MedicaidAdministrativeHigh impact
New Edits for NCPDP Version 5.1 and Version 1.1
Illinois Medicaid - HFS·IL · Pharmacy·Provider Notice
Effective date
Oct 18, 2004
We identified it
Jun 21, 2026
Summary
New validation edits will be activated for NCPDP pharmacy billing transactions in both Version 5.1 and 1.1 formats. All submitted fields must conform to strict formatting standards or the transmission will be rejected with an Authorization Number for error identification.
Action Required
Before October 18, 2004: Pharmacy billing teams must ensure all NCPDP transmission fields conform to Version 5.1 Data Dictionary standards. Contact software vendors to verify compatibility with new validation edits. Monitor for reject codes in field 503-F3 and use Authorization Numbers to identify errors. Contact 217-782-5565 Option 7 for assistance with rejections.