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Global: ^BPS(9002313.77

Package: E Claims Management Engine

Global: ^BPS(9002313.77


Information

FileMan FileNo FileMan Filename Package
9002313.77 BPS REQUESTS E Claims Management Engine

Description

Directly Accessed By Routines, Total: 27

Package Total Routines
E Claims Management Engine 23 BPSUSCR2    ^BPS(9002313.77    BPS10P11    BPS10PST    BPS19PST    BPSNCPD1    BPSNCPD5    BPSNCPD6
BPSNCPDP    BPSOSRB    BPSOSRX    BPSOSRX3    BPSOSRX4    BPSOSRX5    BPSOSRX6    BPSOSRX7
BPSOSU    BPSUTIL2    COB OTHER PAYERS    DUR    INSURER DATA    OTHER PAYER AMT PAID MULTIPLE    OTHER PAYER REJECT MULTIPLE    

Accessed By FileMan Db Calls, Total: 3

Package Total Routines
E Claims Management Engine 3 BPSOSRX4    BPSUSCR1    BPSUSCR2    

Pointed To By FileMan Files, Total: 3

Package Total FileMan Files
E Claims Management Engine 3 BPS REQUESTS(#9002313.77)[.05]    BPS TRANSACTION(#9002313.59)[16405]    BPS LOG OF TRANSACTIONS(#9002313.57)[16405]    

Pointer To FileMan Files, Total: 14

Package Total FileMan Files
E Claims Management Engine 7 BPS NCPDP OTHER PAYER AMT PAID QUAL(#9002313.2)[#9002313.7781(.02)]    BPS NCPDP DELAY REASON CODE(#9002313.29)[2.1]    BPS CERTIFICATION(#9002313.31)[4.06]    BPS NCPDP OVERRIDE(#9002313.511)[2.04]    BPS REQUESTS(#9002313.77)[.05]    BPS INSURER DATA(#9002313.78)[#9002313.772(.03)]    BPS TRANSACTION(#9002313.59)[.06]    
Integrated Billing 3 BILL/CLAIMS(#399)[1.09]    RATE TYPE(#399.3)[1.08]    CLAIMS TRACKING NON-BILLABLE REASONS(#356.8)[7.02]    
Outpatient Pharmacy 2 OUTPATIENT SITE(#59)[1.02]    PRESCRIPTION(#52)[1.13]    
Kernel 1 NEW PERSON(#200)[6.026.046.06]
Registration 1 PATIENT(#2)[1.15]    

Fields, Total: 55

Field # Name Loc Type Details
.01 KEY1 0;1 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the first key of the request (1-9999999999999).
  • DESCRIPTION:  
    For claim requests and reversals, this is the prescription IEN that will be processed. For Eligibility Verification requests, this is the Patient IEN that will be processed.
  • CROSS-REFERENCE:  9002313.77^B
    1)= S ^BPS(9002313.77,"B",$E(X,1,30),DA)=""
    2)= K ^BPS(9002313.77,"B",$E(X,1,30),DA)
  • RECORD INDEXES:  AC (#804), D (#806)
.02 KEY2 0;2 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 18, 2010
  • HELP-PROMPT:  Enter the second key of the request (0-9999).
  • DESCRIPTION:  For billing requests and reversals, this is the fill number where 0 is the original fill and 1-999 are refills. For eligibility verification requests, this is the policy number plus 9000. So, for policy number 4, this
    would be 9004.
  • RECORD INDEXES:  AC (#804), D (#806)
.03 ACTING COB 0;3 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  JUN 23, 2008
  • HELP-PROMPT:  Answer with a Coordination of Benefits indicator
  • DESCRIPTION:  This field indicates for which insurer (in terms of coordination of benefits) this particular request was created. For example, if the patient has three insurances then three separate requests can be created for the same
    prescription/refill in order to bill patient's Primary, Secondary and Tertiary insurers. This field indicates for which insurer this request is for.
  • RECORD INDEXES:  AC (#804), AN (#805), D (#806)
.04 PROCESS FLAG 0;4 SET
************************REQUIRED FIELD************************
  • '0' FOR SCHEDULED;
  • '1' FOR ACTIVATED;
  • '2' FOR IN PROCESS;
  • '3' FOR COMPLETED;
  • '4' FOR CANCELLED;
  • '5' FOR INACTIVE;

