NCPDP Module FAQ.

Q: What is the Redix NCPDP module?

The NCPDP module supports NCPDP Telecommunication, Script, and Batch Standards for pharmacy claims processing.

Q: What standards and versions does the NCPDP module support?

NCPDP Telecommunication Standard (Version 5.1 and D0), NCPDP Batch Standard (Version 1.1), and NCPDP Script Standard (Version 5.0).

Q: Can the NCPDP module be licensed alone?

No, the NCPDP module is an add-on module for the Redix AnyToAny Format Converter Engine. Users must also license the engine.

Q: What predefined maps are included with the NCPDP module?

Two predefined maps: CSV_to_NCPDP_51_B1 converts a Redix-defined CSV file to an NCPDP Version 5.1 Billing Request (B1) transaction, and NCPDP_51_B1_to_CSV converts in reverse. The CSV file contains one record with 126 fields covering the most commonly used data elements in the pharmaceutical industry.

Q: What fields are covered in the predefined NCPDP CSV format?

The 126-field CSV covers: Payer information, Patient demographics, Insurance/insured details, Clinical data, Prescription details, Financial data, Pharmacy information, and NCPDP-specific fields. Fields are marked as Mandatory (M) or Optional (O).

Q: What types of pharmacy transactions can the NCPDP module process?

The module handles pharmacy billing claims (B1 transactions) via the Telecommunication standard, batch claim submissions via the Batch standard, and electronic prescribing workflows via the Script standard. All processing uses the AnyToAny Engine's ONE-PASS architecture.

Q: How do I prepare data for the NCPDP predefined maps?

Prepare a single-record CSV file with up to 126 fields. Mandatory fields include: Insured Policy Number (pos. 9), Service Branch NABP Number (pos. 62), Service Start Date (pos. 77), Rx Number (pos. 87), BIN Number (pos. 94), Version Number (pos. 95), Transaction Code (pos. 96), Processor Control Number (pos. 97), Transaction Count (pos. 98), Service Provider ID Qualifier (pos. 99), Software Vendor ID (pos. 100), PreService Ref Number Qualifier (pos. 103), and Product Service Id Qualifier (pos. 104).

Common questions about the Redix NCPDP module — pharmacy claims, Telecommunication, Batch, and SCRIPT standards, predefined maps, and CSV format.

What is the Redix NCPDP module?

The NCPDP module supports NCPDP Telecommunication, Script, and Batch Standards for pharmacy claims processing. It is an add-on module for the Redix AnyToAny Format Converter Engine.

What standards and versions does the NCPDP module support?

NCPDP Telecommunication Standard — Version 5.1 and D0
NCPDP Batch Standard — Version 1.1
NCPDP Script Standard — Version 5.0

Can the NCPDP module be licensed alone?

No. The NCPDP module is an add-on module for the Redix AnyToAny Format Converter Engine. Users must also license the engine.

What predefined maps are included with the NCPDP module?

Two predefined maps are included:

CSV_to_NCPDP_51_B1 — Converts a Redix-defined CSV file to an NCPDP Version 5.1 Billing Request (B1) transaction
NCPDP_51_B1_to_CSV — Converts an NCPDP Version 5.1 B1 transaction back to the Redix CSV format

The Redix CSV file contains one record with 126 fields, covering the most commonly used data elements in the pharmaceutical industry. As long as the user can prepare such a CSV file, the predefined map will convert it into an NCPDP B1 transaction.

What fields are covered in the predefined NCPDP CSV format?

The 126-field CSV covers the following categories of data:

Payer information — type, plan name, address, code (positions 1-8)
Patient demographics — name, DOB, sex, address, phone, marital status (positions 10-18, 25)
Insurance/insured details — policy number, group number, relationships, employer (positions 9, 13, 19-24, 28-41)
Clinical data — diagnoses, physician IDs, prior authorization (positions 26, 44-52)
Prescription details — Rx number, NDC, dates, doses, days supply, refills, compound ingredients (positions 86-93, 105-125)
Financial data — charges, amounts, dispensing fees, gross amount due (positions 57-60, 84-85, 93, 114-116)
Pharmacy information — NABP number, service branch, addresses (positions 61-76)
NCPDP-specific fields — BIN, transaction code, version number, processor control number, compound ingredients (positions 94-104, 126)

Each field is marked as Mandatory (M) or Optional (O), with data type AN (alphanumeric) and variable length (0-256).

What types of pharmacy transactions can the NCPDP module process?

The module handles three types of pharmacy transactions:

Pharmacy billing claims (B1 transactions) — via the Telecommunication standard
Batch claim submissions — via the Batch standard
Electronic prescribing workflows — via the Script standard

All processing uses the AnyToAny Engine's ONE-PASS architecture.

How do I prepare data for the NCPDP predefined maps?

Prepare a single-record CSV file with up to 126 fields. The following fields are mandatory:

Insured Policy Number (pos. 9)
Service Branch NABP Number (pos. 62)
Service Start Date (pos. 77)
Rx Number (pos. 87)
BIN Number (pos. 94)
Version Number (pos. 95)
Transaction Code (pos. 96)
Processor Control Number (pos. 97)
Transaction Count (pos. 98)
Service Provider ID Qualifier (pos. 99)
Software Vendor ID (pos. 100)
PreService Ref Number Qualifier (pos. 103)
Product Service ID Qualifier (pos. 104)

All remaining fields are optional. Each field is alphanumeric (AN) with a maximum length of 256 characters.

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NCPDP Module FAQ.

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