NCPDP Module FAQ

The NCPDP module supports the NCPDP Telecommunication and Batch Standards for pharmacy claims and the NCPDP SCRIPT Standard for e-prescribing, for the versions listed below. It is an add-on module for the Redix AnyToAny Format Converter Engine.

• NCPDP Telecommunication Standard — Version 5.1 and D.0 (pharmacy claims)
• NCPDP Batch Standard — Version 1.1 (batch pharmacy claims)
• NCPDP SCRIPT Standard — Versions 5.0, 8.1, and 10.6 (e-prescribing)
• NCPDP Prescription Transfer Standard — Versions 1.0 and 2.0

These are the definitions listed for the module. Telecommunication 5.1, Batch 1.1, and the SCRIPT versions listed are legacy versions, not a claim of current coverage. Medicare Part D e-prescribing is moving from SCRIPT 2017071 to 2023011, which is required from January 1, 2028, and the current pharmacy claim standard pairs Telecommunication D.0 with Batch 1.2. Ask Redix to confirm the exact version and transaction coverage for your project.

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

Two predefined maps are included, for the legacy NCPDP Telecommunication Version 5.1:

• 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. A CSV file that follows this layout is the supported input for the map. Validate the resulting B1 transaction and confirm the receiving processor's requirements before production use. These maps produce Version 5.1, not D.0; D.0 coverage is confirmed per project.

The positions below are positions in the Redix CSV input layout for the 5.1 B1 maps, not NCPDP field numbers. Confirm the field list with Redix before you build to it. 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)

In this CSV layout, each field is marked Mandatory (M) or Optional (O), with data type AN (alphanumeric) and variable length (0-256). These are rules for the CSV input, not NCPDP field formats.

The module's standards cover three types of pharmacy transactions:

• Pharmacy billing claims (B1 transactions) — via the Telecommunication standard
• Batch claim submissions — via the Batch standard
• Electronic prescribing messages — via the SCRIPT standard, which carries prescriptions between prescribers and pharmacies and is not a claims format

Coverage follows the versions listed above; the predefined maps cover Version 5.1 B1 claims only. All processing uses the AnyToAny Engine's ONE-PASS architecture.

Prepare a single-record CSV file in the 126-field Redix layout for the 5.1 B1 map. Keep every position, leaving unused fields empty, so later fields do not shift. The following fields are mandatory in this CSV layout:

• 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 in the CSV layout. Each field is alphanumeric (AN) with a maximum length of 256 characters. The receiving processor's requirements, including situational fields, still apply, so validate the generated B1 transaction with your trading partner. Changing the Version Number field does not make the 5.1 map produce a D.0 transaction.