NCPDP 5 1 Companion Guide_NPI v1 12_Comment

CAPS Data Warehouse

NCPDP 5.1Companion Guide

Wave 2Version 1.12

Prescription Drug File

document.xlsx 3 of 21 CAPS Wave 2

NCPDP 5.1 - Prescription Drug File - Version 1.12102-A2 VERSION/RELEASE NUMBER 11 - Version 1.1 Field Mapping according to D.0 BRFR880-K5 TRANSACTION REFERENCE NUMBER

Field Mapping according to D.0 BRFR102-A2 VERSION/RELEASE NUMBER 51 Field Mapping according to D.0 BRFR103-A3 TRANSACTION CODE

Field Mapping according to D.0 BRFR104-A4 PROCESSOR CONTROL NUMBER

Field Mapping according to D.0 BRFR326-CQ PATIENT PHONE NUMBER

Field Mapping according to D.0 BRFR301-C1 GROUP ID

Field Mapping according to D.0 BRFR457-EP ASSOCIATED PRESCRIPTION/SERVICE DATE Field Mapping according to D.0 BRFR414-DE DATE PRESCRIPTION WRITTEN Field Mapping according to D.0 BRFR308-C8 OTHER COVERAGE CODE

Field Mapping according to D.0 BRFR600-28 UNIT OF MEASURE

Field Mapping according to D.0 BRFR463-EW INTERMEDIARY AUTHORIZATION TYPE ID

Field Mapping according to D.0 BRFR465-EY PROVIDER ID QUALIFIER

Field Mapping according to D.0 BRFR468-2E PRIMARY CARE PROVIDER ID QUALIFIER

Field Mapping according to D.0 BRFR

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.

E1=Eligibility VerificationB1=Billing

B2=ReversalB3=Rebill

P1=P.A. Request & BillingP2=P.A. ReversalP3=P.A. Inquiry

P4=P.A. Request OnlyN1=Information Reporting

N2=Information Reporting ReversalN3=Information Reporting Rebill

C1=Controlled Substance ReportingC2=Controlled Substance Reporting Reversal

C3=Controlled Substance Reporting Rebill

ØØ=Not SpecifiedØ1=No other coverage

Ø2=Other coverage exists-payment collectedØ3=Other coverage exists- claim not covered

Ø4=Other coverage exists-payment not collectedØ5=Managed care plan denial

Ø6=Other coverage denied-not participating providerØ7=Other coverage exists-not in effect on DOS

Ø8=Claim is billing for copay

ØØ=Not SpecifiedEA=Each

GM=GramsML=Milliliters

ØØ=Not SpecifiedØ1=Intermediary Authorization

99=Other Override

ØØ=Not SpecifiedØ1=Drug Enforcement Administration (DEA)

Ø2=State LicenseØ3=Social Security Number (SSN)

Ø4=NameØ5=National Provider Identifier (NPI)

Ø6=Health Industry Number (HIN)Ø7=State Issued

Ø8=NCPDP99=Other

ØØ=Not SpecifiedØ1=National Provider Identifier (NPI)

Ø2=Blue CrossØ3=Blue ShieldØ4=MedicareØ5=Medicaid

Ø6=UPINØ7=NCPDP Provider ID

Ø8=State LicenseØ9=Champus

1Ø=Health Industry Number (HIN)11=Federal Tax ID

12=Drug Enforcement Administration(DEA) Number

13=State Issued14=Plan Specific

99=Other



338-5C OTHER PAYER COVERAGE TYPE

Field Mapping according to D.0 BRFR339-6C OTHER PAYER ID QUALIFIER

Field Mapping according to D.0 BRFR443-E8 OTHER PAYER DATE Field Mapping according to D.0 BRFR342-HC OTHER PAYER AMOUNT PAID QUALIFIER

Field Mapping according to D.0 BRFR431-DV OTHER PAYER AMOUNT PAID Field Mapping according to D.0 BRFR439-E4 REASON FOR SERVICE CODE

