| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | transaction order | 0;1 | NUMERIC | B | This is the numeric value to indicate the order of the transactions. This is a sequential value starting at 1 to store multiple transactions on this request. | |
| .04 | medication name | 0;4 | FREE TEXT | Name of the med ordered. | ||
| .05 | prescription number | 0;5 | POINTER | 52 | This is the prescription associated with the claim | |
| 113 | medicaid paid amount | 110;3 | FREE TEXT | This is used to store NCPDP field 113-N3 (Medicaid Paid Amount), which is defined as "Amount paid by the Medicaid Agency." | ||
| 117 | billing entity type indicator | 110;7 | FREE TEXT | This is used to store NCPDP field 117-TR (Billing Entity Type Indicator), which is defined as "A code that identifies the entity submitting the billing transaction." | ||
| 118 | pay to qualifier | 110;8 | FREE TEXT | This is used to store NCPDP field 118-TS (Pay To Qualifier), which is defined as "Code qualifying the Pay To ID (119-TT)." | ||
| 119 | pay to id | 110;9 | FREE TEXT | This is used to store NCPDP field 119-TT (Pay To ID), which is defined as "Identifying number of the entity to receive payment for claim." | ||
| 120 | pay to name | 110;10 | FREE TEXT | This is used to store NCPDP field 120-TU (Pay To Name), which is defined as "Name of the entity to receive payment for claim." | ||
| 121 | pay to street address | 120;1 | FREE TEXT | This is used to store NCPDP field 121-TV (Pay To Street Address), which is defined as "Street address of the entity to receive payment for claim." | ||
| 122 | pay to city address | 120;2 | FREE TEXT | This is used to store NCPDP field 122-TW (Pay To City Address), which is defined as "City of the entity to receive payment for claim." | ||
| 123 | pay to state/province address | 120;3 | FREE TEXT | This is used to store NCPDP field 123-TX (Pay to State/Province Address). | ||
| 124 | pay to zip/postal zone | 120;4 | FREE TEXT | This is used to store NCPDP field 124-TY (Pay To Zip/Postal Zone), which is defined as "Code defining international postal zone excluding punctuation and blanks (zip code for US)." | ||
| 125 | generic eqvlnt product id qlfr | 120;5 | FREE TEXT | This is used to store NCPDP field 125-TZ (Generic Equivalent Product ID Qualifier), which is defined as "Code qualifying the Generic Equivalent Product ID (126-UA)." | ||
| 126 | generic equivalent product id | 120;6 | FREE TEXT | This is used to store NCPDP field 126-UA (Generic Equivalent Product ID), which is defined as "Identifies the generic equivalent of the brand product dispensed." | ||
| 147 | pharmacy service type | 140;7 | FREE TEXT | This is used to store NCPDP field 147-U7 (Pharmacy Service Type), which is defined as "The type of service being performed by a pharmacy when different contractual terms exist between a payer and the pharmacy, or when benefits are based upon the type of service performed." | ||
| 308 | other coverage code | 300;8 | FREE TEXT | Code indicating whether or not the patient has other insurance coverage. NCPDP standard field 308-C8. | ||
| 315 | employer name | 310;5 | FREE TEXT | Complete name of employer. NCPDP standard field 315-CF. | ||
| 316 | employer street address | 310;6 | FREE TEXT | The Street address of the insured's employer. NCPDP standard field 316-CG. | ||
| 317 | employer city address | 310;7 | FREE TEXT | Free-form text for city name. NCPDP standard field 317-CH. | ||
| 318 | employer state prov address | 310;8 | FREE TEXT | Standard State/Province Code as defined by appropriate government agency. NCPDP standard field 318-CI. | ||
| 319 | employer zip postal zone | 310;9 | FREE TEXT | Code defining international postal zone excluding punctuation and blanks (zip code for US). NCPDP standard field 319-CJ. | ||
| 320 | employer phone number | 310;10 | FREE TEXT | Ten digit phone number of employer. NCPDP standard field 320-CK. | ||
