External Address Country Pharmacy Code External Code Country Code of Report the three-character country code PC 26 Country 12/1/10 char[3] All 90% B Source Source 1 - the Pharmacy as defined by ISO 3166-1, Alpha 3. Code 1 - Text Countries Lookup Claim Claim Line Report the value that defines the PC 27 11/8/12 - tlkpClaimStatus varchar[2] All 98% A0 Status Status payment status of this claim line Numeric Value Description 1 Processed as primary 2 Processed as secondary 3 Processed as tertiary 4 Denied Processed as primary, forwarded to 19 additional Processed as secondary, forwarded to 20 additional payer(s) Processed as tertiary, forwarded to 21 additional payer(s) 22 Reversal of previous payment Not our claim, forwarded to additional 23 payer(s) Predetermination Pricing Only - no 25 payment External External Code Code Report the NDC Code as defined by the Drug Source 12 - National Drug PC 28 11/8/12 Source char[11] FDA in 11 digit format (5-4-2) without All 98% A0 Code National Drug Code (NDC) 12 - hyphenation. Codes Text External External Code Report the name of the drug that aligns to Code Name of the Drug Source 12 - the National Drug Code. Do not report PC 29 Source drug as All 95% B Name National Drug generic names with brand National Drug 12 - supplied Names Codes. Text New Report the status of prescription by Prescription PC 30 6/24/10 Numeric ID Count char[2] numeric value. EXAMPLE: 00 = new All 99% A0 Status Indicator or Refill prescription; First Refill = 01, etc. Generic Lookup Report the value that defines the element. Generic Drug PC 31 Drug 11/8/12 - tlkpFlagIndicators int[1] EXAMPLE: 1 = Yes, the drug reported is All 100% A2 Indicator Indicator Integer a generic. Value Description
PC 26 Pharmacy Country Code 12/1/10 External Code Source 1 - Text Address Country External Code Source 1 - Countries char[3] Country Code of the Pharmacy Report the three-character country code as defined by ISO 3166-1, Alpha 3. All 90% B PC 27 Claim Status 11/8/12 Lookup - Numeric tlkpClaimStatus varchar[2] Claim Line Status Report the value that defines the payment status of this claim line All 98% A0 Value Description 1 Processed as primary 2 Processed as secondary 3 Processed as tertiary 4 Denied 19 Processed as primary, forwarded to additional 20 Processed as secondary, forwarded to additional payer(s) 21 Processed as tertiary, forwarded to additional payer(s) 22 Reversal of previous payment 23 Not our claim, forwarded to additional payer(s) 25 Predetermination Pricing Only - no payment PC 28 Drug Code 11/8/12 External Code Source 12 - Text External Code Source 12 - National Drug Codes char[11] National Drug Code (NDC) Report the NDC Code as defined by the FDA in 11 digit format (5-4-2) without hyphenation. All 98% A0 PC 29 Drug Name External Code Source 12 - Text External Code Source 12 - National Drug Names Name of the drug as supplied Report the name of the drug that aligns to the National Drug Code. Do not report generic names with brand National Drug Codes. All 95% B PC 30 New or Refill 6/24/10 Numeric ID Count char[2] Prescription Status Indicator Report the status of prescription by numeric value. EXAMPLE: 00 = new prescription; First Refill = 01, etc. All 99% A0 PC 31 Generic Drug Indicator 11/8/12 Lookup - Integer tlkpFlagIndicators int[1] Generic Drug Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, the drug reported is a generic. All 100% A2 Value Description
v6-apcd-pharmacy-claim-file-submission-guide-FINAL.docx