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Global: ^BPST

Package: E Claims Management Engine

Global: ^BPST


Information

FileMan FileNo FileMan Filename Package
9002313.59 BPS TRANSACTION E Claims Management Engine

Description

Directly Accessed By Routines, Total: 76

Package Total Routines
E Claims Management Engine 74 BPS10P7    BPS19PST    BPSBUTL    BPSCMT01    BPSECA8    BPSNCPD3    BPSNCPD5    BPSOSCA
BPSOSCB    BPSOSIY    BPSOSQ    BPSOSQ4    BPSOSQA    BPSOSRX    BPSPRRX4    BPSPRRX5
BPSPRRX6    BPSREOP1    BPSRES    BPSRPT5    BPSRPT8    BPSRPT9A    BPSSCR03    BPSSCRL1
BPSSCRRJ    BPSSCRRS    BPSSCRRV    BPSSCRU1    BPSSCRU2    BPSSCRU3    BPSUSCR1    BPSUSCR4
BPSVRX    BPSWRKLS    COB OTHER PAYERS    DUR DATA    PATIENT INSURANCE MULTIPLE    ^BPST    BPSBCKJ    BPSECMC2
BPSECMP2    BPSECX1    BPSELG    BPSNCPD1    BPSNCPD4    BPSNCPDP    BPSOS6M    BPSOSCC
BPSOSCD    BPSOSIZ    BPSOSQ2    BPSOSQG    BPSOSQL    BPSOSRX6    BPSOSU    BPSPRRX
BPSPRRX3    BPSPSOU1    BPSRCRI    BPSRPT1    BPSRPT2    BPSRPT6    BPSRPT7    BPSSCR02
BPSSCR05    BPSSCRCL    BPSSCRU6    BPSUSCR2    BPSUTIL    BPSUTIL2    BPSVRX1    COMMENT MULTIPLE
OTHER PAYER AMT PAID MULTIPLE    OTHER PAYER REJECT MULTIPLE    

Accessed By FileMan Db Calls, Total: 18

Package Total Routines
E Claims Management Engine 18 BPSBUTL    BPSECA8    BPSECMP2    BPSOS03    BPSOSCB    BPSOSCF    BPSOSH2    BPSOSIZ
BPSOSU    BPSRCRI    BPSRPT1    BPSRPT6    BPSSCR03    BPSSCRCL    BPSSCRN0    BPSSCRRJ
BPSUTIL    BPSUTIL2    

Pointed To By FileMan Files, Total: 4

Package Total FileMan Files
E Claims Management Engine 4 BPS ASLEEP PAYERS(#9002313.15)[.04]    BPS REQUESTS(#9002313.77)[.06]    BPS CLAIMS(#9002313.02)[.08]    BPS NCPDP FORMATS(#9002313.92)[1.11]    

Pointer To FileMan Files, Total: 17

Package Total FileMan Files
E Claims Management Engine 9 BPS ASLEEP PAYERS(#9002313.15)[801]    BPS NCPDP OTHER PAYER AMT PAID QUAL(#9002313.2)[#9002313.59141(.02)]    BPS CERTIFICATION(#9002313.31)[#9002313.59902(902.23)]    BPS NCPDP OVERRIDE(#9002313.511)[1.13]    BPS PHARMACIES(#9002313.56)[1.07]    BPS REQUESTS(#9002313.77)[16405]    BPS CLAIMS(#9002313.02)[3401]    BPS NCPDP FORMATS(#9002313.92)[#9002313.59902(902.02)#9002313.59902(902.19)#9002313.59902(902.21)#9002313.59902(902.34)]    BPS RESPONSES(#9002313.03)[4402]    
Integrated Billing 4 BILL/CLAIMS(#399)[#9002313.59902(902.3)]    RATE TYPE(#399.3)[#9002313.59902(902.29)]    INSURANCE COMPANY(#36)[#9002313.59902(902.33)]    GROUP INSURANCE PLAN(#355.3)[#9002313.59902(.01)]    
Outpatient Pharmacy 2 OUTPATIENT SITE(#59)[11]    PRESCRIPTION(#52)[1.11]    
Kernel 1 NEW PERSON(#200)[13304307#9002313.59111(.02)]    
Registration 1 PATIENT(#2)[5]    

