Medco Version D.0 Medicare Part D Payer Sheet - Express Scripts

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Insurance SegmentSegment Identification (111-AM) =“Ø4”Field # NCPDP Field Name Value PayerUsageClaim BillingPayer SituationPayer Requirement: May be submittedby Long Term Care Pharmacies.Patient Segment Questions Check Claim BillingIf Situational, Payer SituationThis Segment is always sentXThis Segment is situationalPatient SegmentClaim BillingSegment Identification (111-AM) =“Ø1”Field # NCPDP Field Name Value Payer Payer SituationUsage3Ø4-C4 DATE OF BIRTH R3Ø5-C5 PATIENT GENDER CODE R31Ø-CA PATIENT FIRST NAME R Imp Guide: Required when the patienthas a first name.311-CB PATIENT LAST NAME R325-CP PATIENT ZIP/POSTAL ZONE RW Imp Guide: Optional.Payer Requirement: Emergency/DisasterSituations; Patient Zip Code of theemergency should be entered.3Ø7-C7 PLACE OF SERVICE 01(Pharmacy) RW Imp Guide: Required if this field couldresult in different coverage, pricing, orpatient financial responsibility.Payer Requirement: Valid valuesrequired for Patient Residence andPharmacy Type. Values entered shouldbe consistent with your contract384-4X PATIENT RESIDENCE RW Imp Guide: Required if this field couldresult in different coverage, pricing, orpatient financial responsibility.Payer Requirement: Valid valuesrequired for Patient Residence andPharmacy Type. Values entered shouldbe consistent with your contractClaim Segment Questions Check Claim BillingIf Situational, Payer SituationThis Segment is always sentXThis payer does support partial fillsThis payer does not support partial fillsX“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”3

Claim SegmentSegment Identification (111-AM) =“Ø7”Field # NCPDP Field Name Value PayerUsage455-EMPRESCRIPTION/SERVICEREFERENCE NUMBER QUALIFIERMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingPayer Situation1(Rx Billing) M Imp Guide: For Transaction Code of“B1”, in the Claim Segment, thePrescription/Service ReferenceNumber Qualifier (455-EM) is “1”(Rx Billing).M4Ø2-D2 PRESCRIPTION/SERVICEREFERENCE NUMBER436-E1 PRODUCT/SERVICE ID QUALIFIER ØØ (Not Specified)M Use 00 for Multi- ingredientØ3(NDC)compound claim.4Ø7-D7 PRODUCT/SERVICE ID M Use 0 for Multi- ingredientcompound claim.442-E7 QUANTITY DISPENSED R4Ø3-D3 FILL NUMBER R4Ø5-D5 DAYS SUPPLY R4Ø6-D6 COMPOUND CODE 1(Not a Compound)2 (Compound)RSee Compound Segment forsupport of multi-ingredientcompounds when compound = 2.4Ø8-D8 DISPENSE AS WRITTENR(DAW)/PRODUCT SELECTIONCODE414-DE DATE PRESCRIPTION WRITTEN R419-DJ PRESCRIPTION ORIGIN CODE R Imp Guide: Required if necessary forplan benefit administration.354-NXSUBMISSION CLARIFICATIONCODE COUNTMaximum count of 3 RW Imp Guide: Required if SubmissionClarification Code (42Ø-DK) is used.42Ø-DKSUBMISSION CLARIFICATIONCODERWImp Guide: Required if clarification isneeded and value submitted isgreater than zero (Ø).If the Date of Service (4Ø1-D1)contains the subsequent payercoverage date, the SubmissionClarification Code (42Ø-DK) isrequired with value of “19” (SplitBilling – indicates the quantitydispensed is the remainder billed to asubsequent payer when MedicarePart A expires. Used only in long-termcare settings) for individual unit of usemedications.3Ø8-C8 OTHER COVERAGE CODE 2(Other coverage existspaymentcollected )3(Other Coverage Billed –claim not covered)4(Other coverage existspaymentnot collected)RWPayer Requirement: The value of 2 isused to respond to a Max DailyDose/High Dose Reject.Imp Guide: Required if needed byreceiver, to communicate asummation of other coverageinformation that has been collectedfrom other payers.Required for Coordination of Benefits.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”4

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim SegmentClaim BillingSegment Identification (111-AM) =“Ø7”Field # NCPDP Field Name Value Payer Payer SituationUsage995-E2 ROUTE OF ADMINISTRATION RW Imp Guide: Required if specified intrading partner agreement.147-U7 PHARMACY SERVICE TYPE 1 (Community/RetailPharmacy Services)3( Home Infusion TherapyServices)5( Long Term Care PharmacyServices)RWPayer Requirement: Required whenCompound Code (4Ø6-D6) = 2(compound).Imp Guide: Required when thesubmitter must clarify the type ofservices being performed as acondition for proper reimbursement bythe payer.Payer Requirement: Valid values arerequired for Patient Residence andPharmacy Service Type. Valuesentered should be consistent withyour contract.Pricing Segment Questions Check Claim BillingIf Situational, Payer SituationThis Segment is always sentXPricing SegmentClaim BillingSegment Identification (111-AM) =“11”Field # NCPDP Field Name Value Payer Payer SituationUsage4Ø9-D9 INGREDIENT COST SUBMITTED R412-DC DISPENSING FEE SUBMITTED RW Imp Guide: Required if its value hasan effect on the Gross Amount Due(43Ø-DU) calculation.Payer Requirement: DispensingFee Submitted is required whenSubmission Clarification Code=19(Split Billing). Pharmacy shouldprovide appropriate dispensing feefor the transaction.438-E3 INCENTIVE AMOUNT SUBMITTED RW Imp Guide: Required if its value hasan effect on the Gross Amount Due(43Ø-DU) calculation.Payer Requirement: Required whensubmitting a claim for a vaccine drugand administrative fee together.481-HAFLAT SALES TAX AMOUNTSUBMITTEDRWImp Guide: Required if its value hasan effect on the Gross Amount Due(43Ø-DU) calculation.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”6