Field Mapping according to D.0 BRFR440-E5 PROFESSIONAL SERVICE CODE

Field Mapping according to D.0 BRFR

ØØ=Not SpecifiedØ1=Primary

Ø2=SecondaryØ3=Tertiary98=Coupon

99=Composite

ØØ=Not SpecifiedØ1=National Payer ID

Ø2=Health Industry Number (HIN)Ø3=Bank Information Number (BIN)

Ø4=National Association of Insurance Commissioners (NAIC)

Ø5-Federal Tax ID NumberØ9=Coupon

99=Other

Ø8- Sum of All Reimbursements98-Coupon99-Other

ØØ=Not SpecifiedAD=Additional Drug Needed

AN=Prescription AuthenticationAR=Adverse Drug Reaction

AT=Additive ToxicityCD=Chronic Disease Management

CH=Call Help DeskCS=Patient Complaint/Symptom

DA=Drug-AllergyDC=Drug-Disease (Inferred)DD=Drug-Drug InteractionDF=Drug-Food interaction

DI=Drug IncompatibilityDL=Drug-Lab Conflict

DM=Apparent Drug MisuseDS=Tobacco Use

ED=Patient Education/InstructionER=Overuse

EX=Excessive QuantityHD=High Dose

IC=Iatrogenic ConditionID=Ingredient Duplication

LD=Low DoseLK=Lock In Recipient

LR=UnderuseMC=Drug-Disease (Reported)

MN=Insufficeint DurationMS=Missing Information/Clarification

MX=Excessive DurationNA=Drug Not Available

NC=Non-covered Drug PurchaseND=New Disease/Diagnosis

NF=Non-Formulary DrugNN=Unnecessary Drug

NP=New Patient ProcessingNR=Lactation/Nursing Interaction

NS=Insufficient QuantityØØ=No intervention

AS=Patient assessmentCC=Coordination of care

DE=Dosing evaluation/determinationFE=Formulary enforcement

GP=Generic product selectionMA=Medication administration

MØ=Prescriber consultedMR=Medication review

PE=Patient education/instructionPH=Patient medication history

PM=Patient monitoringPØ=Patient consulted

PT=Perform laboratory testPF=Patient Referral

RØ=Pharmacist consulted other sourceRT=Recommend laboratory test

SC=Self-care consultationSW=Literature search/review

TC=Payer/processor consultedTH=Therapeutic product interchange



441-E6 RESULT OF SERVICE CODE

Field Mapping according to D.0 BRFR474-8E DUR/PPS LEVEL OF EFFORT

Field Mapping according to D.0 BRFR475-J9 DUR CO-AGENT ID QUALIFIER

Field Mapping according to D.0 BRFR479-H8 OTHER AMOUNT CLAIMED SUBMITTED QUALI

Field Mapping according to D.0 BRFR423-DN BASIS OF COST DETERMINATION

ØØ=Not Specified1A=Filled As Is, False Positive

1B=Filled Prescription As Is1C=Filled, With Different Dose

1D=Filled, With Different Directions1E=Filled, With Different Drug

1F=Filled, With Different Quantity1G=Filled, With Prescriber Approval

1H=Brand-to-Generic Change1J=Rx-to-OTC Change

1K=Filled with Different Dosage Form2A=Prescription Not Filled

2B=Not Filled, Directions Clarified3A=Recommendation Accepted

3B=Recommendation Not Accepted3C=Discontinued Drug3D=Regimen Changed3E=Therapy Changed

3F=Therapy Changed-cost increasedacknowledged

3G=Drug Therapy Unchanged3H=Follow-Up/Report3J=Patient Referral

3K=Instructions Understood3M=Compliance Aid Provided3N=Medication Administered

ØØ=Not Specified11=Level 1 (Lowest)

12=Level 213=Level 314=Level 4

15=Level 5 (Highest)

ØØ=Not Specified Ø1=Universal Product Code (UPC)

Ø2=Health Related Item (HRI) Ø3=National Drug Code (NDC)

Ø4=Universal Product Number (UPN) Ø5=Department of Defense (DOD)

Ø7=Common Procedure Terminology (CPT4) Ø8=Common Procedure Terminology (CPT5)

