NCPDP Version D.0 Payer Sheet Medicaid - Express Scripts

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Jan 01, 2018 · Field # NCPDP Field Name Value Payer Usage . 111-AM Segment Identification Ø1=Patient M 331-CX Patient ID Qualifier O 332-CY Patient ID As indicated on member ID card O 3Ø4-C4 Date of Birth R 3Ø5-C5 Patient Gender Code 1=Male 2=Female R 31Ø-CA Patient First Name Example: John R

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