Collection of Drug Event Data from Contracted Part D Providers For Payments

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Overview

HDR
BHD
DET
BTR
TLR

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Sheet 1: HDR

FIELD NO.	FIELD NAME	POSITION	PICTURE	LENGTH	DEFINITION / VALUES
1	RECORD ID	1-3	X(3)	3	"HDR"
2	SUBMITTER ID	4-9	X(6)	6	Unique ID assigned by CMS.
3	FILE ID	10-19	X(10)	10	Unique ID provided by Submitter.
4	TRANS DATE	20-27	9(8)	8	Date of file transmission to PDFS.
5	PROD TEST CERT IND	28-31	X(4)	4	PROD, TEST, or CERT
6	DDPS SYSTEM DATE	32-39	9(8)	8	CCYYMMDD = DDPS file creation date
7	DDPS SYSTEM TIME	40-45	9(6)	6	HHMMSS = DDPS file creation time
8	DDPS REPORT ID	46-50	X(5)	5	DDPS report identifier (Always '01'). Field is right-padded with spaces.
9	FILLER	51-1000	X(950)	950	SPACES

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Sheet 2: BHD

FIELD NO.	FIELD NAME	POSITION	PICTURE	LENGTH	DEFINITION / VALUES
1	RECORD ID	1-3	X(3)	3	"BHD"
2	SEQUENCE NO	4-10	9(7)	7	Must start with 0000001
3	CONTRACT NO	11-15	X(5)	5	Contract Number from submitted batch
4	PBP ID	16-18	X(3)	3	Plan Benefit Package (PBP) ID from submitted batch
5	DDPS SYSTEM DATE	19-26	9(8)	8	CCYYMMDD = DDPS file creation date
6	DDPS SYSTEM TIME	27-32	9(6)	6	HHMMSS = DDPS file creation time
7	DDPS REPORT ID	33-37	X(5)	5	DDPS report identifier (Always '01'). Field is right-padded with spaces.
8	FILLER	38-1000	X(963)	963	SPACES

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Sheet 3: DET

FIELD NO.	FIELD NAME	POSITION	PICTURE	LENGTH	DEFINITION / VALUES
1	RECORD ID	1 - 3	X(3)	3	"ACC", "REJ", or "INF"
2	SEQUENCE NO	4 - 10	9(7)	7	Must start with 0000001
3	CLAIM CONTROL NUMBER	11 - 50	X(40)	40	A number assigned by the plan to identify the prescription drug event. This is an optional field. *non-numeric values should be left justified.
4	MEDICARE BENEFICIARY IDENTIFIER	51 - 70	X(20)	20	Medicare Health Insurance Claim Number (HICN) or Railroad Retirement Board (RRB) number or Medicare Beneficiary Identifier (MBI).
5	CARDHOLDER ID	71 - 90	X(20)	20	Plan identification of the enrollee. Assigned by plan. *non-numeric values should be left justified.
6	PATIENT DATE OF BIRTH (DOB)	91 - 98	9(8)	8	Optional field. If populated, the format is CCYYMMDD.
7	PATIENT GENDER CODE	99 - 99	9(1)	1	Valid values are: 1 = M 2 = F
8	DATE OF SERVICE (DOS)	100 - 107	9(8)	8	CCYYMMDD
9	PAID DATE	108 - 115	9(8)	8	The date the plan paid the pharmacy for the prescription drug. Mandatory for Fallback plans. Optional for all other plans. If populated, the format is CCYYMMDD.
10	PRESCRIPTION SERVICE REFERENCE NO	116 - 127	9(12)	12	Applies to all PDEs with a DOS >= 01/01/2011. Field is right justified and filled with 5 leading zeros.
11	PRODUCT SERVICE ID	128 - 167	X(40)	40	Submit 11 digit NDC only. Fill the first 11 positions, no spaces or hyphens, followed by 29 spaces. Format is MMMMMDDDDPP. DDPS will reject the following billing codes for compounded legend and/or scheduled drugs with a value of: 99999999999, 99999999992, 99999999993, 99999999994, 99999999995, or 99999999996.
12	FILLER	168 - 197	X(30)	30	SPACES
13	SERVICE PROVIDER ID QUALIFIER	198 - 199	X(2)	2	The type of pharmacy provider identifier used in field 14. Valid values are: 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 or 07. For non-standard format any of the above values are acceptable.
14	SERVICE PROVIDER ID	200 - 214	X(15)	15	When Plans report Service Provider ID Qualifier = 99, populate Service Provider ID with the default value PAPERCLAIM defined for the TrOOP Facilitation Contract. When Plans report Federal Tax Number (TIN), use the following format: ex: 999999999 (do not report embedded dashes). * non-numeric values should be left justified.
