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Global: ^BPSR

Package: E Claims Management Engine

Global: ^BPSR


Information

FileMan FileNo FileMan Filename Package
9002313.03 BPS RESPONSES E Claims Management Engine

Description

Directly Accessed By Routines, Total: 31

Package Total Routines
E Claims Management Engine 28 ADDITIONAL MESSAGE MLTPL    APPROVED MESSAGE CODE    BENEFIT STAGE INFO    BPS10P7    BPS10PST    BPSNCPD1    BPSOS03    BPSOS57
BPSOSQ4    BPSOSQL    BPSPRRX5    BPSPRRX6    BPSRPT2    BPSRPT5    BPSRPT9A    BPSSCRLG
BPSSCRRJ    BPSSCRU3    BPSSCRU5    DAYS SUPPLY LIM TM PD MULTIPLE    DUR PPS    INTERMEDIARY MULTIPLE    OTHER AMOUNTS PAID    OTHER PAYER ID MLTPL
PREFERRED PRODUCT REPEATING    QUAN LIMIT TIME PERIOD MLTPL    REJECT CODE    RESPONSES    
Integrated Billing 3 IBCNBLE2    IBJTRX    IBNCPDP3    

Accessed By FileMan Db Calls, Total: 6

Package Total Routines
E Claims Management Engine 4 BPSECMPS    BPSNCPD3    BPSOS57    BPSRCRI    
Integrated Billing 2 IBCNBLE2    IBNCPDP3    

Pointed To By FileMan Files, Total: 3

Package Total FileMan Files
E Claims Management Engine 2 BPS TRANSACTION(#9002313.59)[4402]    BPS LOG OF TRANSACTIONS(#9002313.57)[4402]    
Integrated Billing 1 INSURANCE VERIFICATION PROCESSOR(#355.33)[.17]    

Pointer To FileMan Files, Total: 4

Package Total FileMan Files
E Claims Management Engine 4 BPS NCPDP BENEFIT STAGE INDICATOR(#9002313.35)[#9002313.0301(2151)]    BPS NCPDP PATIENT PAY COMPONENT QUALIFIER(#9002313.37)[#9002313.0301(2195)]    BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)[#9002313.0301(2147)]    BPS CLAIMS(#9002313.02)[.01]    

Fields, Total: 23

Field # Name Loc Type Details
.01 BPS CLAIM 0;1 POINTER TO BPS CLAIMS FILE (#9002313.02)
************************REQUIRED FIELD************************
BPS CLAIMS(#9002313.02)

  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Select the BPS Claim.
  • DESCRIPTION:  
    Identifier for BPS responses.
  • CROSS-REFERENCE:  9002313.03^B
    1)= S ^BPSR("B",$E(X,1,30),DA)=""
    2)= K ^BPSR("B",$E(X,1,30),DA)
.02 DATE RESPONSE RECEIVED 0;2 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Enter the date the Response was received.
  • DESCRIPTION:  
    Date that response was received on the system.
  • CROSS-REFERENCE:  9002313.03^AE
    1)= S ^BPSR("AE",$E(X,1,30),DA)=""
    2)= K ^BPSR("AE",$E(X,1,30),DA)
102 VERSION RELEASE NUMBER 100;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    NCPDP Version/Release Number.
103 TRANSACTION CODE 100;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    Code identifying the type of transaction.
109 TRANSACTION COUNT 100;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>4)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  JUN 18, 2008
  • HELP-PROMPT:  Type a number between 1 and 4, 0 Decimal Digits
  • DESCRIPTION:  
    Count of transactions in the transmission.
115 MEDICAID ID INDICATOR 100;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-22 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."
116 MEDICAID AGENCY NUMBER 100;16 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-17 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."
201 SERVICE PROVIDER ID 200;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    ID assigned to a pharmacy or provider.
202 SERVICE PROVIDER ID QUALIFIER 200;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Code qualifying the 'Service Provider ID' (21)
301 GROUP ID 300;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    ID assigned to the cardholder group or employer group.
302 CARDHOLDER ID 300;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>22!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-22 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 302-C2 (Cardholder ID), which is defined as "Insurance ID assigned to the cardholder or identification number used by the plan."
304 DATE OF BIRTH 300;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-10 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 304-C4 (Date Of Birth), which is defined as "Date of birth of patient."
310 PATIENT FIRST NAME 300;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>14!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-14 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 310-CA (Patient First Name), which is defined as "Individual first name."
311 PATIENT LAST NAME 310;1 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 in length.
  • DESCRIPTION:  
    This is used to store NCPDP field 311-CB (Patient Last Name), which is defined as "Individual last name."
  • TECHNICAL DESCR:  
    REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT.
401 DATE OF SERVICE 400;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y=$$FM3EXT^BPSOSU1(Y)
  • LAST EDITED:  JUN 18, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Identifies date the prescription was filled or professional service rendered.
501 RESPONSE STATUS 500;1 SET
  • 'A' FOR ACCEPTED;
  • 'R' FOR REJECTED;