Fields, Total: 72

Field # Name Loc Type Details
.01 ENTRY NUMBER 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Transaction entry number.
  • CROSS-REFERENCE:  9002313.59^B
    1)= S ^BPST("B",$E(X,1,30),DA)=""
    2)= K ^BPST("B",$E(X,1,30),DA)
1 STATUS 0;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  FEB 27, 2007
  • HELP-PROMPT:  Type a Number between 0 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    The status of the transaction as a percentage of completion. The text value can be obtained by running $$STATI^BPSOSU(). Note that 99 indicates complete.
  • CROSS-REFERENCE:  9002313.59^AD
    1)= S ^BPST("AD",$E(X,1,30),DA)=""
    2)= K ^BPST("AD",$E(X,1,30),DA)
1.05 POLICY NUMBER 1;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter the policy number that will be processed for this request (0-9999).
  • DESCRIPTION:  
    This is the policy number that is being processed for this eligibility verification request.
1.07 PHARMACY 1;7 POINTER TO BPS PHARMACIES FILE (#9002313.56) BPS PHARMACIES(#9002313.56)

  • LAST EDITED:  NOV 25, 2003
  • HELP-PROMPT:  Answer with BPS PHARMACIES NAME
  • DESCRIPTION:  
    Textual description of the Pharmacy involved with this transaction.
1.08 PINS PIECE 1;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 18, 2000
  • HELP-PROMPT:  Type a Number between 1 and 9, 0 Decimal Digits
  • DESCRIPTION:  Pointer to which of the PINS pieces in ^(6) is in use for this claim. Use this to keep track of where you are in billing down the line to various insurers. (Probably won't automatically roll over to next insurer, but
    maybe we will have an option to edit insurance info, try next insurance, etc.)
1.09 PRIOR AUTHORIZATION NUMBER 1;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<1) X
  • LAST EDITED:  MAR 19, 2008
  • HELP-PROMPT:  Enter the prior authorization number (1-11 characters)
  • DESCRIPTION:  
    Number assigned by the processor to identify a prior authorized transaction.
1.11 PRESCRIPTION NUMBER 1;11 POINTER TO PRESCRIPTION FILE (#52) PRESCRIPTION(#52)

  • LAST EDITED:  JUN 03, 2008
  • HELP-PROMPT:  Answer with PRESCRIPTION RX #
  • DESCRIPTION:  
    This stores a pointer from the PRESCRIPTION (#52) file.
1.1199 RXI INTERNAL COMPUTED

  • MUMPS CODE:  S Y(9002313.59,1.1199,1)=$S($D(^BPST(D0,1)):^(1),1:"") S X=$P(Y(9002313.59,1.1199,1),U,11),X=X
  • ALGORITHM:  INTERNAL(ABSBRXI)
  • LAST EDITED:  NOV 25, 2003
  • DESCRIPTION:  
    Internal ID to the claims file.
1.12 RESUBMIT AFTER REVERSAL 1;12 SET
  • '1' FOR RESUBMIT AFTER REVERSAL;
  • '0' FOR DONE;
  • '2' FOR RESUBMITTING;

  • LAST EDITED:  DEC 07, 2005
  • HELP-PROMPT:  Enter the status of the resubmit
  • DESCRIPTION:  
    Indicator that a transaction has been resubmitted after being backed out.
1.13 NCPDP OVERRIDES 1;13 POINTER TO BPS NCPDP OVERRIDE FILE (#9002313.511) BPS NCPDP OVERRIDE(#9002313.511)

  • LAST EDITED:  OCT 19, 2000
  • HELP-PROMPT:  Enter an NCPDP field to be overridden during transmission of this transaction.
  • DESCRIPTION:  
    Override information for the NCPDP fields.
1.15 PRIOR AUTHORIZATION TYPE CODE 1;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  MAR 14, 2007
  • HELP-PROMPT:  Enter the prior authorization type (1-2 characters)
  • DESCRIPTION:  
    Indicates the type of authorization made before transaction was submitted.
2 HL7 MESSAGE ID 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  JUN 27, 2011
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is the unique HL7 message ID used for the NCPDP message created for this transaction.
3 CLAIM 0;4 POINTER TO BPS CLAIMS FILE (#9002313.02) BPS CLAIMS(#9002313.02)

