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Payer Sheet User Instructions

The following Segments, Field IDs, Field Names, and values in the Mandatory or Situational Columns are as defined or recommended in the NCPDP Standard, Data Dictionary, and draft Protocol Document. The Comments/Values column instructs the pharmacy if the field is to be required and under what circumstances.

Mandatory Segments must ALWAYS be transmitted with every transaction. transmitted under the conditions defined in the Comments/Values column.

Situational Segments only need to be

Once determination of the Segments transmission is determined, each field in the segment is considered for mandatory or situational transmission. Mandatory fields within a Situational segment are required ONLY if the segment is transmitted. If the segment is not transmitted, then the mandatory fields within that segment are NOT to be transmitted.

Fields defined as Repeating can occur in the transaction more than one time, as defined in the NCPDP documentation. If the client desires the transmission of a repeating field, the comments/values cell for that field should indicate how many times the pharmacist should or may transmit that data element.

Note: The ‘Comments/Values’ section defining when, if at all, the fields are to be required. Clients should be specific in defining these uses. Population of data in any Situational field identified as “Not Required” will not result in a claim rejection, unless otherwise noted, or unless a value or format is submitted that violates the NCPDP Data Dictionary.

  • 1.

    Delete this page before printing

  • 2.

    Tab to desired field and type replacement text as needed. Clients are STRONGLY ENCOURAGED to specifically state what value(s) are needed in a field when they identify is as a REQUIRED field. For example, in the Patient Segment Date of Birth field “REQUIRED in order to locate correct member record” or “REQUIRED to edit age limitations”.

3.

If a functionality is not supported (for example, Coupons), Change Comment/Value field in Segment Header section to NOT REQUIRED/SUPPORTED or something similar.

4.

SAVE AS a file specific to the client

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