NCPDP 5 1 Companion Guide - NPI v1 12 - Comment

Prescription Drug File
CAPS Data Warehouse
NCPDP 5.1
Companion Guide
Wave 2
Version 1.12
62547093
1 of 16
CAPS Wave 2

NCPDP 5.1 - Prescription Drug File - Version 1.12
102-A2 VERSION/RELEASE NUMBER
880-K5 TRANSACTION REFERENCE NUMBER
11 - Version
1.1 Mapping according to D.0 BRFR
Field
Determined by the Provider. The Transaction
Reference Number will be returned with the
response and can be used to explicitly tie a
response back to the original claim.
Field Mapping according to D.0 BRFR
102-A2 VERSION/RELEASE NUMBER

103-A3 TRANSACTION CODE
51 Field Mapping according to D.0 BRFR

E1=Eligibility Verification
B1=Billing
B2=Reversal
B3=Rebill
P1=P.A. Request & Billing
P2=P.A. Reversal
P3=P.A. Inquiry
P4=P.A. Request Only
N1=Information Reporting
N2=Information Reporting Reversal
N3=Information Reporting Rebill
C1=Controlled Substance Reporting
C2=Controlled Substance Reporting Reversal
C3=Controlled Substance Reporting Rebill

104-A4 PROCESSOR CONTROL NUMBER

326-CQ PATIENT PHONE NUMBER

301-C1 GROUP ID
457-EP ASSOCIATED PRESCRIPTION/SERVICE DATE

414-DE DATE PRESCRIPTION WRITTEN
308-C8 OTHER COVERAGE CODE
600-28 UNIT OF MEASURE

=Not Specified
1=No other coverage
2=Other coverage exists-payment collected
3=Other coverage exists- claim not covered
4=Other coverage exists-payment not
collected
5=Managed care plan denial
6=Other coverage denied-not participating
provider
7=Other coverage exists-not in effect on DOS
8=Claim is billing
for copay
Field
Mapping according to D.0 BRFR
=Not Specified
EA=Each
GM=Grams
ML=Milliliters

463-EW INTERMEDIARY AUTHORIZATION TYPE ID
=Not Specified
1=Intermediary Authorization
99=Other Override

465-EY PROVIDER ID QUALIFIER
62547093
=Not Specified
1=Drug Enforcement Administration (DEA)
2=State License
3=Social Security Number (SSN)
4=Name
5=National Provider Identifier (NPI)
6=Health Industry Number (HIN)
7=State Issued
8=NCPDP
99=Other
2 of 16
CAPS Wave 2

468-2E PRIMARY CARE PROVIDER ID QUALIFIER
338-5C OTHER PAYER COVERAGE TYPE
339-6C OTHER PAYER ID QUALIFIER
443-E8 OTHER PAYER DATE

342-HC OTHER PAYER AMOUNT PAID QUALIFIER
=Not Specified
1=National Provider Identifier (NPI)
2=Blue Cross
3=Blue Shield
4=Medicare
5=Medicaid
6=UPIN
7=NCPDP Provider ID
8=State License
9=Champus
11=Federal Tax ID
12=Drug Enforcement Administration
(DEA) Number
13=State Issued
14=Plan Specific
99=Other
=Not Specified
1=Primary
2=Secondary
3=Tertiary
98=Coupon
99=Composite
=Not Specified
1=National Payer ID
3=Bank Information Number (BIN)
4=National Association of Insurance
Commissioners (NAIC)
5-Federal Tax ID Number
9=Coupon
99=Other

8- Sum of All Reimbursements
98-Coupon
99-Other

431-DV OTHER PAYER AMOUNT PAID
62547093
3 of 16
CAPS Wave 2

439-E4 REASON FOR SERVICE CODE
=Not Specified
AD=Additional Drug Needed
AN=Prescription Authentication
AR=Adverse Drug Reaction
AT=Additive Toxicity
CD=Chronic Disease Management
CH=Call Help Desk
CS=Patient Complaint/Symptom
DA=Drug-Allergy
DC=Drug-Disease (Inferred)
DD=Drug-Drug Interaction
DF=Drug-Food interaction
DI=Drug Incompatibility
DL=Drug-Lab Conflict
DM=Apparent Drug Misuse
DS=Tobacco Use
ED=Patient Education/Instruction
ER=Overuse
EX=Excessive Quantity
HD=High Dose
IC=Iatrogenic Condition
ID=Ingredient Duplication
LD=Low Dose
LK=Lock In Recipient
LR=Underuse
MC=Drug-Disease (Reported)
MN=Insufficeint Duration
MS=Missing Information/Clarification
MX=Excessive Duration
NA=Drug Not Available
NC=Non-covered Drug Purchase
ND=New Disease/Diagnosis
NF=Non-Formulary Drug
NN=Unnecessary Drug
NP=New Patient Processing
NR=Lactation/Nursing Interaction
NS=Insufficient Quantity
OH=Alcohol Conflict
PA=Drug-Age
PC=Patient Question/Concern
PG=Drug-Pregnancy
PH=Preventive Health Care
PN=Prescriber Consultation
PP=Plan Protocol
PR=Prior Adverse Reaction
PS=Product Selection Opportunity
RE=Suspected Environmental Risk
RF=Health Provider Referral
SC=Suboptimal Compliance
SD=Suboptimal Drug/Indication
SE=Side Effect
SF=Suboptimal Dosage Form
SR=Suboptimal Regimen
SX=Drug-Gender
TD=Therapeutic
TN=Laboratory Test Needed
TP=Payer/Processor Question