Ø9=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

2Ø=International Classification of Diseases(ICD9) 21=International Classification of Diseases (ICD1Ø)

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

ØØ=Not SpecifiedØ1=Delivery CostØ2=Shipping CostØ3=Postage Cost

Ø4=Administrative Cost99=Other

ØØ=Not SpecifiedØ1=AWP (Average Wholesale Price)

Ø2=Local WholesalerØ3=Direct

Ø4=EAC (Estimated Acquisition Cost)Ø5=Acquisition

Ø6=MAC (Maximum Allowable Cost)Ø7=Usual & Customary

Ø8 = Disproportionate Share Pricing/Public Health Service

Ø9=Other



498-PA REQUEST TYPE

498-PB REQUEST PERIOD DATE-BEGIN

498-PC REQUEST PERIOD DATE-END

498-PD BASIS OF REQUEST

492-WE DIAGNOSIS CODE QUALIFIER

Field Mapping according to D.0 BRFR494-ZE MEASUREMENT DATE Field Mapping according to D.0 BRFR497-H3 MEASUREMENT UNIT

Field Mapping according to D.0 BRFR5Ø3-F3 AUTHORIZATION NUMBER Field Mapping according to D.0 BRFR561-AZ PERCENTAGE SALES TAX BASIS PAID

564-J3 OTHER AMOUNT PAID QUALIFIER

Field Mapping according to D.0 BRFR346-HH BASIS OF CALCULATION—DISPENSING FEE

347-HJ BASIS OF CALCULATION—COPAY

Ø=Not availbable1=Initial

2=Reauthorization3=Deferred

ME=Medical ExceptionPR=Plan Requirement

PL=Increase Plan LimitationXX=not available

ØØ=Not SpecifiedØ1=International Classification of Diseases (ICD9)

Ø2=International Classification of Diseases (ICD1Ø)Ø3=National Criteria Care Institute (NCCI)

Ø4=The Systematized Nomenclature of Human and Veterinary Medicine (SNOMED)

Ø5=Common Dental Terminology (CDT)Ø6=Medi-Span Diagnosis Code

Ø7=American Psychiatric Association Diagnostic Statistical Manual of Mental Disorders(DSM IV)

99=Other

ØØ=Not SpecifiedØ1=Inches (In)

Ø2=Centimeters (cm)Ø3=Pounds (lb)

Ø4=Kilograms (kg)Ø5=Celsius (C)

Ø6=Fahrenheit (F)Ø7=Meters squared (m2)

Ø8=Milligrams per deciliter (mg/dl)Ø9=Units per milliliter (U/ml)

1Ø=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=Ratio2Ø=SI Units

21=Millimoles (mmol/l)22=Seconds

23=Grams per deciliter (g/dl)24=Cells per cubic millimeter (cells/cu mm)

25=1,ØØØ,ØØØ cells per cubic millimeter (million cells/cu mm)

26=Standard deviation27=Beats per minute

ØØ=Not SpecifiedØ1=Gross Amount Due

Ø2=Ingredient CostØ3=Ingredient Cost + Dispensing Fee

ØØ=Not SpecifiedØ1=DeliveryØ2=ShippingØ3=Postage

Ø4=Administrative99=Other

ØØ=Not SpecifiedØ1=Quantity Dispensed

Ø2=Quantity Intended To Be DispensedØ3=Usual & Customary/Prorated

Ø4=Waived Due To Partial Fill99=Other


Ø2=Quantity Intended To Be DispensedØ3=Usual & Customary/Prorated

Ø4=Waived Due To Partial Fill99=Other



348-HK BASIS OF CALCULATION—FLAT SALES TAX

349-HM

439-E4 REASON FOR SERVICE CODE

Field Mapping according to D.0 BRFR529-FT OTHER PHARMACY INDICATOR

Field Mapping according to D.0 BRFR531-FV QUANTITY OF PREVIOUS FILL Field Mapping according to D.0 BRFR533-FX OTHER PRESCRIBER INDICATOR

Field Mapping according to D.0 BRFR701 SEGMENT IDENTIFIER 99 - File Trailer Field Mapping according to D.0 BRFR

