Table 5: SDMCD Duplicate Claim Response Format
FROM CURRENT CLAIM NCPDP DUPLICATE REJECT
Constant value ‘D’ NCPDP DUPLICATE REJECT
Constant value zero DEDUCTIBLE, FIELD 505

INGR-COST-PD, FIELD 506

DISPENSING FEE, FIELD 507

SALES TAX, FIELD 508

Constant value ‘ORIGINAL CLAIM PAID’, SDMCD Reference Number, and date paid from the previously paid claim. MESSAGE FIELD, 504
SDMCD Reference Number for the current rejected claim. AUTHORIZATION NUMBER, FIELD 503
Reimbursement amount from previously paid claim TOTAL AMOUNT PAID, FIELD 509
SDMCD amount to be paid by recipient (copayment) from the previously paid claim MESSAGE FIELD, 504

Return to Format Table Requirements