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Pricing SegmentSegment Identification (111-AM) =“11”Field # NCPDP Field Name Value PayerUsage482-GE PERCENTAGE SALES TAX AMOUNTRWSUBMITTEDClaim BillingPayer SituationImp Guide: Required if its value hasan effect on the Gross Amount Due(43Ø-DU) calculation.483-HEPERCENTAGE SALES TAX RATESUBMITTEDRWImp Guide: Required if PercentageSales Tax Amount Submitted (482-GE) and Percentage Sales Tax BasisSubmitted (484-JE) are used.Required if this field could result indifferent pricing.Required if needed to calculatePercentage Sales Tax Amount Paid(559-AX).484-JEPERCENTAGE SALES TAX BASISSUBMITTEDRWImp Guide: Required if PercentageSales Tax Amount Submitted (482-GE) and Percentage Sales Tax RateSubmitted (483-HE) are used.Required if this field could result indifferent pricing.Required if needed to calculatePercentage Sales Tax Amount Paid(559-AX).426-DQ USUAL AND CUSTOMARY CHARGE R Imp Guide: Required if needed pertrading partner agreement.43Ø-DU GROSS AMOUNT DUE R423-DN BASIS OF COST DETERMINATION R Imp Guide: Required if needed forreceiver claim/encounter adjudication.Payer Requirement: Basis of CostDetermination not required for MultiIngredient Compound claims.Prescriber Segment Questions Check Claim BillingIf Situational, Payer SituationThis Segment is always sentXThis Segment is situational“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”7

Prescriber SegmentSegment Identification (111-AM) =“Ø3”Field # NCPDP Field Name Value PayerUsage466-EZ PRESCRIBER ID QUALIFIER Ø1 = NPIRØ8 = State License12 = DEAMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingPayer SituationImp Guide: Required if Prescriber ID(411-DB) is used.411-DB PRESCRIBER ID NPI, State License or DEA R Imp Guide: Required if this field couldresult in different coverage or patientfinancial responsibility.Required if necessary forstate/federal/regulatory agencyprograms.Payer Requirement: NPI, DEA orState License Number. For vaccines,an individual NPI is required. It may bethe prescriber who wrote the prescriptionor alternate care provider (pharmacist,nurse practitioner, etc.) who administeredthe vaccine.427-DR PRESCRIBER LAST NAME RW Imp Guide: Required when thePrescriber ID (411-DB) is not known.Required if needed for Prescriber ID(411-DB) validation/clarification.367-2N PRESCRIBER STATE/PROVINCEADDRESSRWPayer Requirement: Required whenPrescriber Id Qualifier =08 (StateLicense) is submitted.Imp Guide: Required if needed toassist in identifying the prescriber.Required if necessary forstate/federal/regulatory agencyprograms.Payer Requirement: Required whensubmitting Prescriber Id Qualifier = 8(State License) or Prescriber IdQualifier = 12 (DEA) is submitted.Coordination of Benefits/Other Payments Segment Check Claim BillingQuestionsIf Situational, Payer SituationThis Segment is situational X Required only for secondary, tertiary, etc claims.Scenario 1 - Other Payer Amount Paid Repetitions OnlyXScenario 2 - Other Payer-Patient Responsibility AmountRepetitions and Benefit Stage Repetitions OnlyScenario 3 - Other Payer Amount Paid, Other Payer-Patient Responsibility Amount, and Benefit StageRepetitions Present (Government Programs)“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”8

Coordination of Benefits/OtherPayments SegmentSegment Identification (111-AM) =“Ø5”Field # NCPDP Field Name Value PayerUsage337-4C COORDINATION OFMaximum count of 9. MBENEFITS/OTHER PAYMENTSCOUNTMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingScenario 1- Other Payer AmountPaid Repetitions OnlyPayer Situation338-5C OTHER PAYER COVERAGE TYPE M339-6C OTHER PAYER ID QUALIFIER Ø3(BIN) M Imp Guide: Required if Other Payer ID(34Ø-7C) is used.34Ø-7C OTHER PAYER ID M Imp Guide: Required if identification ofthe Other Payer is necessary forclaim/encounter adjudication.443-E8 OTHER PAYER DATE RW Imp Guide: Required if identification ofthe Other Payer Date is necessary forclaim/encounter adjudication.341-HB342-HCOTHER PAYER AMOUNT PAIDCOUNTOTHER PAYER AMOUNT PAIDQUALIFIERMaximum count of 9 RW Imp Guide: Required if Other PayerAmount Paid Qualifier (342-HC) isused07 = Drug Benefit10 = Sales TaxRWImp Guide: Required if Other PayerAmount Paid (431-DV) is used.431-DV OTHER PAYER AMOUNT PAID RW Imp Guide: Required if Other Payerhas approved payment for some/all ofthe billing.471-5E OTHER PAYER REJECT COUNT Maximum count of 5 RW Imp Guide: Required if Other PayerReject Code (472-6E) is used.472-6E OTHER PAYER REJECT CODE RW Imp Guide: Required when the otherpayer has denied the payment for thebilling.DUR/PPS Segment Questions Check Claim BillingIf Situational, Payer SituationThis Segment is always sentThis Segment is situational X Based on pharmacy determination for clinical or vaccineprocessing. When submitting a claim for a vaccine andadministration fee, only the 440-E5 (Professional Service Code)field is required in this segment.When submitting a compound claim, Field 474-8E (DUR/PPSLevel of Effort) is required; using the values consistent with yourcontract.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”9