751 RECORD COUNT Field Mapping according to D.0 BRFR


Ø2=Quantity Intended To Be Dispensed

BASIS OF CALCULATION—PERCENTAGE SALES TAX


Ø2=Quantity Intended To Be Dispensed

ØØ=Not SpecifiedAD=Additional Drug Needed

AN=Prescription AuthenticationAR=Adverse Drug Reaction

AT=Additive ToxicityCD=Chronic Disease Management

CH=Call Help DeskCS=Patient Complaint/Symptom

DA=Drug-AllergyDC=Drug-Disease (Inferred)DD=Drug-Drug InteractionDF=Drug-Food interaction

DI=Drug IncompatibilityDL=Drug-Lab Conflict

DM=Apparent Drug MisuseDS=Tobacco Use

ED=Patient Education/InstructionER=Overuse

EX=Excessive QuantityHD=High Dose

IC=Iatrogenic ConditionID=Ingredient Duplication

LD=Low DoseLK=Lock In Recipient

LR=UnderuseMC=Drug-Disease (Reported)

MN=Insufficeint DurationMS=Missing Information/Clarification

MX=Excessive DurationNA=Drug Not Available

NC=Non-covered Drug PurchaseND=New Disease/Diagnosis

NF=Non-Formulary DrugNN=Unnecessary Drug

NP=New Patient ProcessingNR=Lactation/Nursing Interaction

NS=Insufficient QuantityØ=Not Specified

1=Your Pharmacy2=Other Pharmacy in Same Chain

3=Other Pharmacy

Ø=Not Specified1=Same Prescriber2=Other Prescriber

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 and one Transaction

Trailer.



# Revision/Change Segment Element(s) Version Date of Revision

1

Billing COB/Other Payments Segment

431-DV 1.1 28-Feb-052 456-EN is optional 456-EN 1.1 9-Mar-053 457-EP is optional 457-EP 1.1 9-Mar-054 458-SE is optional 458-SE 1.1 9-Mar-055 459-ER is optional 459-ER 1.1 9-Mar-056 436-E1 = 453-EJ Billing Claim Segment 436-E1 1.1 9-Mar-05

7 PCP information optional; required if available. Billing Prescriber Segment 1.1 9-Mar-05

8 Billing Coupon Segment 1.1 9-Mar-059 Diagnosis code information optional Billing Clinical Segment 1.1 9-Mar-05

10 Not applicable (0) added to values Billing Compound Segment 451-EG 1.2 4-Apr-0511 Other (99) added to values Billing Compound Segment 450-EF 1.2 4-Apr-05

12 Billing Pharmacy Provider 465-EY 1.2 4-Apr-05

13 Not specified value changed from blank to '00' Billing Compound Segment 49Ø-UE 1.2 4-Apr-05

14 Not specified value changed from blank to '00' Billing Compound Segment 488-RE 1.2 4-Apr-05

15 Not specified value changed from blank to '00' Billing Compound Segment 45Ø-EF 1.2 4-Apr-0516 COB Information is optional Billing COB/Other Payments Segment 1.2 4-Apr-05

17 Billing COB/Other Payments Segment 1.3 4-Apr-05

18 Billing Pharmacy Provider Segment 1.4 5-Apr-05

19 Billing COB/Other Payments Segment 341-HB 1.4 5-Apr-05

20 Billing COB/Other Payments Segment 1.4 5-Apr-05

21 Billing Patient Segment 331-CX 1.4 5-Apr-0522 Added Billing Pricing Segment Billing Pricing Segment 1.5 26-Apr-05

431-DV - OTHER PAYER AMOUNT PAID should be used to communicate the paid amount.

Coupon information optional; required if available.

NCPDP (08) added to list of values for Pharmacy Provider ID

CAPS Use correction for values in Billing COB/Other Payments Segment.

The previous version did not indicate the CAPS use for the Billing Pharmacy Provider Segment. The CAPS use columns have been updated accordingly.