  • LAST EDITED:  JUN 25, 2008
  • HELP-PROMPT:  Select a process flag for the request
  • DESCRIPTION:  State of the request.
    SCHEDULED - scheduled for the future (for example : the secondary claim is scheduled to be processed after the primary is completed)
    ACTIVATED - ready to be processed
    IN PROCESS - currently in process
    COMPLETED - has been completed
    CANCELLED - cancelled
    INACTIVE - the system marks the records with "bad" data as inactive instead of removing them - to keep them for repair or for investigation
  • RECORD INDEXES:  AC (#804), AN (#805), D (#806)
.05 NEXT REQUEST 0;5 POINTER TO BPS REQUESTS FILE (#9002313.77) BPS REQUESTS(#9002313.77)

  • LAST EDITED:  JUN 19, 2008
  • HELP-PROMPT:  Answer with the request that follows this one
  • DESCRIPTION:  
    To store the pointer to the next request which should be processed.
  • RECORD INDEXES:  AN (#805)
.06 ECME TRANSACTION RECORD 0;6 POINTER TO BPS TRANSACTION FILE (#9002313.59) BPS TRANSACTION(#9002313.59)

  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the transaction record from the BPS Transaction file.
  • DESCRIPTION:  
    This is the BPS Transaction. It is not initially populated but is populated after the request is activated and the BPS Transaction record is created.
  • CROSS-REFERENCE:  9002313.77^C
    1)= S ^BPS(9002313.77,"C",$E(X,1,30),DA)=""
    2)= K ^BPS(9002313.77,"C",$E(X,1,30),DA)
.07 WAITING RESOLUTION? 0;7 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUN 23, 2008
  • HELP-PROMPT:  Is this request awaiting resolution?
  • DESCRIPTION:  
    Flag to mark requests with problems.
.08 DONT PROCESS UNTIL 0;8 DATE

  • INPUT TRANSFORM:  S %DT="ET" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  NOV 13, 2008
  • HELP-PROMPT:  Enter Date/Time
  • DESCRIPTION:  
    The request cannot be processed until the date and time specified in this field. If null then it can be processed at any time (immediately).
1.01 RX ACTION 1;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.
  • TECHNICAL DESCR:  
    The RX Actions are documented at the top of routine BPSNCPD3.
1.02 OUTPATIENT SITE 1;2 POINTER TO OUTPATIENT SITE FILE (#59) OUTPATIENT SITE(#59)

  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the Outpatient Site associated with the request.
  • DESCRIPTION:  
    This is the outpatient site that will be used to generate the NPI number for the Service Provider ID (201-B1) field of a NCPDP request.
1.04 TRANSACTION TYPE 1;4 SET
  • 'C' FOR CLAIM;
  • 'E' FOR ELIGIBILITY;
  • 'U' FOR UNCLAIM;

  • LAST EDITED:  OCT 18, 2010
  • 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.
  • RECORD INDEXES:  AN (#805)
1.05 BILLING DETERMINATION 1;5 SET
  • '0' FOR NOT BILLABLE;
  • '1' FOR BILLABLE;

  • LAST EDITED:  JUN 23, 2008
  • HELP-PROMPT:  Is this claim billable?
  • DESCRIPTION:  
    Billing determination result
1.06 ELIGIBILITY 1;6 SET
  • 'V' FOR VETERAN;
  • 'T' FOR TRICARE;
  • 'C' FOR CHAMPVA;

  • LAST EDITED:  JUN 24, 2008
  • HELP-PROMPT:  Enter eligibility of the claim.
  • DESCRIPTION:  
    The insurance eligibility type of the claim.
1.07 CLAIM STATUS 1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>99!($L(X)<1) X
  • LAST EDITED:  JUN 19, 2008
  • 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.
1.08 RATE TYPE 1;8 POINTER TO RATE TYPE FILE (#399.3) RATE TYPE(#399.3)

