TIBCO Foresight® HIPAA Validator® Desktop Standards and Guidelines Reference
Manual
52 | Appendix B: NCPDP Standards
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P3 – Prior Authorization Inquiry
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P4 – Prior Authorization Request Only
Request or Response
Each transaction can be either a:
Transaction
The originating request.
Response
Acknowledgement of a request. Responses are prefaced with the letter R in
EDISIM. For example, the response to a B1 is an RB1.
Parts of a Batch
A batch contains these parts:
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One 00 Transmission header segment with ISA-type information.
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One or more G1 detail records, each containing one to four “transactions” such as
claims.
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One 99 trailer containing a control number and segment count.
Codes
NCPDP doesn’t have actual code sets but the standard specifies allowed values. These are
implemented as code sets in TIBCO Foresight products.
Elements
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The first value in a segment is AM followed by the segment tag.
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Other elements can be in any order, except mandatory elements come before
optional elements.
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Each element in the transaction sections of the batch (in the claim itself, for example)
starts with the Field Separator character (x1C). Elements in header segments have no