440-E5 PROFESSIONAL SERVICE CODE
=No intervention
AS=Patient assessment
CC=Coordination of care
DE=Dosing evaluation/determination
FE=Formulary enforcement
GP=Generic product selection
MA=Medication administration
M=Prescriber consulted
MR=Medication review
PE=Patient education/instruction
PH=Patient medication history
PM=Patient monitoring
P=Patient consulted
PT=Perform laboratory test
PF=Patient Referral
R=Pharmacist consulted other source
RT=Recommend laboratory test
SC=Self-care consultation
SW=Literature search/review
TC=Payer/processor consulted
TH=Therapeutic product interchange
62547093
4 of 16
CAPS Wave 2

441-E6 RESULT OF SERVICE CODE
=Not Specified
1A=Filled As Is, False Positive
1B=Filled Prescription As Is
1C=Filled, With Different Dose
1D=Filled, With Different Directions
1E=Filled, With Different Drug
1F=Filled, With Different Quantity
1G=Filled, With Prescriber Approval
1H=Brand-to-Generic Change
1J=Rx-to-OTC Change
1K=Filled with Different Dosage Form
2A=Prescription Not Filled
2B=Not Filled, Directions Clarified
3A=Recommendation Accepted
3B=Recommendation Not Accepted
3C=Discontinued Drug
3D=Regimen Changed
3E=Therapy Changed
3F=Therapy Changed-cost increased
acknowledged
3G=Drug Therapy Unchanged
3H=Follow-Up/Report
3J=Patient Referral
3K=Instructions Understood
3M=Compliance Aid Provided
3N=Medication Administered
474-8E DUR/PPS LEVEL OF EFFORT
475-J9 DUR CO-AGENT ID QUALIFIER
=Not Specified
11=Level 1 (Lowest)
12=Level 2
13=Level 3
14=Level 4
15=Level 5 (Highest)
=Not Specified
1=Universal Product Code (UPC)
2=Health Related Item (HRI)
3=National Drug Code (NDC)
4=Universal Product Number (UPN)
5=Department of Defense (DOD)
7=Common Procedure Terminology (CPT4)
8=Common Procedure Terminology (CPT5)
9=Health Care Financing Administration
Common Procedural Coding System (HCPCS)
11=National Pharmaceutical Product Interface
Code(NAPPI)
12=International Article Numbering
System(EAN)
13=Drug Identification Number(DIN)
14=Medi-Span GPI
15=First DataBank GCN
16=Medical Economics GPO
17=Medi-Span DDID
18=First DataBank SmartKey
19=Medical Economics GM
2=International Classification of
Diseases(ICD9)
21=International Classification of Diseases
(ICD1)
22=Medi-Span Diagnosis Code
23=National Criteria Care Institute(NCCI)
24=The Systematized Nomenclature of Human
and Veterinary Medicine (SNOMED)
25=Common Dental Terminology (CDT)
26=American Psychiatric Association Diagnostic
Statistical Manual of Mental Disorders (DSM IV)
99=Other
479-H8 OTHER AMOUNT CLAIMED SUBMITTED QUALIFIER
=Not Specified
1=Delivery Cost
2=Shipping Cost
3=Postage Cost
4=Administrative Cost
99=Other

423-DN BASIS OF COST DETERMINATION
62547093
=Not Specified
1=AWP (Average Wholesale Price)
2=Local Wholesaler
3=Direct
4=EAC (Estimated Acquisition Cost)
5=Acquisition
6=MAC (Maximum Allowable Cost)
7=Usual & Customary
8 = Disproportionate Share Pricing/Public
Health Service
9=Other
5 of 16
CAPS Wave 2

498-PA REQUEST TYPE
=Not availbable
1=Initial
2=Reauthorization
3=Deferred
498-PB REQUEST PERIOD DATE-BEGIN
498-PC REQUEST PERIOD DATE-END
498-PD BASIS OF REQUEST
492-WE DIAGNOSIS CODE QUALIFIER
494-ZE MEASUREMENT DATE

497-H3 MEASUREMENT UNIT
53-F3 AUTHORIZATION NUMBER

561-AZ PERCENTAGE SALES TAX BASIS PAID
564-J3 OTHER AMOUNT PAID QUALIFIER
346-HH BASIS OF CALCULATION

DISPENSING FEE
347-HJ BASIS OF CALCULATIONCOPAY
62547093
ME=Medical Exception
PR=Plan Requirement
PL=Increase Plan Limitation
XX=not available
=Not Specified
(ICD9)
(ICD1)
3=National Criteria Care Institute (NCCI)
4=The Systematized Nomenclature of Human
and Veterinary Medicine (SNOMED)
5=Common Dental Terminology (CDT)
6=Medi-Span Diagnosis Code
7=American Psychiatric Association Diagnostic
Statistical Manual of Mental Disorders(DSM IV)
99=Other