  • LAST EDITED:  NOV 25, 2003
  • HELP-PROMPT:  Answer with BPS CLAIMS CLAIM ID
  • DESCRIPTION:  
    Claim number for this transaction.
  • CROSS-REFERENCE:  9002313.59^AE
    1)= S ^BPST("AE",$E(X,1,30),DA)=""
    2)= K ^BPST("AE",$E(X,1,30),DA)
3.1 CLAIM IEN COMPUTED

  • MUMPS CODE:  S Y(9002313.59,3.1,1)=$S($D(^BPST(D0,0)):^(0),1:"") S X=$P(Y(9002313.59,3.1,1),U,4),X=X
  • ALGORITHM:  INTERNAL(CLAIM)
  • LAST EDITED:  NOV 25, 2003
  • DESCRIPTION:  
    Claim internal identifier for this transaction.
4 RESPONSE 0;5 POINTER TO BPS RESPONSES FILE (#9002313.03) BPS RESPONSES(#9002313.03)

  • LAST EDITED:  NOV 25, 2003
  • HELP-PROMPT:  Answer with BPS RESPONSES ID
  • DESCRIPTION:  
    Textual description of the response to this submission.
  • CROSS-REFERENCE:  9002313.59^AF
    1)= S ^BPST("AF",$E(X,1,30),DA)=""
    2)= K ^BPST("AF",$E(X,1,30),DA)
4.0098 RESULT WITH REVERSAL COMPUTED

  • MUMPS CODE:  S X=$$CATEG^BPSOSUC(D0,1)
  • ALGORITHM:  S X=$$CATEG^BPSOSUC(D0,1)
  • DESCRIPTION:  
    The overall result.
4.0099 RESULT COMPUTED

  • MUMPS CODE:  S X=$$CATEG^BPSOSUC(D0)
  • ALGORITHM:  S X=$$CATEG^BPSOSUC(D0)
  • DESCRIPTION:  
    The result of the transmission.
4.1 RESPONSE IEN COMPUTED

  • MUMPS CODE:  S Y(9002313.59,4.1,1)=$S($D(^BPST(D0,0)):^(0),1:"") S X=$P(Y(9002313.59,4.1,1),U,5),X=X
  • ALGORITHM:  INTERNAL(RESPONSE)
  • LAST EDITED:  NOV 25, 2003
  • DESCRIPTION:  
    Internal identifier for the response.
5 PATIENT 0;6 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  JUN 09, 2004
  • HELP-PROMPT:  Answer with PATIENT NAME
  • DESCRIPTION:  
    Patient name.
  • CROSS-REFERENCE:  9002313.59^AC
    1)= S ^BPST("AC",$E(X,1,30),DA)=""
    2)= K ^BPST("AC",$E(X,1,30),DA)
6 SUBMIT DATE 0;7 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Enter the date/time that the claim was submitted
  • DESCRIPTION:  
    This is the date/time that the RX/Fill was submitted to ECME
7 LAST UPDATE 0;8 DATE

  • INPUT TRANSFORM:  S %DT="EST" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUN 13, 2008
  • HELP-PROMPT:  Enter the Date/Time this Transaction was last updated.
  • DESCRIPTION:  
    Last date this record was updated.
  • CROSS-REFERENCE:  9002313.59^AH
    1)= S ^BPST("AH",$E(X,1,30),DA)=""
    2)= K ^BPST("AH",$E(X,1,30),DA)
9 FILL NUMBER 1;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Type a number between 0 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    Prescription fill/refill number.
10 NDC 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<5) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 5-11 characters in length.
  • DESCRIPTION:  
    The NDC number of the drug involved in this transaction.
10.0099 USER NUMBER COMPUTED

  • MUMPS CODE:  S Y(9002313.59,10.0099,1)=$S($D(^BPST(D0,0)):^(0),1:"") S X=$P(Y(9002313.59,10.0099,1),U,10),X=X
  • ALGORITHM:  INTERNAL(USER)
  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    The DUZ of the user who sent the transaction.
11 PHARMACY DIVISION 1;4 POINTER TO OUTPATIENT SITE FILE (#59) OUTPATIENT SITE(#59)

