Medco Version 5.1 Payer Sheet January 2006 Use when submitting ...
Medco Version 5.1 Payer Sheet January 2006 Use when submitting ...
Medco Version 5.1 Payer Sheet January 2006 Use when submitting ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
<strong>Medco</strong> Health Solutions, Inc.100 Parsons Pond DriveFranklin Lakes, NJ 07417www.medco.com/rph1 800-922-1557529-FT530-FU531-FV532-FW544-FYOther Pharmacy IndicatorPrevious Date of FillQuantity of Previous FillDatabase IndicatorDUR Free Text MessageReversal Transaction: Transaction Header Segment: Mandatory in all casesNCPDP Values SupportedField #NCPDP Field Nameby <strong>Medco</strong>Mandatory /Optional101-A1 BIN Number 610031 M102-A2 <strong>Version</strong>/Release Number 51 M103-A3 Transaction Code B2 M104-A4 Processor Control Number Meddcobseg M109-A9 Transaction Count 1 M202-B2 Service Provider ID Qualifier Values 07 M201-B1 Service Provider ID NCPDP M401-D1 Date of Service M110-AKSoftware Vendor /Certification IdClaim Segment: MandatoryField #NCPDP Field NameAssigned <strong>when</strong> certified, claim will reject ifnot valid for 51NCPDP Values Supportedby <strong>Medco</strong>MMandatory /Optional111-AM Segment Identification 07 M455-EM Prescription/ Service Ref Number Qualifier 1 M402-D2 Prescription/ Service Ref Number M436-E1 Product/Service ID Qualifier 03 M407-D7 Product/Service ID NDC M403-D3 Fill Number M308-C8 Other Coverage Code When reversing a secondary claim COB8
Change language