External Pharmacy Address Code State of the Report the state where the dispensing PC 24 Location 11/8/12 External Code char[2] All 90% B Source Pharmacy pharmacy is located. State Source 2 - States 2 - Text External Address Zip Report the 5 or 9 digit Zip Code as Pharmacy Code External Code Zip code of the defined by the United States Postal PC 25 11/8/12 varchar[9] All 90% B ZIP Code Source Source 2 - Zip Pharmacy Service. When submitting the 9-digit Zip 2 - Text Codes Code do not include hyphen. External Address Country Pharmacy Code External Code Country Code of Report the country code as PC 26 Country 12/1/10 char[3] All 90% B Source Source 1 - the Pharmacy 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 Table - 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 payer(s) 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 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 format (5-4-2) without All 98% A0 Code National Drug Code (NDC) 12 - hyphenation Codes Text
PC 24 Pharmacy Location State 11/8/12 External Code Source 2 - Text Address External Code Source 2 - States char[2] State of the Pharmacy Report the state where the dispensing pharmacy is located. All 90% B PC 25 Pharmacy ZIP Code 11/8/12 External Code Source 2 - Text Address Zip External Code Source 2 - Zip Codes varchar[9] Zip code of the Pharmacy Report the 5 or 9 digit Zip Code as defined by the United States Postal Service. When submitting the 9-digit Zip Code do not include hyphen. All 90% B 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 country code as defined by ISO 3166-1, Alpha 3 All 90% B PC 27 Claim Status 11/8/12 Lookup Table - 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 payer(s) 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 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 format (5-4-2) without hyphenation All 98% A0
v5-apcd-pharmacy-claim-file-submission-guide-FINAL.docx