Federal Tax ID ('05') qualifer added to OTHER PAYER ID QUALIFIER

New notes added to Billing COB/Other Payments Segment

Contractor ID (04) and UCI (05) added to qualifer list for PATIENT ID QUALIFIER



# Revision/Change Segment Element(s) Version Date of Revision23 Added Billing Prior Response Segment Billing Prior Response Segment 1.5 26-Apr-0524 Added Response Status Segment Response Status Segment 1.5 26-Apr-0525 Added Response Pricing Segment Response Pricing Segment 1.5 26-Apr-0526 Added Response DUR/PPS Segment Response DUR/PPS Segment 1.5 26-Apr-0527 Removed Billing Compound Segment Billing Compound Segment 1.5 26-Apr-0528 Removed Billing Coupon Segment Billing Coupon Segment 1.5 26-Apr-05

29 Billing DUR/PPS Segment 439-E4 1.6 11-May-05

30 PRIOR AUTHORIZATION SUPPORTING DOCU

498-PP

1.6 11-May-05

31 Billing Response Status Segment 526-FQ 1.6 11-May-05

32 Billing Response Status Segment 112-AN 1.6 11-May-0533 Added XX=not available to list of qualifers Billing Prior Authorization Segment 498-PD 1.7 18-May-0534 Added 00=not available as to list of qualifiers Billing Prior Authorization Segment 498-PA 1.7 18-May-0535 Added 00=not available as to list of qualifiers Billing Claim Segment 600-28 1.7 23-May-05

36 Added PF=Patient Referral to list of qualifiers Billing DUR/PPS Segment 440-E5 1.7 23-May-05

37 Not specified value changed from blank to '00' PERCENTAGE SALES TAX BASIS PAID 561-AZ 1.8 21-Jul-05

38 Not specified value changed from blank to '00' 564-J3 1.8 21-Jul-05

39 Not specified value changed from blank to '00' Billing Patient Segment 331-CX 1.8 21-Jul-05

40 Not specified value changed from blank to '00' Billing Response Pricing Segment 349-HM 1.8 21-Jul-05

41 Billing Claim Segment 418-DI 1.8 26-Jul-05

42 Billing Claim Segment 461-EU 1.8 26-Jul-05

43 Billing Claim Segment 420-DK 1.8 26-Jul-05

44 Billing Claim Segment 403-D3 1.8 26-Jul-05

Added 00=not specified as option for reason for service code

PRIOR AUTHORIZATION SUPPORTING DOCUMENTATION is fixed length field - 500 characters

ADDITIONAL MESSAGE INFORMATION is a fixed length field - 200 characters.

Reversal/Adjustment (X) qualifer added to TRANSACTION RESPONSE STATUS.

OTHER AMOUNT PAID QUALIFIER

Values changed to match field length as 2 characters






# Revision/Change Segment Element(s) Version Date of Revision

45 Billing Patient Segment 307-C7 1.8 26-Jul-05

46 Header Record Definition Segment added Header Record Definition 1.8 27-Jul-05

47 Batch Detail Definition Segment added Batch Detail Definition 1.8 27-Jul-05

48 Batch Transaction Trailer Segment added Batch Transaction Trailer 1.8 27-Jul-0549 Start Text Indicator added Start of Text (STX) - X02 880-K4 1.8 27-Jul-0550 End Text Indicator added End of Text (ETX) - X03 880-K4 1.8 27-Jul-0551 Field Removed from Batch Detail Definition Batch Detail Definition 806-5C 1.9 11-Aug-05

52 Batch Detail Definition 880-K5 1.9 11-Aug-0553 File samples 3 and 4 added n/a 880-K6 1.10 18-Aug-05

54 File Start and Field End columns are added n/a 1.11 25-Aug-05


880-K4701880-K6880-K1806-5C880-K2880-K3702102-A2880-K7880-K4

880-K4701880-K5880-K4

880-K4701806-5C751504-F4880-K4

Field Added to Batch Detail Definition to replace 806-5C above

Note: These start/end positions include the segment/field ID (where applicable) and the field VALUE start and end positions


11 11 of 21 CAPS Wave 2

Number Contractor Distribution Date Type Version Notes

1 23-Jun-04 Draft 1.0

2 30-Jun-04 Final 1.03 9-Mar-05 Final 1.1 Distributed to contractors.4 4-Apr-05 Final 1.2 Distributed to contractors.5 4-Apr-05 Final 1.3 Distributed to contractors.6 5-Apr-05 Final 1.4 Distributed to contractors.7 26-Apr-05 Final 1.5 Distributed to contractors.8 18-May-05 Final 1.6 Distributed to contractors.9 29-Aug-05 Final 1.11 Distributed to contractors.