  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Select the Pharmacy Division
  • DESCRIPTION:  
    The division ID for the transaction.
13 USER 0;10 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer with NEW PERSON NAME
  • DESCRIPTION:  
    User name who entered this transaction.
  • CROSS-REFERENCE:  9002313.59^AG
    1)= S ^BPST("AG",$E(X,1,30),DA)=""
    2)= K ^BPST("AG",$E(X,1,30),DA)
14 POSITION IN CLAIM 0;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  NOV 25, 2003
  • HELP-PROMPT:  Type a Number between 1 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    Sequential order in the claim transactions.
15 START TIME 0;11 DATE

  • INPUT TRANSFORM:  S %DT="EST" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Answer with the date/time this transaction was started.
  • DESCRIPTION:  
    Time this transaction was started.
16 SUBMIT REQUEST 0;12 POINTER TO BPS REQUESTS FILE (#9002313.77) BPS REQUESTS(#9002313.77)

  • LAST EDITED:  DEC 12, 2007
  • HELP-PROMPT:  Answer with BPS REQUESTS RX NUMBER
  • DESCRIPTION:  
    IEN of the BPS REQUEST file (#9002313.77)
17 SUBMIT REQUEST DATE TIME 0;13 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  DEC 12, 2007
  • HELP-PROMPT:  Answer with the date/time this request was submitted.
  • DESCRIPTION:  
    Submit Request Date/Time
  • CROSS-REFERENCE:  9002313.59^AS
    1)= S ^BPST("AS",$E(X,1,30),DA)=""
    2)= K ^BPST("AS",$E(X,1,30),DA)
    Submit Request Date/Time cross-reference - when the request was placed to the queue.
18 COB INDICATOR 0;14 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  DEC 03, 2007
  • HELP-PROMPT:  Answer with a Coordination of Benefits indicator
  • DESCRIPTION:  
    COB indicator.
19 TRANSACTION TYPE 0;15 SET
  • 'C' FOR CLAIM;
  • 'E' FOR ELIGIBILITY;
  • 'U' FOR UNCLAIM;
  • 'N' FOR NON-BILLABLE;

  • LAST EDITED:  MAY 14, 2015
  • HELP-PROMPT:  Answer with the type of transaction that will be processed for this NCPDP request.
  • DESCRIPTION:  This is the type of transaction that is being processed:
    CLAIM - An NCPDP billing request.
    UNCLAIM - An NCPDP reversal request.
    ELIGIBILITY - An eligibility verification request.
    NON-BILLABLE - A TRICARE/CHAMPVA non-billable prescription.
  • TECHNICAL DESCR:  
    NON-BILLABLE has been added with patch BPS*1*20.
111 COMMENT MULTIPLE 11;0 DATE Multiple #9002313.59111 9002313.59111

  • LAST EDITED:  JUN 27, 2005
  • HELP-PROMPT:  Enter the date/time of a user's comments
  • DESCRIPTION:  
    User's comment
201 RESULT CODE 2;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999.999)!(X<0)!(X?.E1"."8N.N) X
  • LAST EDITED:  JUN 03, 2008
  • HELP-PROMPT:  Type a Number between 0 and 999.999, 7 Decimal Digits
  • DESCRIPTION:  
    Code indicating the result of the adjudication of this claim.
202 RESULT TEXT 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>200!($L(X)<1) X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Answer must be 1-200 characters in length.
  • DESCRIPTION:  
    Textual explanation of the result code.
301 NON-BILLABLE REASON 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  AUG 19, 2015
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    This is the reason why this prescription is Non-Billable. It is the free text value as returned by the IB Billing Determination process. This is only for TRICARE or CHAMPVA prescriptions.
  • TECHNICAL DESCR:  
    This value comes from piece [2] of the return value of $$RX^IBNCPDP when the prescription is reported as non-billable. This is only for TRICARE or CHAMPVA prescriptions.
302 NON-BILLABLE CLOSED 3;2 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  MAY 14, 2015
  • HELP-PROMPT:  Enter Yes if the Non-Billable entry is Closed.
  • DESCRIPTION:  Enter Yes if this Non-Billable entry has been Closed. Enter No if this Non-Billable entry is still Open. When Non-Billable entries are initially created in the BPS Transaction file, they are automatically defaulted to
    Open.
303 NON-BILLABLE DATE CLOSED 3;3 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAY 14, 2015
  • HELP-PROMPT:  Enter the date and time when this Non-Billable entry was closed.
  • DESCRIPTION:  
    This field contains the date and time when this Non-Billable entry was closed. It is set by the system when a user performs this action on the ECME User Screen.
304 NON-BILLABLE CLOSED BY 3;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 15, 2015
  • HELP-PROMPT:  Enter the person who closed this non-billable entry.
  • DESCRIPTION:  
    This is the person who closed this non-billable entry. It is automatically populated when this close action happens.
305 NON-BILLABLE CLOSED COMMENT 3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  MAY 15, 2015
  • HELP-PROMPT:  Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    This is a free text comment explaining why this non-billable entry is being closed.
306 NON-BILLABLE DATE RE-OPENED 3;6 DATE