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417CLAIM BILLING RESPONSEGENERAL INFORMATIONPayer Name: Medco Date: March 1, 2013Plan Name/Group Name: MEDICARE PART D AS PAYER or BIN: 610014PCN:MEDDPRIMEMEDICARE PART D AS A SECONDARY PAYERPlan Name/Group Name: Plan Name/Group Name: BIN: PCN:Plan Name/Group Name: Plan Name/Group Name BIN: PCN:CLAIM BILLING PAID (OR DUPLICATE OF PAID) RESPONSEThe following lists the segments and fields in a Claim Billing response (Paid or Duplicate of Paid) Transaction for theNCPDP Telecommunication Standard Implementation Guide Version D.Ø. Please note the payer requirement isconsidered to be the same as stated in the Imp Guide statement of the Payer Situation unless otherwisenoted.Response Transaction Header Segment Questions Check Claim BillingAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is always sentXResponse Transaction HeaderSegmentField # NCPDP Field Name Value PayerUsage1Ø2-A2 VERSION/RELEASE NUMBER DØ M1Ø3-A3 TRANSACTION CODE B1 M1Ø9-A9 TRANSACTION COUNT Same value as in request M5Ø1-F1 HEADER RESPONSE STATUS A M2Ø2-B2 SERVICE PROVIDER ID QUALIFIER Same value as in request M2Ø1-B1 SERVICE PROVIDER ID Same value as in request M4Ø1-D1 DATE OF SERVICE Same value as in request MClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer SituationResponse Message Header Segment Questions Check Claim BillingAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is always sentThis Segment is situational X Provided when additional message text is necessaryResponse Message SegmentSegment Identification (111-AM) =“2Ø”Field # NCPDP Field Name Value PayerUsageClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation5Ø4-F4 MESSAGE RW Imp Guide: Required if text is neededfor clarification or detail.Response Insurance Header Segment Questions Check Claim BillingAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is always sentX“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”12

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Response Insurance SegmentSegment Identification (111-AM) =“25”Claim BillingAccepted/Paid (or Duplicate ofPaid)Field # NCPDP Field Name Value Payer Payer SituationUsage3Ø1-C1 GROUP ID R Imp Guide: Required if needed toidentify the actual cardholder oremployer group, to identifyappropriate group number, whenavailable.Required to identify the actual groupthat was used when multiple groupcoverage exists.545-2F NETWORK REIMBURSEMENT ID R Imp Guide: Required if needed toidentify the network for the coveredmember.Required if needed to identify theactual Network Reimbursement ID,when applicable and/or available.Required to identify the actualNetwork Reimbursement ID that wasused when multiple NetworkReimbursement IDs exist.3Ø2-C2 CARDHOLDER ID RW Imp Guide: Required if theidentification to be used in futuretransactions is different than whatwas submitted on the request.Response Status Segment Questions Check Claim BillingAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is always sentXResponse Status SegmentSegment Identification (111-AM) =“21”Field # NCPDP Field Name Value PayerUsage112-AN TRANSACTION RESPONSEP, D MSTATUSClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation5Ø3-F3 AUTHORIZATION NUMBER R Imp Guide: Required if needed toidentify the transaction.547-5F APPROVED MESSAGE CODECOUNTMaximum count of 5. RW Imp Guide: Required if ApprovedMessage Code (548-6F) is used.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”13

Response Status SegmentSegment Identification (111-AM) =“21”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation548-6F APPROVED MESSAGE CODE RW Imp Guide: Required if ApprovedMessage Code Count (547-5F) isused and the sender needs tocommunicate additional follow up fora potential opportunity.13Ø-UFADDITIONAL MESSAGEINFORMATION COUNTMaximum count of 9. RW Imp Guide: Required if AdditionalMessage Information (526-FQ) isused.132-UHADDITIONAL MESSAGEINFORMATION QUALIFIERØ1-Ø9 = Free Form Text1Ø = Next Available FillDate (CCYYMMDDRWImp Guide: Required if AdditionalMessage Information (526-FQ) isused.526-FQADDITIONAL MESSAGEINFORMATIONRWImp Guide: Required when additionaltext is needed for clarification ordetail.131-UGADDITIONAL MESSAGEINFORMATION CONTINUITYRWImp Guide: Required if and only ifcurrent repetition of AdditionalMessage Information (526-FQ) isused, another populated repetition ofAdditional Message Information (526-FQ) follows it, and the text of thefollowing message is a continuation ofthe current.549-7F HELP DESK PHONE NUMBERQUALIFIERRWImp Guide: Required if Help DeskPhone Number (55Ø-8F) is used.55Ø-8F HELP DESK PHONE NUMBER RW Imp Guide: Required if needed toprovide a support telephone numberto the receiver.Response Claim Segment Questions Check Claim BillingAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is always sentXResponse Claim SegmentSegment Identification (111-AM) =“22”Field # NCPDP Field Name Value PayerUsage455-EM PRESCRIPTION/SERVICEMREFERENCE NUMBER QUALIFIER4Ø2-D2PRESCRIPTION/SERVICEREFERENCE NUMBERM“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”Claim BillingAccepted/Paid (or Duplicate ofPaid)Payer SituationImp Guide: For Transaction Code of“B1”, in the Response ClaimSegment, the Prescription/ServiceReference Number Qualifier (455-EM)is “1” (Rx Billing).14