15	FILL NUMBER	215 - 216	9(2)	2	Valid values are: 0–99 If unavailable, use zero.
16	DISPENSING STATUS	217 - 217	X(1)	1	On PDEs with a DOS >= 01/01/2011, must be a SPACE. On PDEs with a DOS < 01/01/2011, valid values are: SPACE = Not Specified P = Partial Fill C = Completion of Partial Fill
17	COMPOUND CODE	218 - 218	9(1)	1	Valid values are: 0 = Not specified 1 = Not a Compound 2 = Compound
18	DISPENSE AS WRITTEN (DAW) PRODUCT SELECTION CODE	219 - 219	X(1)	1	Valid values are: 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	ORIGINALLY PRESCRIBED QUANTITY	220 - 229	9(7)V999	10	Required for PDEs with a DOS >= 01/01/2025. For Schedule II drugs that are reported as standard, electronically-submitted PDEs, this field must contain the originally prescribed quantity. Must be zero for DOS < 01/01/2025, or for non-Schedule II PDEs.
20	QUANTITY DISPENSED	230 - 239	9(7)V999	10	Number of Units, Grams, Milliliters, other. If compounded item, total of all ingredients will be supplied as Quantity Dispensed; report quantity in the unit form of the final state of the resulting compound.
21	FILLER	240 - 242	X(3)	3	SPACES
22	DAYS SUPPLY	243 - 245	9(3)	3	Valid values are: 0 - 999
23	PRESCRIBER ID QUALIFIER	246 - 247	X(2)	2	The type of prescriber identifier used in field 24. For PDEs with a DOS >= 01/01/2013, the value of 01 is mandatory for all formats. For PDEs with a DOS < 01/01/2013, valid values are: 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 for PDEs with a DOS >= 01/01/2012 For PDEs with a DOS < 01/01/2012, optional when the Non-Standard Format Code = B, C, P, or X, but must be a valid value if present.
24	PRESCRIBER ID	248 - 282	X(35)	35	Mandatory * non-numeric values should be left justified.
25	DRUG COVERAGE STATUS CODE	283 - 283	X(1)	1	Coverage status of the drug under Part D and/or the PBP. Valid values are: C = Covered E = Supplemental drugs (reported by Enhanced Alternative plans only) O = Over-the-counter drugs
26	ADJUSTMENT DELETION CODE	284 - 284	X(1)	1	Valid values are: A = Adjustment D = Deletion SPACE = Original PDE
27	NON- STANDARD FORMAT CODE	285 - 285	X(1)	1	Format of claims originating in a non-standard format. Valid values are: A = Medicaid subrogation claim B = Beneficiary submitted claim C = COB claim P = Paper claim from provider X = X12 837 SPACE = NCPDP electronic format
28	PRICING EXCEPTION CODE	286 - 286	X(1)	1	Valid Values are: M= Medicare as Secondary Payer O = Out-of-network pharmacy (Medicare is Primary) SPACE = In-network pharmacy (Medicare is Primary)
29	PART D MODEL INDICATOR	287 - 288	X(2)	2	Plan reported value indicating the Part D Model type applied to the PDE. Valid values are: 01 = Value-based Insurance Design (VBID) Model 07 = Part D Senior Savings (PDSS) Model SPACES = No Part D Model applied For PDSS model eligible PDEs submitted by Plans participating in the PDSS Model, this field is required to be populated with 07 on PDEs with a DOS >= 01/01/2022. For VBID model eligible PDEs submitted by Plans participating in a VBID Model, this field is required to be populated with 01 on PDEs with a DOS >= 01/01/2023. This field is optional for VBID eligible PDEs with a DOS < 01/01/2023. Applies to covered drugs only. For non-model PDEs submitted by Plans participating in a Part D Model, and for PDEs submitted by Plans that are not participating in a Part D Model, this field must contain SPACES.
30	FILLER	289 - 314	X(26)	26	SPACES
31	CATASTROPHIC COVERAGE CODE	315 - 315	X(1)	1	Optional for PDEs with a DOS >= 01/01/2011. Mandatory on PDEs with a DOS < 01/01/2011. Valid values are: A = Attachment Point met on this event C = Above Attachment Point SPACE = Attachment Point not met
32	INGREDIENT COST PAID	316 - 326	S9(9)V99	11	Amount the pharmacy is paid for the drug itself. Dispensing fees or other costs are not included in this amount.
33	DISPENSING FEE PAID	327 - 337	S9(9)V99	11	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 or Additional Dispensing Fee is reported in Field 37.
