ACSIAB1 (82)    BPS NCPDP FORMATS (9002313.92)

Name Value
RECORD FORMAT NAME ACSIAB1
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:   307
    PROCESSING MODE:   STANDARD
  • PATIENT SEGMENT ORDER:   52
    NCPDP FIELD NUMBER:   335
    PROCESSING MODE:   STANDARD
INSURANCE SEGMENT
  • INSURANCE SEGMENT ORDER:   61
    NCPDP FIELD NUMBER:   111
    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:   524
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   70
    NCPDP FIELD NUMBER:   309
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   73
    NCPDP FIELD NUMBER:   301
    PROCESSING MODE:   STANDARD
  • INSURANCE SEGMENT ORDER:   74
    NCPDP FIELD NUMBER:   306
    PROCESSING MODE:   STANDARD
CLAIM SEGMENT
  • CLAIM SEGMENT ORDER:   101
    NCPDP FIELD NUMBER:   458
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   104
    NCPDP FIELD NUMBER:   459
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   106
    NCPDP FIELD NUMBER:   442
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   108
    NCPDP FIELD NUMBER:   403
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   109
    NCPDP FIELD NUMBER:   405
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   110
    NCPDP FIELD NUMBER:   406
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   111
    NCPDP FIELD NUMBER:   408
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   113
    NCPDP FIELD NUMBER:   414
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   116
    NCPDP FIELD NUMBER:   415
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   119
    NCPDP FIELD NUMBER:   419
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   121
    NCPDP FIELD NUMBER:   420
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   125
    NCPDP FIELD NUMBER:   308
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   127
    NCPDP FIELD NUMBER:   429
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   129
    NCPDP FIELD NUMBER:   418
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   130
    NCPDP FIELD NUMBER:   461
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   133
    NCPDP FIELD NUMBER:   462
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   137
    NCPDP FIELD NUMBER:   463
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   140
    NCPDP FIELD NUMBER:   464
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   143
    NCPDP FIELD NUMBER:   343
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   145
    NCPDP FIELD NUMBER:   344
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   148
    NCPDP FIELD NUMBER:   345
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   84
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   86
    NCPDP FIELD NUMBER:   455
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   89
    NCPDP FIELD NUMBER:   402
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   91
    NCPDP FIELD NUMBER:   436
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   93
    NCPDP FIELD NUMBER:   407
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   95
    NCPDP FIELD NUMBER:   456
    PROCESSING MODE:   STANDARD
  • CLAIM SEGMENT ORDER:   98
    NCPDP FIELD NUMBER:   457
    PROCESSING MODE:   STANDARD
PHARMACY PROVIDER SEGMENT
  • PHARMACY PROVIDER ORDER:   158
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PHARMACY PROVIDER ORDER:   160
    NCPDP FIELD NUMBER:   465
    PROCESSING MODE:   STANDARD
  • PHARMACY PROVIDER ORDER:   162
    NCPDP FIELD NUMBER:   444
    PROCESSING MODE:   STANDARD
PRESCRIBER SEGMENT
  • PRESCRIBER SEGMENT ORDER:   170
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   172
    NCPDP FIELD NUMBER:   466
    PROCESSING MODE:   SPECIAL
    SPECIAL CODE:   
    S BPS("X")="05"
    
  • PRESCRIBER SEGMENT ORDER:   174
    NCPDP FIELD NUMBER:   411
    PROCESSING MODE:   SPECIAL
    SPECIAL CODE:   
    S BPS("X")=$G(BPS("RX",BPS(9002313.0201),"CAID #"))
    
