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pdfFIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
1
RECORD ID
1-3
X(3)
3
PDFS
"HDR"
2
SUBMITTER ID
4-9
X(6)
6
CMS
Unique ID assigned by CMS.
3
FILE ID
10 - 19
X(10)
10
PDFS
4
TRANS DATE
20 - 27
9(8)
8
PDFS
Unique ID provided by Submitter.
Same ID cannot be used within 12
months.
Date of file transmission to PDFS.
5
PROD TEST CERT IND
28 - 31
X(4)
4
PDFS
PROD, TEST, or CERT
6
FILLER
32 - 512
X(481)
481
N/A
SPACES
FIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
1
RECORD ID
1-3
X(3)
3
PDFS
"BHD"
2
SEQUENCE NO
4 - 10
9(7)
7
PDFS
Must start with 0000001
3
4
5
CONTRACT NO
PBP ID
FILLER
11 - 15
16 - 18
19 - 512
X(5)
X(3)
X(494)
5
3
494
CMS
CMS
N/A
Assigned by CMS
Assigned by CMS
SPACES
FIELD NO.
FIELD NAME
POSITION
PICTURE
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
1-3
4 - 10
11 - 50
51 - 70
X(3)
9(7)
X(40)
X(20)
3
7
40
20
PDFS
PDFS
CMS
CMS
302-C2
304-C4
71 - 90
91 - 98
X(20)
9(8)
20
8
NCPDP
NCPDP
305-C5
99 - 99
9(1)
1
NCPDP
"DET"
Must start with 0000001
Optional Field
Medicare Health Insurance Claim Number (HICN) or Railroad
Retirement Board (RRB) number or Medicare Beneficiary
Identifier (MBI).
Plan identification of the enrollee. Assigned by plan.
CCYYMMDD
Optional Field
1=M
2=F
DATE OF SERVICE (DOS)
PAID DATE
401-D1
100 - 107
108 - 115
9(8)
9(8)
8
8
NCPDP
CMS
10
PRESCRIPTION SERVICE
REFERENCE NO
402-D2
116 - 127
9(12)
12
NCPDP
11
12
FILLER
PRODUCT SERVICE ID
128 - 129
130 - 148
X(2)
X(19)
2
19
N/A
NCPDP
1
2
3
4
RECORD ID
SEQUENCE NO
CLAIM CONTROL NUMBER
Medicare beneficiary
identifier
5
6
7
CARDHOLDER ID
PATIENT DATE OF BIRTH
(DOB)
PATIENT GENDER CODE
8
9
NCPDP FIELD
407-D7 or 489TE
LENGTH
Unspecified or unknown values are not accepted
CCYYMMDD
CCYYMMDD. The date the plan paid the pharmacy for the
prescription drug. Mandatory for Fallback plans. Optional for
all other plans.
The field length of 12 was implemented in DDPS on January 1,
2011 for the NCPDP D.0 standard in 2012 . Field is right
justified and filled with 5 leading zeroes. Applies to all PDEs
submitted January 1, 2011 and after.
SPACES
Submit 11 digit NDC only. Fill the first 11 positions, no spaces
or hyphens, followed by 8 spaces. Format is
MMMMMDDDDPP. DDPS will reject the following billing
codes for compounded legend and/or scheduled drugs:
99999999999, 99999999992, 99999999993, 99999999994,
99999999995, and 99999999996
FIELD NO.
13
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
SERVICE PROVIDER ID
QUALIFIER
202-B2
149 - 150
X(2)
LENGTH
2
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
NCPDP
The type of pharmacy provider identifier used in field 14.
01 = National Provider Identifier (NPI)
06 = UPIN
07 = NCPDP Provider ID
08 = State License
11 = Federal Tax Number
99 = Other (Reported Gap Discount must = 0)
Mandatory for standard format. For standard format, valid
values are 01 - NPI or 07 - NCPDP Provider ID.
For non-standard format any of the above values are
acceptable.
14
SERVICE PROVIDER ID
201-B1
151 - 165
X(15)
15
NCPDP
When Plans report Service Provider ID Qualifier = “99” Other, populate Service Provider ID with the default value
“PAPERCLAIM” defined for TrOOP Facilitation Contract.
