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Global: ^BPSC

Package: E Claims Management Engine

Global: ^BPSC


Information

FileMan FileNo FileMan Filename Package
9002313.02 BPS CLAIMS E Claims Management Engine

Description

Directly Accessed By Routines, Total: 43

Package Total Routines
E Claims Management Engine 39 BPS10P11    BPS10P7    BPS10PST    BPSBCKJ    BPSBUTL    BPSECA1    BPSECA8    BPSECMC2
BPSECMP2    BPSECX0    BPSELG    BPSFLD01    BPSOPR2    BPSOS03    BPSOSCE    BPSOSH2
BPSOSQG    BPSOSQL    BPSOSRB    BPSOSSG    BPSOSU    BPSPRRX6    BPSREOP1    BPSRES
BPSRPT1    BPSRPT2    BPSRPT6    BPSRPT7    BPSSCR03    BPSSCR05    BPSSCRCL    BPSSCRL1
BPSSCRLG    BPSSCRU1    BPSSCRU2    BPSSCRU3    BPSSCRU5    BPSUTIL2    BPSVRX1    
Integrated Billing 2 IB20P276    IBCNRXI1    

Accessed By FileMan Db Calls, Total: 14

Package Total Routines
E Claims Management Engine 13 BPSBUTL    BPSECA1    BPSECMP2    BPSNCPD3    BPSOS57    BPSOSCE    BPSOSH2    BPSOSU
BPSRES    BPSRES1    BPSRPT6    BPSSCRCL    BPSSCRLG    
Outpatient Pharmacy 1 PSOBPSU3    

Pointed To By FileMan Files, Total: 4

Package Total FileMan Files
E Claims Management Engine 4 BPS CERTIFICATION(#9002313.31)[.03]    BPS RESPONSES(#9002313.03)[.01]    BPS TRANSACTION(#9002313.59)[3401]    BPS LOG OF TRANSACTIONS(#9002313.57)[3401]    

Pointer To FileMan Files, Total: 10

Package Total FileMan Files
Uncategorized 4 BPS NCPDP PRESCRIBER PLACE OF SERVICE(#9002313.34)[#9002313.0201(2257)]    BPS NCPDP BENEFIT STAGE INDICATOR(#9002313.35)[#9002313.0201(2151)]    BPS NCPDP LTPAC DISPENSE FREQUENCY(#9002313.36)[#9002313.0201(2191)]    BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)[#9002313.0201(2147)]    
E Claims Management Engine 2 BPS NCPDP FORMATS(#9002313.92)[.02]    BPS TRANSACTION(#9002313.59)[.08]    
Integrated Billing 2 GROUP INSURANCE PLAN(#355.3)[1.04]    CLAIMS TRACKING NON-BILLABLE REASONS(#356.8)[904]    
Kernel 1 NEW PERSON(#200)[903907]    
Outpatient Pharmacy 1 PRESCRIPTION(#52)[#9002313.0201(.05)]    

Fields, Total: 72

Field # Name Loc Type Details
.01 CLAIM ID 0;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<1) X
  • LAST EDITED:  JUN 04, 2008
  • HELP-PROMPT:  Answer must be 1-32 characters in length.
  • DESCRIPTION:  External Claim ID value. This value is a concatenation of the text 'VA' along with the current year, the pharmacy ID, the VA National Plan ID (without the alpha prefix), and a unique sequence number. Each of the four
    pieces is delimited by the equal sign ("=").
  • CROSS-REFERENCE:  9002313.02^B^MUMPS
    1)= S ^BPSC("B",$E(X,1,32),DA)=""
    2)= K ^BPSC("B",$E(X,1,32),DA)
.02 ELECTRONIC PAYER 0;2 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Enter the payer sheet for the claim
  • DESCRIPTION:  
    This is the payer sheet used by the claim
.04 TRANSMIT FLAG 0;4 SET
  • '1' FOR YES (BATCH FILE);
  • '0' FOR NO;
  • '2' FOR YES (POINT OF SALE);