34	TOTAL AMOUNT ATTRIBUTED TO SALES TAX	338 - 348	S9(9)V99	11	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.
35	ESTIMATED REMUNERATION AT POS AMOUNT (ERPOSA)	349 - 359	S9(9)V99	11	For PDEs with a DOS >= 01/01/2025, this field contains the estimated amount of remuneration that are not pharmacy price concessions that the plan sponsor is required to apply, or 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 (POS). This estimate includes the rebate or other price concession amount that the plan sponsor expects to receive from a pharmaceutical manufacturer or other non-pharmacy entity and has elected to apply to the negotiated price. This estimate does not include pharmacy price concessions applied at the point of sale, which must be reported in the “Pharmacy Price Concessions at POS” field. For PDEs with a DOS >= 01/01/2024 and a DOS <= 12/31/2024, this estimate must reflect the maximum amount of any contingent payments or adjustments that the plan sponsor might receive from a network pharmacy that would serve to decrease the total amount that the plan sponsor pays for the drug, i.e., all pharmacy price concessions. This estimate must also reflect the rebate or other price concession amount that the plan sponsor expects to receive from a pharmaceutical manufacturer or other non-pharmacy entity and has elected to apply to the negotiated price. For PDEs with a DOS < 01/01/2024, this field must contain the estimated amount of rebates and/or other price concessions that the plan sponsor is required to apply, or has elected to apply, to the negotiated price as a reduction in the drug price made available to the beneficiary at the POS. When there is no rebate or price concession made available to the beneficiary at the POS, this field may be zero dollars. This field must contain a positive dollar amount; the field may never be negative.
36	PHARMACY PRICE CONCESSIONS AT POS	360 - 370	S9(9)V99	11	For PDEs with a DOS >= 01/01/2025, this field must contain the maximum amount of any contingent payments or adjustments that the plan sponsor might receive from a network pharmacy that would serve to decrease the total amount that the plan sponsor pays for the drug, i.e., all pharmacy price concessions. All other estimated remuneration applied at the POS must be reported in the “Estimated Remuneration at POS Amount (ERPOSA)” field. This field must contain a positive dollar amount, or zero dollars when there is no price concession applied at the POS; the field may never be negative. For PDEs with a DOS < 01/01/2025, this field must be zero.
37	VACCINE ADMINISTRATION FEE OR ADDITIONAL DISPENSING FEE	371 - 381	S9(9)V99	11	Amount the plan paid the pharmacy for administering a vaccination. For PDEs with a DOS >= 01/01/2008, a value must be reported when there is a vaccine administration fee or additional Emergency Use Authorization (EUA) dispensing fee charged. For PDEs with a DOS < 01/01/2008, this field must be zero. This field may also include amounts of additional dispensing fees paid for EUA oral antiviral drugs procured by the U.S. Government, over and above what was reported in the “Dispensing Fee Paid” field.
38	FILLER	382 - 436	X(55)	55	SPACES
39	GROSS DRUG COST BELOW OUT-OF-POCKET THRESHOLD (GDCB)	437 - 447	S9(9)V99	11	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 or Additional Dispensing Fee. For PDEs with a DOS < 01/01/2011, when the Catastrophic Coverage Code = SPACE, this field equals the sum of Ingredient Cost Paid + Dispensing Fee Paid + Total Amount Attributed to Sales Tax + Vaccine Administration Fee or Additional Dispensing 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 or Additional Dispensing 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.
40	GROSS DRUG COST ABOVE OUT-OF-POCKET THRESHOLD (GDCA)	448 - 458	S9(9)V99	11	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 or Additional Dispensing Fee. For PDEs with a DOS < 01/01/2011, 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 or Additional Dispensing 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 or Additional Dispensing Fee falling above the OOP threshold. Any remaining portion is reported in GDCB. This amount increments the Total Gross Covered Drug Cost Accumulator amount.
41	PATIENT PAY AMOUNT	459 - 469	S9(9)V99	11	Payments made by the beneficiary or by family or friends at point of sale. This amount increments the True Out-of-Pocket (TrOOP) Accumulator amount.
42	OTHER TROOP AMOUNT	470 - 480	S9(9)V99	11	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 the Reported Gap Discount (for PDEs with a DOS < 01/01/2025) or Manufacturer Discount (for PDEs with a DOS >= 01/01/2025). This amount increments the True Out-of-Pocket Accumulator amount. For PDEs with a DOS >= 01/01/2023 and DOS <= 12/31/2023, this field may contain the Inflation Reduction Act Subsidy Amount (IRASA). When this field contains IRASA, the Other TrOOP Amount Indicator field must be reported with a value of S or B.
43	LOW INCOME COST SHARING SUBSIDY AMOUNT (LICS)	481 - 491	S9(9)V99	11	Amount the plan advanced at point-of-sale due to a beneficiary's LI status. This amount increments the True Out-of-Pocket Accumulator amount.
44	PATIENT LIABILITY REDUCTION DUE TO OTHER PAYER AMOUNT (PLRO)	492 - 502	S9(9)V99	11	Amount by which patient liability is reduced due to payment by other payers that are not TrOOP-eligible and do not participate in Part D.
45	COVERED D PLAN PAID AMOUNT (CPP)	503 - 513	S9(9)V99	11	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 Over-the-Counter drugs are excluded from this field.
46	NON COVERED PLAN PAID AMOUNT (NPP)	514 - 524	S9(9)V99	11	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.
47	GOVERNMENT PAY SUBSIDY	525 - 535	S9(9)V99	11	Required for PDEs with a DOS >= 01/01/2025, the government pay selected drug subsidy amount. On PDEs with a DOS < 01/01/2025, must be zeros.
48	REPORTED MANUFACTURER DISCOUNT	536 - 546	S9(9)V99	11	Required for PDEs with a DOS >= 01/01/2025. The reported amount that the plan sponsor advanced at point of sale for the Manufacturer Discount for applicable drugs. On PDEs with a DOS < 01/01/2025, must be zero. This amount will not increment the True Out-of-Pocket Accumulator amount.