  • INPUT TRANSFORM:  S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAY 15, 2015
  • HELP-PROMPT:  Enter the date and time when the non-billable entry was re-opened.
  • DESCRIPTION:  
    This is the date and time when the user re-opened the non-billable entry.
307 NON-BILLABLE RE-OPENED BY 3;7 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  MAY 15, 2015
  • HELP-PROMPT:  Enter the user who re-opened this non-billable entry.
  • DESCRIPTION:  
    This is the user who re-opened this non-billable entry. It is set automatically by the system when this action is performed.
308 NON-BILLABLE RE-OPENED COMMENT 3;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  MAY 15, 2015
  • HELP-PROMPT:  Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    This field holds the free-text comments entered by the user for the reason that this non-billable entry was re-opened.
401 REVERSAL CLAIM 4;1 POINTER TO BPS CLAIMS FILE (#9002313.02) BPS CLAIMS(#9002313.02)

  • LAST EDITED:  NOV 25, 2003
  • HELP-PROMPT:  Answer with BPS CLAIMS CLAIM ID for the reversal.
  • DESCRIPTION:  
    Request to reverse this claim.
  • CROSS-REFERENCE:  9002313.59^AER
    1)= S ^BPST("AER",$E(X,1,30),DA)=""
    2)= K ^BPST("AER",$E(X,1,30),DA)
    ^BPST("AER",reversal claim #,IEN59)=""
402 REVERSAL RESPONSE 4;2 POINTER TO BPS RESPONSES FILE (#9002313.03) BPS RESPONSES(#9002313.03)

  • LAST EDITED:  NOV 25, 2003
  • HELP-PROMPT:  Answer with BPS RESPONSES BPS CLAIM for the reversal.
  • DESCRIPTION:  
    Response to reversal message.
  • CROSS-REFERENCE:  9002313.59^AFR
    1)= S ^BPST("AFR",$E(X,1,30),DA)=""
    2)= K ^BPST("AFR",$E(X,1,30),DA)
    ^BPST("AFR",reversal response,IEN59)=""
404 REVERSAL REASON 4;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  MAY 25, 2005
  • HELP-PROMPT:  Answer must be 1-40 characters in length
  • DESCRIPTION:  
    Reason for the reversal
405 REVERSAL REQUEST 4;5 POINTER TO BPS REQUESTS FILE (#9002313.77) BPS REQUESTS(#9002313.77)

