NUMBER:   414
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   125
    NCPDP FIELD NUMBER:   415
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   128
    NCPDP FIELD NUMBER:   419
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   130
    NCPDP FIELD NUMBER:   420
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   133
    NCPDP FIELD NUMBER:   460
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   135
    NCPDP FIELD NUMBER:   308
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   137
    NCPDP FIELD NUMBER:   429
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   139
    NCPDP FIELD NUMBER:   453
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   142
    NCPDP FIELD NUMBER:   445
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   145
    NCPDP FIELD NUMBER:   446
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   147
    NCPDP FIELD NUMBER:   330
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   148
    NCPDP FIELD NUMBER:   454
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   151
    NCPDP FIELD NUMBER:   600
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   152
    NCPDP FIELD NUMBER:   418
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   153
    NCPDP FIELD NUMBER:   461
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   156
    NCPDP FIELD NUMBER:   462
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   160
    NCPDP FIELD NUMBER:   463
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   163
    NCPDP FIELD NUMBER:   464
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   166
    NCPDP FIELD NUMBER:   343
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   168
    NCPDP FIELD NUMBER:   344
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   171
    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
DUR PPS SEGMENT
  • DUR PPS SEGMENT ORDER:   181
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   183
    NCPDP FIELD NUMBER:   473
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   185
    NCPDP FIELD NUMBER:   439
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   187
    NCPDP FIELD NUMBER:   440
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   189
    NCPDP FIELD NUMBER:   441
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   191
    NCPDP FIELD NUMBER:   474
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   193
    NCPDP FIELD NUMBER:   475
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   195
    NCPDP FIELD NUMBER:   476
    PROCESSING MODE:   STANDARD
PRICING SEGMENT
  • PRICING SEGMENT ORDER:   203
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   205
    NCPDP FIELD NUMBER:   409
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   207
    NCPDP FIELD NUMBER:   412
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   209
    NCPDP FIELD NUMBER:   477
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   212
    NCPDP FIELD NUMBER:   433
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   215
    NCPDP FIELD NUMBER:   438
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   217
    NCPDP FIELD NUMBER:   478
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   220
    NCPDP FIELD NUMBER:   479
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   224
    NCPDP FIELD NUMBER:   480
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   227
    NCPDP FIELD NUMBER:   481
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   230
    NCPDP FIELD NUMBER:   482
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   233
    NCPDP FIELD NUMBER:   483
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   236
    NCPDP FIELD NUMBER:   484
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   239
    NCPDP FIELD NUMBER:   426
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   242
    NCPDP FIELD NUMBER:   430
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   243
    NCPDP FIELD NUMBER:   423
    PROCESSING MODE:   STANDARD