When Plans report Federal Tax Number (TIN), use the
following format: ex: 999999999 (do not report embedded
dashes).
15
16
FILL NUMBER
DISPENSING STATUS
403-D3
343-HD
166 - 167
168 - 168
9(2)
X(1)
2
1
NCPDP
NCPDP
Values = 0 - 99.
On PDEs with DOS on or after January 1, 2011, must be blank.
On PDEs with DOS prior to January 1, 2011, valid values are:
Blank = Not Specified
P = Partial Fill
C = Completion of Partial Fill
17
COMPOUND CODE
406-D6
169 - 169
9(1)
1
NCPDP
0=Not specified
1=Not a Compound
2=Compound
FIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
18
DISPENSE AS WRITTEN (DAW) 408-D8
PRODUCT SELECTION CODE
170 - 170
X(1)
1
NCPDP
0=No Product Selection Indicated
1=Substitution Not Allowed by Prescriber
2=Substitution Allowed - Patient Requested Product
Dispensed
3=Substitution Allowed - Pharmacist Selected Product
Dispensed
4=Substitution Allowed - Generic Drug Not in Stock
5=Substitution Allowed - Brand Drug Dispensed as Generic
6=Override
7=Substitution Not Allowed - Brand Drug Mandated by Law
8=Substitution Allowed Generic Drug Not Available in
Marketplace
9=Other
19
QUANTITY DISPENSED
442-E7
171 - 180
9(7)V999
10
NCPDP
20
21
22
FILLER
DAYS SUPPLY
PRESCRIBER ID QUALIFIER
405-D5
466-EZ
181 - 182
183 - 185
186 - 187
X(2)
9(3)
X(2)
2
3
2
N/A
NCPDP
NCPDP
Number of Units, Grams, Milliliters, other. If compounded
item, total of all ingredients will be supplied as Quantity
Dispensed.
SPACES
0 – 999
The type of prescriber identifier used in field 23.
Prior to January 1, 2013:
01 = National Provider Identifier (NPI)
06 = UPIN
08 = State License Number
12 = Drug Enforcement Administration (DEA) number
Mandatory for standard format.
Mandatory for Non-Standard Format with DOS => 1/1/2012
For DOS <1/1/2012, Optional when Non-Standard Format
Code = "B", "C", "P", or "X" but must be valid value if present.
As of January 1, 2013, 01 = NPI is mandatory for all formats
23
PRESCRIBER ID
411-DB
188 - 202
X(15)
15
NCPDP
Mandatory
FIELD NO.
24
FIELD NAME
NCPDP FIELD
DRUG COVERAGE STATUS
CODE
POSITION
PICTURE
203 - 203
X(1)
LENGTH
1
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
CMS
Coverage status of the drug under Part D and/or the PBP.
C = Covered
E = Supplemental drugs (reported by Enhanced Alternative
plans only)
O = Over-the-counter drugs
25
ADJUSTMENT DELETION
CODE
204 - 204
X(1)
1
CMS
26
NON- STANDARD FORMAT
CODE
205 - 205
X(1)
1
CMS
27
PRICING EXCEPTION CODE
206 - 206
X(1)
1
CMS
28
CATASTROPHIC COVERAGE
CODE
207 - 207
X(1)
1
CMS
A = Adjustment
D = Deletion
Blank = Original PDE
Format of claims originating in a non-standard format.
B = Beneficiary submitted claim
C = COB claim
P = Paper claim from provider
X = X12 837
Blank = NCPDP electronic format
M= Medicare as Secondary Payer
O = Out-of-network pharmacy (Medicare is Primary)
Blank = In-network pharmacy (Medicare is Primary)
Optional for PDEs with DOS January 1, 2011 and forward.
Mandatory on PDEs with DOS prior to January 1, 2011. Valid
values are:
A = Attachment Point met on this event
C = Above Attachment Point
Blank = Attachment Point not met
29
INGREDIENT COST PAID
506-F6
208 - 215
S9(6)V99
8
NCPDP
Amount the pharmacy is paid for the drug itself. Dispensing
fees or other costs are not included in this amount.
