Program Name

• Traditional Medicaid
• Children with Special Health Care Needs (CSHCN) Services Program
• Healthy Texas Women (HTW) Program
• Kidney Health Care (KHC) Program

Transaction Code

• National Council for Prescription Drug Programs (NCPDP) B1 - Claims Billing
• Refer to the Claims Billing (B1) Transaction section of the Pharmacy Provider Procedure Manual for more information about the NCPDP transaction.

Notes

• The processor edits all submitted data elements for valid format and values.
• Provider software should support all data elements on the required segments.
• In cases where multiple iterations of a field ("repeating fields") are allowed, the maximum number of iterations is indicated.

Field Usage Description

• Mandatory (M):
  • Submitted following the NCPDP Telecommunication Implementation Guide Version D.0.
• Required (R):
  • Always submitted.
• Required When (RW):
  • Submitted under circumstances explained in the Comment column.
• Optional (O):
  • Submitted at the discretion of the pharmacy provider.
• Repeating (***R***):
  • Designates a repeating field.