Medco MedicareD Payer Sheet - Catalyst Rx

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Response Status Segment Questions Check Claim Billing Accepted/Rejected If Situational, Payer Situation This Segment is always sent X Response Status Segment Segment Identification (111-AM) = “21” Field # NCPDP Field Name Value Payer Usage 112-AN TRANSACTION RESPONSE R = Reject M STATUS 51Ø-FA REJECT COUNT Maximum count of 5. R 511-FB REJECT CODE R 546-4F REJECT FIELD OCCURRENCE RW INDICATOR 13Ø-UF ADDITIONAL MESSAGE INFORMATION COUNT Medco 100 Parsons Pond Drive Franklin Lakes, NJ 07417 Claim Billing Accepted/Rejected Payer Situation Imp Guide: Required if a repeating field is in error, to identify repeating field occurrence Maximum count of 9. RW Imp Guide: Required if Additional Message Information (526-FQ) is used. 132-UH ADDITIONAL MESSAGE INFORMATION QUALIFIER RW Imp Guide: Required if Additional Message Information (526-FQ) is used. 526-FQ ADDITIONAL MESSAGE INFORMATION RW Imp Guide: Required when additional text is needed for clarification or detail. 131-UG ADDITIONAL MESSAGE INFORMATION CONTINUITY RW Imp Guide: Required if and only if current repetition of Additional Message Information (526-FQ) is used, another populated repetition of Additional Message Information (526-FQ) follows it, and the text of the following message is a continuation of the current. 549-7F HELP DESK PHONE NUMBER QUALIFIER RW Imp Guide: Required if Help Desk Phone Number (55Ø-8F) is used. 55Ø-8F HELP DESK PHONE NUMBER RW Imp Guide: Required if needed to provide a support telephone number. 987-MA URL RW Imp Guide: Provided for informational purposes only to relay healthcare communications via the Internet. Payer Requirement: Will return WWW. MEDCO.COM/RPH “Materials Reproduced With the Consent of ©National Council for Prescription Drug Programs, Inc. 2008 NCPDP” 2_v7 26
Response Claim Segment Questions Check Claim Billing Accepted/Rejected If Situational, Payer Situation This Segment is always sent X Response Claim Segment Segment Identification (111-AM) = “22” Field # NCPDP Field Name Value Payer Usage 455-EM PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER Medco 100 Parsons Pond Drive Franklin Lakes, NJ 07417 Claim Billing Accepted/Paid (or Duplicate of Paid) Payer Situation 1 M Imp Guide: For Transaction Code of “B1”, in the Response Claim Segment, the Prescription/Service Reference Number Qualifier (455- EM) is “1” (Rx Billing). M 4Ø2-D2 PRESCRIPTION/SERVICE REFERENCE NUMBER 551-9F PREFERRED PRODUCT COUNT Maximum count of 6. RW Imp Guide: Required if Preferred Product ID (553-AR) is used. 552-AP PREFERRED PRODUCT ID QUALIFIER RW Imp Guide: Required if Preferred Product ID (553-AR) is used. 553-AR PREFERRED PRODUCT ID RW Imp Guide: Required if a product preference exists that needs to be communicated to the receiver via an ID. 556-AU PREFERRED PRODUCT DESCRIPTION RW Imp Guide: Required if a product preference exists that either cannot be communicated by the Preferred Product ID (553-AR) or to clarify the Preferred Product ID (553-AR). Response DUR/PPS Segment Questions Check Claim Billing Accepted/Rejected If Situational, Payer Situation This Segment is always sent This Segment is situational X When DUR has additional information to be returned Response DUR/PPS Segment Segment Identification (111-AM) = “24” Field # NCPDP Field Name Value Payer Usage Claim Billing/ Accepted/Rejected Payer Situation “Materials Reproduced With the Consent of ©National Council for Prescription Drug Programs, Inc. 2008 NCPDP” 2_v7 27
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Medco MedicareD Payer Sheet - Catalyst Rx

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