Response Claim SegmentSegment Identification (111-AM) =“22”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation551-9F PREFERRED PRODUCT COUNT Maximum count of 6. RW Imp Guide: Required if PreferredProduct ID (553-AR) is used.Payer Requirement: Based on benefitand when preferred alternative areavailable for the submitted productservice ID.552-APPREFERRED PRODUCT IDQUALIFIERRWImp Guide: Required if PreferredProduct ID (553-AR) is used.553-AR PREFERRED PRODUCT ID RW Imp Guide: Required if a productpreference exists that needs to becommunicated to the receiver via anID.556-AUPREFERRED PRODUCTDESCRIPTIONRWImp Guide: Required if a productpreference exists that either cannotbe communicated by the PreferredProduct ID (553-AR) or to clarify thePreferred Product ID (553-AR).Response Pricing Segment Questions Check Claim BillingAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is always sentXResponse Pricing SegmentSegment Identification (111-AM)= “23”Field # NCPDP Field Name Value PayerUsageClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation5Ø5-F5 PATIENT PAY AMOUNT R5Ø6-F6 INGREDIENT COST PAID R5Ø7-F7 DISPENSING FEE PAID R Imp Guide: Required if this value isused to arrive at the finalreimbursement.557-AV TAX EXEMPT INDICATOR R Imp Guide: Required if the sender(health plan) and/or patient is taxexempt and exemption applies tothis billing.558-AW FLAT SALES TAX AMOUNT PAID RW Imp Guide: Required if Flat SalesTax Amount Submitted (481-HA) isgreater than zero (Ø) or if Flat SalesTax Amount Paid (558-AW) is usedto arrive at the final reimbursement.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”15

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Response Pricing SegmentSegment Identification (111-AM)= “23”Field # NCPDP Field Name Value PayerUsage559-AX PERCENTAGE SALES TAXRWAMOUNT PAIDClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer SituationImp Guide: Required if this value isused to arrive at the finalreimbursement.Required if Percentage Sales TaxAmount Submitted (482-GE) isgreater than zero (Ø).Required if Percentage Sales TaxRate Paid (56Ø-AY) and PercentageSales Tax Basis Paid (561-AZ) areused.56Ø-AYPERCENTAGE SALES TAX RATEPAIDRWImp Guide: Required if PercentageSales Tax Amount Paid (559-AX) isgreater than zero (Ø).561-AZPERCENTAGE SALES TAX BASISPAIDRWImp Guide: Required if PercentageSales Tax Amount Paid (559-AX) isgreater than zero (Ø).521-FL INCENTIVE AMOUNT PAID RW Imp Guide: Required if this value isused to arrive at the finalreimbursement.Required if Incentive AmountSubmitted (438-E3) is greater thanzero (Ø).5Ø9-F9 TOTAL AMOUNT PAID R522-FM BASIS OF REIMBURSEMENTRDETERMINATIONImp Guide: Required if IngredientCost Paid (5Ø6-F6) is greater thanzero (Ø).523-FNAMOUNT ATTRIBUTED TOSALES TAXRWRequired if Basis of CostDetermination (432-DN) is submittedon billing.Imp Guide: Required if Patient PayAmount (5Ø5-F5) includes sales taxthat is the financial responsibility ofthe member but is not also includedin any of the other fields that add upto Patient Pay Amount.Imp Guide: Provided forinformational purposes only.Imp Guide: Provided forinformational purposes only.512-FC ACCUMULATED DEDUCTIBLEAMOUNTRW513-FD REMAINING DEDUCTIBLERWAMOUNT514-FE REMAINING BENEFIT AMOUNT RW Imp Guide: Provided forinformational purposes only.517-FH AMOUNT APPLIED TO PERIODICRWDEDUCTIBLEImp Guide: Required if Patient PayAmount (5Ø5-F5) includesdeductible.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”16

Response Pricing SegmentSegment Identification (111-AM)= “23”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation518-FI AMOUNT OF COPAY RW Imp Guide: Required if Patient PayAmount (5Ø5-F5) includes co-payas patient financial responsibility.52Ø-FK571-NZAMOUNT EXCEEDING PERIODICBENEFIT MAXIMUMAMOUNT ATTRIBUTED TOPROCESSOR FEERWImp Guide: Required if Patient PayAmount (5Ø5-F5) includes amountexceeding periodic benefitmaximum.Imp Guide: Required if the customeris responsible for 1ØØ% of theprescription payment and when theprovider net sale is less than theamount the customer is expected topay.575-EQ PATIENT SALES TAX AMOUNT RW Imp Guide: Used when necessary toidentify the Patient’s portion of theSales Tax.574-2Y PLAN SALES TAX AMOUNT RW Imp Guide: Used when necessary toidentify the Plan’s portion of theSales Tax.572-4U AMOUNT OF COINSURANCE RW Imp Guide: Required if Patient PayAmount (5Ø5-F5) includescoinsurance as patient financialresponsibility.392-MU BENEFIT STAGE COUNT Maximum count of 4. R Imp Guide: Required if BenefitStage Amount (394-MW) is used.RW“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”17