  • LAST EDITED:  JUN 17, 2008
  • HELP-PROMPT:  Enter the status of the response from the payer.
  • DESCRIPTION:  
    A code indicating the status of this response.
504 MESSAGE 504;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>250!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1-250 characters in length.
  • DESCRIPTION:  
    Free form message.
524 PLAN IDENTIFICATION 500;24 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Assigned by the processor to identify a set of parameters, benefit, or coverage criteria used to adjudicate a claim.
545 NETWORK REIMBURSEMENT ID 540;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    Field defined by the processor. It identifies the network, for the covered member, used to calculate the reimbursement to the pharmacy.
568 PAYER ID QUALIFIER 560;8 SET
  • '01' FOR STANDARD UNIQUE HEALTH PLAN ID;
  • '02' FOR HIN;
  • '03' FOR BIN;
  • '04' FOR NAIC;
  • '99' FOR OTHER;

  • LAST EDITED:  FEB 25, 2015
  • HELP-PROMPT:  Enter a code specifying the type of payer ID.
  • DESCRIPTION:  
    Code indicating the type of payer ID.
  • TECHNICAL DESCR:  
    NCPDP field 568-J7.
569 PAYER ID 560;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    Payer identification - the payer this claim was submitted to.
1000 RESPONSES 1000;0 Multiple #9002313.0301 9002313.0301

  • LAST EDITED:  FEB 07, 2008
  • DESCRIPTION:  
    This is the transaction response data returned by the third-party payer.
9999 RAW DATA RECEIVED M;0 WORD-PROCESSING #9002313.39999

  • HELP-PROMPT:  Enter the raw NCPDP data received from the payer.
  • DESCRIPTION:  
    This is to store the raw data received from the payer.

External References

Name Field # of Occurrence
^%DT .02+1
$$FM3EXT^BPSOSU1 401OT+1

Global Variables Directly Accessed

Name Line Occurrences  (* Changed,  ! Killed)
^BPSR("AE" .02(XREF 1S), .02(XREF 1K)
^BPSR("B" .01(XREF 1S), .01(XREF 1K)

Local Variables

Legend:

>> Not killed explicitly
* Changed
! Killed
~ Newed

Name Field # of Occurrence
>> %DT .02+1*
>> DA .01(XREF 1S), .01(XREF 1K), .02(XREF 1S), .02(XREF 1K)
X .01(XREF 1S), .01(XREF 1K), .02+1*!, .02(XREF 1S), .02(XREF 1K), 102+1!, 103+1!, 109+1!, 115+1!, 116+1!
, 201+1!, 202+1!, 301+1!, 302+1!, 304+1!, 310+1!, 311+1!, 401+1!, 504+1!, 524+1!
, 545+1!, 569+1!
>> Y .02+1, 401OT+1*
>> Y(0 401OT+1*
Info |  Desc |  Directly Accessed By Routines |  Accessed By FileMan Db Calls |  Pointed To By FileMan Files |  Pointer To FileMan Files |  Fields |  External References |  Global Variables Directly Accessed |  Local Variables  | All