Distributed to contractors for comment and review.

Delivered to PID as part of Wave 2 design


12 12 of 21 CAPS Wave 2

Number Note Version 1 File Format: Fixed Block 1.2

2 1.43 Note number 2 is no longer valid. 1.54 No special characters should be submitted in 498-PP and 526-FQ. 1.6

5 1.8

6 1.9

7 1.9

8 1.10

9 1.10

10 1.1011 New tab added to detail signed/unsigned overpunch fields 1.10

If CHIP/aB contractor is primary payer, please complete Billing COB/Other Payments Segment using 'Primary Payer - 01' in other payer coverage type to indicate primary payer.

The NCPDP Data record should be delimited based on approved standards. (See example attached)

Any date fields that need defaults, not specified, should be set to 99991231 (CCYYMMDD) when the value is not available

Any amount fields that need a default, not specified, should be 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.....

The Group Separator HEX<1D> will not be used in this file format. Each drug claim should be sent as a single transaction.

On the File Specification tab the Field format and field length describe only the value of the field. The length does NOT include the Segment/Field identifier

Sample 1

Transaction Header 1 per fileTransaction Detail DataTransaction Detail Data....

Transaction Trailer 1 per file

Sample 2

(STX)00R99999910001 1234567199412020941P11765432109876543212345678(ETX)(STX)G190000000213201A1DP...............(ETX)(STX)G190000000223201A1DR0173........(ETX)(STX)G187600000213C01A1CFO 1DP...............(ETX)(STX)G187600000223C01R1CFO 1DR0105........(ETX)(STX)9912345670000000006 (ETX)