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Response Pricing SegmentSegment Identification (111-AM)= “23”Field # NCPDP Field Name Value Payer393-MV BENEFIT STAGE QUALIFIER Blank = Not specifiedØ1 = DeductibleØ2 = Initial BenefitØ3 = Coverage Gap (donuthole)Ø4 = Catastrophic Coverage5Ø = Not paid under Part D,Paid Under Part C benefit (forMA-PD plan)6Ø = Not paid under Part D,paid as or under asupplemental benefit only.*61 = Part D drug not paid byPart D plan benefit. Paid as orunder a co-administeredbenefit only.**62 = Non-Part D/non-qualifieddrug not paid by Part D planbenefit. Paid as or under a coadministeredbenefit only.**7Ø = Part D drug not paid byPart D plan benefit, paid by thebeneficiary under plansponsorednegotiated pricing8Ø = Non-Part D/non-qualifieddrug not paid by Part D planbenefit, hospice benefit or anyother component of Medicare;paid by the beneficiary underplan-sponsored negotiatedpricing9Ø = Enhance or OTC drug(PDE value of E/O) notapplicable to Part D drugspend, but covered by Part Dplan***(Occurs up to 4 times)UsageRClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer SituationImp Guide: Required if BenefitStage Amount (394-MW) is used.Payer Requirement: See values“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”18

Response Pricing SegmentSegment Identification (111-AM)= “23”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation394-MW BENEFIT STAGE AMOUNT R Imp Guide: Required when aMedicare Part D payer appliesfinancial amounts to Medicare PartD beneficiary benefit stages. Thisfield is required when the plan is aparticipant in a Medicare Part Dprogram that requires reporting ofbenefit stage specific financialamounts.Required if necessary forstate/federal/regulatory agencyprograms.Payer Requirement: Amount willbe returned as appropriate for thecorresponding Benefit StageQualifiers (393-MV).577-G3 ESTIMATED GENERIC SAVINGS RW Imp Guide: This information shouldbe provided when a patient selectedthe brand drug and a generic form ofthe drug was available. It will containan estimate of the differencebetween the cost of the brand drugand the generic drug, when thebrand drug is more expensive thanthe generic.128-UCSPENDING ACCOUNT AMOUNTREMAININGRWImp Guide: This dollar amount willbe provided, if known, to thereceiver when the transaction hadspending account dollars reportedas part of the patient pay amount.129-UDHEALTH PLAN-FUNDEDASSISTANCE AMOUNTRWImp Guide: Required when thepatient meets the plan-fundedassistance criteria, to reduce PatientPay Amount (5Ø5-F5). The resultingPatient Pay Amount (5Ø5-F5) mustbe greater than or equal to zero.133-UJAMOUNT ATTRIBUTED TOPROVIDER NETWORKSELECTIONRWImp Guide: Required if Patient PayAmount (5Ø5-F5) includes anamount that is attributable to a costshare differential due to theselection of one pharmacy overanother.134-UKAMOUNT ATTRIBUTED TOPRODUCT SELECTION/BRANDDRUGRWImp Guide: Required if Patient PayAmount (5Ø5-F5) includes anamount that is attributable to apatient’s selection of a Brand drug.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”19

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Response Pricing SegmentSegment Identification (111-AM)= “23”Field # NCPDP Field Name Value PayerUsage135-UM AMOUNT ATTRIBUTED TORWPRODUCT SELECTION/NON-PREFERRED FORMULARYSELECTIONClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer SituationImp Guide: Required if Patient PayAmount (5Ø5-F5) includes anamount that is attributable to apatient’s selection of a non-preferredformulary product.136-UNAMOUNT ATTRIBUTED TOPRODUCT SELECTION/BRANDNON-PREFERRED FORMULARYSELECTIONRWImp Guide: Required if Patient PayAmount (5Ø5-F5) includes anamount that is attributable to apatient’s selection of a Brand nonpreferredformulary product.137-UPAMOUNT ATTRIBUTED TOCOVERAGE GAPRWImp Guide: Required when thepatient’s financial responsibility isdue to the coverage gap.566-J5 OTHER PAYER AMOUNTRECOGNIZEDImp Guide: Required if this value isused to arrive at the finalreimbursement.Required if Other Payer AmountPaid (431-DV) is greater than zero(Ø) and Coordination ofBenefits/Other Payments Segmentis supported.*Only available for use on claims with fill dates of 12/31/2012 and prior.**Benefit Stage Qualifier (393-MV) values 61 or 62 replace value of 6Ø. Available for use as of 1/1/13.*** Available for use as of 1/1/13.Check Claim BillingResponse DUR/PPS Segment QuestionsAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is always sentThis Segment is situational X When DUR Information to be providedResponse DUR/PPS SegmentSegment Identification (111-AM) =“24”Field # NCPDP Field Name Value PayerUsage567-J6 DUR/PPS RESPONSE CODECOUNTERMaximum 9 occurrencessupported.RWClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer SituationImp Guide: Required if ReasonFor Service Code (439-E4) isused.439-E4 REASON FOR SERVICE CODE RW Imp Guide: Required if utilizationconflict is detected.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”20