=Not Specified
1=Inches (In)
2=Centimeters (cm)
3=Pounds (lb)
4=Kilograms (kg)
5=Celsius (C)
6=Fahrenheit (F)
7=Meters squared (m2)
8=Milligrams per deciliter (mg/dl)
9=Units per milliliter (U/ml)
1=Millimeters of mercury (mmHg)
11=Centimeters squared (cm2)
12=Milliliters per minute (ml/min)
13=Percent (%)
14=Milliequivalents per milliliter (mEq/ml)
15=International units per liter (IU/L)
16=Micrograms per milliliter (mcg/ml)
17=Nanograms per milliliter (ng/ml)
18=Milligrams per milliliter (mg/ml)
19=Ratio
2=SI Units
21=Millimoles (mmol/l)
22=Seconds
23=Grams per deciliter (g/dl)
24=Cells per cubic millimeter (cells/cu mm)
25=1,, cells per cubic millimeter
(million cells/cu mm)
26=Standard deviation
27=Beats per minute

=Not Specified
1=Gross Amount Due
2=Ingredient Cost
3=Ingredient Cost + Dispensing Fee
=Not Specified
1=Delivery
2=Shipping
3=Postage
4=Administrative
99=Other
=Not Specified
1=Quantity Dispensed
2=Quantity Intended To Be Dispensed
3=Usual & Customary/Prorated
4=Waived Due To Partial Fill
99=Other
=Not Specified
3=Usual & Customary/Prorated
4=Waived Due To Partial Fill
99=Other
6 of 16
CAPS Wave 2

348-HK BASIS OF CALCULATIONFLAT SALES
TAX
349-HM BASIS OF CALCULATION
PERCENTAGE SALES TAX
439-E4 REASON FOR SERVICE CODE
=Not Specified
=Not Specified
=Not Specified
AD=Additional Drug Needed
AN=Prescription Authentication
AR=Adverse Drug Reaction
AT=Additive Toxicity
CD=Chronic Disease Management
CH=Call Help Desk
CS=Patient Complaint/Symptom
DA=Drug-Allergy
DC=Drug-Disease (Inferred)
DD=Drug-Drug Interaction
DF=Drug-Food interaction
DI=Drug Incompatibility
DL=Drug-Lab Conflict
DM=Apparent Drug Misuse
DS=Tobacco Use
ED=Patient Education/Instruction
ER=Overuse
EX=Excessive Quantity
HD=High Dose
IC=Iatrogenic Condition
ID=Ingredient Duplication
LD=Low Dose
LK=Lock In Recipient
LR=Underuse
MC=Drug-Disease (Reported)
MN=Insufficeint Duration
MS=Missing Information/Clarification
MX=Excessive Duration
NA=Drug Not Available
NC=Non-covered Drug Purchase
ND=New Disease/Diagnosis
NF=Non-Formulary Drug
NN=Unnecessary Drug
NP=New Patient Processing
NR=Lactation/Nursing Interaction
NS=Insufficient Quantity
OH=Alcohol Conflict
PA=Drug-Age
PC=Patient Question/Concern
PG=Drug-Pregnancy
PH=Preventive Health Care
PN=Prescriber Consultation
PP=Plan Protocol
PR=Prior Adverse Reaction
PS=Product Selection Opportunity
RE=Suspected Environmental Risk
RF=Health Provider Referral
SC=Suboptimal Compliance
SD=Suboptimal Drug/Indication
SE=Side Effect
SF=Suboptimal Dosage Form
SR=Suboptimal Regimen
SX=Drug-Gender
TD=Therapeutic
TN=Laboratory Test Needed
TP=Payer/Processor Question

529-FT OTHER PHARMACY INDICATOR
531-FV QUANTITY OF PREVIOUS FILL

533-FX OTHER PRESCRIBER INDICATOR
701
751
SEGMENT IDENTIFIER
RECORD COUNT
62547093
=Not Specified
1=Your Pharmacy
2=Other Pharmacy in Same Chain
3=Other Pharmacy

=Not Specified
1=Same Prescriber
2=Other Prescriber

99 - File Trailer
Count of Version 1.1 Batch records (one Version
1.1 Batch Transaction Header, one to many
Version 1.1 Batch Transaction Detail Data
Records, and one Version 1.1 Batch Transaction
Trailer) The record count field includes the total
number of Version 1.1 records in the batch,
including the header and trailer records. The
maximum number of records in a file is
9,999,999,999 including one Transaction Header
FieldTrailer.
Mapping according to D.0 BRFR
and one Transaction
7 of 16
CAPS Wave 2