49	REPORTED GAP DISCOUNT	547 - 557	S9(9)V99	11	The reported amount that the plan sponsor advanced at point of sale for the Gap Discount for applicable drugs. Required on PDEs with a DOS >= 01/01/2011 and a DOS <= 12/31/2024. On PDEs with a DOS < 01/01/2011 or PDEs with a DOS >= 01/01/2025, must be zero. This amount increments the True Out-of-Pocket Accumulator amount.
50	FILLER	558 - 623	X(66)	66	SPACES
51	TOTAL GROSS COVERED DRUG COST ACCUMULATOR	624 - 634	S9(9)V99	11	Sum of the beneficiary's covered drug costs for the benefit year known immediately prior to adjudicating the claim. Required on PDEs with a DOS >= 01/01/2011. On PDEs with a DOS < 01/01/2011, must be zero.
52	FILLER	635 - 636	X(2)	2	SPACES
53	TRUE OUT-OF-POCKET ACCUMULATOR	637 - 647	S9(9)V99	11	Sum of the beneficiary's incurred costs for the benefit year known immediately prior to adjudicating the claim. Required on PDEs with a DOS >= 01/01/2011. On PDEs with a DOS < 01/01/2011, must be zero.
54	FILLER	648 -649	X(2)	2	SPACES
55	DEDUCTIBLE ACCUMULATOR	650 - 660	S9(9)V99	11	Sum of the beneficiary's deductible amount for the benefit year known immediately prior to adjudicating the claim. Required for PDEs with a DOS >= 01/01/2025. On PDEs with a DOS < 01/01/2025, must be zero.
56	OTHER TROOP AMOUNT INDICATOR	661 - 661	X(1)	1	This code is used for PDEs with a DOS >= 01/01/2023 and a DOS <= 12/31/2023, when the Other TrOOP Amount includes Inflation Reduction Act Subsidy Amount (IRASA) dollars for benefit year 2023. Valid values are: B = indicates the amount reported in Other TrOOP field contains both IRASA and non-IRASA Other TrOOP amounts. S = indicates the amount reported in Other TrOOP field contains only IRASA Other TrOOP amount. SPACE = indicates amount reported in Other TrOOP field contains only non-IRASA Other TrOOP amount, if any; and for PDEs with a DOS < 01/01/2023 or for PDEs with a DOS >= 01/01/2024.
57	BEGINNING BENEFIT PHASE	662 - 662	X(1)	1	Required on PDEs with a DOS >= 01/01/2011 and a DOS <= 12/31/2024. Plan-defined benefit phase in effect immediately prior to the time the sponsor began adjudicating the individual claim being reported. Valid values are: D = Deductible N = Initial Coverage Period G = Coverage Gap C = Catastrophic For PDEs with a DOS < 01/01/2011, must be SPACE. For PDEs with a DOS >= 01/01/2025, the value of G no longer applies, and will not be accepted. Applies to covered drugs only.
58	ENDING BENEFIT PHASE	663 - 663	X(1)	1	Required on PDEs with a DOS >= 01/01/2011 and a DOS <= 12/31/2024. Plan-defined benefit phase in effect upon the sponsor completing adjudication of the individual claim being reported. Valid values are: D = Deductible N = Initial Coverage Period G = Coverage Gap C = Catastrophic For PDEs with a DOS < 01/01/2011, must be SPACE. For PDEs with a DOS >= 01/01/2025, the value of G no longer applies, and will not be accepted. Applies to covered drugs only.
59	PRESCRIPTION ORIGIN CODE	664 - 664	X(1)	1	Valid values are: 1 = Written 2 = Telephone 3 = Electronic 4 = Facsimile 5 = Pharmacy 0 = Not Specified SPACE = Unknown For PDEs with a DOS >= 01/01/2010, only the values of 1, 2, 3, 4 or 5 are valid for the following scenarios: 1. PDEs that are standard claims (excluding Medicaid Subrogation) and Fill Number = 00 2. PACE claims with non-standard format code not in X, B, P or C and Fill Number = 00
60	DATE ORIGINAL CLAIM RECEIVED	665 - 672	9(8)	8	Date sponsor received original claim. Required on PDEs with a DOS >= 01/01/2011. On PDEs with a DOS < 01/01/2011, must be zero. Required for all LI NET PDEs submitted on and after 01/01/2011, regardless of the DOS.
61	CLAIM ADJUDICATION BEGAN TIMESTAMP	673 - 698	X(26)	26	Date and time sponsor began adjudicating the claim in Greenwich Mean Time. Required on PDEs with a DOS >= 01/01/2011. On PDEs with a DOS < 01/01/2011, must be SPACES or zero.
62	BRAND/GENERIC CODE	699 - 699	X(1)	1	Plan reported value indicating whether the plan adjudicated the claim as a brand or generic drug. Valid values are: B = Brand G = Generic Required on PDEs with a DOS >= 01/01/2011. On PDEs with a DOS < 01/01/2011, must be a SPACE. Applies to covered drugs only.