Response DUR/PPS SegmentSegment Identification (111-AM) =“24”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation528-FS CLINICAL SIGNIFICANCE CODE RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.529-FT OTHER PHARMACY INDICATOR RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.53Ø-FU PREVIOUS DATE OF FILL RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.Required if Quantity of PreviousFill (531-FV) is used.531-FV QUANTITY OF PREVIOUS FILL RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.Required if Previous Date Of Fill(53Ø-FU) is used.532-FW DATABASE INDICATOR RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.533-FX OTHER PRESCRIBER INDICATOR RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.544-FY DUR FREE TEXT MESSAGE RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.57Ø-NS DUR ADDITIONAL TEXT RW Imp Guide: Required if needed tosupply additional information forthe utilization conflict.Response Coordination of Benefits/Other PayersSegment QuestionsCheck Claim BillingAccepted/Paid (or Duplicate of Paid)If Situational, Payer SituationThis Segment is situational X When available 4Rx or Medicare D OHI DATA to be returned.Response Coordination ofBenefits/Other Payers SegmentSegment Identification (111-AM) =“28”Field # NCPDP Field Name Value PayerUsage355-NT OTHER PAYER ID COUNT Maximum count of 3 M338-5C OTHER PAYER COVERAGE TYPE MClaim BillingAccepted/Paid (or Duplicate of Paid)Payer Situation“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”21

Response Coordination ofBenefits/Other Payers SegmentSegment Identification (111-AM) =“28”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/Paid (or Duplicate of Paid)Payer Situation339-6C OTHER PAYER ID QUALIFIER RW Imp Guide: Required if Other Payer ID(34Ø-7C) is used.Payer Requirement: When availableand required, 4Rx (Primary) orMedicare D OHI Data may be returnedon a claim response.34Ø-7C OTHER PAYER ID RW Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.991-MHOTHER PAYER PROCESSORCONTROL NUMBERRWPayer Requirement: When availableand required, 4Rx (Primary) orMedicare D OHI Data may be returnedon a claim response.Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.Payer Requirement: When availableand required, 4Rx (Primary) orMedicare D OHI Data may be returnedon a claim response.356-NU OTHER PAYER CARDHOLDER ID RW Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.Payer Requirement: When availableand required, 4Rx (Primary) orMedicare D OHI Data may be returnedon a claim response.992-MJ OTHER PAYER GROUP ID RW Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.Payer Requirement: When availableand required, 4Rx (Primary) orMedicare D OHI Data may be returnedon a claim response.142-UV OTHER PAYER PERSON CODE RW Imp Guide: Required if needed touniquely identify the family memberswithin the Cardholder ID, as assignedby the other payer.Payer Requirement: When availableand required, 4Rx (Primary) orMedicare D OHI Data may be returnedon a claim response.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”22

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Response Coordination ofBenefits/Other Payers SegmentSegment Identification (111-AM) =“28”Field # NCPDP Field Name Value PayerUsage127-UB OTHER PAYER HELP DESKRWPHONE NUMBERClaim BillingAccepted/Paid (or Duplicate of Paid)Payer SituationImp Guide: Required if needed toprovide a support telephone number ofthe other payer to the receiver.Payer Requirement: When availableand required, 4Rx (Primary) orMedicare D OHI Data may be returnedon a claim response.CLAIM BILLING/ACCEPTED/REJECTED RESPONSEResponse Transaction Header Segment Questions Check Claim Billing/Claim Rebill Accepted/RejectedIf Situational, Payer SituationThis Segment is always sentXResponse Transaction HeaderSegmentField # NCPDP Field Name Value PayerUsage1Ø2-A2 VERSION/RELEASE NUMBER DØ M1Ø3-A3 TRANSACTION CODE B1 M1Ø9-A9 TRANSACTION COUNT Same value as in request M5Ø1-F1 HEADER RESPONSE STATUS A M2Ø2-B2 SERVICE PROVIDER ID QUALIFIER Same value as in request M2Ø1-B1 SERVICE PROVIDER ID Same value as in request M4Ø1-D1 DATE OF SERVICE Same value as in request MClaim BillingAccepted/RejectedPayer SituationResponse Message Segment Questions Check Claim Billing/Claim Rebill Accepted/RejectedIf Situational, Payer SituationThis Segment is always sentThis Segment is situational X Provided when additional message textResponse Message SegmentSegment Identification (111-AM) =“2Ø”Field # NCPDP Field Name Value PayerUsageClaim BillingAccepted/RejectedPayer Situation5Ø4-F4 MESSAGE Imp Guide: Required if text isneeded for clarification or detail.Response Insurance Segment Questions Check Claim Billing Accepted/RejectedIf Situational, Payer SituationThis Segment is always sentXThis Segment is situational“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”23

Response Insurance SegmentSegment Identification (111-AM) =“25”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/RejectedPayer Situation3Ø1-C1 GROUP ID RW Imp Guide: Required if needed toidentify the actual cardholder oremployer group, to identifyappropriate group number, whenavailable.Required to identify the actual groupthat was used when multiple groupcoverage exist.545-2F NETWORK REIMBURSEMENT ID RW Imp Guide: Required if needed toidentify the network for the coveredmember.Required if needed to identify theactual Network Reimbursement ID,when applicable and/or available.Required to identify the actualNetwork Reimbursement ID thatwas used when multiple NetworkReimbursement IDs exist.3Ø2-C2 CARDHOLDER ID RW Imp Guide: Required if theidentification to be used in futuretransactions is different than whatwas submitted on the request.Response Status Segment Questions Check Claim BillingAccepted/RejectedIf Situational, Payer SituationThis Segment is always sentXResponse Status SegmentSegment Identification (111-AM) =“21”Field # NCPDP Field Name Value PayerUsage112-AN TRANSACTION RESPONSER = RejectMSTATUS51Ø-FA REJECT COUNT Maximum count of 5 R511-FB REJECT CODE R546-4F REJECT FIELD OCCURRENCERWINDICATOR13Ø-UFADDITIONAL MESSAGEINFORMATION COUNTClaim Billing Accepted/RejectedPayer SituationImp Guide: Required if a repeatingfield is in error, to identify repeatingfield occurrenceMaximum count of 9 RW Imp Guide: Required if AdditionalMessage Information (526-FQ) isused.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”24

