# | Name | Location | Type | Details | Index | Description |
---|---|---|---|---|---|---|
.01 | record format name(+) | 0;1 | FREE TEXT | B | Textual description of this record format. | |
1.02 | version | 1;2 | SET OF CODES | 51:Version 5.1 D0:Version D.0 | This is the NCPDP Version Number. The request that is created will follow the specification of this NCPDP Version. | |
1.06 | production status | 1;6 | SET OF CODES | 0:DISABLED 1:DEVELOPMENT 2:FIELD TESTING 3:PRODUCTION | To be used as a screen when attaching a format to an insurer. Don't allow non-production formats. Those will have to be entered directly with Fileman. | |
1.1 | total exclusive patient amount | 1;10 | BOOLEAN | 1:Y 0:N | This refers to the interpretation of the fields in the response packets, as copied to 9002313.03, Response(s) multiple, fields 509 Total Amount Paid and 505 Patient Paid Amount. For most formats and insurers 509 Total Amount Paid means Total, Patient plus Insurer. Other insurers don't do it that way - for them, 509 contains only the amount paid by insurance. $$NETPAID1 needs to know whether to do the subtraction. If $$NETPAID1 encounters a case where (#509)<(#505), it will set the flag in the format, locally. | |
1.11 | asleep prober | 1;11 | POINTER | 9002313.59 | The BPS Transaction used as the test prober to test when the insurer is 'awake'. | |
1.12 | asleep retry time | 1;12 | DATE-TIME | The time to wait before re-trying to see if the insurer is 'awake'. | ||
1.14 | payer sheet version(+) | 1;14 | NUMERIC | Which version of the NCPDP standard this payer sheet is for. | ||
100 | transaction header segment | 100;0 | MULTIPLE | 9002313.9205 | ||
110 | patient segment | 110;0 | MULTIPLE | 9002313.9206 | ||
120 | insurance segment | 120;0 | MULTIPLE | 9002313.9207 | ||
130 | claim segment | 130;0 | MULTIPLE | 9002313.9208 | ||
140 | pharmacy provider segment | 140;0 | MULTIPLE | 9002313.9209 | ||
150 | prescriber segment | 150;0 | MULTIPLE | 9002313.921 | ||
160 | cob other payments segment | 160;0 | MULTIPLE | 9002313.9213 | ||
170 | workers comp segment | 170;0 | MULTIPLE | 9002313.9214 | ||
180 | dur pps segment | 180;0 | MULTIPLE | 9002313.9215 | ||
190 | pricing segment | 190;0 | MULTIPLE | 9002313.9216 | ||
200 | coupon segment | 200;0 | MULTIPLE | 9002313.9217 | ||
210 | compound segment | 210;0 | MULTIPLE | 9002313.9218 | ||
220 | prior auth segment | 220;0 | MULTIPLE | 9002313.9219 | ||
230 | clinical segment | 230;0 | MULTIPLE | 9002313.922 | ||
240 | addl doc segment | 240;0 | MULTIPLE | 9002313.9223 | This subfile holds the fields and processing rules for the Additional Documentation Segment. | |
250 | facility segment | 250;0 | MULTIPLE | 9002313.9224 | This subfile holds the fields and processing rules for the Facility segment. | |
260 | narrative segment | 260;0 | MULTIPLE | 9002313.9225 | This subfile holds the fields and processing rules for the Narrative segment. | |
270 | purchaser segment | 270;0 | MULTIPLE | 9002313.9227 | This subfile holds the fields and processing rules for the Purchaser segment. | |
280 | service provider segment | 280;0 | MULTIPLE | 9002313.9228 | This subfile holds the fields and processing rules for the Service Provider segment. | |
1901 | development remarks | DEVELOPER'S REMARKS;0 | WORD-PROCESSING | General remarks for the payer sheet, anything that will help describe the function of the sheet, etc. |