Claims Billing (B1) Transaction

This transaction captures and processes the claim in real time. On payable claims, the system notifies the pharmacy of the dollar amount allowed under the Medicaid reimbursement calculation. If the claim is not payable, the system returns an NCPDP error code. In some cases, a message is included in "Addition Message Information" (field 526-FQ).

The following payer sheets are available:

B1 transactions submitted to HHSC for clients enrolled in Medicaid managed care or CHIP will reject with NCPDP code "AF" (“Patient Enrolled Under Managed Care") and identify the name of the client's MCO. Pharmacy providers should contact the client's specific MCO for details.