Response Status SegmentSegment Identification (111-AM) =“21”Field # NCPDP Field Name Value PayerUsage132-UH526-FQ131-UGADDITIONAL MESSAGEINFORMATION QUALIFIERADDITIONAL MESSAGEINFORMATIONADDITIONAL MESSAGEINFORMATION CONTINUITY549-7F HELP DESK PHONE NUMBERQUALIFIERØ1- Ø9 = Free-Form Text1Ø = Next Available FillDate (CCYYMMDD)RWRWRWRWMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim Billing Accepted/RejectedPayer SituationImp Guide: Required if AdditionalMessage Information (526-FQ) isused.Imp Guide: Required whenadditional text is needed forclarification or detail.Imp Guide: Required if and only ifcurrent repetition of AdditionalMessage Information (526-FQ) isused, another populated repetitionof Additional Message Information(526-FQ) follows it, and the text ofthe following message is acontinuation of the current.Imp Guide: Required if Help DeskPhone Number (55Ø-8F) is used.55Ø-8F HELP DESK PHONE NUMBER RW Imp Guide: Required if needed toprovide a support telephonenumber.987-MA URL RW Imp Guide: Provided forinformational purposes only to relayhealthcare communications via theInternet.Payer Requirement: Will returnhttp://www.expressscripts.com/services/pharmacistsResponse Claim Segment Questions Check Claim Billing Accepted/RejectedIf Situational, Payer SituationThis Segment is always sentXResponse Claim SegmentSegment Identification (111-AM) =“22”Field # NCPDP Field Name Value PayerUsage455-EMPRESCRIPTION/SERVICEREFERENCE NUMBER QUALIFIERClaim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation1 M Imp Guide: For Transaction Codeof “B1”, in the Response ClaimSegment, the Prescription/ServiceReference Number Qualifier (455-EM) is “1” (Rx Billing).M4Ø2-D2 PRESCRIPTION/SERVICEREFERENCE NUMBER551-9F PREFERRED PRODUCT COUNT Maximum count of 6. RW Imp Guide: Required if PreferredProduct ID (553-AR) is used.552-APPREFERRED PRODUCT IDQUALIFIERRWImp Guide: Required if PreferredProduct ID (553-AR) is used.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”25

Response Claim SegmentSegment Identification (111-AM) =“22”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingAccepted/Paid (or Duplicate ofPaid)Payer Situation553-AR PREFERRED PRODUCT ID RW Imp Guide: Required if a productpreference exists that needs to becommunicated to the receiver viaan ID.556-AUPREFERRED PRODUCTDESCRIPTIONRWImp Guide: Required if a productpreference exists that either cannotbe communicated by the PreferredProduct ID (553-AR) or to clarifythe Preferred Product ID (553-AR).Response DUR/PPS Segment Questions Check Claim Billing Accepted/RejectedIf Situational, Payer SituationThis Segment is always sentThis Segment is situational X When DUR has additional information to be returnedResponse DUR/PPS SegmentSegment Identification (111-AM) =“24”Field # NCPDP Field Name Value PayerUsage567-J6 DUR/PPS RESPONSE CODECOUNTERMaximum 9 occurrencessupported.RWClaim Billing/Accepted/RejectedPayer SituationImp Guide: Required if and only ifcurrent repetition of AdditionalMessage Information (526-FQ) isused, another populated repetitionof Additional Message Information(526-FQ) follows it, and the text ofthe following message is acontinuation of the current.439-E4 REASON FOR SERVICE CODE RW Imp Guide: Required if utilizationconflict is detected.528-FS CLINICAL SIGNIFICANCE CODE RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.529-FT OTHER PHARMACY INDICATOR RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.53Ø-FU PREVIOUS DATE OF FILL RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.Required if Quantity of Previous Fill(531-FV) is used.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”26

Response DUR/PPS SegmentSegment Identification (111-AM) =“24”Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim Billing/Accepted/Rejected531-FV QUANTITY OF PREVIOUS FILL RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.Required if Previous Date Of Fill(53Ø-FU) is used.532-FW DATABASE INDICATOR RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.533-FX OTHER PRESCRIBER INDICATOR RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.544-FY DUR FREE TEXT MESSAGE RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.57Ø-NS DUR ADDITIONAL TEXT RW Imp Guide: Required if needed tosupply additional information for theutilization conflict.Response Prior Authorization Segment Questions Check Claim Billing Accepted/RejectedIf Situational, Payer SituationThis Segment is always sentThis Segment is situational X Provided when the receiver has the opportunity to reprocessthe claim with using a Prior Authorization Number.Response Prior AuthorizationSegmentSegment Identification (111-AM) =“26”Field # NCPDP Field Name Value PayerUsage498-PY PRIOR AUTHORIZATIONRWNUMBER–ASSIGNEDClaim BillingAccepted/RejectedPayer SituationImp Guide: Required whenthe receiver must submit this PriorAuthorization Number in order toreceive payment for the claim.Payer Requirement: The valuereturned in this field will provide thevalue that may be submitted in PriorAuthorization Number Submitted,field 462-EV. This value must besubmitted with appropriatecorresponding Prior AuthorizationType Code, field 461-EU.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”27