  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Specify if this claim should be transmitted and the mode.
  • DESCRIPTION:  
    Numerical code to indicate a transmit status.  Current values are 0 for 'No' 1 for 'Yes' Batch and 2 for 'Yes' Point of Sale.
  • CROSS-REFERENCE:  9002313.02^AD
    1)= S ^BPSC("AD",$E(X,1,30),DA)=""
    2)= K ^BPSC("AD",$E(X,1,30),DA)
.05 TRANSMITTED ON 0;5 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • OUTPUT TRANSFORM:  S Y=$$FM2EXT^BPSOSU1(Y)
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Enter Date/Time this claim was transmitted
  • DESCRIPTION:  
    Date on which the data was transmitted.
  • CROSS-REFERENCE:  9002313.02^AE
    1)= S ^BPSC("AE",$E(X,1,30),DA)=""
    2)= K ^BPSC("AE",$E(X,1,30),DA)
.06 CREATED ON 0;6 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • OUTPUT TRANSFORM:  S Y=$$FM2EXT^BPSOSU1(Y)
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Enter Date/Time this claim was created
  • DESCRIPTION:  
    Date on which this record was created.
.07 AUTO REVERSE FLAG 0;7 SET
  • '0' FOR NO;
  • '1' FOR UNRELEASED CLAIM;
  • '2' FOR INPATIENT CLAIM;

  • LAST EDITED:  JAN 05, 2006
  • HELP-PROMPT:  If auto-reversed, enter the type of auto-reversal
  • DESCRIPTION:  
    This flag is marking ECME Claims that were automatically reversed because the Prescription was not released in time or the claim was an inpatient claim.
.08 TRANSACTION 0;8 POINTER TO BPS TRANSACTION FILE (#9002313.59) BPS TRANSACTION(#9002313.59)

  • LAST EDITED:  DEC 29, 2008
  • HELP-PROMPT:  Enter the transaction for the claim.
  • DESCRIPTION:  
    This is the ECME transaction that generates the claim.
1.01 PATIENT NAME 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Patient name extracted from the VA patient file.  This entry is free text to accommodate the NCPDP formatting requirements.
  • CROSS-REFERENCE:  9002313.02^C
    1)= S ^BPSC("C",$E(X,1,30),DA)=""
    2)= K ^BPSC("C",$E(X,1,30),DA)
1.04 GROUP INSURANCE PLAN 1;4 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) GROUP INSURANCE PLAN(#355.3)

