Transcription of NCPDP REFERENCE MANUAL - CMS
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NCPDP REFERENCE MANUAL - CMS
Rev. 2005-4/October 3-1 2002 VIPS, Inc. All Rights Reserved. Use or disclosure of the information contained on this page is subject to the restrictions on the title page of this material. Chapter 3: NCPDP Flat File Format About the Flat File Format (FFF) File Layout The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires that a single standard be used for the electronic submission of retail pharmacy claims NCPDP format. These incoming claims are first passed through an NCPDP translator and stored in a Flat-File-Format (FFF). ViPS programs pass the FFF data through a series of editing programs and produce reports that list the claims included in the transmission and identify any errors in the submitted data. The process then formats the FFF file into the Claims-In-Process (CIP) format used by the VMS subsystems and the Certificate of Medical Necessity (CMN) format used for DME.
Reference Number* 880-K5 Number assigned by provider to each transaction record. This number is unique to each set of flat file records that represent a single claim. This field is only populated on records with Segment Identifier G1. X(10) Spaces NCPKFLAT 37 46 Group Indicator *1 N/A This field is used to indicate a group of related segments ...
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