30
DISPENSING FEE PAID
507-F7
216 - 223
S9(6)V99
8
NCPDP
Amount the pharmacy is paid for dispensing the medication.
The fee may be negotiated with pharmacies at the plan or
PBM level. Additional fees may be charged for
compounding/mixing multiple drugs. Do not include
administrative fees. Vaccine Administration Fee reported in
Field 41.
FIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
31
TOTAL AMOUNT ATTRIBUTED
TO SALES TAX
224 - 231
S9(6)V99
8
CMS
Depending on jurisdiction, sales tax may be calculated in
different ways or distributed in multiple NCPDP fields. Plans
will report the total sales tax for the PDE regardless of how
the tax is calculated or reported at point-of-sale.
32
GROSS DRUG COST BELOW
OUT- OF-POCKET THRESHOLD
(GDCB)
232 - 239
S9(6)V99
8
CMS
Reports covered drug cost at or below the out of pocket
threshold. Any remaining portion of covered drug cost is
reported in GDCA. Covered drug cost is the sum of Ingredient
Cost Paid + Dispensing Fee Paid + Total Amount Attributed to
Sales Tax + Vaccine Administration Fee.
For DOS prior to January 1, 2011, when the Catastrophic
Coverage Code = blank, this field equals the sum of Ingredient
Cost Paid + Dispensing Fee Paid + Total Amount Attributed to
Sales Tax + Vaccine Administration Fee. When the
Catastrophic Coverage Code = 'A', this field equals the portion
of Ingredient Cost Paid + Dispensing Fee Paid + Total Amount
Attributed to Sales Tax + Vaccine Administration Fee falling at
or below the OOP threshold. Any remaining portion is
reported in GDCA. This amount increments the Total Gross
Covered Drug Cost Accumulator amount.
FIELD NO.
33
FIELD NAME
NCPDP FIELD
GROSS DRUG COST ABOVE
OUT-OF-POCKET THRESHOLD
(GDCA)
POSITION
PICTURE
LENGTH
240 - 247
S9(6)V99
8
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
CMS
Reports covered drug cost above the out of pocket threshold.
Any remaining portion of covered drug cost is reported in
GDCB. Covered drug cost is the sum of Ingredient Cost Paid +
Dispensing Fee Paid + Total Amount Attributed to Sales Tax +
Vaccine Administration Fee.
For DOS prior to January 1, 2011, when the Catastrophic
Coverage Code = 'C', this field equals the sum of Ingredient
Cost Paid + Dispensing Fee Paid + Total Amount Attributed to
Sales Tax + Vaccine Administration Fee above the OOP
threshold. When the Catastrophic Coverage Code = 'A', this
field equals the portion of Ingredient Cost Paid + Dispensing
Fee Paid + Total Amount Attributed to Sales Tax + Vaccine
Administration Fee falling above the OOP threshold. Any
remaining portion is reported in GDCB. This amount
increments the Total Gross Covered Drug Cost Accumulator
amount.
34
PATIENT PAY AMOUNT
35
505-F5
248 - 255
S9(6)V99
8
NCPDP
OTHER TROOP AMOUNT
256 - 263
S9(6)V99
8
CMS
36
LOW INCOME COST SHARING
SUBSIDYAMOUNT (LICS)
264 - 271
S9(6)V99
8
CMS
37
PATIENT LIABILITY
REDUCTION DUE TO OTHER
PAYER AMOUNT (PLRO)
272 - 279
S9(6)V99
8
CMS
Payments made by the beneficiary or by family or friends at
point of sale. This amount increments the True Out-of-Pocket
Accumulator amount.
Other health insurance payments by TrOOP-eligible other
payers (e.g. SPAPs). This field records all third party payments
that contribute to a beneficiary's TrOOP except LICS, Patient
Pay Amount, and Reported Gap Discount. This amount
increments the True Out-of-Pocket Accumulator amount.