Sample 3

NCPDP Actual file content (some HEX values may not appear properly)00T123456789 2005178200506271558T11236003060 G1999999990100385851N19999999901107XXXXXXXXXXXXXXX19000101XXXXX AM01CX04CY C4 C52CA CB CM CN COPACP CQ C700CZ 1C 2C AM04C2XXXXXXXXXXXXXXXXXXXXCC CD CE FO364 C9 8C C1 C3 C61AM07EM1D29999999E103D7XXXXXXXXXXXXXXXXXXXEN EP SE ER E70000020000D3 D5003D61D80DE DF00DJ0DK00ET0000020000C801DT0EJ03EA EB CW EK 28EADI EU EV EW00EX HD HF HG AM02EY08E9 AM03EZ12DB 1E DR PM 2E DL H5 4E AM054C15C016C057C E820050322HB1HC08DV0000061D5E 6E AM087E0E400E500E6008E J9 H6 AM11D90000047IDC0000013EBE DX0000000{E3 H7 H800H9 HA GE HE JE DQ0000129FDU0000061DDN01AM12PA0PB00000000PC00000000PDXXPE PF PG PH PJ PK PY F3 PP AM13VE WE DO XE ZE H1 H2 H3 H4 AM21ANPF3 FA FB 4F 5F 6F FQ 7F 8F AM23F50000000{F60000047IF70000013EAV2AW0000000{AX0000000{AY000000{AZ00FL0000002EJ10000000{J20J300J40000000{J50000000{F90000061DFM00FN0000000{FC0000000{FD FE FH0000000{FI0000000{FJ FK HH00HJ00HK00HM00AM24J60E4 FS FT FU FV FW FX FY G1999999990200385851N19999999902107XXXXXXXXXXXXXXX19000101XXXXX AM01CX04CY C4 C51CA CB CM CN COPACP CQ C700CZ 1C 2C AM04C2XXXXXXXXXXXXXXXXXXXXCC CD CE FO364 C9 8C C1 C3 C61AM07EM1D29999999E103D7XXXXXXXXXXXXXXXXXXXEN EP SE ER E70000240000D3 D5003D61D80DE DF00DJ0DK00ET0000240000C801DT0EJ03EA EB CW EK 28MLDI EU EV EW00EX HD HF HG AM02EY08E9 AM03EZ12DB 1E DR PM 2E DL H5 4E AM054C15C016C057C E820050322HB1HC08DV0000079C5E 6E AM087E0E400E500E6008E J9 H6 AM11D90000065HDC0000013EBE DX0000000{E3 H7 H800H9 HA GE HE JE DQ0000141GDU0000079CDN06AM12PA0PB00000000PC00000000PDXXPE PF PG PH PJ PK PY F3 PP AM13VE WE DO XE ZE H1 H2 H3 H4 AM21ANPF3 FA FB 4F 5F 6F FQ 7F 8F AM23F50000000{F60000065HF70000013EAV2AW0000000{AX0000000{AY000000{AZ00FL0000002EJ10000000{J20J300J40000000{J50000000{F90000079CFM00FN0000000{FC0000000{FD FE FH0000000{FI0000000{FJ FK HH00HJ00HK00HM00AM24J60E4 FS FT FU FV FW FX FY G1999999990300385851N19999999903107XXXXXXXXXXXXXXX19000101XXXXX AM01CX04CY C4 C52CA CB CM CN COPACP CQ C700CZ 1C 2C AM04C2XXXXXXXXXXXXXXXXXXXXCC CD CE FO364 C9 8C C1 C3 C61AM07EM1D29999999E103D7XXXXXXXXXXXXXXXXXXXEN EP SE ER E70000017000D3 D5025D61D80DE DF00DJ0DK00ET0000017000C800DT0EJ03EA EB CW EK 28GMDI EU EV EW00EX HD HF HG AM02EY08E9 AM03EZ12DB 1E DR PM 2E DL H5 4E AM054C15C016C057C E820050322HB1HC08DV0000672I5E 6E AM087E0E400E500E6008E J9 H6 AM11D90000659DDC0000013EBE DX0000000{E3 H7 H800H9 HA GE HE JE DQ0000829IDU0000672IDN01AM12PA0PB00000000PC00000000PDXXPE PF PG PH PJ PK PY F3 PP AM13VE WE DO XE ZE H1 H2 H3 H4 AM21ANPF3 FA FB 4F 5F 6F FQ 7F 8F AM23F50000000{F60000659DF70000013EAV2AW0000000{AX0000000{AY000000{AZ00FL0000000{J10000000{J20J300J40000000{J50000000{F90000672IFM00FN0000000{FC0000000{FD FE FH0000000{FI0000000{FJ FK HH00HJ00HK00HM00AM24J60E4 FS FT FU FV FW FX FY G1999999990400385851N19999999904107XXXXXXXXXXXXXXX19000101XXXXX AM01CX04CY C4 C51CA CB CM CN COPACP CQ C700CZ 1C 2C AM04C2XXXXXXXXXXXXXXXXXXXXCC CD CE FO364 C9 8C C1 C3 C61AM07EM1D29999999E103D7XXXXXXXXXXXXXXXXXXXEN EP SE ER E70000060000D3 D5010D61D80DE DF00DJ0DK00ET0000060000C800DT0EJ03EA EB CW EK 28MLDI EU EV EW00EX HD HF HG AM02EY08E9 AM03EZ12DB 1E DR PM 2E DL H5 4E AM054C15C016C057C E820050322HB1HC08DV0000832{5E 6E AM087E0E400E500E6008E J9 H6 AM11D90000818EDC0000013EBE DX0000000{E3 H7 H800H9 HA GE HE JE DQ0001069IDU0000832{DN01AM12PA0PB00000000PC00000000PDXXPE PF PG PH PJ PK PY F3 PP AM13VE WE DO XE ZE H1 H2 H3 H4 AM21ANPF3 FA FB 4F 5F 6F FQ 7F 8F AM23F50000000{F60000818EF70000013EAV2AW0000000{AX0000000{AY000000{AZ00FL0000000{J10000000{J20J300J40000000{J50000000{F90000832{FM00FN0000000{FC0000000{FD FE FH0000000{FI0000000{FJ FK HH00HJ00HK00HM00AM24J60E4 FS FT FU FV FW FX FY G1999999990500385851N19999999905107XXXXXXXXXXXXXXX19000101XXXXX AM01CX04CY C4 C51CA CB CM CN COPACP CQ C700CZ 1C 2C AM04C2XXXXXXXXXXXXXXXXXXXXCC CD CE FO364 C9 8C C1 C3 C61AM07EM1D29999999E103D7XXXXXXXXXXXXXXXXXXXEN EP SE ER E70000060000D3 D5030D61D80DE 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AM11D90000588IDC0000013EBE DX0000000{E3 H7 H800H9 HA GE HE JE DQ0000856CDU0000602DDN01AM12PA0PB00000000PC00000000PDXXPE PF PG PH PJ PK PY F3 PP AM13VE WE DO XE ZE H1 H2 H3 H4 AM21ANPF3 FA FB 4F 5F 6F FQ 7F 8F AM23F50000000{F60000588IF70000013EAV2AW0000000{AX0000000{AY000000{AZ00FL0000000{J10000000{J20J300J40000000{J50000000{F90000602DFM00FN0000000{FC0000000{FD FE FH0000000{FI0000000{FJ FK HH00HJ00HK00HM00AM24J60E4 FS FT FU FV FW FX FY G1999999990800385851N19999999908107XXXXXXXXXXXXXXX19000101XXXXX AM01CX04CY C4 C51CA CB CM CN COPACP CQ C700CZ 1C 2C AM04C2XXXXXXXXXXXXXXXXXXXXCC CD CE FO364 C9 8C C1 C3 C61AM07EM1D29999999E103D7XXXXXXXXXXXXXXXXXXXEN EP SE ER E70000017000D3 D5025D61D80DE DF05DJ0DK00ET0000017000C800DT0EJ03EA EB CW EK 28GMDI EU EV EW00EX HD HF HG AM02EY08E9 AM03EZ12DB 1E DR PM 2E DL H5 4E AM054C15C016C057C E820050322HB1HC08DV0000128H5E 6E AM087E0E400E500E6008E J9 H6 AM11D90000115CDC0000013EBE DX0000000{E3 H7 H800H9 HA GE HE JE 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Sample 4