| 321 | employer contact name | 320;1 | FREE TEXT | Employer primary contact. NCPDP standard field 321-CL. | ||
| 327 | carrier id | 320;7 | FREE TEXT | Carrier code assigned in Worker's Compensation Program. NCPDP standard field 327-CR. | ||
| 330 | alternate id | 320;10 | FREE TEXT | Person identifier to be used for controlled product reporting. Identifier may be that of the patient or the person picking up the prescription as required by the governing body. NCPDP standard field 330-CW. | ||
| 337 | cob other payments count | 330;7 | FREE TEXT | Count of other payment occurrences. | ||
| 337.01 | cob other payments | 337;0 | MULTIPLE | 9002313.0401 | Multiple counter to store other coordination of benefit payments. | |
| 343 | dispensing status | 340;3 | FREE TEXT | Code indicating the quantity dispensed is a partial fill or the completion of a partial fill. Used only in situations where inventory shortages do not allow the full quantity to be dispensed. NCPDP standard field 343-HD. | ||
| 344 | quantity ordered | 340;4 | FREE TEXT | Metric decimal quantity of medication that would be dispensed on original filling if inventory were available. Used in association with a 'P' or 'C' in Dispensing Status (343-HD). NCPDP standard field 344-HF. | ||
| 345 | days supply ordered | 340;5 | FREE TEXT | Days supply for metric decimal quantity of medication that would be dispensed on original dispensing if inventory were available. Used in association with a 'P' or 'C' in Dispensing Status (343-HD). NCPDP standard field 345-HG. | ||
| 354 | subm clarification code count | 350;4 | FREE TEXT | This is used to store NCPDP field 354-NX (Submission Clarification Code Count), which is defined as "Count of the Submission Clarification Code (420-DK) occurrences." | ||
| 354.01 | submission clarification mltpl | 354.01;0 | MULTIPLE | 9002313.02354 | This sub-file stores Submission Clarification values. | |
| 357 | delay reason code | 350;7 | FREE TEXT | This is used to store NCPDP field 357-NV (Delay Reason Code), which is defined as "Code to specify the reason that submission of the transactions has been delayed." | ||
| 364 | prescriber first name | 360;4 | FREE TEXT | This is used to store NCPDP field 364-2J (Prescriber First Name). | ||
| 365 | prescriber street address | 360;5 | FREE TEXT | This is used to store NCPDP field 365-2K (Prescriber Street Address), which is defined as "Free form text for prescriber address information." | ||
| 366 | prescriber city address | 360;6 | FREE TEXT | This is used to store NCPDP field 366-2M (Prescriber City Address), which is defined as "Free form text for prescriber city name." | ||
| 367 | prescriber state/prov address | 360;7 | FREE TEXT | This is used to store NCPDP field 367-2N (Prescriber State/Province Address), which is defined as "Standard state /province code as defined by appropriate government agency." | ||
| 368 | prescriber zip/postal zone | 360;8 | FREE TEXT | This is used to store NCPDP field 368-2P (Prescriber Zip/Postal Zone), which is defined as "Code defining international postal zone excluding punctuation and blanks." | ||
| 369 | additional documntn type id | 360;9 | FREE TEXT | This is used to store NCPDP field 369-2Q (Additional Documentation Type ID), which is defined as "Unique identifier for the data being submitted." | ||
| 370 | length of need | 360;10 | FREE TEXT | This is used to store NCPDP field 370-2R (Length of Need), which is defined as "Length of time the physician expects the patient to require use of the ordered item. Qualified by Length of Need Qualifier (371-2S)." | ||
| 371 | length of need qualifier | 370;1 | FREE TEXT | This is used to store NCPDP field 371-2S (Length of Need Qualifier), which is defined as "Code qualifying the length of need." | ||