63	TIER	700 - 700	X(1)	1	Formulary tier in which the sponsor adjudicated the claim. Required on PDEs with a DOS >= 01/01/2011. On PDEs with a DOS >= 01/01/2022, values must be 1-7 or a SPACE. On PDEs with a DOS >= 01/01/2011 and DOS <= 12/31/2021, values must be 1-6 or a SPACE. On PDEs with a DOS < 01/01/2011, must be a SPACE. Applies to covered drugs only.
64	FORMULARY CODE	701 - 701	X(1)	1	Indicates if the drug is on the plan's formulary. Valid values are: F = Formulary N = Non-Formulary Required on PDEs with a DOS >= 01/01/2011. On PDEs with a DOS < 01/01/2011, must be a SPACE. Applies to covered drugs only.
65	PHARMACY SERVICE TYPE	702 - 703	X(2)	2	Required on PDEs with a DOS >= 02/28/2013. 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 PDEs with a DOS < 02/28/2013, valid values are SPACES or any of the valid values listed above. For COB PDEs, valid values are SPACES or any of the valid values listed above.
66	PATIENT RESIDENCE	704 - 705	X(2)	2	Required on PDEs with a DOS >= 02/28/2013. 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/Intellectual Disability 11 = Hospice For DOS < 02/28/2013, valid values are SPACES or any of the valid values listed above. For COB PDEs, valid values are SPACES or any of the valid values listed above.
67	SUBMISSION TYPE CODE 1	706 - 707	X(2)	2	Optional on PDEs with a DOS >= 01/01/2025. Used to identify specific types of claims with the following valid values: SPACES AA = 340B Claims AB = Split Billing AD = Nominal Price AF = Synchronization Fill AG = Trial Fill For PDES with a DOS < 01/01/2025, must be SPACES.
68	SUBMISSION TYPE CODE 2	708 - 709	X(2)	2	Optional on PDEs with a DOS >= 01/01/2025. Used to identify specific types of claims with the following valid values: SPACES AA = 340B Claims AB = Split Billing AD = Nominal Price AF = Synchronization Fill AG = Trial Fill For PDES with a DOS < 01/01/2025, must be SPACES.
69	SUBMISSION TYPE CODE 3	710 - 711	X(2)	2	Optional on PDEs with a DOS >= 01/01/2025. Used to identify specific types of claims with the following valid values: SPACES AA = 340B Claims AB = Split Billing AD = Nominal Price AF = Synchronization Fill AG = Trial Fill For PDES with a DOS < 01/01/2025, must be SPACES.
70	SUBMISSION TYPE CODE 4	712 - 713	X(2)	2	Optional on PDEs with a DOS >= 01/01/2025. Used to identify specific types of claims with the following valid values: SPACES AA = 340B Claims AB = Split Billing AD = Nominal Price AF = Synchronization Fill AG = Trial Fill For PDES with a DOS < 01/01/2025, must be SPACES.
71	SUBMISSION TYPE CODE 5	714 - 715	X(2)	2	Optional on PDEs with a DOS >= 01/01/2025. Used to identify specific types of claims with the following valid values: SPACES AA = 340B Claims AB = Split Billing AD = Nominal Price AF = Synchronization Fill AG = Trial Fill For PDES with a DOS < 01/01/2025, must be SPACES.
72	SUBMISSION CLARIFICATION CODE 1	716 - 718	X(3)	3	For PDEs with a DOS >= 01/01/2025, any numeric value or SPACES may be reported in this field; if an LTC-related value is reported, Patient Residence must be 03. For PDEs with a DOS >= 02/28/2013 and DOS <= 12/31/2024, if Patient Residence = 03, the valid values are: SPACES 16 = Long Term Care (LTC) emergency box (kit) or automated dispensing machine 21 = LTC dispensing: 14 days or less not applicable 22 = LTC dispensing: 7 days 23 = LTC dispensing: 4 days 24 = LTC dispensing: 3 days 25 = LTC dispensing: 2 days 26 = LTC dispensing: 1 day 27 = LTC dispensing: 4-3 days 28 = LTC dispensing: 2-2-3 days 29 = LTC dispensing: daily and 3-day weekend 30 = LTC dispensing: Per shift dispensing 31 = LTC dispensing: Per med pass dispensing 32 = LTC dispensing: PRN on demand 33 = LTC dispensing: 7 day or less cycle not otherwise represented 34 = LTC dispensing: 14 days dispensing 35 = LTC dispensing: 8–14 day dispensing method not listed above 36 = LTC dispensing: dispensed outside short cycle, determined to be Medicare Part D after originally submitted to another payer For PDEs with a DOS >= 02/28/2013 and a DOS <= 12/31/2024, and with a Patient Residence Code not equal to 03, must be SPACES. For PDEs with a DOS < 02/28/2013, must be SPACES.