  • LAST EDITED:  DEC 12, 2007
  • HELP-PROMPT:  Answer with BPS REQUESTS RX NUMBER for the reversal.
  • DESCRIPTION:  
    Reversal Request IEN
406 REVERSAL REQUEST DATE TIME 4;6 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  DEC 12, 2007
  • HELP-PROMPT:  Answer with the Reversal Request Date/Time
  • DESCRIPTION:  
    Reversal Request Date/Time
501 QUANTITY 5;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Type a number between 0 and 9999999, 3 decimal digits.
  • DESCRIPTION:  
    This is the quantity that will be used for the NCPDP field 442-E7 (QUANTITY DISPENSED) of the NCPDP submission.
502 UNIT PRICE 5;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."7N.N) X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Type a Number between 0 and 9999999, 6 Decimal Digits
  • DESCRIPTION:  
    Price per unit of prescription.
503 SUBTOTAL 5;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."7N.N) X
  • LAST EDITED:  MAR 13, 2000
  • HELP-PROMPT:  Type a Number between 0 and 999999, 6 Decimal Digits
  • DESCRIPTION:  
    = QUANTITY * UNIT PRICE This is probably what we want to send as the INGREDIENT COST field in the NCPDP message.
504 DISPENSING FEE 5;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99)!(X<0) X
  • LAST EDITED:  MAR 13, 2000
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99, 2 Decimal Digits
  • DESCRIPTION:  
    Storing it here, since it can vary by insurer (or maybe by Pharmacy, too? maybe we want to put a field in 9002313.56)
505 TOTAL PRICE 5;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • OUTPUT TRANSFORM:  S X=$J(X,0,2)
  • LAST EDITED:  JAN 16, 2004
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
  • DESCRIPTION:  
    =SUBTOTAL + DISPENSING FEE
507 ADMINISTRATIVE FEE 5;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Any fee charged for handling of the paperwork.
508 UNIT OF MEASURE 5;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JUN 27, 2007
  • HELP-PROMPT:  Enter the Unit of Measure (1-2 characters)
  • DESCRIPTION:  
    Enter the Unit of Measure for the drug. This is usually GR (grams), ML (milliliters), or EA (Each).
509 BILLING QUANTITY 5;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Type a number between 0 and 999999, 2 decimal digits.
  • DESCRIPTION:  
    This is the quantity from the prescription and is used to calculate the ingredient cost. It may be different than the quantity used in the actual NCPDP submission.
510 BILLING UNIT 5;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JUN 03, 2011
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the billing units associated with the billing quantity.
801 ASLEEP PAYER 8;1 POINTER TO BPS ASLEEP PAYERS FILE (#9002313.15) BPS ASLEEP PAYERS(#9002313.15)

  • LAST EDITED:  JUN 13, 2008
  • HELP-PROMPT:  Specify a payer that is identified as being asleep.
  • DESCRIPTION:  
    This field identifies an asleep payer for this transaction.
  • CROSS-REFERENCE:  9002313.59^ASL
    1)= S ^BPST("ASL",$E(X,1,30),DA)=""
    2)= K ^BPST("ASL",$E(X,1,30),DA)
901 CURRENT VA INSURER 9;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  JUN 26, 2003
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    The insurer being submitted to currently, if there are Primary, Secondary, and tertiary insurers defined.
901.04 ELIGIBILITY 9;4 SET
  • 'V' FOR VETERAN;
  • 'T' FOR TRICARE;
  • 'C' FOR CHAMPVA;

  • LAST EDITED:  OCT 24, 2007
  • HELP-PROMPT:  Enter (V)eteran, (T)ricare, or (C)hampVA.
  • DESCRIPTION:  
    The insurance eligibility type of the claim.
902 PATIENT INSURANCE MULTIPLE 10;0 POINTER Multiple #9002313.59902 9002313.59902

  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer with GROUP INSURANCE PLAN.
  • DESCRIPTION:  
    List of the insurers for the patient.
1201 RX ACTION 12;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  FEB 10, 2011
  • HELP-PROMPT:  Enter the mnemonic that indicates what type of action should be performed (1-4 characters).
  • DESCRIPTION:  This is the action that is being performed on this request. It is either the BWHERE parameter passed into BPSNCPDP or 'ELIG' for an eligibility verification request. The list of BWHERE values are documented at the top of
    routine BPSNCPD3.
1202 DATE OF SERVICE 12;2 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAY 25, 2005
  • HELP-PROMPT:  (No range limit on date)
  • DESCRIPTION:  
    Date to be used for the 401-D1 (DATE OF SERVICE) field for the claim
1203 SUBMISSION CLARIFICATION CODE 12;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JAN 19, 2007
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Submission Clarification Code
1204 COB OTHER PAYMENTS COUNT 12;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUN 14, 2010
  • HELP-PROMPT:  Enter a number between 0 and 9 for a count of other payment occurrences.
  • DESCRIPTION:  NCPDP field 337-4C - Coordination of Benefits/Other Payments Count
    This value corresponds to the number of multiple entries in the #1400 multiple field - COB OTHER PAYERS.
1205 OTHER COVERAGE CODE 12;5 SET
  • '00' FOR NOT SPECIFIED;
  • '01' FOR NO OTH COVERAGE;
  • '02' FOR PYMT COLLECT/OTH PAYER;
  • '03' FOR CLAIM NOT COVER/OTH PAYER;
  • '04' FOR PYMT NOT COLLECT/OTH PAYER;
  • '05' FOR PLAN DENIAL;
  • '06' FOR NONPARTICIPAT PROV/OTH PAYER;
  • '07' FOR OTH COVER NOT EFFECT ON DOS;
  • '08' FOR COPAY BILLING;