# Revision/Change
Segment
431-DV - OTHER PAYER AMOUNT
Billing COB/Other Payments Segment
PAID should be used to communicate the
1 paid amount.
2 456-EN is optional
3 457-EP is optional
4 458-SE is optional
5 459-ER is optional
6 436-E1 = 453-EJ
Billing Claim Segment
PCP information optional; required if
7 available.
Billing Prescriber Segment
Coupon information optional; required if
8 available.
Billing Coupon Segment
9 Diagnosis code information optional
Billing Clinical Segment
10 Not applicable (0) added to values
Billing Compound Segment
11 Other (99) added to values
NCPDP (08) added to list of values for
12 Pharmacy Provider ID
Billing Pharmacy Provider
Not specified value changed from blank
13 to '00'
14 to '00'
15 to '00'
16 COB Information is optional
CAPS Use correction for values in Billing
17 COB/Other Payments Segment.
Element(s)Version
431-DV
456-EN
457-EP
458-SE
459-ER
436-E1
1.1
1.1
1.1
1.1
1.1
1.1
28-Feb-05
9-Mar-05
9-Mar-05
9-Mar-05
9-Mar-05
9-Mar-05
1.1
9-Mar-05
451-EG
450-EF
1.1
1.1
1.2
1.2
9-Mar-05
9-Mar-05
4-Apr-05
4-Apr-05
465-EY
1.2
4-Apr-05
49-UE
1.2
4-Apr-05
488-RE
1.2
4-Apr-05
45-EF
1.2
1.2
4-Apr-05
4-Apr-05
1.3
4-Apr-05
1.4
5-Apr-05
1.4
5-Apr-05
1.4
5-Apr-05
1.4
1.5
1.5
1.5
1.5
1.5
1.5
1.5
5-Apr-05
26-Apr-05
26-Apr-05
26-Apr-05
26-Apr-05
26-Apr-05
26-Apr-05
26-Apr-05
1.6
11-May-05
1.6
11-May-05
1.6
11-May-05
1.6
11-May-05
1.7
18-May-05
1.7
18-May-05
1.7
23-May-05
1.7
23-May-05
1.8
21-Jul-05
1.8
21-Jul-05
1.8
21-Jul-05
1.8
21-Jul-05
1.8
26-Jul-05
1.8
26-Jul-05
1.8
26-Jul-05
1.8
26-Jul-05
1.8
26-Jul-05
The previous version did not indicate the

CAPS use for the Billing Pharmacy
Provider Segment. The CAPS use
18 columns have been updated accordingly. Billing Pharmacy Provider Segment
Federal Tax ID ('05') qualifer added to
19 OTHER PAYER ID QUALIFIER
341-HB
New notes added to Billing COB/Other
20 Payments Segment
Contractor ID (04) and UCI (05) added to
21 qualifer list for PATIENT ID QUALIFIER Billing Patient Segment
331-CX
22 Added Billing Pricing Segment
Billing Pricing Segment
23 Added Billing Prior Response Segment Billing Prior Response Segment
24 Added Response Status Segment
Response Status Segment
25 Added Response Pricing Segment
Response Pricing Segment
26 Added Response DUR/PPS Segment
Response DUR/PPS Segment
27 Removed Billing Compound Segment
28 Removed Billing Coupon Segment
Billing Coupon Segment
Added 00=not specified as option for
29 reason for service code
Billing DUR/PPS Segment
439-E4
PRIOR AUTHORIZATION SUPPORTING
498-PP
DOCUMENTATION is fixed length field 30 500 characters
PRIOR AUTHORIZATION SUPPORTING DOCUMENTATION
ADDITIONAL MESSAGE INFORMATION
is a fixed length field -(X)
200
characters.
31 Reversal/Adjustment
526-FQ
qualifer
added Billing Response Status Segment
to TRANSACTION RESPONSE
32 STATUS.
Billing Response Status Segment
112-AN
498-PD
33 Added XX=not available to list of qualifers Billing Prior Authorization Segment
Added 00=not available as to list of
34 qualifiers
Billing Prior Authorization Segment
498-PA
Added 00=not available as to list of
35 qualifiers
600-28
Added PF=Patient Referral to list of
36 qualifiers
Billing DUR/PPS Segment
440-E5
37 to '00'
PERCENTAGE SALES TAX BASIS PAID 561-AZ
38 to '00'
OTHER AMOUNT PAID QUALIFIER
564-J3
39 to '00'
Billing Patient Segment
331-CX
40 to '00'
Billing Response Pricing Segment
349-HM
Values changed to match field length as
41 2 characters
418-DI
42 2 characters
461-EU
43 2 characters
420-DK
44 2 characters
403-D3
45 2 characters
Billing Patient Segment
307-C7
62547093
Date of Revision
8 of 16
CAPS Wave 2

# Revision/Change
Segment
46 Header Record Definition Segment added Header Record Definition
47 Batch Detail Definition Segment added
Batch Detail Definition
48 Batch Transaction Trailer Segment added Batch Transaction Trailer

49 Start Text Indicator added
Start of Text (STX) - X02
50 End Text Indicator added
End of Text (ETX) - X03
Field Removed from Batch Detail
51 Definition
Field Added to Batch Detail Definition to
52 replace 806-5C above
53 File samples 3 and 4 added
n/a
Note: These start/end positions include
the segment/field ID (where applicable)
File Start and Field End columns are
and the field VALUE start and end
54 added
positions
62547093
Element(s)Version
880-K4
701
880-K6
880-K1
806-5C
880-K2
880-K3
702
102-A2
880-K7
880-K4
880-K4
701
880-K5
880-K4
880-K4
701
806-5C
751
504-F4
880-K4
880-K4
880-K4
Date of Revision
1.8
27-Jul-05
1.8
27-Jul-05
1.8
1.8
1.8
27-Jul-05
27-Jul-05
27-Jul-05
806-5C
1.9
11-Aug-05
880-K5
880-K6
1.9
1.10
11-Aug-05
18-Aug-05
n/a
1.11
25-Aug-05
9 of 16
CAPS Wave 2