  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Enter the Group Insurance
  • DESCRIPTION:  
    Internal identifier number for the Group Insurance Record
101 BIN NUMBER 100;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<6) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 6 characters in length.
  • DESCRIPTION:  
    Card Issuer ID or Bank ID Number used for network routing.
102 VERSION RELEASE NUMBER 100;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    Code identifying the Enrollment Standard format of the file sent or received.
103 TRANSACTION CODE 100;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  Code to identify the transaction type for this claim. E1=Eligibility Verification B1=Billing B2=Reversal B3=Rebill P1=P.A. Request & Billing P2=P.A. Reversal P3=P.A. Inquiry P4=P.A. Request Only N1=Information Reporting
    N2=Information Reporting Reversal N3=Information Reporting Rebill C1=Controlled Substance Reporting C2=Controlled Substance Reporting Reversal C3=Controlled Substance Reporting Rebill
104 PROCESSOR CONTROL NUMBER 100;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Number which will uniquely identify the submitter of the claim.  NCPDP field 104-A4.
109 TRANSACTION COUNT 100;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>1!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 1 character in length.
  • DESCRIPTION:  
    Count of transactions in the transmission.  NCPDP standard field 109-A9.
  • TECHNICAL DESCR:  
    A transaction count of >1 is not allowed for Eligibility and Prior Authorization transactions.  REQUEST TRANSACTION HEADER SEGMENT.
110 SOFTWARE VENDER CERT ID 100;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  JUN 04, 2008
  • HELP-PROMPT:  Answer must be 10 characters in length.
  • DESCRIPTION:  
    Certification number which Identifies the patient's insurance carrier.  NCPDP standard field 110-AK.
  • TECHNICAL DESCR:  
    REQUEST TRANSACTION HEADER SEGMENT.
114 MEDICAID SUBROGATION ICN/TCN 110;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<1) X
  • LAST EDITED:  OCT 04, 2010
  • HELP-PROMPT:  Answer must be 1-22 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 114-N4 (Medicaid Subrogation Internal Control Number/Transaction Control Number (ICN/TCN)), which is defined as "Claim number assigned by the Medicaid Agency."
  • TECHNICAL DESCR:  
    REQUEST CLAIM SEGMENT.  RESPONSE CLAIM SEGMENT.
115 MEDICAID ID NUMBER 110;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-20 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 115-N5 (Medicaid ID Number), which is defined as "A unique member identification number assigned by the Medicaid Agency."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.  RESPONSE INSURANCE SEGMENT.
116 MEDICAID AGENCY NUMBER 110;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-15 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 116-N6 (Medicaid Agency Number), which is defined as "Number assigned by processor to identify the individual Medicaid Agency or representative."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.  RESPONSE INSURANCE SEGMENT.
201 SERVICE PROVIDER ID 200;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<15) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 15 characters in length
  • DESCRIPTION:  
    ID assigned to a pharmacy or provider.  NCPDP standard field 201-B1.
  • TECHNICAL DESCR:  
    REQUEST TRANSACTION HEADER SEGMENT.  RESPONSE HEADER SEGMENT.
202 SERVICE PROVIDER ID QUAL 200;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    Qualifier indicating which ID number was used.  NCPDP standard field 202-B2.
  • TECHNICAL DESCR:  
    REQUEST TRANSACTION HEADER SEGMENT.  RESPONSE HEADER SEGMENT.
301 GROUP ID 300;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<17) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 17 characters in length
  • DESCRIPTION:  
    ID assigned to the cardholder group or employer group.  NCPDP standard field 301-C1.
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.  RESPONSE INSURANCE SEGMENT.
302 CARDHOLDER ID 300;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<2) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 2-20 characters in length
  • DESCRIPTION:  
    Insurance ID assigned to the cardholder or identification number used by the plan.  NCPDP standard field 302-C2.
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.  RESPONSE INSURANCE SEGMENT.
303 PERSON CODE 300;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<5) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 5 characters in length
  • DESCRIPTION:  
    Code assigned to a specific person within a family.  NCPDP standard field 303-C3.
  • TECHNICAL DESCR:  Regarding the Telecommunication Standard: REQUEST INSURANCE SEGMENT.
    - - - - - - - - - - - - - - - - - - - - - - -
    Enrollment Standard Examples: Examples: 001=Cardholder 002=Spouse 003-999=Dependents and Others (including second spouses, etc.)
304 DATE OF BIRTH 300;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • OUTPUT TRANSFORM:  NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 10 characters in length
  • DESCRIPTION:  
    Date of birth of patient.  NCPDP standard field 304-C4.
  • TECHNICAL DESCR:  
    Format=CCYYMMDD CC=Century YY=Year MM=Month DD=Day Examples: If a patient was born on July 27, 1970, this field would reflect: 19700727.  REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT.
305 PATIENT GENDER CODE 300;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<3) X
  • OUTPUT TRANSFORM:  S Y=$S(Y="C51":"MALE",Y="C52":"FEMALE",1:Y)
  • LAST EDITED:  JUN 13, 2008
  • HELP-PROMPT:  Answer must be 3 characters in length
  • DESCRIPTION:  One of three codes to indicate the gender of the patient. 0 = Not Specific 1 = Male 2 = Female
    NCPDP standard field 305-C5.
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT.
306 PATIENT RELATIONSHIP CODE 300;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<3) X
  • OUTPUT TRANSFORM:  S Y=$S(Y="C60":"NOT SPECIFIED",Y="C61":"CARDHOLDER",Y="C62":"SPOUSE",Y="C63":"CHILD",Y="C64":"OTHER",1:Y)
  • LAST EDITED:  MAR 09, 2011
  • HELP-PROMPT:  Answer must be 3 characters in length
  • DESCRIPTION:  
    Code indicating relationship of patient to cardholder.  NCPDP standard field 306-C6.
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.
307 PLACE OF SERVICE 300;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<4) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 4 characters in length
  • DESCRIPTION:  Code identifying the location of the patient when receiving pharmacy services. NCPDP standard field 307-C7. (was PATIENT LOCATION)
    Ø=Not Specified 1=Home 2=Inter-Care 3=Nursing Home 4=Long Term/Extended Care 5=Rest Home 6=Boarding Home 7=Skilled Care Facility 8=Sub-Acute Care Facility 9=Acute Care Facility 1Ø=Outpatient 11=Hospice
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT.
309 ELIGIBILITY CLARIFICATION CODE 300;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<3) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 3 characters in length
  • DESCRIPTION:  
    Code indicating that the pharmacy is clarifying eligibility based on receiving a denial.  NCPDP standard field 309-C9.
  • TECHNICAL DESCR:  
    Examples: The patient has become a student but eligibility has not yet been updated. The pharmacy can indicate "3" so that the carrier may override eligibility for this patient.  REQUEST INSURANCE SEGMENT.
310 PATIENT FIRST NAME 300;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>14!($L(X)<14) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 14 characters in length
  • DESCRIPTION:  
    First name of patient receiving the prescription.  NCPDP standard field 310-CA.
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT.  RESPONSE PATIENT SEGMENT
311 PATIENT LAST NAME 300;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<17) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 17 characters in length
