Name	Value
RECORD FORMAT NAME	ILMDB1V5
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: SPECIAL SPECIAL CODE: S BPS("X")="05" TRANSACTION HEADER ORDER: 19 NCPDP FIELD NUMBER: 201 PROCESSING MODE: SPECIAL SPECIAL CODE: S BPS("X")=BPS("Site","Medicaid Pharmacy #") TRANSACTION HEADER ORDER: 22 NCPDP FIELD NUMBER: 401 PROCESSING MODE: STANDARD TRANSACTION HEADER ORDER: 23 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: 304 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 35 NCPDP FIELD NUMBER: 333 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 36 NCPDP FIELD NUMBER: 334 PROCESSING MODE: STANDARD PATIENT SEGMENT ORDER: 38 NCPDP FIELD NUMBER: 335 PROCESSING MODE: STANDARD
INSURANCE SEGMENT	INSURANCE SEGMENT ORDER: 47 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 49 NCPDP FIELD NUMBER: 302 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 50 NCPDP FIELD NUMBER: 312 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 52 NCPDP FIELD NUMBER: 313 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 54 NCPDP FIELD NUMBER: 314 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 55 NCPDP FIELD NUMBER: 524 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 56 NCPDP FIELD NUMBER: 309 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 59 NCPDP FIELD NUMBER: 336 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 60 NCPDP FIELD NUMBER: 301 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 61 NCPDP FIELD NUMBER: 303 PROCESSING MODE: STANDARD INSURANCE SEGMENT ORDER: 62 NCPDP FIELD NUMBER: 306 PROCESSING MODE: STANDARD
CLAIM SEGMENT	CLAIM SEGMENT ORDER: 102 NCPDP FIELD NUMBER: 419 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 104 NCPDP FIELD NUMBER: 420 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 107 NCPDP FIELD NUMBER: 460 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 109 NCPDP FIELD NUMBER: 308 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 111 NCPDP FIELD NUMBER: 429 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 113 NCPDP FIELD NUMBER: 453 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 116 NCPDP FIELD NUMBER: 445 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 119 NCPDP FIELD NUMBER: 446 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 121 NCPDP FIELD NUMBER: 418 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 122 NCPDP FIELD NUMBER: 463 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 125 NCPDP FIELD NUMBER: 464 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 128 NCPDP FIELD NUMBER: 343 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 130 NCPDP FIELD NUMBER: 344 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 133 NCPDP FIELD NUMBER: 345 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 72 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 74 NCPDP FIELD NUMBER: 455 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 77 NCPDP FIELD NUMBER: 402 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 79 NCPDP FIELD NUMBER: 436 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 81 NCPDP FIELD NUMBER: 407 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 83 NCPDP FIELD NUMBER: 456 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 86 NCPDP FIELD NUMBER: 457 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 89 NCPDP FIELD NUMBER: 442 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 91 NCPDP FIELD NUMBER: 403 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 92 NCPDP FIELD NUMBER: 405 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 93 NCPDP FIELD NUMBER: 406 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 94 NCPDP FIELD NUMBER: 408 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 96 NCPDP FIELD NUMBER: 414 PROCESSING MODE: STANDARD CLAIM SEGMENT ORDER: 99 NCPDP FIELD NUMBER: 415 PROCESSING MODE: STANDARD
PRESCRIBER SEGMENT	PRESCRIBER SEGMENT ORDER: 143 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 145 NCPDP FIELD NUMBER: 466 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 147 NCPDP FIELD NUMBER: 411 PROCESSING MODE: STANDARD PRESCRIBER SEGMENT ORDER: 148 NCPDP FIELD NUMBER: 467 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
COB OTHER PAYMENTS SEGMENT	COB OTHER PAYMENTS ORDER: 164 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 166 NCPDP FIELD NUMBER: 337 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 168 NCPDP FIELD NUMBER: 338 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 170 NCPDP FIELD NUMBER: 339 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 172 NCPDP FIELD NUMBER: 340 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 173 NCPDP FIELD NUMBER: 443 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 174 NCPDP FIELD NUMBER: 341 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 177 NCPDP FIELD NUMBER: 342 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 180 NCPDP FIELD NUMBER: 431 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 182 NCPDP FIELD NUMBER: 471 PROCESSING MODE: STANDARD COB OTHER PAYMENTS ORDER: 184 NCPDP FIELD NUMBER: 472 PROCESSING MODE: STANDARD
DUR PPS SEGMENT	DUR PPS SEGMENT ORDER: 193 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 195 NCPDP FIELD NUMBER: 473 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 197 NCPDP FIELD NUMBER: 439 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 199 NCPDP FIELD NUMBER: 440 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 201 NCPDP FIELD NUMBER: 441 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 203 NCPDP FIELD NUMBER: 474 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 205 NCPDP FIELD NUMBER: 475 PROCESSING MODE: STANDARD DUR PPS SEGMENT ORDER: 207 NCPDP FIELD NUMBER: 476 PROCESSING MODE: STANDARD
PRICING SEGMENT	PRICING SEGMENT ORDER: 216 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 218 NCPDP FIELD NUMBER: 409 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 220 NCPDP FIELD NUMBER: 412 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 222 NCPDP FIELD NUMBER: 477 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 225 NCPDP FIELD NUMBER: 433 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 228 NCPDP FIELD NUMBER: 438 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 230 NCPDP FIELD NUMBER: 478 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 233 NCPDP FIELD NUMBER: 479 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 237 NCPDP FIELD NUMBER: 480 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 240 NCPDP FIELD NUMBER: 426 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 243 NCPDP FIELD NUMBER: 430 PROCESSING MODE: STANDARD PRICING SEGMENT ORDER: 244 NCPDP FIELD NUMBER: 423 PROCESSING MODE: STANDARD
COMPOUND SEGMENT	COMPOUND SEGMENT ORDER: 253 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 255 NCPDP FIELD NUMBER: 450 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 258 NCPDP FIELD NUMBER: 451 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 260 NCPDP FIELD NUMBER: 452 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 262 NCPDP FIELD NUMBER: 447 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 264 NCPDP FIELD NUMBER: 488 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 266 NCPDP FIELD NUMBER: 489 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 267 NCPDP FIELD NUMBER: 448 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 269 NCPDP FIELD NUMBER: 449 PROCESSING MODE: STANDARD COMPOUND SEGMENT ORDER: 271 NCPDP FIELD NUMBER: 490 PROCESSING MODE: STANDARD
CLINICAL SEGMENT	CLINICAL SEGMENT ORDER: 281 NCPDP FIELD NUMBER: 111 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 283 NCPDP FIELD NUMBER: 491 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 285 NCPDP FIELD NUMBER: 492 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 287 NCPDP FIELD NUMBER: 424 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 289 NCPDP FIELD NUMBER: 493 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 292 NCPDP FIELD NUMBER: 494 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 294 NCPDP FIELD NUMBER: 495 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 296 NCPDP FIELD NUMBER: 496 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 298 NCPDP FIELD NUMBER: 497 PROCESSING MODE: STANDARD CLINICAL SEGMENT ORDER: 300 NCPDP FIELD NUMBER: 499 PROCESSING MODE: STANDARD

ILMDB1V5 (45) BPS NCPDP FORMATS (9002313.92)