Amount the plan advanced at point-of-sale due to a
beneficiary's LI status. This amount increments the True Outof-Pocket Accumulator amount.
Amounts by which patient liability is reduced due to payment
by other payers that are not TrOOP-eligible and do not
participate in Part D. Examples of non-TrOOP-eligible payers:
group health plans, governmental programs (e.g. VA,
TRICARE), Workers' Compensation, Auto/No-Fault/Liability
Insurances.
FIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
38
COVERED D PLAN PAID
AMOUNT (CPP)
280 - 287
S9(6)V99
8
CMS
The net Medicare covered amount which the plan has paid for
a Part D covered drug under the Basic benefit. Amounts paid
for supplemental drugs, supplemental cost-sharing and Overthe-Counter drugs are excluded from this field.
39
NON COVERED PLAN PAID
AMOUNT (NPP)
288 - 295
S9(6)V99
8
CMS
The amount of plan payment for enhanced alternative
benefits (cost sharing fill-in and/or non-Part D drugs). This
dollar amount is excluded from risk corridor calculations.
40
ESTIMATED REBATE AT POS
296 - 303
S9(6)V99
8
CMS
The estimated amount of rebate that the plan sponsor has
elected to apply to the negotiated price as a reduction in the
drug price made available to the beneficiary at the point of
sale. This estimate should reflect the rebate amount that the
plan sponsor reasonably expects to receive from a
pharmaceutical manufacturer or other entity.
41
VACCINE ADMINISTRATION
FEE
304 - 311
S9(6)V99
8
CMS
42
PRESCRIPTION ORIGIN CODE
312 - 312
X(1)
1
NCPDP
The amount reported by a pharmacy, physician, or provider to
cover the cost of administering a vaccine, excluding the
ingredient cost and dispensing fee.
Required on PDEs with DOS January 1, 2010 and forward.
419-DJ
Valid values are:
“1” = Written
“2” = Telephone
“3” = Electronic
“4” = Facsimile
"5" = Pharmacy
On PDEs with DOS prior to January 1, 2010, “0” = Not
Specified and blank are also allowed.
43
DATE ORIGINAL CLAIM
RECEIVED
313 - 320
9(8)
8
CMS
Date sponsor received original claim. Required on PDEs with
DOS January 1, 2011 and forward. On PDEs with DOS prior to
January 1, 2011, must be blank or zeros. Required for all LI
NET PDEs submitted January 1, 2011 and after, regardless of
DOS.
FIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
Date and time sponsor began adjudicating the claim in
Greenwich Mean Time. Required on PDEs with DOS January
1, 2011 and forward. On PDEs with DOS prior to January 1,
2011, must be blank or zeros.
Sum of beneficiary's covered drug costs for the benefit year
known immediately prior to adjudicating the claim. Required
on PDEs with DOS January 1, 2011 and forward. On PDEs with
DOS prior to January 1, 2011, must be blank or zeros.
44
CLAIM ADJUDICATION BEGAN
TIMESTAMP
321 - 346
X(26)
26
CMS
45
TOTAL GROSS COVERED
DRUG COST ACCUMULATOR
347 - 355
S9(7)V99
9
CMS
46
TRUE OUT-OF-POCKET
ACCUMULATOR
356 - 363
S9(6)V99
8
CMS
47
BRAND/GENERIC CODE
364 - 364
X(1)
1
CMS
Sum of beneficiary's incurred costs (Patient Pay Amount, LICS,
Other TrOOP Amount, Reported Gap Discount) for the benefit
year known immediately prior to adjudicating the claim.
Required on PDEs with DOS January 1, 2011 and forward. On
PDEs with DOS prior to January 1, 2011, must be blank or
zeros.
Plan reported value indicating whether the plan adjudicated
the claim as a brand or generic drug.
B - Brand
G - Generic
48
BEGINNING BENEFIT PHASE
365 - 365
X(1)
1
CMS
Required on PDEs with DOS January 1, 2011 and forward. On
PDEs with DOS prior to January 1, 2011, must be blank.
Applies to covered drugs only.
Plan-defined benefit phase in effect immediately prior to the
time the sponsor began adjudicating the individual claim being
reported.
