5.3.1. NCPDP Transactions
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 |