| 372 | prescriber/supplier dt signed | 370;2 | FREE TEXT | This is used to store NCPDP field 372-2T (Prescriber/Supplier Date Signed), which is defined as "The date the form was completed and signed by the ordering physician." | ||
| 373 | request status | 370;3 | FREE TEXT | This is used to store NCPDP field 373-2U (Request Status), which is defined as "Code identifying type of request." | ||
| 374 | request period begin date | 370;4 | FREE TEXT | This is used to store NCPDP field 374-2V (Request Period Begin Date), which is defined as "The beginning date of need." | ||
| 375 | request pd recert/revised date | 370;5 | FREE TEXT | This is used to store NCPDP field 375-2W (Request Period Recert/Revised Date), which is defined as "The effective date of the revision or re-certification provided by the certifying physician." | ||
| 376 | supporting documentation | 370;6 | FREE TEXT | This is used to store NCPDP field 376-2X (Supporting Documentation), which is defined as "Free text message." | ||
| 377 | question number/letter count | 370;7 | FREE TEXT | This is used to store NCPDP field 377-2Z (Question Number/Letter Count), which is defined as "Count of Question Number/Letter occurrences." | ||
| 377.01 | question number/letter mltpl | 377.01;0 | MULTIPLE | 9002313.023771 | This sub-file stores Question Number/Letter values. | |
| 385 | facility name | 380;5 | FREE TEXT | This is used to store NCPDP field 385-3Q (Facility Name), which is defined as "Name identifying the location of the service rendered." | ||
| 386 | facility street address | 380;6 | FREE TEXT | This is used to store NCPDP field 386-3U (Facility Street Address), which is defined as "Free form text for Facility address information." | ||
| 387 | facility state/prov address | 380;7 | FREE TEXT | This is used to store NCPDP field 387-3V (Facility State/Province Address), which is defined as "Standard state /province code as defined by appropriate government agency." | ||
| 388 | facility city address | 380;8 | FREE TEXT | This is used to store NCPDP field 388-5J (Facility City Address), which is defined as "Free form text for facility city name." | ||
| 389 | facility zip/postal zone | 380;9 | FREE TEXT | This is used to store NCPDP field 389-6D (Facility Zip/Postal Zone), which is defined as "Code defining international postal zone excluding punctuation and blanks." | ||
| 390 | narrative message | 389;2 | FREE TEXT | This is used to store NCPDP field 390-BM (Narrative Message), which is defined as "Free form text." | ||
| 391 | patient assignment indicator | 390;1 | FREE TEXT | This is used to store NCPDP field 391-MT (Patient Assignment Indicator (Direct Member Reimbursement Indicator)), which is defined as "Code to indicate a patient's choice on assignment of benefits." | ||
| 402 | prescription/service ref no | 400;2 | FREE TEXT | This is the reference number assigned by the provider for the dispensed drug/product and/or service provided. It is NCPDP field 402-D2. The VA uses the Prescription IEN for this field. | ||
| 403 | fill number | 400;3 | FREE TEXT | The fill/refill number, starting at 0 for the original fill. The code indicating whether the prescription is an original or a refill. NCPDP standard field 403-D3. | ||
| 405 | days supply | 400;5 | FREE TEXT | Estimated number of days the prescription will last. NCPDP standard field 405-D5. | ||
| 406 | compound code | 400;6 | FREE TEXT | Field indicating whether this prescription was a compound (1) or not a compound (0). | ||
| 407 | product service id | 400;7 | FREE TEXT | ID of the product dispensed or service provided. NDC code in our case. NCPDP standard field 407-D7. | ||
| 408 | dispense as written | 400;8 | FREE TEXT | Code indicating whether or not the prescriber's instructions regarding generic substitution were followed. NCPDP standard field 408-D8. | ||
| 409 | ingredient cost submitted | 400;9 | FREE TEXT | Submitted product component cost of the dispensed prescription. This amount is included in the 'Gross Amount Due' (430-DU). | ||