D - Deductible
N - Initial Coverage Period
G - Coverage Gap
C - Catastrophic
Required on PDEs with DOS January 1, 2011 and forward. On
PDEs with DOS prior to January 1, 2011, must be blank.
Applies to covered drugs only.
FIELD NO.
49
FIELD NAME
ENDING BENEFIT PHASE
NCPDP FIELD
POSITION
366 - 366
PICTURE
X(1)
LENGTH
1
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
CMS
Plan-defined benefit phase in effect upon the sponsor
completing adjudication of the individual claim being
reported.
D - Deductible
N - Initial Coverage Period
G - Coverage Gap
C - Catastrophic
50
REPORTED GAP DISCOUNT
367 - 374
S9(6)V99
8
CMS
Required on PDEs with DOS January 1, 2011 and forward. On
PDEs with DOS prior to January 1, 2011, must be blank.
Applies to covered drugs only.
The reported amount that sponsor advanced at point of sale
for the Gap Discount for applicable drugs.
Required on PDEs with DOS January 1, 2011 and forward.
On PDEs with DOS prior to January 1, 2011 must be blank or
zeros. This amount increments the True Out-of-Pocket
Accumulator amount.
51
TIER
375 - 375
X(1)
1
CMS
Formulary tier in which the sponsor adjudicated the claim.
Values = 1-6 or space.
Required on PDEs with DOS January 1, 2011 and forward.
On PDEs with DOS prior to January 1, 2011, must be blank.
Applies to covered drugs only.
FIELD NO.
52
FIELD NAME
FORMULARY CODE
NCPDP FIELD
POSITION
376 - 376
PICTURE
X(1)
LENGTH
1
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
CMS
Indicates if the drug is on the plan's formulary.
F - Formulary
N - Non-Formulary
Required on PDEs with DOS January 1, 2011 and forward.
On PDEs with DOS prior to January 1, 2011, must be blank.
Applies to covered drugs only.
53
OAP Indicator
377 - 377
X(1)
1
CMS
This is a placeholder field related to Prescriber ID editing. Field
should be blank until further notice.
Note: This replaced Gap Discount Plan Override Code on
5/15/2016.
54
Pharmacy Service Type
378 - 379
X(2)
2
CMS
Required on PDEs with DOS February 28, 2013 and forward.
Valid values are:
01 – Community/Retail Pharmacy Services
02 – Compounding Pharmacy Services
03 – Home Infusion Therapy Provider Services
04 – Institutional Pharmacy Services
05 – Long Term Care Pharmacy Services
06 – Mail Order Pharmacy Services
07 – Managed Care Organization Pharmacy Services
08 – Specialty Care Pharmacy Services
99 - Other
For DOS on or before February 27, 2013, can be spaces or any
of the valid values listed above.
For COB PDEs, can be spaces or any of the valid values listed
above.
FIELD NO.
55
FIELD NAME
Patient Residence
NCPDP FIELD
POSITION
PICTURE
380 - 381
X(2)
LENGTH
2
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
CMS
Required on PDEs with DOS February 28, 2013 and forward.
Valid values are:
00 – Not specified, other patient residence not identified
below
01 – Home
03 – Nursing Facility
04 – Assisted Living Facility
06 – Group Home
09 – Intermediate Care Facility/Mentally Retarded
11 – Hospice
For DOS on or before February 27, 2013, can be spaces or any
of the valid values listed above.
For COB PDEs, can be spaces or any of the valid values listed
above.
FIELD NO.