  • DESCRIPTION:  
    Last Name of patient receiving the prescription.  NCPDP standard field 311-CB.
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT
312 CARDHOLDER FIRST NAME 300;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>14!($L(X)<14) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 14 characters in length
  • DESCRIPTION:  
    First name of the Cardholder/Subscriber.  NCPDP standard field 312-CC.
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT
313 CARDHOLDER LAST NAME 300;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<17) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 17 characters in length
  • DESCRIPTION:  
    Last name of the cardholder/subscriber.  NCPDP standard field 313-CD.
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT
314 HOME PLAN 300;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<5) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 5 characters in length
  • DESCRIPTION:  
    Code identifying the Blue Cross or Blue Shield plan ID which indicates where the member's coverage has been designated. Usually where the member lives or purchased their coverage.  NCPDP standard field 314-CE.
  • TECHNICAL DESCR:  
    Used for interstate processing between Blue Cross and Blue Shield plans.  The Blue Cross codes are in the range less than 600 and Blue Shield codes are greater than 599.  REQUEST INSURANCE SEGMENT
322 PATIENT STREET ADDRESS 321;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<32) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 32 characters in length
  • DESCRIPTION:  
    Free-form text for Patient address information.  NCPDP standard field 322-CM.
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT
323 PATIENT CITY ADDRESS 321;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<22) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 22 characters in length
  • DESCRIPTION:  
    Free-form text for city name.  NCPDP standard field 323-CN.
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT
324 PATIENT STATE PROV ADDRESS 321;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<4) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 4 characters in length
  • DESCRIPTION:  
    Standard State/Province Code as defined by appropriate government agency.  NCPDP standard field 324-CO.
  • TECHNICAL DESCR:  
    Standard United States and Canadian province two-letter postal service abbreviations should be used.  REQUEST PATIENT SEGMENT
325 PATIENT ZIP POSTAL ZONE 321;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 1-17 characters in length
  • DESCRIPTION:  
    Code defining international postal zone excluding punctuation and blanks (zip code for US).  NCPDP standard field 325-CP.
  • TECHNICAL DESCR:  This left-justified field contains the five-digit zip code, and may include the four-digit expanded zip code in which the patient is located.
    Examples: If the zip code is 98765-4321, this field would reflect: 987654321.
    If the zip code is 98765, this field would reflect: 98765 left justified.
    REQUEST PATIENT SEGMENT
326 PATIENT TELEPHONE NUMBER 321;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<12) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Answer must be 12 characters in length
  • DESCRIPTION:  
    Ten-digit phone number of patient.  NCPDP standard field 326-CQ.
  • TECHNICAL DESCR:  Format=AAAEEENNNN AAA=Area Code EEE=Exchange NNNN=Number
    Examples: If the phone number is (313) 555-1212, this field would reflect: 3135551212.
    REQUEST PATIENT SEGMENT
331 PATIENT ID QUALIFIER 330;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<4) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 4 characters in length
  • DESCRIPTION:  Code qualifying the 'Patient ID'(332-CY). NCPDP standard field 331-CX.
    Blank=Not Specified Ø1=Social Security Number Ø2=Driver's License Number Ø3=U.S. Military ID 99=Other
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT
332 PATIENT ID 330;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<22) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 22 characters in length
  • DESCRIPTION:  
    ID assigned to the patient.  NCPDP standard field 332-CY.
  • TECHNICAL DESCR:  
    Qualified by Patient Id Qualifier (331-CX).  REQUEST PATIENT SEGMENT
333 EMPLOYER ID 330;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<17) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 17 characters in length
  • DESCRIPTION:  
    ID assigned to employer.  NCPDP standard field 333-CZ.
  • TECHNICAL DESCR:  The Internal Revenue Service, Department of the Treasury, assigns the Employer ID. The format of this field is nine-digits with a hyphen, as in 00-0000000. The hyphen must be transmitted as part of the Employer ID Number.
    Information on the Employer ID may be found at http://www.irs.ustreas.gov/.  REQUEST PATIENT SEGMENT
334 SMOKER INDICATOR 330;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<3) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 3 characters in length
  • DESCRIPTION:  Code indicating the patient as a smoker or non-smoker. NCPDP standard field 334-1C.
    Blank=Not Specified 1=Non-Smoker 2=Smoker
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT
335 PREGNANCY INDICATOR 330;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<3) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 3 characters in length
  • DESCRIPTION:  Code indicating the patient as pregnant or non-pregnant. NCPDP standard field 335-2C.
    Blank=Not Specified 1=Not pregnant 2=Pregnant
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT
336 FACILITY ID 330;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<12) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 12 characters in length
  • DESCRIPTION:  
    ID assigned to the patient's clinic/host party.  NCPDP standard field 336-8C.
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT
350 PATIENT E-MAIL ADDRESS 340;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>82!($L(X)<1) X
  • LAST EDITED:  JUL 27, 2010
  • HELP-PROMPT:  Answer must be 1-82 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field 350-HN (Patient E-Mail Address), which is defined as "The E-Mail address of the patient (member)."
356 OTHER PAYER CARDHOLDER ID 350;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-22 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 356-NU (Other Payer Cardholder ID), which is defined as "Cardholder ID for this member that is associated with the Payer noted."
  • TECHNICAL DESCR:  
    RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.  REQUEST INSURANCE SEGMENT.
359 MEDIGAP ID 350;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-22 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 359-2A (Medigap ID), which is defined as "Patient's ID assigned by the Medigap Insurer."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.
360 MEDICAID INDICATOR 350;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  OCT 07, 2010
  • HELP-PROMPT:  Answer must be 1-4 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 360-2B (Medicaid Indicator), which is defined as "Two character State Postal Code indicating the state where Medicaid coverage exists."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.
361 PROVIDER ACCEPT ASSGNMT INDCTR 360;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  SEP 01, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 361-2D (Provider Accept Assignment Indicator), which is defined as "Code indicating whether the provider accepts assignment."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.
384 PATIENT RESIDENCE 380;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JUL 27, 2010
  • HELP-PROMPT:  Answer must be 1-2 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 384-4X (Patient Residence), which is defined as "Code identifying the patient's place of residence."
400 TRANSACTIONS 400;0 Multiple #9002313.0201 9002313.0201

