Table 3: SDMCD Claim Captured Format
FROM CURRENT CLAIM NCPDP CLAIM ACCEPTED REVERSAL OUTPUT

NCPDP FIELD NUMBER

Constant value ‘32' or ‘3C’ VERSION NUMBER

102

The NCPDP TRANS CODE submitted for the claim being captured. TRANS CODE

103

Constant value ‘A’ HEADER STATUS

501

Constant value zero PLAN IDENTIFICATION

524

Constant value ‘C’ RESPONSE STATUS

501

SDMCD Reference Number for the captured claim AUTHORIZATION NUMBER

503

A SDMCD specific message, if assigned to the condition, or a constant value ‘CLAIM NOT PROCESSED’. MESSAGE

504

Constant value ‘ / CAPTURED FOR REVIEW’ MESSAGE

504

Constant value zero AMT OF COPAY

518

DUR messages pertaining to the claim (See Table 9) DUR RESPONSE DATA

525

Constant value spaces ADDITIONAL MESSAGE INFO

526

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