| 411 | prescriber id | 400;11 | FREE TEXT | ID assigned to the prescriber. | ||
| 412 | dispensing fee submitted | 400;12 | FREE TEXT | Dispensing fee submitted by the pharmacy. This amount is included in the 'Gross Amount Due' (430-DU). NCPDP standard field 412-DC. | ||
| 414 | date prescription written | 400;14 | FREE TEXT | Date prescription was written. This will be the fill/refill date for local fills, the released date for CMOP. NCPDP standard field 414-DE. | ||
| 415 | number of refills authorized | 400;15 | FREE TEXT | Number of refills authorized by the prescriber. The number of refills allowed that was entered during order entry. NCPDP standard field 415-DF. | ||
| 418 | level of service | 400;18 | FREE TEXT | Coding indicating the type of service the provider rendered. Not utilized, populated with DI00. NCPDP standard field 418-DI. | ||
| 419 | prescription origin code | 400;19 | FREE TEXT | Code indicating the origin of the prescription. | ||
| 421 | primary care provider id | 400;21 | FREE TEXT | ID assigned to the primary care provider. Used when the patient is referred to a secondary care provider. NCPDP standard field 421-DL. | ||
| 423 | basis of cost determination | 400;23 | FREE TEXT | Code indicating the method by which 'Ingredient Cost Submitted' (Field 409-D9) was calculated. How the amount charged was determined. NCPDP standard field 423-DN. | ||
| 424 | diagnosis code | 400;24 | FREE TEXT | Code identifying the diagnosis of the patient. Not used for third party billing as of this date - so it is not used, but may be used in the future. NCPDP standard field 424-DO. | ||
| 426 | usual and customary charge | 400;26 | FREE TEXT | Amount charged cash customers for the prescription exclusive of sales tax or other amounts claimed. NCPDP standard field 426-DQ. | ||
| 427 | prescriber last name | 420;27 | FREE TEXT | Last Name of the Prescriber. NCPDP standard field 427-DR. | ||
| 429 | special packaging indicator | 400;29 | FREE TEXT | Code indicating the type of Unit Dose dispensing. NCPDP standard field 429-DT. 0=Not Specified 1=Not Unit Dose 2=Manufacturer Unit Dose 3=Pharmacy Unit Dose | ||
| 430 | gross amount due | 400;30 | FREE TEXT | Total price claimed from all sources. For prescription claim request, field represents a sum of Ingredient Cost Submitted (409-D9), Dispensing Fee Submitted (412-DC), Flat Sales Tax Amount Submitted (481-HA), Percentage Sales Tax Amount Submitted (482-GE), Incentive Amount Submitted (438-E3), Other Amount Claimed (480-H9). For service claim request, field represents a sum of Professional Services Fee Submitted (477-BE), Flat Sales Tax Amount Submitted (481-HA), Percentage Sales Tax Amount Submitted (482-GE), Other Amount Claimed (480-H9). NCPDP standard field 430-DU. | ||
| 431 | other payer amount | 430;1 | FREE TEXT | Amount of any payment known by the pharmacy from other sources. NCPDP standard field 431-DV. | ||
| 433 | patient paid amount submitted | 430;3 | FREE TEXT | Amount the pharmacy received from the patient for the prescription dispensed. | ||
| 434 | date of injury | 430;4 | FREE TEXT | Date on which the injury occurred. NCPDP standard field 434-DY. | ||
| 435 | claim reference id | 430;5 | FREE TEXT | Identifies the claim number assigned by Worker s Compensation Program. NCPDP standard field 435-DZ. | ||
| 436 | product service id qualifier | 430;6 | FREE TEXT | Code qualifying the value in 'Product/Service ID' (407-D7). NCPDP standard field 436-E1. | ||
| 438 | incentive amount submitted | 430;8 | FREE TEXT | Amount represents a fee that is submitted by the pharmacy for contractually agreed upon services. This amount is included in the 'Gross Amount Due' (430-DU). | ||
| 442 | quantity dispensed | 440;2 | FREE TEXT | Quantity dispensed expressed in metric decimal units. NCPDP standard field 442-E7. | ||