  • LAST EDITED:  JUN 14, 2010
  • HELP-PROMPT:  Select the Other Coverage Code.
  • DESCRIPTION:  
    NCPDP field 308-C8 - code indicating whether or not the patient has other insurance coverage.
1300 DUR DATA 13;0 Multiple #9002313.5913 9002313.5913

  • HELP-PROMPT:  Enter a DUR Data Counter.
  • DESCRIPTION:  
    This multiple will track the Drug Utilization Review (DUR) information passed by Outpatient Pharmacy to ECME and that will eventually be put in the DUR segment of the NCPDP claim.
1400 COB OTHER PAYERS 14;0 Multiple #9002313.5914 9002313.5914

  • LAST EDITED:  JUN 14, 2010
  • DESCRIPTION:  This multiple structure stores information about each of the other payers involved in the payment or rejection of the claim.
    NCPDP has a maximum of 9 occurrences here with a recommendation of less than or equal to 3 occurrences. However, VA only stores data for at most 3 insurance policies for any given claim. So at most there will only be 2
    occurrences of this other payer multiple.
9999.96 NET PAID BY INSURER COMPUTED

  • MUMPS CODE:  N RESP,POSITION S X=$G(^BPSTL(D0,0)),RESP=$P(X,U,5),POSITION=$P(X,U,9),X=$S(RESP&POSITION:$$NETPAID1^BPSOS03(RESP,POSITION),1:"")
  • ALGORITHM:  N RESP,POSITION S X=$G(^BPSTL(D0,0)),RESP=$P(X,U,5),POSITION=$P(X,U,9),X=$S(RESP&POSITION:$$NETPAID1^BPSOS03(RESP,POSITION),1:"")
  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    Amount paid after the discounts and deductible have been subtracted.
9999.97 ELAPSED TIME (PRINTABLE) COMPUTED

  • MUMPS CODE:  S X=$$TIMEDIF^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
  • ALGORITHM:  S X=$$TIMEDIF^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
  • LAST EDITED:  JAN 02, 2008
  • DESCRIPTION:  
    The elapsed time between the filling of the prescription and the return of the response from the payer.
9999.98 ELAPSED TIME (SECONDS) COMPUTED

  • MUMPS CODE:  S X=$$TIMEDIFI^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
  • ALGORITHM:  S X=$$TIMEDIFI^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
  • LAST EDITED:  OCT 20, 2000
  • DESCRIPTION:  
    The number of seconds between the placing of the order and the receipt of the response.
9999.99 RESULT CATEGORY COMPUTED

  • MUMPS CODE:  S X=$$CATEG^BPSOSUC(D0)
  • ALGORITHM:  S X=$$CATEG^BPSOSUC(D0)
  • LAST EDITED:  APR 05, 2004
  • DESCRIPTION:  The category of the response.
    "P"aid "R"ejected "A"ccepted

External References

Name Field # of Occurrence
^%DT 6+1, 7+1, 15+1, 17+1, 303+1, 306+1, 406+1, 1202+1
$$NETPAID1^BPSOS03 9999.96+1
$$CATEG^BPSOSUC 4.0098+1, 4.0099+1, 9999.99+1
$$TIMEDIF^BPSOSUD 9999.97+1
$$TIMEDIFI^BPSOSUD 9999.98+1