73	SUBMISSION CLARIFICATION CODE 2	719 - 721	X(3)	3	For PDEs with a DOS >= 01/01/2025, any numeric value or SPACES may be reported in this field; if an LTC-related value is reported, Patient Residence must be 03. For PDEs with a DOS >= 02/28/2013 and DOS <= 12/31/2024, if Patient Residence = 03, the valid values are: SPACES 16 = Long Term Care (LTC) emergency box (kit) or automated dispensing machine 21 = LTC dispensing: 14 days or less not applicable 22 = LTC dispensing: 7 days 23 = LTC dispensing: 4 days 24 = LTC dispensing: 3 days 25 = LTC dispensing: 2 days 26 = LTC dispensing: 1 day 27 = LTC dispensing: 4-3 days 28 = LTC dispensing: 2-2-3 days 29 = LTC dispensing: daily and 3-day weekend 30 = LTC dispensing: Per shift dispensing 31 = LTC dispensing: Per med pass dispensing 32 = LTC dispensing: PRN on demand 33 = LTC dispensing: 7 day or less cycle not otherwise represented 34 = LTC dispensing: 14 days dispensing 35 = LTC dispensing: 8–14 day dispensing method not listed above 36 = LTC dispensing: dispensed outside short cycle, determined to be Medicare Part D after originally submitted to another payer For PDEs with a DOS >= 02/28/2013 and a DOS <= 12/31/2024, and with a Patient Residence Code not equal to 03, must be SPACES. For PDEs with a DOS < 02/28/2013, must be SPACES.
74	SUBMISSION CLARIFICATION CODE 3	722 - 724	X(3)	3	For PDEs with a DOS >= 01/01/2025, any numeric value or SPACES may be reported in this field; if an LTC-related value is reported, Patient Residence must be 03. For PDEs with a DOS >= 02/28/2013 and DOS <= 12/31/2024, if Patient Residence = 03, the valid values are: SPACES 16 = Long Term Care (LTC) emergency box (kit) or automated dispensing machine 21 = LTC dispensing: 14 days or less not applicable 22 = LTC dispensing: 7 days 23 = LTC dispensing: 4 days 24 = LTC dispensing: 3 days 25 = LTC dispensing: 2 days 26 = LTC dispensing: 1 day 27 = LTC dispensing: 4-3 days 28 = LTC dispensing: 2-2-3 days 29 = LTC dispensing: daily and 3-day weekend 30 = LTC dispensing: Per shift dispensing 31 = LTC dispensing: Per med pass dispensing 32 = LTC dispensing: PRN on demand 33 = LTC dispensing: 7 day or less cycle not otherwise represented 34 = LTC dispensing: 14 days dispensing 35 = LTC dispensing: 8–14 day dispensing method not listed above 36 = LTC dispensing: dispensed outside short cycle, determined to be Medicare Part D after originally submitted to another payer For PDEs with a DOS >= 02/28/2013 and a DOS <= 12/31/2024, and with a Patient Residence Code not equal to 03, must be SPACES. For PDEs with a DOS < 02/28/2013, must be SPACES.
75	SUBMISSION CLARIFICATION CODE 4	725 - 727	X(3)	3	For PDEs with a DOS >= 01/01/2025, any numeric value or SPACES may be reported in this field; if an LTC-related value is reported, Patient Residence must be 03. For PDEs with a DOS >= 02/28/2013 and DOS <= 12/31/2024, if Patient Residence = 03, the valid values are: SPACES 16 = Long Term Care (LTC) emergency box (kit) or automated dispensing machine 21 = LTC dispensing: 14 days or less not applicable 22 = LTC dispensing: 7 days 23 = LTC dispensing: 4 days 24 = LTC dispensing: 3 days 25 = LTC dispensing: 2 days 26 = LTC dispensing: 1 day 27 = LTC dispensing: 4-3 days 28 = LTC dispensing: 2-2-3 days 29 = LTC dispensing: daily and 3-day weekend 30 = LTC dispensing: Per shift dispensing 31 = LTC dispensing: Per med pass dispensing 32 = LTC dispensing: PRN on demand 33 = LTC dispensing: 7 day or less cycle not otherwise represented 34 = LTC dispensing: 14 days dispensing 35 = LTC dispensing: 8–14 day dispensing method not listed above 36 = LTC dispensing: dispensed outside short cycle, determined to be Medicare Part D after originally submitted to another payer For PDEs with a DOS >= 02/28/2013 and a DOS <= 12/31/2024, and with a Patient Residence Code not equal to 03, must be SPACES. For PDEs with a DOS < 02/28/2013, must be SPACES.