| 443 | other payer date | 440;3 | FREE TEXT | Payment or denial date of the claim submitted to the other payer. Used for coordination of benefits. NCPDP standard field 443-E8. | ||
| 444 | provider id | 440;4 | FREE TEXT | Unique ID assigned to the person responsible for the dispensing of the prescription or provision of the service. | ||
| 445 | original prescribed prod code | 440;5 | FREE TEXT | Code of the initially prescribed product or service. NCPDP standard field 445-EA. | ||
| 446 | originally prescribed quantity | 440;6 | FREE TEXT | Product initially prescribed amount expressed in metric decimal units. NCPDP standard field 446-EB. | ||
| 447 | compound ingredient count | 440;7 | FREE TEXT | Count of compound product IDs (both active and inactive) in the compound mixture submitted. NCPDP standard field 447-EC. | ||
| 447.01 | compound repeating fields | 447;0 | MULTIPLE | 9002313.0501 | Multiple to store multiple compounds in a prescription. | |
| 450 | compound dosage description | 440;10 | FREE TEXT | Dosage form of the complete compound mixture. NCPDP standard field 450-EF. | ||
| 451 | compound dispensing indicator | 450;1 | FREE TEXT | NCPDP standard product billing codes. NCPDP standard field 451-EG. | ||
| 452 | compound route of admin | 450;2 | FREE TEXT | Code for the route of administration of the complete compound mixture. NCPDP standard field 452-EH. | ||
| 453 | original product service id | 450;3 | FREE TEXT | Code qualifying the value in 'Originally Prescribed Product/Service Code' (Field 445-EA). NCPDP standard field 453-EJ. | ||
| 454 | scheduled rx id number | 450;4 | FREE TEXT | The serial number of the prescription blank/form. NCPDP standard field 454-EK. | ||
| 455 | prescription service reference | 450;5 | FREE TEXT | Indicates the type of billing submitted. NCPDP standard field 455-EM. | ||
| 456 | associated rx/service ref no | 450;6 | FREE TEXT | This is the Related Prescription/Service Reference Number (402-D2) to which the service is associated. It is NCPDP field 456-EN. | ||
| 457 | associated prescription date | 450;7 | FREE TEXT | Date of the Associated Prescription/Service Reference Number (456-EN). NCPDP standard field 457-EP. | ||
| 458 | procedure modifier code count | 450;8 | FREE TEXT | This is the count of the Procedure Modifier Code (459-ER) occurrences. It is NCPDP field 458-SE. | ||
| 459 | procedure modifier code | 459;0 | MULTIPLE | 9002313.201459 | Multiple for storing procedure code information. | |
| 460 | quantity prescribed | 450;10 | FREE TEXT | Amount expressed in metric decimal units. Quantity prescribed during order entry. NCPDP standard field 460-ET. | ||
| 461 | prior authorization type code | 460;1 | FREE TEXT | Code clarifying the Prior Authorization Number Submitted (462-EV) or benefit/plan exemption. NCPDP standard field 461-EU. | ||
| 462 | prior authorization submitted | 460;2 | FREE TEXT | Number submitted by the provider to identify the prior authorization. NCPDP standard field 462-EV. | ||
| 463 | intermediary auth type id | 460;3 | FREE TEXT | Value indicating that authorization occurred for intermediary processing. NCPDP standard field 463-EW. | ||
| 464 | intermediary authorization id | 460;4 | FREE TEXT | Value indicating intermediary authorization occurred. NCPDP standard field 464-EX. | ||
| 465 | provider id qualifier | 460;5 | FREE TEXT | Code qualifying the Provider ID (444-E9). NCPDP standard field 465-EY. | ||
| 466 | prescriber id qualifier | 460;6 | FREE TEXT | Code qualifying the Prescriber ID (411-DB). NCPDP standard field 466-EZ. | ||
| 467 | prescriber location code | 460;7 | FREE TEXT | Location address code assigned to the prescriber as identified in the National Provider System (NPS). NCPDP standard field 467-1E. | ||
| 468 | pc provider id qualifier | 460;8 | FREE TEXT | Code qualifying the Primary Care Provider ID (421-DL). NCPDP standard field 468-2E. | ||