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The Overpunch Sign: (for signed values)

The purpose of using Overpunch signs in dollar fields is to allow the representation of positive andnegative dollar amounts without expanding the size of the field (i.e., to hold the plus or minuscharacter).

The Overpunch sign replaces the right most character in a dollar field. The signed value designatesthe positive or negative status of the numeric value. The dollar field of $99.95 would berepresented as 999E with truncation. A negative dollar amount of $2.5Ø would be represented as25} with truncation.

UNITS SIGNED POSITIVE SIGNED NEGATIVEDigit Graphics Oct Dec Hex Graphics Oct Dec HexØ { 173 123 7B } 175 125 7D1 A 1Ø1 65 41 J 112 74 4A2 B 1Ø2 66 42 K 113 75 4B3 C 1Ø3 67 43 L 114 76 4C4 D 1Ø4 68 44 M 115 77 4D5 E 1Ø5 69 45 N 116 78 4E6 F 1Ø6 7Ø 46 O 117 79 4F7 G 1Ø7 71 47 P 12Ø 8Ø 5Ø8 H 11Ø 72 48 Q 121 81 519 I 111 73 49 R 122 82 52

Implied Decimal Points:

In the 5.1 standard, only patient clinical value fields will contain decimal points. All other decimalpoints are implied. For example, patient diagnosis codes should be formatted with explicit decimalpoints. 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.

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

For Signed Positive and Signed Negative values for numeric fields formatted as s9(3)v99s9(3)v99 : 123.45 => 1234E -123.45 => 1234N s9(3)v99 : 234.56 => 2345F -23456 => 2345Os9(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

Date post:	27-Nov-2014
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NCPDP 5 1 Companion Guide_NPI v1 12_Comment

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