Pharmacy Claim (B1 Transaction) Example

Below is an example of a pharmacy claim (B1 transaction) in NCPDP format.

This example includes batch headers and trailers as per the NCPDP batch standard.

NCPDP transactions rely on non-printable separators. See this post for the explanation.

␂00T123456789               2021123456789123456P1234567WPS0000000         ␃
␂G11234567890123456D1B101        1234567890123     202108210000000100	
␞␜AM04␜C2123456789␜CCJANE␜CDDOE␜FOMYPLAN␜C90␜C1GR1␜C3001␜C62	␞␜AM01␜C419800225␜C52␜CAJANE␜CBDOE␜CM100 MAIN STR␜CNWASHINGTON␜CODC␜CP100010000␜CQ5551234567␝
␞␜AM07␜EM1␜D2000000123456␜E103␜D700003089421␜E70000030000␜D301␜D5030␜D80␜DE20210701␜DJ3␜C800␜DT3␜28EA	␞␜AM11␜D90000057A␜DC0000027E␜DX0000016B␜DQ00000000␜DU0000084F␜DN07	␞␜AM03␜EZ01␜DB1234567890␜DREVIL␜PM5557654321␃
␂9920211840000005162END Dyl B1                         ␃

Below is an interactive view of this example:

Please use our viewer to decipher your NCPDP files. You can also use our API to programmatically convert your NCPDP transactions into JSON.