  • LAST EDITED:  SEP 22, 2010
  • DESCRIPTION:  
    This subfile has the transactions that are included in this request.  There is only one for reversals and eligibility verification request and up to four for a billing request.
401 DATE OF SERVICE 401;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • LAST EDITED:  JUN 04, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length
  • DESCRIPTION:  
    Date prescription was dispensed.  NCPDP standard field 401-D1.
  • TECHNICAL DESCR:  Format=CCYYMMDD
    CC=Century YY=Year MM=Month DD=Day
    Examples: If the prescription was dispensed on April 22, 2000, this field would reflect 20000422.
    REQUEST TRANSACTION HEADER SEGMENT.  RESPONSE HEADER SEGMENT.
  • CROSS-REFERENCE:  9002313.02^AF
    1)= S ^BPSC("AF",$E(X,1,30),DA)=""
    2)= K ^BPSC("AF",$E(X,1,30),DA)
524 PLAN ID 520;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • LAST EDITED:  JAN 04, 2008
  • HELP-PROMPT:  Answer must be 10 characters in length
  • DESCRIPTION:  
    Assigned by the processor to identify a set of parameters, benefit, or coverage criteria used to adjudicate a claim.  NCPDP standard field 524-FO.
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.  RESPONSE INSURANCE SEGMENT.
901 CLOSED 900;1 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JAN 04, 2008
  • HELP-PROMPT:  Enter if this claim is closed or not.
  • DESCRIPTION:  
    Specify if the claim has been closed (no longer needed for followup) or not.
902 DATE CLOSED 900;2 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JAN 04, 2008
  • HELP-PROMPT:  Enter the date this claim was closed.
  • DESCRIPTION:  
    This is automatically populated with the date a claim was closed.
  • CROSS-REFERENCE:  9002313.02^AG
    1)= S ^BPSC("AG",$E(X,1,30),DA)=""
    2)= K ^BPSC("AG",$E(X,1,30),DA)
903 CLOSED BY 900;3 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JAN 04, 2008
  • HELP-PROMPT:  Enter the person who closed this claim.
  • DESCRIPTION:  
    This is automatically populated with the user who closed the claim.
904 CLOSED REASON 900;4 POINTER TO CLAIMS TRACKING NON-BILLABLE REASONS FILE (#356.8) CLAIMS TRACKING NON-BILLABLE REASONS(#356.8)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  JAN 04, 2008
  • HELP-PROMPT:  Enter the Claim Close Reason.
  • DESCRIPTION:  
    The ECME-supported non-billable reason entered by the user or defaulted by the system.
  • SCREEN:  S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)"
  • EXPLANATION:  Only ECME-supported non-billable reasons can be entered.
905 DROP TO PAPER 900;5 SET
  • 'D' FOR DROP TO PAPER;
  • 'N' FOR NON-BILLABLE;