| 469 | pc provider location code | 460;9 | FREE TEXT | Location address code assigned to the primary care provider as identified in the National Provider System (NPS). NCPDP standard field 469-H5. | ||
| 470 | pc provider last name | 460;10 | FREE TEXT | Last name of the Primary Care Provider. NCPDP standard field 470-4E. | ||
| 471 | other payer reject count | 470;1 | FREE TEXT | Count of Other Payer Reject Code (472-6E) occurrences. NCPDP standard field 471-5E. | ||
| 473.01 | dur pps repeating fields | 473.01;0 | MULTIPLE | 9002313.1001 | Count of Drug Utilization sub-records. | |
| 477 | professional fee submitted | 470;7 | FREE TEXT | Amount submitted by the provider for professional services rendered. NCPDP standard field 477-BE. | ||
| 478 | other amt claimed submttd cnt | 470;8 | FREE TEXT | This is NCPDP field 478-H7 (Other Amount Claimed Submitted Count). It is the count of 'Other Amount Claimed Submitted' occurrences. | ||
| 478.01 | other amt claimed multiple | 478.01;0 | MULTIPLE | 9002313.0601 | This sub-file stores Other Amount Claimed values. | |
| 481 | flat sales tax submitted | 480;1 | FREE TEXT | Flat sales tax submitted for prescription. This amount is included in the Gross Amount Due (430-DU). NCPDP standard field 481-HA. | ||
| 482 | percentage sales tax submitted | 480;2 | FREE TEXT | Percentage sales tax submitted. NCPDP standard field 482-GE. | ||
| 483 | percentage sales tax rate | 480;3 | FREE TEXT | Percentage sales tax rate used to calculate Percentage Sales Tax Amount Submitted (482-GE). NCPDP standard field 483-HE. | ||
| 484 | percentage sales tax basis | 480;4 | FREE TEXT | Code indicating the basis for percentage sales tax. NCPDP standard field 484-JE. | ||
| 485 | coupon type | 480;5 | FREE TEXT | Code indicating the type of coupon being used. NCPDP standard field 485-KE. | ||
| 486 | coupon number | 480;6 | FREE TEXT | Unique serial number assigned to the prescription coupons. NCPDP standard field 486-ME. | ||
| 487 | coupon value amount | 480;7 | FREE TEXT | Value of the coupon. NCPDP standard field 487-NE. | ||
| 491 | diagnosis code count | 490;1 | FREE TEXT | Count of diagnosis occurrences. NCPDP standard field 491-VE. | ||
| 491.01 | clinical diagnosis | 491.01;0 | MULTIPLE | 9002313.0701 | Diagnosis sub-records. | |
| 493 | clinical information count | 493;1 | FREE TEXT | Counter number of clinical information measurement set/logical grouping. NCPDP standard field 493-XE. | ||
| 493.01 | clinical information | 493.01;0 | MULTIPLE | 9002313.0801 | Count of clinical information sub-records. | |
| 498.01 | request type | 498;1 | FREE TEXT | Code identifying type of prior authorization request. NCPDP standard field 498-PA. | ||
| 498.02 | request period begin date | 498;2 | FREE TEXT | Beginning date for a prior authorization request. NCPDP standard field 498-PB. | ||
| 498.03 | request period end date | 498;3 | FREE TEXT | End date for a prior authorization request. NCPDP standard field 498-PC. | ||
| 498.04 | basis of request | 498;4 | FREE TEXT | Code describing the reason for prior authorization request. NCPDP standard field 498-PD. | ||
| 498.05 | authorized rep first name | 498;5 | FREE TEXT | First name of the patients authorized representative. NCPDP standard field 498-PE. | ||
| 498.06 | authorized rep last name | 498;6 | FREE TEXT | Last name of the patients authorized representative. NCPDP standard field 498-PF. | ||
| 498.07 | authorized rep street address | 498;7 | FREE TEXT | Free-form text for address information. NCPDP standard field 498-PG. | ||
| 498.08 | authorized rep city address | 498;8 | FREE TEXT | Free-form text for city name. NCPDP standard field 498-PH. | ||
| 498.09 | authorized rep state prov | 498;9 | FREE TEXT | Authorized Rep's State or Province. NCPDP standard field 498-PJ. | ||
| 498.11 | authorized rep zip | 498;11 | FREE TEXT | Authorized Rep's Zip Code. NCPDP standard field 498-PK. | ||
