Programs: Maryland Medical Assistance Program (MA)
BILLING TRANSACTION: Transaction Header Segment: Mandatory in all cases
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- M/R/RW Comment
- Insurance Segment: Mandatory
BILLING TRANSACTION:Transaction Header Segment: Mandatory in all cases
|
Field |
NCPDP Field Name |
Value | M/R/RW |
Comment |
|
111-AM |
Segment Identification |
Ø1 |
M |
Patient Segment |
|
304-C4 |
Date of Birth |
CCYYMMDD |
R |
|
|
305-C5 |
Patient Gender Code |
Ø =Not specified 1=Male
2=Female |
R |
|
|
310 –CA |
Patient First Name |
|
R |
First 5 characters – |
|
311 – CB |
Patient Last Name |
|
R |
First 5 characters |
|
307-C7 |
Patient Location |
0=Not specified 1=Home
2=Inter-Care 3=Nursing Home 4=Long Term/Extended Care 5=Rest Home 6=Boarding Home 7=Skilled Care Facility 8=Sub-Acute care Facility 9=Acute Care Facility 10=Outpatient 11=Hospice |
RW |
Use location Code 4 or 11 when the patient is in a LTC setting or hospice Bolded values are the current accepted values |
Insurance Segment: Mandatory
|
Field # |
NCPDP Field Name |
Value | M/R/RW | Comment |
|
111-AM |
Segment Identification |
Ø4 |
M |
Insurance Segment |
|
3Ø2-C2 |
Cardholder ID |
Recipient’s KDP Recipient ID Number |
M |
KDP Recipient number + 5 leading zeros 11 numeric
|
|
301-C1 |
Group ID |
MDDKDP |
R |
|
|
306-C6 |
Patient Relationship Code |
1 = Cardholder 2 = Spouse 3=Child 4=Other
|
R |
1 = Cardholder |
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common -> Programs: Maryland Medical Assistance Program (MA)
docs -> Application for acem
docs -> Observational Assessment of Teaching Practices Teaching Assessment Initiative Proposal Submitted to The Teachers for a New Era project
docs -> Traditional British values
docs -> From Warfighters to Crimefighters: The Origins of Domestic Police Militarization
docs -> Borzoi Club of America Register of Merit Program I. What is a Register Of Merit
docs -> Protecting the rights of the child in the context of migration
docs -> United Nations E/C. 12/Esp/5
docs -> 9th May 1950 the schuman declaration
docs -> Getting To Outcomes® in Services for Homeless Veterans 10 Steps for Achieving Accountability
common -> Programs: Maryland Medical Assistance Program (MA)
Download 3.34 Mb.
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