  • LAST EDITED:  JAN 04, 2008
  • HELP-PROMPT:  Enter D if this claim should be billed on a paper claim.
  • DESCRIPTION:  
    If close reason is 90 DAY RX FILL NOT COVERED or NOT A CONTRACTED PROVIDER then user will be prompted: Treat as (N)on-Billable Episode or (D)rop Bill to Paper? the answer is stored in this field and sent to IB
906 DATE REOPENED 900;6 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JAN 04, 2008
  • HELP-PROMPT:  Enter the date and time when the claim was re-opened
  • DESCRIPTION:  
    Date and time when the claim was re-opened.
907 REOPENED BY 900;7 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 14, 2006
  • HELP-PROMPT:  Enter the user who re-opened the claim
  • DESCRIPTION:  
    The system user who re-opened the claim.
908 REOPENED COMMENT 900;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  JUN 14, 2006
  • HELP-PROMPT:  Enter the reason for the re-opening of the claim
  • DESCRIPTION:  
    User comments for the re-opening of the claim.
990 OTHER PAYER BIN NUMBER 980;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 990-MG (Other Payer BIN Number), which is defined as "The secondary, tertiary, etc. card issuer or bank ID number used for network routing."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.
991 OTHER PAYER PROCESSOR CNTRL NO 990;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-12 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 991-MH (Other Payer Processor Control Number), which is defined as "A number that uniquely identifies the secondary, tertiary, etc. payer to the processor."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.  RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
992 OTHER PAYER GROUP ID 990;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-17 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 992-MJ (Other Payer Group ID), which is defined as "ID assigned to the cardholder group or employer group by the secondary, tertiary, etc. payer."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.  RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
997 CMS PART D DEFINED QLFD FACLTY 990;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 997-G2 (CMS Part D Defined Qualified Facility), which is defined as "Indicates that the patient resides in a facility that qualifies for the CMS Part D benefit."
  • TECHNICAL DESCR:  
    REQUEST INSURANCE SEGMENT.
1022 PATIENT ID STATE/PROVINCE A20;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  MAR 01, 2013
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  NCPDP Standard field A22-YR
    The postal state code abbreviation that is used in conjunction with the Patient ID Qualifier and the Patient ID fields to identify what state the identification is from.
  • TECHNICAL DESCR:  
    PATIENT SEGMENT
1043 PATIENT COUNTRY CODE A40;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  MAR 01, 2013
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  NCPDP Standard field A43-1K
    The country of the patient's permanent residence.
  • TECHNICAL DESCR:  
    PATIENT SEGMENT
1045 VETERINARY USE INDICATOR A40;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  MAR 01, 2013
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  NCPDP Standard field A45-1R
    To indicate that the prescription was dispensed for use on something other than human.
  • TECHNICAL DESCR:  
    PATIENT SEGMENT
2008 PATIENT STREET ADDRESS LINE 1 B00;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>42!($L(X)<1) X
  • LAST EDITED:  DEC 23, 2014
  • HELP-PROMPT:  Answer must be 1-42 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field B08-7A (Patient Street Address Line 1), which is defined as "Free-form text for address line 1 information".
2009 PATIENT STREET ADDRESS LINE 2 B00;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>42!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Answer must be 1-42 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field B09-7B (Patient Street Address Line 2), which is defined as "Free-form text for address line 2 information".
2038 PATIENT ID ASSOC COUNTRY CODE B30;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field B38-1Y (Patient ID Associated Country Code), which is defined as "Code of the country".
9999 RAW DATA SENT M;0 WORD-PROCESSING #9002313.29999

  • HELP-PROMPT:  Enter the Raw data transmitted to the payer.
  • DESCRIPTION:  
    An exact copy of the record sent via the communications protocol.
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