| 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 |