Medco100 Parsons Pond DriveFranklin Lakes, NJ 07417Response Coordination of Benefits/Other Payers Check Claim Billing Accepted/RejectedSegment QuestionsIf Situational, Payer SituationThis Segment is situational X When 4Rx or Medicare OHI data availableResponse Coordination ofBenefits/Other Payers SegmentSegment Identification (111-AM) =“28”Field # NCPDP Field Name Value PayerUsageClaim Billing/Accepted/RejectedPayer Situation355-NT OTHER PAYER ID COUNT Maximum count of 3. M338-5C OTHER PAYER COVERAGE TYPE M339-6C OTHER PAYER ID QUALIFIER 03 (BIN Number) RW Imp Guide: Required if Other Payer ID(34Ø-7C) is used.Payer Requirement: The 4Rx datasubmitted on the claim must beupdated this field maybe returned orwhen available Medicare D OHI Datamay be returned.34Ø-7C OTHER PAYER ID RW Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.991-MHOTHER PAYER PROCESSORCONTROL NUMBERRWPayer Requirement: The 4Rx datasubmitted on the claim must beupdated this field maybe returned orwhen available Medicare D OHI Datamay be returned.Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.Payer Requirement: The 4Rx datasubmitted on the claim must beupdated this field maybe returned orwhen available Medicare D OHI Datamay be returned.356-NU OTHER PAYER CARDHOLDER ID RW Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.Payer Requirement: The 4Rx datasubmitted on the claim must beupdated this field maybe returned orwhen available Medicare D OHI Datamay be returned.992-MJ OTHER PAYER GROUP ID RW Imp Guide: Required if other insuranceinformation is available for coordinationof benefits.Payer Requirement: The 4Rx datasubmitted on the claim must beupdated this field maybe returned orwhen available Medicare D OHI Datamay be returned.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”28

Response Coordination ofBenefits/Other Payers SegmentSegment Identification (111-AM) =“28”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim Billing/Accepted/RejectedPayer Situation142-UV OTHER PAYER PERSON CODE RW Imp Guide: Required if needed touniquely identify the family memberswithin the Cardholder ID, as assignedby the other payer.127-UBOTHER PAYER HELP DESKPHONE NUMBERRWPayer Requirement: The 4Rx datasubmitted on the claim must beupdated this field maybe returned orwhen available Medicare D OHI Datamay be returned.Imp Guide: Required if needed toprovide a support telephone number ofthe other payer to the receiver.Payer Requirement: The 4Rx datasubmitted on the claim must beupdated this field maybe returned orwhen available Medicare D OHI Datamay be returned.CLAIM BILLING REJECTED/REJECTED RESPONSEResponse Transaction Header Segment Questions Check Claim BillingRejected/RejectedIf Situational, Payer SituationThis Segment is always sentXResponse Transaction HeaderSegmentField # NCPDP Field Name Value PayerUsage1Ø2-A2 VERSION/RELEASE NUMBER DØ M1Ø3-A3 TRANSACTION CODE B1 M1Ø9-A9 TRANSACTION COUNT Same value as in request M5Ø1-F1 HEADER RESPONSE STATUS R M2Ø2-B2 SERVICE PROVIDER IDSame value as in request MQUALIFIER2Ø1-B1 SERVICE PROVIDER ID Same value as in request M4Ø1-D1 DATE OF SERVICE Same value as in request MClaim BillingRejected/RejectedPayer SituationResponse Message Segment Questions Check Claim BillingRejected/RejectedIf Situational, Payer SituationThis Segment is always sentThis Segment is situationalX“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”29

Response Message SegmentSegment Identification (111-AM) =“2Ø”Field # NCPDP Field Name Value PayerUsageMedco100 Parsons Pond DriveFranklin Lakes, NJ 07417Claim BillingRejected/RejectedPayer Situation5Ø4-F4 MESSAGE Imp Guide: Required if text is neededfor clarification or detail.Response Status Segment Questions Check Claim Billing/Rejected/RejectedIf Situational, Payer SituationThis Segment is always sentXResponse Status SegmentSegment Identification (111-AM) =“21”Field # NCPDP Field Name Value PayerUsage112-AN TRANSACTION RESPONSERMClaim BillingRejected/RejectedPayer SituationSTATUS5Ø3-F3 AUTHORIZATION NUMBER RW Imp Guide: Required if needed toidentify the transaction.51Ø-FA REJECT COUNT Maximum count of 5 R511-FB REJECT CODE R546-4F REJECT FIELD OCCURRENCEINDICATORRWImp Guide: Required if a repeatingfield is in error, to identify repeatingfield occurrence.13Ø-UF132-UHADDITIONAL MESSAGEINFORMATION COUNTADDITIONAL MESSAGEINFORMATION QUALIFIERMaximum count of 9 RW Imp Guide: Required if AdditionalMessage Information (526-FQ) isused.RWImp Guide: Required if AdditionalMessage Information (526-FQ) isused.526-FQ131-UGADDITIONAL MESSAGEINFORMATIONADDITIONAL MESSAGEINFORMATION CONTINUITY549-7F HELP DESK PHONE NUMBERQUALIFIERRWRWRWImp Guide: Required when additionaltext is needed for clarification ordetail.Imp Guide: Required if and only ifcurrent repetition of AdditionalMessage Information (526-FQ) isused, another populated repetition ofAdditional Message Information (526-FQ) follows it, and the text of thefollowing message is a continuation ofthe current.Imp Guide: Required if Help DeskPhone Number (55Ø-8F) is used.55Ø-8F HELP DESK PHONE NUMBER RW Imp Guide: Required if needed toprovide a support telephone numberto the receiver.“Materials Reproduced With the Consent of©National Council for Prescription Drug Programs, Inc.2008 NCPDP”30