Header Segment

Field #

Field Name

Possible Value or Explanation of Field

101-A1

BIN Number

Provided on an insurance card or eligibility check; located in the Insurance Plan File (F3)

102-A2

NCPDP Version

D.Ø (Current standard), TP (Third-party billing), 5.1 (Old standard); located in the Insurance Plan File (F3)

103-A3

Transaction Code

B1 (Claim processing), B2 (reversal), B3 (Adjustment transaction)

104-A4

Processor Control Number

Provided on an insurance card or eligibility check, not required; located in the Insurance Plan File (F3)

109-A9

Transaction Count

The number of transactions sent (up to 4); this can be controlled by the "Transmit Multiple Claims" located in the Insurance Plan File (F3)

202-B2

Service Provider ID Qualifier

Pharmacy's ID qualifier corresponding to the below number; located in the Insurance Plan File (F3)

201-B1

Service Provider ID

Pharmacy's ID number corresponding to the above qualifier; located in the Insurance Plan File (F3)

401-D1

Date of Service

Fill date; located on the main processing screen

110-AK

Software Vendor Certification ID

Number depends on insurance (if required); located in the Insurance Plan File (F3)