| Table 2: SDMCD Claim Payable Response Format | ||
| From Current Claim | NCPDP Claim Payable Response Output Format | NCPDP Field Number |
| Constant value ‘32' or ‘3C’ | VERSION NUMBER | 102 |
| The NCPDP trans code submitted for the claim being processed | TRANS CODE | 103 |
| Constant value ‘A’ | HEADER STATUS | 501 |
| Constant value spaces | PLAN IDENTIFICATION | 524 |
| Constant value ‘P’ | RESPONSE STATUS | 501 |
| SDMCD amount to be paid by recipient (copay) | PATIENT PAY AMOUNT | 505 |
| Drug MAC price or Drug EAC price |
INGREDIENT COST PAID | 506 |
| Professional/dispensing fee | CONTRACT FEE PAID | 507 |
| Constant value zero | PAID SALES TAX | 508 |
| SDMCD reimbursement amount | TOTAL PAID AMOUNT Note: The amount paid may be reconciled as: The sum of: Ingredient Cost Paid (506) Contract Fee Paid (Dispensing Fee) (507) Sales Tax Paid $0 (508) Less: Other payor amount (from incoming record) Equals the sum of: Patient Pay Amount (505) Total Amount Paid (509) |
509 |
| SDMCD Reference Number for paid claim | PAID AUTHORIZATION NUMBER | 503 |
| Constant value ‘PAID’ | PAID MESSAGE | 504 |
| DUR messages pertaining to the claim | PAID DUR RESPONSE | 525 |