  • PRESCRIBER SEGMENT ORDER:   177
    NCPDP FIELD NUMBER:   427
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   179
    NCPDP FIELD NUMBER:   498
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   181
    NCPDP FIELD NUMBER:   468
    PROCESSING MODE:   STANDARD
  • PRESCRIBER SEGMENT ORDER:   184
    NCPDP FIELD NUMBER:   421
    PROCESSING MODE:   STANDARD
COB OTHER PAYMENTS SEGMENT
  • COB OTHER PAYMENTS ORDER:   193
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   195
    NCPDP FIELD NUMBER:   337
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   197
    NCPDP FIELD NUMBER:   338
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   199
    NCPDP FIELD NUMBER:   339
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   201
    NCPDP FIELD NUMBER:   340
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   203
    NCPDP FIELD NUMBER:   443
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   206
    NCPDP FIELD NUMBER:   341
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   209
    NCPDP FIELD NUMBER:   342
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   212
    NCPDP FIELD NUMBER:   431
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   214
    NCPDP FIELD NUMBER:   471
    PROCESSING MODE:   STANDARD
  • COB OTHER PAYMENTS ORDER:   216
    NCPDP FIELD NUMBER:   472
    PROCESSING MODE:   STANDARD
WORKERS COMP SEGMENT
  • WORKERS COMP SEGMENT ORDER:   225
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • WORKERS COMP SEGMENT ORDER:   228
    NCPDP FIELD NUMBER:   434
    PROCESSING MODE:   STANDARD
DUR PPS SEGMENT
  • DUR PPS SEGMENT ORDER:   236
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   238
    NCPDP FIELD NUMBER:   473
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   240
    NCPDP FIELD NUMBER:   439
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   242
    NCPDP FIELD NUMBER:   440
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   245
    NCPDP FIELD NUMBER:   441
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   247
    NCPDP FIELD NUMBER:   474
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   249
    NCPDP FIELD NUMBER:   475
    PROCESSING MODE:   STANDARD
  • DUR PPS SEGMENT ORDER:   251
    NCPDP FIELD NUMBER:   476
    PROCESSING MODE:   STANDARD
PRICING SEGMENT
  • PRICING SEGMENT ORDER:   260
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   262
    NCPDP FIELD NUMBER:   409
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   264
    NCPDP FIELD NUMBER:   412
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   266
    NCPDP FIELD NUMBER:   477
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   269
    NCPDP FIELD NUMBER:   433
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   272
    NCPDP FIELD NUMBER:   481
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   275
    NCPDP FIELD NUMBER:   482
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   278
    NCPDP FIELD NUMBER:   484
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   281
    NCPDP FIELD NUMBER:   426
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   284
    NCPDP FIELD NUMBER:   430
    PROCESSING MODE:   STANDARD
  • PRICING SEGMENT ORDER:   285
    NCPDP FIELD NUMBER:   423
    PROCESSING MODE:   STANDARD
COMPOUND SEGMENT
  • COMPOUND SEGMENT ORDER:   294
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   296
    NCPDP FIELD NUMBER:   450
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   299
    NCPDP FIELD NUMBER:   451
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   301
    NCPDP FIELD NUMBER:   452
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   303
    NCPDP FIELD NUMBER:   447
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   305
    NCPDP FIELD NUMBER:   488
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   307
    NCPDP FIELD NUMBER:   489
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   308
    NCPDP FIELD NUMBER:   448
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   310
    NCPDP FIELD NUMBER:   449
    PROCESSING MODE:   STANDARD
  • COMPOUND SEGMENT ORDER:   312
    NCPDP FIELD NUMBER:   490
    PROCESSING MODE:   STANDARD
PRIOR AUTH SEGMENT
  • PRIOR AUTH SEGMENT ORDER:   322
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   326
    NCPDP FIELD NUMBER:   498.01
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   327
    NCPDP FIELD NUMBER:   498.02
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   329
    NCPDP FIELD NUMBER:   498.03
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   331
    NCPDP FIELD NUMBER:   498.04
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   332
    NCPDP FIELD NUMBER:   498.05
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   334
    NCPDP FIELD NUMBER:   498.06
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   336
    NCPDP FIELD NUMBER:   498.07
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   338
    NCPDP FIELD NUMBER:   498.08
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   340
    NCPDP FIELD NUMBER:   498.09
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   343
    NCPDP FIELD NUMBER:   498.11
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   345
    NCPDP FIELD NUMBER:   498.14
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   348
    NCPDP FIELD NUMBER:   503
    PROCESSING MODE:   STANDARD
  • PRIOR AUTH SEGMENT ORDER:   350
    NCPDP FIELD NUMBER:   498.13
    PROCESSING MODE:   STANDARD
CLINICAL SEGMENT
  • CLINICAL SEGMENT ORDER:   359
    NCPDP FIELD NUMBER:   111
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   362
    NCPDP FIELD NUMBER:   491
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   364
    NCPDP FIELD NUMBER:   492
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   366
    NCPDP FIELD NUMBER:   424
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   367
    NCPDP FIELD NUMBER:   493
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   370
    NCPDP FIELD NUMBER:   494
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   371
    NCPDP FIELD NUMBER:   495
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   372
    NCPDP FIELD NUMBER:   496
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   374
    NCPDP FIELD NUMBER:   497
    PROCESSING MODE:   STANDARD
  • CLINICAL SEGMENT ORDER:   375
    NCPDP FIELD NUMBER:   499
    PROCESSING MODE:   STANDARD