56
FIELD NAME
Submission Clarification Code
NCPDP FIELD
POSITION
PICTURE
382 - 383
X(2)
LENGTH
2
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
CMS
For PDEs with DOS February 28, 2013 and forward IF Patient
Residence is "03", valid values are:
Spaces
16 – Long Term Care (LTC) emergency box or automated
dispensing machine
21 – LTC dispensing, 14 days or less not applicable
22 – LTC dispensing, 7 day supply
23 – LTC dispensing, 4 day supply
24 – LTC dispensing, 3 day supply
25 – LTC dispensing, 2 day supply
26 – LTC dispensing, 1 day supply
27 – LTC dispensing, 4 day, then 3 day supply
28 – LTC dispensing, 2 day, then 2 day, then 3 day supply
29 – LTC dispensing, daily during the week then multiple days
for weekend
30 – LTC dispensing, per shift
31 – LTC dispensing, per med pass
32 – LTC dispensing, PRN on demand
33 – LTC dispensing, other 7 day or less cycle
34 – LTC dispensing, 14 day supply
35 – LTC dispensing, other 8-14 day dispensing not listed
above
36 – LTC dispensing, outside short cycle, determined to be
Medicare Part D after originally submitted to another payer
For all other cases, field must be spaces .
57
Adjustment Reason Code
Qualifier
384 - 384
X(1)
1
CMS
The type of Adjustment Reason Code used in field 58:
2 - CMS Audit
3 - CMS Identified Overpayment (CIO)
4 - CGDP Dispute or Appeal
9 - Other
BLANK - Not Applicable
The Adjustment Reason Code Qualifier of ‘1’ has been
removed from the list of valid values for PDEs for all dates of
service submitted on or after 11/13/2016.
FIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
58
Adjustment Reason Code
385 - 396
X(12)
12
CMS
This code will assist CMS to track the reason for an adjustment
or deletion. Accepted values are dependent upon the
qualifier submitted in field 57
Where qualifier... Accepted value is:
*
2
'OFM', 'RAC', or 'MEDIC'
3
‘CIO’ *
4
‘DISPUTE’ or 'APPEAL' *
9
For future use at CMS' direction
BLANK
BLANK
59
Type of Fill Code
397 - 397
X(1)
1
CMS
60
FILLER
398 - 512
X(115)
115
CMS
This is a placeholder field related to Prescriber ID editing. Field
should be blank until further notice.
SPACES
Notes:
For any field that references NCPDP values, please refer to the appropriate NCPDP specification to ensure compliance.
All dollar fields are mandatory. If the field is not applicable, report a default value of zeroes. Since the field is a signed field, plans must utilize the appropriate overpunch signs as specified in the NCPDP Telecommunications
Standard, Version 5.1.
FIELD NO.
FIELD NAME
NCPDP FIELD
POSITION
PICTURE
1
2
RECORD ID
SEQUENCE NO
1-3
4 - 10
X(3)
9(7)
3
4
5
6
CONTRACT NO
PBP ID
DET RECORD TOTAL
FILLER
11 - 15
16 - 18
19 - 25
26 -512
X(5)
X(3)
9(7)
X(487)
LENGTH
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
3
7
PDFS
PDFS
5
3
7
487
CMS
CMS
CMS
CMS
"BTR"
Must match BHD. Must start with
0000001.
Must match BHD
Must match BHD
Total count of DET records
SPACES
FIELD NO.
1
2
3
4
5
6
FIELD NAME
RECORD ID
SUBMITTER ID
FILE ID
TLR BHD RECORD TOTAL
TLR DET RECORD TOTAL
FILLER
NCPDP FIELD
POSITION
PICTURE
1-3
4-9
10 - 19
20 - 28
29 - 37
38 -512
X(3)
X(6)
X(10)
9(9)
9(9)
X(475)
LENGTH
3
6
10
9
9
475
NCPDP, CMS OR PDFS DEFINED
DEFINITION / VALUES
PDFS
CMS
PDFS
CMS
CMS
CMS
"TLR"
Must match HDR
Must match HDR
Total count of BHD records
Total count of DET records
SPACES
Note:
Maximum number of detail records per file is 3 million records. If one file contains multiple batches, maximum record count applies to the cumulative
total across all batches.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0938-0982. The time required to complete this information collection
is estimated to average two (2) hours per one million (1,000,000) transactions or 0.0074 seconds per response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the
accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance
Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
| File Type | application/pdf |
| File Title | PDE Inbound File Layout |
| Subject | PDE |
| Author | CMS - GDIT |
| File Modified | 2021-06-15 |
| File Created | 2021-06-14 |