Number Contractor Distribution Date
Type
Version
23-Jun-04
Draft
1.0
2
3
4
5
6
7
8
9
30-Jun-04
9-Mar-05
4-Apr-05
4-Apr-05
5-Apr-05
26-Apr-05
18-May-05
29-Aug-05
Final
Final
Final
Final
Final
Final
Final
Final
1.0
1.1
1.2
1.3
1.4
1.5
1.6
1.11
62547093
Notes
Distributed to contractors for
comment and review.
Delivered to PID as part of
Wave 2 design
Distributed to contractors.
10 of 16
CAPS Wave 2

Number
Note
Version
1
1.2
File Format: Fixed Block
If CHIP/aB contractor is primary payer, please complete Billing
COB/Other Payments Segment using 'Primary Payer - 01' in
2
1.4
other payer coverage type to indicate primary payer.
3
1.5
Note number 2 is no longer valid.
4
1.6
No special characters should be submitted in 498-PP and
526-FQ.
The NCPDP Data record should be delimited based on
5
1.8
approved standards. (See example attached)
Any date fields that need defaults, not specified, should be set
6
1.9
to 99991231 (CCYYMMDD) when the value is not available
Any amount fields that need a default, not specified, should be
7
1.9
set to zero
Starting from the Billing Patient Segment and up to, but not
including, the Batch Transaction Trailer; The NCPDP Data
record should be delimited in the following way: Segment
preceded by HEX<1E>; Field preceded by HEX<1C>, followed
by Segment/Field Identifier, followed by field value. (Please
see the example tab) Such as: <1E><1C>AM01<1C>CX04.....
8
1.10
The Group Separator HEX<1D> will not be used in this file
format. Each drug claim should be sent as a single
9
1.10
transaction.
On the File Specification tab the Field format and field length
describe only the value of the field. The length does NOT
10
include the Segment/Field identifier
1.10
11
1.10
New tab added to detail signed/unsigned overpunch fields
62547093
11 of 16
CAPS Wave 2
Sample 1
Sample 2
Sample 3
Sample 4
62547093
Transaction Header 1 per file

Transaction Detail Data
Transaction Detail Data
....
Transaction Trailer
1 per file
(STX)00R99999910001
1234567199412020941P11765432109876543212345678(ETX)
(STX)G190000000213201A1DP...............(ETX)
(STX)G190000000223201A1DR0173........(ETX)
(STX)G187600000213C01A1CFO
1DP...............(ETX)
(STX)G187600000223C01R1CFO
1DR0105........(ETX)
(STX)9912345670000000006
(ETX)
NCPDP Actual file content (some HEX values may not appear properly)
_x0002_00T123456789
2005178200506271558T11236003060
_x0003_
_x0002_G1999999990100385851N19999999901107XXXXXXXXXXXXXXX19000101XXXXX _x001E__x001C_AM01_x001C_CX04_x001C_CY
_x0002_9920059999999900011
_x0003_
NCPDP File content with HEX values noted as <HEX>
<STX>00T123456789
2005178200506271558T11236003060
<ETX>
<STX>G1999999990100385851N19999999901107XXXXXXXXXXXXXXX19000101XXXXX <1E><1C>AM01<1C>CX04<1C>CY
<1C>C4
<1C>C4
<1C>C4
<1C>C4
<1C>C4
<1C>C4
<1C>C4
<1C>C4
<1C>C4
<STX>9920059999999900011
<ETX>
12 of 16
_x001C_C4
_x001C_C4
_x001C_C4
_x001C_C4
_x001C_C4
_x001C_C4
_x001C_C4
_x001C_C4
_x001C_C4
<1C>C52<1C>CA
<1C>C51<1C>CA
<1C>C52<1C>CA
<1C>C51<1C>CA
<1C>C51<1C>CA
<1C>C51<1C>CA
<1C>C52<1C>CA
<1C>C51<1C>CA
<1C>C52<1C>CA
_x001C_C52_x001C_CA
_x001C_C51_x001C_CA
_x001C_C52_x001C_CA
_x001C_C51_x001C_CA
_x001C_C51_x001C_CA
_x001C_C51_x001C_CA
_x001C_C52_x001C_CA
_x001C_C51_x001C_CA
_x001C_C52_x001C_CA
<1C>CB
<1C>CB
<1C>CB
<1C>CB
<1C>CB
<1C>CB
<1C>CB
<1C>CB
<1C>CB
_x001C_CB
_x001C_CB
_x001C_CB
_x001C_CB
_x001C_CB
_x001C_CB
_x001C_CB
_x001C_CB
_x001C_CB
<1C>CM
<1C>CM
<1C>CM
<1C>CM
<1C>CM
<1C>CM
<1C>CM
<1C>CM
<1C>CM
_x001C_CM
_x001C_CM
_x001C_CM
_x001C_CM
_x001C_CM
_x001C_CM
_x001C_CM
_x001C_CM
_x001C_CM
<1C>CN
<1C>CN
<1C>CN
<1C>CN
<1C>CN
<1C>CN
<1C>CN
<1C>CN
<1C>CN
_x001C_CN
_x001C_CN
_x001C_CN
_x001C_CN
_x001C_CN
_x001C_CN
_x001C_CN
_x001C_CN
_x001C_CN
<1C>COPA<1C>CP
<1C>COPA<1C>CP
<1C>COPA<1C>CP
<1C>COPA<1C>CP
<1C>COPA<1C>CP
<1C>COPA<1C>CP
<1C>COPA<1C>CP
<1C>COPA<1C>CP
<1C>COPA<1C>CP
_x001C_COPA_x001C_CP
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
CAPS Wave 2
_x0
_x0
_x0
_x0
_x0
_x0
_x0
_x0
_x0
<
<
<
<
<
<
<
<
<
1C_CN
1C_CN
1C_CN
1C_CN
1C_CN
1C_CN
1C_CN
1C_CN
1C_CN
>CP
>CP
>CP
>CP
>CP
>CP
>CP
>CP
>CP
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>CQ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
<1C>C700<1C>CZ
62547093
_x001C_CQ
_x001C_CQ
_x001C_CQ
_x001C_CQ
_x001C_CQ
_x001C_CQ
_x001C_CQ
_x001C_CQ
_x001C_CQ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_C700_x001C_CZ
_x001C_1C _x001C_2C _x001E__x001C_AM04_x001C_C2XXXXXXXXXXXXXXXXXXXX_x001C_CC