| 498.12 | prescriber phone number | 498;12 | FREE TEXT | Ten digit phone number of the prescriber. NCPDP standard field 498-PM. | ||
| 498.13 | prior auth supporting documntn | 498.13;0 | WORD-PROCESSING | This is a free text message. It is NCPDP field 498-PP. | ||
| 498.14 | prior auth number assigned | 498;14 | FREE TEXT | Unique number identifying the prior authorization assigned by the processor. NCPDP standard field 498-PY. | ||
| 503 | authorization number | 500;3 | FREE TEXT | Unique number identifying the prior authorization assigned by the processor. NCPDP standard field 503-F3. | ||
| 579 | service provider id qualifier | 570;9 | FREE TEXT | NCPDP Standard field 579-XX Code qualifying the 'Associated Prescription/Service Provider ID' (58Ø-XY) to which the claim/service is related. | ||
| 580 | service provider id | 570;10 | FREE TEXT | NCPDP Standard field 580-XY Related Service Provider ID to which the claim/service is associated. | ||
| 581 | service reference number qual | 580;1 | FREE TEXT | NCPDP Standard field 581-XZ Code qualifying the 'Associated Prescription/Service Reference Number ID' (456-EN) to which the claim/service is related. | ||
| 582 | service fill number | 580;2 | FREE TEXT | NCPDP Standard field 582-X0 Related Fill Number to which the claim/service is associated. | ||
| 583 | service provider name | 580;3 | FREE TEXT | NCPDP Standard field 583-YK The name of the service provider business associated to the service provider ID (2Ø1-B1). | ||
| 584 | service provider street | 580;4 | FREE TEXT | NCPCP Standard field 584-YM The street address of the service provider. | ||
| 585 | service provider city | 580;5 | FREE TEXT | NCPDP Standard field 585-YN Code uniquely identifying the transmission syntax and corresponding Data Dictionary. | ||
| 586 | service provide state/province | 580;6 | FREE TEXT | NCPDP Standard field 586-YP The state/province code of the address of the service provider. | ||
| 587 | service provider zip/post code | 580;7 | FREE TEXT | NCPDP Standard field number 587-YQ The postal code of the address of the service provider. | ||
| 590 | seller initials | 580;10 | FREE TEXT | NCPDP Standard field 590-YT The initials of the person responsible for dispensing the prescription or provision of service. | ||
| 591 | purchaser id qualifier | 590;1 | FREE TEXT | NCPDP Standard field 591-YU Code indicating the type of ID used in the Purchaser ID field. Qualifies Purchaser ID (592-YV). | ||
| 592 | purchaser id | 590;2 | FREE TEXT | NCPDP Standard field 592-YV The ID number used to identify the purchaser of the product/service. Qualified by Purchaser ID Qualifier. | ||
| 593 | purchaser id state/province | 590;3 | FREE TEXT | NCPDP Standard field 593-YW The postal state code abbreviation that is used in conjunction with the Purchaser ID Qualifier and Purchaser ID fields to identify what state the identification is from. | ||
| 594 | purchaser date of birth | 590;4 | FREE TEXT | NCPDP Standard field 594-YX The Date of Birth of the purchaser of the product/service. | ||
| 595 | purchaser gender code | 590;5 | FREE TEXT | NCPDP Standard field 595-YY The Gender of the purchaser of the product/service. | ||
| 596 | purchaser first name | 590;6 | FREE TEXT | NCPDP Standard field 596-YZ The First Name of the purchaser of the product/service. | ||
| 597 | purchaser last name | 590;7 | FREE TEXT | NCPDP Standard field 597-Y0 The Last Name of the purchaser of the product/service. | ||
| 598 | purchaser street address | 590;8 | FREE TEXT | NCPDP Standard field 598-Y1 Free-form text for address information. | ||
| 599 | purchaser city address | 590;9 | FREE TEXT | NCPDP Standard field 599-Y2 The City name associated to the address of the purchaser of the product/service. | ||
| 600 | unit of measure | 600;1 | FREE TEXT | Unit of measure of the prescription. NCPDP standard field 600-28. | ||
