Compound Segment: Required When Submitting a Multi-Line Compound Claim

Compound Segment: Required When Submitting a Multi-Line Compound Claim

Prior Authorization Segment: Not Used by KDP

Clinical Segment: Optional for KDP

NCPDP VERSION 5.1 PAYER SHEET – B1/B3 Transactions

**GENERAL INFORMATION**

Payer Name: Maryland Medical Assistance Program	Date: January 1, 2007
Plan Name/Group Name: MADAP
Processor: ACS	Help Desk: TBD
Effective as of: January 1, 2007	Version/Release #: 5.1
Contact/Information Source: Help Desk, Payer Sheet
Certification Testing Window:
Provider Relations Help Desk Info:
Other versions supported: None

** OTHER TRANSACTIONS SUPPORTED **

Transaction Code	Transaction Name
B1	Billing
B3	ReBill

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