<1C>1C <1C>2C <1E><1C>AM04<1C>C2XXXXXXXXXXXXXXXXXXXX<1C>CC

<1C>CD
<1C>CD
<1C>CD
<1C>CD
<1C>CD
<1C>CD
<1C>CD
<1C>CD
<1C>CD
<1C>CE
<1C>CE
<1C>CE
<1C>CE
<1C>CE
<1C>CE
<1C>CE
<1C>CE
<1C>CE
<1C>FO364
<1C>FO364
<1C>FO364
<1C>FO364
<1C>FO364
<1C>FO364
<1C>FO364
<1C>FO364
<1C>FO364
13 of 16
<1C>C9 <1C>8C
<1C>C9 <1C>8C
<1C>C9 <1C>8C
<1C>C9 <1C>8C
<1C>C9 <1C>8C
<1C>C9 <1C>8C
<1C>C9 <1C>8C
<1C>C9 <1C>8C
<1C>C9 <1C>8C
_x001C_CD
_x001C_CD
_x001C_CD
_x001C_CD
_x001C_CD
_x001C_CD
_x001C_CD
_x001C_CD
_x001C_CD
<1C>C1
<1C>C1
<1C>C1
<1C>C1
<1C>C1
<1C>C1
<1C>C1
<1C>C1
<1C>C1
_x001C_CE
_x001C_CE
_x001C_CE
_x001C_CE
_x001C_CE
_x001C_CE
_x001C_CE
_x001C_CE
_x001C_CE
<1C>C3
<1C>C3
<1C>C3
<1C>C3
<1C>C3
<1C>C3
<1C>C3
<1C>C3
<1C>C3
_x001C_FO364
_x001C_FO364
_x001C_FO364
_x001C_FO364
_x001C_FO364
_x001C_FO364
_x001C_FO364
_x001C_FO364
_x001C_FO364
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C9 _x001C_8C
_x001C_C1
_x001C_C1
_x001C_C1
_x001C_C1
_x001C_C1
_x001C_C1
_x001C_C1
_x001C_C1
_x001C_C1
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C61_x001E_
_x001C_C61_x001E_
_x001C_C61_x001E_
_x001C_C61_x001E_
_x001C_C61_x001E_
_x001C_C61_x001E_
_x001C_C61_x001E_
_x001C_C61_x001E_
_x001C_C61_x001E_
<1C>C61<1E><1C>AM07<1C>EM1<1C>D29999999<1C>E103<1C>D7XXXXXXXXXXXXXXXXXXX<1C>EN
CAPS Wave 2
<1C>
<1C>
<1C>
<1C>
<1C>
<1C>
<1C>
<1C>
<1C>
001C_C1
001C_C1
001C_C1
001C_C1
001C_C1
001C_C1
001C_C1
001C_C1
001C_C1
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C3
_x001C_C61_x001E__x001C_AM07_x001C_EM1_x001C_D29999999_x001C_E103_x001C_D7XXXXXXXXXXXXXXXXXXX_x001C_EN
1C>D7XXXXXXXXXXXXXXXXXXX<1C>EN
62547093
<1C>EP
<1C>EP
<1C>EP
<1C>EP
<1C>EP
<1C>EP
<1C>EP
<1C>EP
<1C>EP
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>SE <1C>ER
<1C>E70000020000<1C>D3
<1C>E70000240000<1C>D3
<1C>E70000017000<1C>D3
<1C>E70000060000<1C>D3
<1C>E70000060000<1C>D3
<1C>E70000050000<1C>D3
<1C>E70000030000<1C>D3
<1C>E70000017000<1C>D3
<1C>E70000240000<1C>D3
<1C>D5003<1C>D61<1C>D80<1C>DE
<1C>D5003<1C>D61<1C>D80<1C>DE
<1C>D5025<1C>D61<1C>D80<1C>DE
<1C>D5010<1C>D61<1C>D80<1C>DE
<1C>D5030<1C>D61<1C>D80<1C>DE
<1C>D5020<1C>D61<1C>D80<1C>DE
<1C>D5030<1C>D61<1C>D80<1C>DE
<1C>D5025<1C>D61<1C>D80<1C>DE
<1C>D5010<1C>D62<1C>D80<1C>DE
_x001C_EP
_x001C_EP
_x001C_EP
_x001C_EP
_x001C_EP
_x001C_EP
_x001C_EP
_x001C_EP
_x001C_EP
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_SE _x001C_ER
_x001C_E70000020000_x001C_D3
_x001C_E70000240000_x001C_D3
_x001C_E70000017000_x001C_D3
_x001C_E70000060000_x001C_D3
_x001C_E70000060000_x001C_D3
_x001C_E70000050000_x001C_D3
_x001C_E70000030000_x001C_D3
_x001C_E70000017000_x001C_D3
_x001C_E70000240000_x001C_D3
<1C>DF00<1C>DJ0<1C>DK00<1C>ET0000020000<1C>C801<1C>DT0<1C>EJ03<1C>EA
14 of 16
_x001C_D5003_x001C_D61_x001C_D80_x001C_DE
_x001C_D5003_x001C_D61_x001C_D80_x001C_DE
_x001C_D5025_x001C_D61_x001C_D80_x001C_DE
_x001C_D5010_x001C_D61_x001C_D80_x001C_DE
_x001C_D5030_x001C_D61_x001C_D80_x001C_DE
_x001C_D5020_x001C_D61_x001C_D80_x001C_DE