| 675 | purchaser state/province code | 670;5 | FREE TEXT | NCPDP Standard field 675-Y3 The Postal State/province code associated to the address of the purchaser of the product/service. | ||
| 676 | purchaser zip/postal code | 670;6 | FREE TEXT | NCPDP Standard field 676-Y4 The associated postal code of the address of the purchaser of the product/service. | ||
| 677 | purchaser country code | 670;7 | FREE TEXT | NCPDP Standard field 677-Y5 The associated Postal country code of the purchaser of the product/service. | ||
| 678 | time of service | 670;8 | FREE TEXT | NCPDP Standard field 678-Y6 The time at which the service is performed as local time that will correspond with the actual date of service. | ||
| 679 | seller id | 670;9 | FREE TEXT | NCPDP Standard field 679-Y9 The identification of the person responsible for dispensing the prescription or provision of the service. | ||
| 680 | seller id qualifier | 670;10 | FREE TEXT | NCPDP Standard field 680-ZB Code indicating the type of ID used in the Seller Identification (xxx-xx). | ||
| 681 | sales transaction id | 680;1 | FREE TEXT | NCPDP Standard field 681-ZF A reference identifier assigned to the sale transaction as assigned by the merchant. | ||
| 880 | transaction reference number | 870;10 | FREE TEXT | This is used to store NCPDP field 880-K5 (Transaction Reference Number), which is defined as "A reference number assigned by the provider to each of the data records in the batch or real-time transactions. The purpose of this number is to facilitate the process of matching the transaction response to the transaction. The transaction reference number assigned should be returned in the response." | ||
| 995 | route of administration | 990;5 | FREE TEXT | This is used to store NCPDP field 995-E2 (Route of Administration), which is defined as "This is an override to the default route referenced for the product. For a multi-ingredient compound, it is the route of the complete compound mixture." | ||
| 996 | compound type | 990;6 | FREE TEXT | This is used to store NCPDP field 996-G1 (Compound Type), which is defined as "Clarifies the type of compound." | ||
| 1023 | purchaser relationship code | A20;3 | FREE TEXT | NCPDP Standard field A23-YS Code indicating the relationship from purchaser to patient. | ||
| 1024 | prescriber id state/province | A20;4 | FREE TEXT | NCPDP Standard field A24-ZK The postal state code abbreviation that is used in conjunction with the Prescriber ID Qualifier and the Prescriber ID fields to identify what state the identification is from. | ||
| 1025 | prescriber alternate id qual | A20;5 | FREE TEXT | NCPDP Standard field A25-ZM A code qualifying the Prescriber Alternate ID (A26-ZP) | ||
| 1026 | prescriber alternate id | A20;6 | FREE TEXT | NCPDP Standard field A26-ZP An alternate ID assigned to the prescriber. | ||
| 1027 | prescriber alternate state | A20;7 | FREE TEXT | NCPDP Standard field A27-ZQ The postal state code abbreviation that is used in conjunction with the Prescriber Alternate ID Qualifier and the Prescriber Alternate ID fields to identify what state the identification is from. | ||
| 1029 | reported payment type | A20;9 | FREE TEXT | NCPDP Standard field A29-ZS The type of prescription benefit plan that adjudicated and paid for the prescription. | ||
| 1030 | released date | A20;10 | FREE TEXT | NCPDP Standard field A30-ZT Identifies the date the prescription was relinquished from the dispensing facility to the patient or purchaser. | ||
| 1031 | released time | A30;1 | FREE TEXT | NCPDP Standard field A31-ZU Indicates the time the prescription was relinquished from the dispensing facility to the patient or purchaser. This is the local time that corresponds with the Released Date (A3Ø-ZT) | ||
| 1032 | compound preparation time | A30;2 | FREE TEXT | NCPDP Standard field A32-ZW Measurement in minutes for the preparation of the compound. |
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