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

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