5.3.3. NCPDP Transaction Segment Data Elements
The system uses program-specific data elements for each transaction outlined below. The pharmacy’s software vendor must review the HHSC payer sheets before setting up the plan in the pharmacy’s system. This will allow the provider access to the required fields.
The system will not process claims without all the required data elements for the transaction submitted. Required fields may or may not be used in the adjudication process for all transactions.
| Code | Description |
|---|---|
|
M |
Designated as MANDATORY in accordance with the NCPDP Telecommunication Implementation Guide Version D.0. These fields must be sent if the segment is required for the transaction. |
|
R |
Designated as REQUIRED for this program. |
|
O |
Designated as OPTIONAL in accordance with the NCPDP Telecommunication Implementation Guide Version D.0. It is necessary to send these fields in noted situations where they are conditional based on data content. |
|
N |
Designated as NOT USED in accordance with the NCPDP Telecommunication Implementation Guide Version D.0. |
| ***R*** | The “***R***” indicates the field is repeating. |