Global Variables Directly Accessed

Name Line Occurrences  (* Changed,  ! Killed)
^BPST - [#9002313.59] 1.1199+1, 3.1+1, 4.1+1, 10.0099+1, 9999.97+1, 9999.98+1
^BPST("AC" 5(XREF 1S), 5(XREF 1K)
^BPST("AD" 1(XREF 1S), 1(XREF 1K)
^BPST("AE" 3(XREF 1S), 3(XREF 1K)
^BPST("AER" 401(XREF 1S), 401(XREF 1K)
^BPST("AF" 4(XREF 1S), 4(XREF 1K)
^BPST("AFR" 402(XREF 1S), 402(XREF 1K)
^BPST("AG" 13(XREF 1S), 13(XREF 1K)
^BPST("AH" 7(XREF 1S), 7(XREF 1K)
^BPST("AS" 17(XREF 1S), 17(XREF 1K)
^BPST("ASL" 801(XREF 1S), 801(XREF 1K)
^BPST("B" .01(XREF 1S), .01(XREF 1K)
^BPSTL - [#9002313.57] 9999.96+1

Naked Globals

Name Field # of Occurrence
^(0 3.1+1, 4.1+1, 10.0099+1
^(1 1.1199+1

Local Variables

Legend:

>> Not killed explicitly
* Changed
! Killed
~ Newed

Name Field # of Occurrence
>> %DT 6+1*, 7+1*, 15+1*, 17+1*, 303+1*, 306+1*, 406+1*, 1202+1*
>> D0 1.1199+1, 3.1+1, 4.0098+1, 4.0099+1, 4.1+1, 10.0099+1, 9999.96+1, 9999.97+1, 9999.98+1, 9999.99+1
>> DA .01(XREF 1S), .01(XREF 1K), 1(XREF 1S), 1(XREF 1K), 3(XREF 1S), 3(XREF 1K), 4(XREF 1S), 4(XREF 1K), 5(XREF 1S), 5(XREF 1K)
7(XREF 1S), 7(XREF 1K), 13(XREF 1S), 13(XREF 1K), 17(XREF 1S), 17(XREF 1K), 401(XREF 1S), 401(XREF 1K), 402(XREF 1S), 402(XREF 1K)
801(XREF 1S), 801(XREF 1K)
POSITION 9999.96+1~*
RESP 9999.96+1~*
U 1.1199+1, 3.1+1, 4.1+1, 10.0099+1, 9999.96+1, 9999.97+1, 9999.98+1
X .01+1!, .01(XREF 1S), .01(XREF 1K), 1+1!, 1(XREF 1S), 1(XREF 1K), 1.05+1!, 1.08+1!, 1.09+1!, 1.1199+1*
, 1.15+1!, 2+1!, 3(XREF 1S), 3(XREF 1K), 3.1+1*, 4(XREF 1S), 4(XREF 1K), 4.0098+1*, 4.0099+1*, 4.1+1*
5(XREF 1S), 5(XREF 1K), 6+1*!, 7+1*!, 7(XREF 1S), 7(XREF 1K), 9+1!, 10+1!, 10.0099+1*, 13(XREF 1S)
13(XREF 1K), 14+1!, 15+1*!, 17+1*!, 17(XREF 1S), 17(XREF 1K), 201+1!, 202+1!, 301+1!, 303+1*!
, 305+1!, 306+1*!, 308+1!, 401(XREF 1S), 401(XREF 1K), 402(XREF 1S), 402(XREF 1K), 404+1!, 406+1*!, 501+1!
, 502+1!, 503+1!, 504+1*!, 505+1*!, 505OT+1*, 507+1!, 508+1!, 509+1!, 510+1!, 801(XREF 1S)
801(XREF 1K), 901+1!, 1201+1!, 1202+1*!, 1203+1!, 1204+1!, 9999.96+1*, 9999.97+1*, 9999.98+1*, 9999.99+1*
>> Y 6+1, 7+1, 15+1, 17+1, 303+1, 306+1, 406+1, 505OT+1, 1202+1
>> Y( 1.1199+1*, 3.1+1*, 4.1+1*, 10.0099+1*
>> Y(0 505OT+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 |  Naked Globals |  Local Variables  | All