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Wisconsin Medicaid Companion Document to HIPAA Implementation Guide — NCPDP 5.1

NCPDP 5.1 V6
PHC 13052 (1/07)
PDF (140 KB)
Revision Log

Table of Contents

B1 Billing Request

Transaction Header Segment

Insurance Segment

Patient Segment

Claim Segment

Pricing Segment

Prescriber Segment

Coordination of Benefits/Other Payments Segment

DUR/PPS Segment

Compound Segment

Clinical Segment

B1 Accepted Response

Response Header Segment

Response Status Segment

Response Claim Segment

Response Pricing Segment

Response DUR/PPS Segment

B1 Rejected Response

Response Header Segment

Response Status Segment

B2 Request

Transaction Header Segment

Claim Segment

DUR/PPS Segment

B2 Accepted Response

Response Header Segment

Response Message Segment

Response Status Segment

Response Claim Segment

B2 Rejected Response

Response Header Segment

Response Status Segment

Attachment 1

Field 526 on a Paid or Duplicate of Paid Response When the AT DUR Alert Has Not Set

Field 526 on a Paid or Duplicate of Paid Response When the AT DUR Alert Has Set

Attachment 2

Field 526 on a Rejected Response When the Claim Denies for a DUR Alert

Field 526 on a Rejected Response When the Claim Does Not Deny for a DUR Alert

Attachment 3

Messages Displayed in Field 544

Attachment 4

Field 504 on a Reversal Response

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