The transaction codes below are defined according to the standards established by NCPDP.  Ability to use these transaction codes will depend on the pharmacy’s software.  At a minimum all pharmacy software should have the capability to submit original claims (transaction code B1) and reversals (transaction code B2).

Code Name Support Requirements

B1

Billing

Required

B2

Reversal

Required

B3

Re-bill

Not Supported

C1

Controlled Substance Reporting

Not Supported

C2

Controlled Substance Reporting

Reversal

Not Supported

C3

Controlled Substance Reporting

Rebill

Not Supported

D1

Predetermination of Benefits

Not Supported

E1

Eligibility Verification

Supported

N1

Informational Reporting

N1 from pharmacies not supported

N2

Informational Reversal

N2 from pharmacies not supported

N3

Informational Re-bill

Not Supported

P1

Prior Authorization Request and

Billing

Not Supported

P2

Prior Authorization Reversal

Not Supported

P3

Prior Authorization Inquiry

Not Supported

P4

Prior Authorization Request Only

Not Supported

S1

Service Billing

Not Supported

S2

Service Reversal

Not Supported

S3

Service Rebill

Not Supported