_x001C_D5030_x001C_D61_x001C_D80_x001C_DE
_x001C_D5025_x001C_D61_x001C_D80_x001C_DE
_x001C_D5010_x001C_D62_x001C_D80_x001C_DE
<1C>EB
<1C>EB
<1C>EB
<1C>EB
<1C>EB
<1C>EB
<1C>EB
<1C>EB
<1C>EB
<1C>CW
<1C>CW
<1C>CW
<1C>CW
<1C>CW
<1C>CW
<1C>CW
<1C>CW
<1C>CW
<1C>EK
<1C>EK
<1C>EK
<1C>EK
<1C>EK
<1C>EK
<1C>EK
<1C>EK
<1C>EK
_x001C_DF00_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF00_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF00_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF00_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF03_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF05_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF05_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF05_x001C_DJ0_x001C_DK00_x001C_
_x001C_DF03_x001C_DJ0_x001C_DK00_x001C_
<1C>28EA<1C>DI
<1C>28ML<1C>DI
<1C>28GM<1C>DI
<1C>28ML<1C>DI
<1C>28EA<1C>DI
<1C>28GM<1C>DI
<1C>28EA<1C>DI
<1C>28GM<1C>DI
<1C>28GM<1C>DI
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
CAPS Wave 2
<1C
<1C
<1C
<1C
<1C
<1C
<1C
<1C
<1C
_x001C_DF00_x001C_DJ0_x001C_DK00_x001C_ET0000020000_x001C_C801_x001C_DT0_x001C_EJ03_x001C_EA
<1C>28EA<1C>DI
<1C>28ML<1C>DI
<1C>28GM<1C>DI
<1C>28ML<1C>DI
<1C>28EA<1C>DI
<1C>28GM<1C>DI
<1C>28EA<1C>DI
<1C>28GM<1C>DI
<1C>28GM<1C>DI
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
<1C>EU <1C>EV
62547093
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>EW00<1C>EX
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HD <1C>HF
<1C>HG
<1C>HG
<1C>HG
<1C>HG
<1C>HG
<1C>HG
<1C>HG
<1C>HG
<1C>HG
_x001C_EB
_x001C_EB
_x001C_EB
_x001C_EB
_x001C_EB
_x001C_EB
_x001C_EB
_x001C_EB
_x001C_EB
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
<1E><1C>AM02<1C>EY08<1C>E9
_x001C_CW
_x001C_CW
_x001C_CW
_x001C_CW
_x001C_CW
_x001C_CW
_x001C_CW
_x001C_CW
_x001C_CW
_x001C_EK
_x001C_EK
_x001C_EK
_x001C_EK
_x001C_EK
_x001C_EK
_x001C_EK
_x001C_EK
_x001C_EK
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
<1E><1C>AM03<1C>EZ12<1C>DB
15 of 16
_x001C_28EA_x001C_DI
_x001C_28ML_x001C_DI
_x001C_28GM_x001C_DI
_x001C_28ML_x001C_DI
<1C>1E
<1C>1E
<1C>1E
<1C>1E
<1C>1E
<1C>1E
<1C>1E
<1C>1E
<1C>1E
<1C>DR
<1C>DR
<1C>DR
<1C>DR
<1C>DR
<1C>DR
<1C>DR
<1C>DR
<1C>DR
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
_x001C_EU _x001C_EV
<1C>PM
<1C>PM
<1C>PM
<1C>PM
<1C>PM
<1C>PM
<1C>PM
<1C>PM
<1C>PM
<1C>2E
<1C>2E
<1C>2E
<1C>2E
<1C>2E
<1C>2E
<1C>2E
<1C>2E
<1C>2E
_x001C_EW00_x001C_EX
<1C>DL
<1C>DL
<1C>DL
<1C>DL
<1C>DL
<1C>DL
<1C>DL
<1C>DL
<1C>DL
<1C>H5
<1C>H5
<1C>H5
<1C>H5
<1C>H5
<1C>H5
<1C>H5
<1C>H5
<1C>H5
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
_x001C_HD _x001C_HF
<1C>4E
<1C>4E
<1C>4E
<1C>4E
<1C>4E
<1C>4E
<1C>4E
<1C>4E
<1C>4E
_x001C_HG
_x001C_HG
_x001C_HG
_x001C_HG
_x001C_HG
_x001C_HG
_x001C_HG
_x001C_HG
_x001C_HG
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
_x001E__x001C_AM02_x
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
<1E><1C>AM05<1C>4C1<1C>5C01<1C>6C05<1C>7C
CAPS Wave 2

