NCPDP Telecommunication Standard

1. Standard overview

   D.0 real-time pharmacy claim, reversal and eligibility transactions between pharmacy and PBM.

2. Segments and fields

   Header, insurance, patient, claim, pricing, DUR and COB segments.

3. Claim response and rejects

   Paid, rejected and captured responses, reject codes and DUR messages.

4. Pricing and COB

   Ingredient cost, dispensing fee, usual and customary, and other coverage code handling.

5. Batch standard

   Batch processing for pharmacy claims and reconciliation.

Each section links to the official page. Titles and summaries by Extra Credit; the docs belong to their authors.

• HL7 Da Vinci Project Implementation Guides
• HL7 FHIR R4
• HL7 FHIR R5
• HL7 Version 2.x
• Medicare and Medicaid Claims Data (CMS data dictionaries)
• NCPDP SCRIPT
• OMOP Common Data Model
• Price Transparency (Transparency in Coverage)
• SMART on FHIR (App Launch)
• TEFCA
• UB-04 (CMS-1450) Claim Form
• US Core Implementation Guide