Insurance Segment

Field #

Field Name

Possible Value or Explanation of Field

302-C2

Cardholder ID

Cardholder ID for the current insurance plan transmitted; located on the Insurance Plans tab of the Patient File (F3)

301-C1

Group Number

Group number for the current insurance plan transmitted; located on the Insurance Plans tab of the Patient File (F3)

314-CE

Home Plan

Field will most likely be phased out in next NCPDP version. Currently located in the patient's insurance plan(s).

524-FO

Plan ID

Field is assigned by the processor to identify a specific set of parameters, might not be used; located on the Insurance Plans tab of the Patient File (F3)

309-C9

Dependency Eligibility Code (Eligibility Clarification Code)

Ø- Not specified, 1- No override, 2- Override, 3- Full Time Student, 4- Disabled Dependent, 5- Dependent Parent, 6- Significant Other; located on the Insurance Plans tab of the Patient File (F3)

336-8C

Facility ID

This ID is assigned to the patient's clinic/host party and might not be required; located on the Insurance Plans tab of the Patient File (F3)

303-C3

Person Code

This code is assigned to a specific person within the family by the plan; located on the Insurance Plans tab of the Patient File (F3)

306-C6

Relationship Code

This code indicates the relationship of patient to the cardholder; located on the Insurance Plans tab of the Patient File (F3)

312-CC

Cardholder First Name

Cardholder first name; can vary from first name used on the main patient screen. Located on the Insurance Plans tab of the Patient File (F3)

313-CD

Cardholder Last Name

Cardholder last name; can vary from first name used on the main patient screen. Located on the Insurance Plans tab of the Patient File (F3)

997-G2

CMD Part D Facility

Y Yes=CMS qualified facility

N No=Not a CMS qualified facility

Located in the Nursing Home file for the nursing home. Patient has to be attached to a home to utilize this field.

359-2A

Medigap ID

ID assigned by the Medigap insurer if applicable; located on the Insurance Plans tab of the Patient File (F3)

360-2B

Medicaid Indicator

Two character postal code indicating the state where the Medicaid coverage exists; located on the Insurance Plans tab of the Patient File (F3)

361-2D

Provider Accept Assignment Indicator

Code indicating if the provider accepts assignment, if applicable; located on the Insurance Plans tab of the Patient File (F3)

115-N5

Medicaid ID Number

A unique member ID number assigned by the Medicaid Agency if applicable; located on the Insurance Plans tab of the Patient File (F3)

116-N6

Medicaid Agency Number

This number is assigned by the processor to identify the individual agency of representative, if applicable; located on the Insurance Plans tab of the Patient File (F3)