This blog post describes the conversion of NCPDP D.0 transactions to CSV files and vice versa.
NCPDP Telecommunications Standard Version D.0 is an updated version of the HIPAA standard for pharmacy claims transactions. NCPDP D.0 includes the following transaction types:
- B1 – Billing
- B2 – Reversal
- B3 – Re-bill
- C1 – Controlled Substance Reporting
- C2 – Controlled Substance Reporting Reversal
- C3 – Controlled Substance Reporting Re-bill
- D1 – Predetermination of Benefits
- E1 – Eligibility Verification
- N1 – Information Reporting
- N2 – Information Reporting Reversal
- N3 – Information Reporting Re-bill
- P1 – Prior Authorization Request and Billing
- P2 – Prior Authorization Reversal
- P3 – Prior Authorization Inquiry
- P4 – Prior Authorization Request Only
- S1 – Service Billing
- S2 – Service Reversal
- S3 – Service Re-bill
Each transaction type contains request and response transactions, e.g., B1 request and B1 response. To help users integrate the NCPDP D.0 transactions into their existing applications, Redix International, Inc. has developed an NCPDP RMap (Redix Maps for NCPDP D.0) module. This module defines the NCPDP D.0 transactions in a CSV (comma separated value) format and yet carries 100% of the D.0 compliance. This format encapsulate NCPDP D.0 data into a more concise and readable format. It is easier to understand and to program because of the fewer number of records and fields. As a result, the Redix NCPDP RMap module is being used by many healthcare entities as their repository for storing their pharmacy claims data.
Redix NCPDP RMap Module
Click here to find more about the NCPDP RMaps specs. You can test the conversion by using this link.
Pre-Defined Maps
The Redix NCPDP RMap module contains pre-defined maps for all NCPDP D.0 transactions. These maps include the conversions from NCPDP D.0 to Redix CSV files and vice versa. Users can test the pre-defined maps by using this link.
Example
Below is an example of NCPDP B1 request transaction in D.0 format:
484848D0B156789012341014563663bbbbbbbb2007091598765bbbbb‑AM04C2987654321‑AM01C419620615C51CAJOSEPHCBSMITHCM123 MAIN STREETCNMY TOWNCOCOCP24567HNJSMITH@NCPDP.ORG‑AM07EM1D21234567E103D700006094268E730000D30D530D61D80DE20070915DF5DJ1EX4689EW1‑AM03EZ08DB00G2345DRJONES‑AM11D9557{DC50{DQ587{DU607{DN03
In the above, is a field separator, which is hex 1C.
HIPAA 837 Professional:
ISA*00* *00* *ZZ*123456789012345*ZZ*123456789012345*030101*1253*?*00501*987654321*1*T*
GS*HC*123456789012345*123456789012345*19991231*0802*123456789*X*005010X222A1
ST*837*2021*005010X222A1
BHT*0019*00*0123*20051015*1023*CH
NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23
PER*IC*JERRY*TE*3055552222
NM1*40*2*XYZ REPRICER*****46*66783JJT
HL*1**20*1
NM1*85*1*KILDARE*BEN****XX*1234567893
N3*1234 SEAWAY ST
N4*MIAMI*FL*33111
REF*EI*123456789
PER*IC*CONNIE*TE*3055551234
NM1*87*2
N3*2345 OCEAN BLVD
N4*MIAMI*FL*33111
HL*2*1*22*1
SBR*P********CI
NM1*IL*1*SMITH*JANE****MI*111223333
DMG*D8*19430501*F
NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666
N3*3333OCEAN ST
N4*SOUTH MIAMI*FL*33000
REF*G2*PBS3334
HL*3*2*23*0
PAT*19
NM1*QC*1*SMITH*TED
N3*236 N MAIN ST
N4*MIAMI*FL*33413
DMG*D8*19730501*M
CLM*26407789*79.04***11:B:1*Y*A*Y*I*P
HI*BK:4779*BF:2724*BF:2780*BF:53081
NM1*82*1*KILDARE*BEN****XX*1234567893
PRV*PE*PXC*204C00000X
REF*G2*KA6663
NM1*77*2*KILDARE ASSOCIATES*****XX*1234567893
N3*2345 OCEAN BLVD
N4*MIAMI*FL*33111
SBR*S*01*******CI
OI***Y*P**Y
NM1*IL*1*SMITH*JACK****MI*T55TY666
N3*236 N MAIN ST
N4*MIAMI*FL*33111
NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666
LX*1
SV1*HC:99213*43*UN*1***1:2:3:4
DTP*472*D8*20051003
LX*2
SV1*HC:90782*15*UN*1***1:2
DTP*472*D8*20051003
LX*3
SV1*HC:J3301*21.04*UN*1***1:2
DTP*472*D8*20051003
SE*52*2021
GE*1*123456789
IEA*1*987654321