In the file specs some fields have a format such as: s9(6)v99 (signed) or 9(6)v99 (unsigned), below
you will see some more details on how this is used.
"s" means it is signed, 9(6) means 6 spaces are available to be filled with a digit, "v" is the implied
decimal point, "v99" means two digits following the decimal
The Overpunch Sign: (for signed values)
The purpose of using Overpunch signs in dollar fields is to allow the representation of positive and
negative dollar amounts without expanding the size of the field (i.e., to hold the plus or minus
character).
The Overpunch sign replaces the right most character in a dollar field. The signed value designates
the positive or negative status of the numeric value. The dollar field of $99.95 would be
represented as 999E with truncation. A negative dollar amount of $2.5 would be represented as
25} with truncation.
UNITS
Digit
1
2
3
4
5
6
7
8
9
SIGNED POSITIVE
Graphics Oct
Dec
{
173
123
A
11
65
B
12
66
C
13
67
D
14
68
E
15
69
F
16
7
G
17
71
H
11
72
I
111
73
Hex
7B
41
42
43
44
45
46
47
48
49
SIGNED NEGATIVE
Graphics Oct
Dec
}
175
125
J
112
74
K
113
75
L
114
76
M
115
77
N
116
78
O
117
79
P
12
8
Q
121
81
R
122
82
Hex
7D
4A
4B
4C
4D
4E
4F
5
51
52
Implied Decimal Points:

In the 5.1 standard, only patient clinical value fields will contain decimal points. All other decimal
points are implied. For example, patient diagnosis codes should be formatted with explicit decimal
points. NOTE: Decimal points in dollar fields are implied.
I would like to give some more examples below to understand correctly.
By using this method we will not lose any data.
For Signed Positive and Signed Negative values for numeric fields formatted as s9(3)v99
s9(3)v99 : 123.45 => 1234E
-123.45 => 1234N
s9(3)v99 : 234.56 => 2345F
-23456 => 2345O
s9(3)v99 : 678.90 => 6789{
-678.90 => 6789}
For Unsigned Values formatted as 9(3)v99 (Note, there is no s to in the format to indicate it is a signed value)
Example 9(3)v99 : 123.78 => 12378
62547093
16 of 16
CAPS Wave 2

NCPDP 5 1 Companion Guide - NPI v1 12 - Comment

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

NCPDP 5 1 Companion Guide - NPI v1 12 - Comment

Uploaded by

Copyright:

Available Formats

Prescription Drug File

CAPS Data Warehouse

Prescription Drug File

Field Mapping according to D.0 BRFR

102-A2 VERSION/RELEASE NUMBER

51 Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

457-EP ASSOCIATED PRESCRIPTION/SERVICE DATE

600-28 UNIT OF MEASURE

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Prescription Drug File

338-5C OTHER PAYER COVERAGE TYPE

339-6C OTHER PAYER ID QUALIFIER

443-E8 OTHER PAYER DATE

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Prescription Drug File

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Prescription Drug File

Field Mapping according to D.0 BRFR

474-8E DUR/PPS LEVEL OF EFFORT

475-J9 DUR CO-AGENT ID QUALIFIER

Field Mapping according to D.0 BRFR

479-H8 OTHER AMOUNT CLAIMED SUBMITTED QUALIFIER

Field Mapping according to D.0 BRFR

Prescription Drug File

498-PB REQUEST PERIOD DATE-BEGIN

498-PC REQUEST PERIOD DATE-END

498-PD BASIS OF REQUEST

492-WE DIAGNOSIS CODE QUALIFIER

494-ZE MEASUREMENT DATE

53-F3 AUTHORIZATION NUMBER

564-J3 OTHER AMOUNT PAID QUALIFIER

346-HH BASIS OF CALCULATION

347-HJ BASIS OF CALCULATIONCOPAY

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Prescription Drug File

Field Mapping according to D.0 BRFR

531-FV QUANTITY OF PREVIOUS FILL

Field Mapping according to D.0 BRFR

Field Mapping according to D.0 BRFR

Prescription Drug File

The previous version did not indicate the

Prescription Drug File

46 Header Record Definition Segment added Header Record Definition

47 Batch Detail Definition Segment added

Batch Detail Definition

48 Batch Transaction Trailer Segment added Batch Transaction Trailer

Prescription Drug File

Prescription Drug File

Prescription Drug File

Transaction Header 1 per file

Prescription Drug File

_x001C_1C _x001C_2C _x001E__x001C_AM04_x001C_C2XXXXXXXXXXXXXXXXXXXX_x001C_CC

<1C>1C <1C>2C <1E><1C>AM04<1C>C2XXXXXXXXXXXXXXXXXXXX<1C>CC

Prescription Drug File