76	SUBMISSION CLARIFICATION CODE 5	728 - 730	X(3)	3	For PDEs with a DOS >= 01/01/2025, any numeric value or SPACES may be reported in this field; if an LTC-related value is reported, Patient Residence must be 03. For PDEs with a DOS >= 02/28/2013 and DOS <= 12/31/2024, if Patient Residence = 03, the valid values are: SPACES 16 = Long Term Care (LTC) emergency box (kit) or automated dispensing machine 21 = LTC dispensing: 14 days or less not applicable 22 = LTC dispensing: 7 days 23 = LTC dispensing: 4 days 24 = LTC dispensing: 3 days 25 = LTC dispensing: 2 days 26 = LTC dispensing: 1 day 27 = LTC dispensing: 4-3 days 28 = LTC dispensing: 2-2-3 days 29 = LTC dispensing: daily and 3-day weekend 30 = LTC dispensing: Per shift dispensing 31 = LTC dispensing: Per med pass dispensing 32 = LTC dispensing: PRN on demand 33 = LTC dispensing: 7 day or less cycle not otherwise represented 34 = LTC dispensing: 14 days dispensing 35 = LTC dispensing: 8–14 day dispensing method not listed above 36 = LTC dispensing: dispensed outside short cycle, determined to be Medicare Part D after originally submitted to another payer For PDEs with a DOS >= 02/28/2013 and a DOS <= 12/31/2024, and with a Patient Residence Code not equal to 03, must be SPACES. For PDEs with a DOS < 02/28/2013, must be SPACES.
77	LTPAC DISPENSE FREQUENCY	731 - 732	X(2)	2	For PDEs with a DOS >= 01/01/2025, used for long-term and post-acute care short-cycle (LTPAC) dispensing. Valid values are: SPACES 1 = Medication dispensed in a day-supply increment equal to the billed days supply (for example: medication dispensed for a 30-day supply and billed for a 30-day supply). 2 = 7 days - dispenses medication in 7-day supplies.  3 = 4 days - dispenses medication in 4-day supplies.  4 = 3 days - dispenses medication in 3-day supplies. 5 = 2 days - dispenses medication in 2-day supplies. 6 = 1 day - dispenses medication in 1-day supplies. 7 = 4-3 days - dispenses medication in 4-day, then 3-day supplies.  8 = 2-2-3 days - dispenses medication in 2-day, then 2-day, then 3-day supplies. 9 = Daily and 3-day weekend - dispensed daily during the week and combines multiple days dispensing for weekends. 10 = Per shift dispensing (multiple med passes). 11 = Per med pass dispensing. 12 = PRN on demand. 13 = 7-day or less cycle not otherwise represented. 14 = 14 days dispensing - dispenses medication in 14-day supplies. 15 = 8–14-Day dispensing cycle not otherwise represented. For PDEs with a DOS < 01/01/2025, must be SPACES.
78	ADJUSTMENT REASON CODE QUALIFIER	733 - 733	X(1)	1	For PDEs with a DOS >= 11/13/2016 and a DOS <= 12/31/2024, the type of Adjustment Reason Code used in field 79. Valid values are: 2 = CMS Audit 3 = CMS Identified Overpayment (CIO) 4 = CGDP Dispute or Appeal 9 = Other SPACE = Not Applicable The Adjustment Reason Code Qualifier of 1 has been removed from the list of valid values for PDEs with a DOS >= 11/13/2016, and will not be accepted. The Adjustment Reason Code Qualifiers of 3, 4, and 9 have been removed from the list of valid values for PDEs with a DOS >= 01/01/2025, and will not be accepted.
79	ADJUSTMENT REASON CODE	734 - 745	X(12)	12	For PDEs with a DOS >= 11/13/2016 and a DOS <= 12/31/2024, this code will assist CMS to track the reason for an adjustment or deletion. Accepted values are dependent upon the adjustment reason code qualifier submitted in field 78. Valid values are: If the qualifier = 2, the valid value is: OFM, RAC, or MEDIC If the qualifier = 3, the valid value is: CIO If the qualifier = 4, the valid value is: DISPUTE or APPEAL If the qualifier = 9, the valid value is: For future use at CMS' direction If the qualifier = SPACES, the valid value is: SPACES * Non-numeric values should be left justified The Adjustment Reason Code Qualifier of 1 has been removed from the list of valid values for PDEs with a DOS >= 11/13/2016, and will not be accepted. The Adjustment Reason Codes of CIO, DISPUTE or APPEAL, and For Future use at CMS' direction have been removed from the list of valid values for PDEs with a DOS >= 01/01/2025, and will not be accepted.
80	FILLER	746 - 829	X(84)	84	SPACES
81	CMS CALCULATED GAP DISCOUNT	830 - 840	S9(9)V99	11	For PDEs with a DOS >= 01/01/2011 and a DOS <= 12/31/2024, the Gap Discount Amount calculated by CMS during on-line PDE editing based on data reported in the PDE.
82	CMS CALCULATED MANUFACTURER DISCOUNT	841 - 851	S9(9)V99	11	For PDEs with a DOS >= 01/01/2025, the Manufacturer Discount Amount calculated by CMS during on-line PDE editing based on data reported on the PDE.
83	APPLICABLE DISCOUNT PERCENTAGE FOR SPECIFIED SMALL MANUFACTURER DRUGS	852 - 853	X(2)	2	For PDEs with a DOS >= 01/01/2025, the phased-in Manufacturer Discount percentage that applies for the benefit year of the PDE for specified small manufacturer drugs, as provided by the statute.
