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Related article: Professional Service/ Description (NCPCP field #440-E5) Result of Service/ Description (NCPDP field #441-E6) 00/ no intervention M0/ prescriber consulted PE/ patient education P0/ patient consulted R0/ pharmacist consulted other source 1A/ filled as is, false positive 1B/ filled prescription as is 1C/ filled with different dose 1D/ filled with different directions 1F/ filled with different quantity 1G/ filled with prescriber approval APPENDIX A PAYER SPECIFICATIONS NCPDP VERSION 5.1 PAYER SHEET � B1/B3 Transactions **GENERAL INFORMATION** Payer Name: Maryland Medical Assistance Program Date: February 4, 2007 Plan Name/Group Name: Maryland Department of Health and Mental Hygiene Processor: ACS Help Desk: TBD Effective as of: February 4, 2007 Version/Release #: 5.1 Contact/Information Source: Help Online Pharmacy Clonazepam Desk, Payer Sheet Certification Testing Window:N/A Provider Relations Help Desk Info: TBD Other versions supported: None** OTHER TRANSACTIONS SUPPORTED ** Transaction Code Transaction Name B1 Billing B3 ReBillBILLING TRANSACTION: Transaction Header Segment: Mandatory in all cases Field # NCPDP Field Name/length Value M/R/RW Comment 1?1-A1 BIN Number 61??84 M 1?2-A2 Version/Release Number 51 M 1?3-A3 Transaction Code B1 = Billing B2 = Reversals B3 = Rebill M 1?4-A4 Processor Control Number DRMDPROD = Production DRMDACCP = Test M 1?9-A9 Transaction Count 1 = One Occurrence 2 = Two Occurrences 3 = Three Occurrences 4 = Four Occurrences M 2?2-B2
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