84	APPLICABLE DISCOUNT PERCENTAGE FOR SPECIFIED MANUFACTURER DRUGS DISPENSED TO LIS BENEFICIARIES	854 - 855	X(2)	2	For PDEs with a DOS >= 01/01/2025, the phased-in Manufacturer Discount percentage that applies for the benefit year of the PDE for specified manufacturer drugs dispensed to Low Income Subsidy (LIS) eligible beneficiaries, as provided by the statute.
85	FILLER	856 - 895	X(40)	40	SPACES
86	ALTERNATE SERVICE PROVIDER ID QUALIFIER	896 - 897	X(2)	2	The Alternate Service Provider ID Qualifier cross-referenced by CMS to the Service Provider ID submitted on the PDE. Valid values are: 01 = NPI (if the Service Provider ID Qualifier submitted on PDE = 07) 07 = NCPDP Provider ID (if the Service Provider ID Qualifier submitted on PDE = 01)
87	ALTERNATE SERVICE PROVIDER ID	898 - 912	X(15)	15	The Alternate Service Provider ID cross-referenced by CMS to the Service Provider ID submitted on the PDE. Corresponds to the Alternate Service Provider ID Qualifier.
88	ORIGINAL SUBMITTING CONTRACT	913 - 917	X(5)	5	Contract that submitted the previously accepted PDE (in conjunction with edit 784).
89	CORRECTED MEDICARE BENEFICIARY IDENTIFIER	918 - 937	X(20)	20	Populated with Medicare Beneficiary Identifier (MBI) if HICN was received on PDE submission file or the beneficiary MBI has changed according to CMS records.
90	P2P CONTRACT OF RECORD	938 - 942	X(5)	5	Contract of Record for accepted P2P PDES
91	PBP OF RECORD	943 - 945	X(3)	3	PBP of Record assigned by CMS during P2P Update Process. Returned only when the PBP of Record changes from the time the PDE was processed and accepted by CMS.
92	ERROR COUNT	946 - 947	9(2)	2	Count of errors encountered during processing
93	ERROR 1	948 - 950	X(3)	3	First error encountered during processing
94	ERROR 2	951 - 953	X(3)	3	Second error encountered during processing
95	ERROR 3	954 - 956	X(3)	3	Third error encountered during processing
96	ERROR 4	957 - 959	X(3)	3	Fourth error encountered during processing
97	ERROR 5	960 - 962	X(3)	3	Fifth error encountered during processing
98	ERROR 6	963 - 965	X(3)	3	Sixth error encountered during processing
99	ERROR 7	966 - 968	X(3)	3	Seventh error encountered during processing
100	ERROR 8	969 - 971	X(3)	3	Eighth error encountered during processing
101	ERROR 9	972 - 974	X(3)	3	Ninth error encountered during processing
102	ERROR 10	975 - 977	X(3)	3	Tenth error encountered during processing
103	EXCLUSION REASON CODE	978 - 980	X(3)	3	Subcategory reject code for an NDC Error Code of 738 identified in Errors 1-10.
104	FILLER	981 - 1000	X(20)	20	SPACES

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Sheet 4: BTR

FIELD NO.	FIELD NAME	POSITION	PICTURE	LENGTH	DEFINITION / VALUES
1	RECORD ID	1-3	X(3)	3	"BTR"
2	SEQUENCE NO	4-10	9(7)	7	Must match BHD. Must start with 0000001.
3	CONTRACT NO	11-15	X(5)	5	Must match BHD
4	PBP ID	16-18	X(3)	3	Must match BHD
5	DET RECORD TOTAL	19-25	9(7)	7	Total count of DET records
6	DET ACCEPTED RECORD TOTAL	26-32	9(7)	7	Total count of ACC records as determined by DDPS processing
7	DET INFORMATIONAL RECORD TOTAL	33-39	9(7)	7	Total count of INF records as determined by DDPS processing
8	DET REJECTED RECORD TOTAL	40-46	9(7)	7	Total count of REJ records as determined by DDPS processing
9	FILLER	47-1000	X(954)	954	SPACES

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Sheet 5: TLR

FIELD NO.	FIELD NAME	POSITION	PICTURE	LENGTH	DEFINITION / VALUES
1	RECORD ID	1-3	X(3)	3	"TLR"
2	SUBMITTER ID	4-9	X(6)	6	Must match HDR
3	FILE ID	10-19	X(10)	10	Must match HDR
4	TLR BHD RECORD TOTAL	20-28	9(9)	9	Total count of BHD records
5	TLR DET RECORD TOTAL	29-37	9(9)	9	Total count of DET records
6	TLR DET ACCEPTED RECORD TOTAL	38-46	9(9)	9	Total count of ACC records as determined by DDPS processing
7	TLR DET INFORMATIONAL RECORD TOTAL	47-55	9(9)	9	Total count of INF records as determined by DDPS processing
8	TLR DET REJECTED RECORD TOTAL	56-64	9(9)	9	Total count of REJ records as determined by DDPS processing
9	FILLER	65-1000	X(936)	936	SPACES