  • LAST EDITED:  MAR 27, 2009
  • HELP-PROMPT:  Select Rate Type for billing.
  • DESCRIPTION:  
    The Rate Type selected by the user for billing.
1.09 PRIMARY PAYER BILL 1;9 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  JAN 09, 2009
  • HELP-PROMPT:  Select Primary bill for secondary billing.
  • DESCRIPTION:  
    Primary bill which should be used to create the secondary bill. This field is used for secondary billing only.
1.1 PRIOR PAYMENT 1;10 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAR 27, 2009
  • HELP-PROMPT:  Enter a Dollar Amount (between 0 and 999999, 2 Decimal Digits) paid by primary insurer.
  • DESCRIPTION:  
    Dollar amount paid by the Primary insurer. This field is used for secondary billing only.
1.11 COB OTHER PAYMENTS COUNT 1;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUN 07, 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 #8 multiple field - COB OTHER PAYERS.
1.12 OTHER COVERAGE CODE 1;12 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 07, 2010
  • HELP-PROMPT:  Select the Other Coverage Code.
  • DESCRIPTION:  
    NCPDP field 308-C8 - code indicating whether or not the patient has other insurance coverage.
1.13 RX NUMBER 1;13 POINTER TO PRESCRIPTION FILE (#52) PRESCRIPTION(#52)

  • LAST EDITED:  OCT 18, 2010
  • HELP-PROMPT:  Enter the prescription to be processed for this request.
  • DESCRIPTION:  For billing requests and reversal, this is the prescription that will be processed for the request. If an eligibility verification request is initiated from the ECME User Screen, this field will also be populated and will
    be used to get the Prescriber information from the prescription.
1.14 FILL NO 1;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the fill number that will be processed for this request (1-99).
  • DESCRIPTION:  For billing requests and reversals, this is the fill number to be processed, where 0 is the original fill and 1-99 are refills. If an eligibility verification request is initiated from the ECME User Screen, this field
    will also be populated and will be used to get the Prescriber information from the prescription.
1.15 PATIENT 1;15 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  MAY 11, 2011
  • HELP-PROMPT:  Enter the patient associated with this request.
  • DESCRIPTION:  
    For billing requests and reversals, this is the patient associated with the prescription. For eligibility verification requests, this is the patient for which the insurance is being verified.
1.16 POLICY NUMBER 1;16 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 18, 2010
  • HELP-PROMPT:  Enter the policy number for the request (0-9999).
  • DESCRIPTION:  
    This is the policy number of the patient that is being verified in an eligibility verification request.
2.01 DATE OF SERVICE 2;1 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Enter the date of service to be used on this NCPDP request.
  • DESCRIPTION:  
    This is the date of service that will be used to populate the 401-D1 field of the NCPDP request. It is generally the fill/refill date of the prescription but may also be the release date.
2.02 REVERSAL REASON 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
  • LAST EDITED:  JUN 19, 2008
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    Reversal Reason as a free text. Examples: ECME RESUBMIT, RX EDITED, RX DISCONTINUED
2.03 DURREC 2;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  JUN 19, 2008
  • HELP-PROMPT:  Answer must be 1-80 characters in length
  • DESCRIPTION:  
    Drug Utilization Review (DUR) information passed by Outpatient Pharmacy to ECME.
2.04 OVERRIDE CODE 2;4 POINTER TO BPS NCPDP OVERRIDE FILE (#9002313.511) BPS NCPDP OVERRIDE(#9002313.511)

  • LAST EDITED:  JUN 24, 2008
  • HELP-PROMPT:  Select a record of the BPS NCPDP OVERRIDE file
  • DESCRIPTION:  
    This is used to store overrides entered by the user via the Resubmit with Edits (RED) option in the ECME User Screen to change certain data elements sent to the payer during resubmission of the claim.
2.05 CLARIFICATION CODE 2;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • LAST EDITED:  FEB 22, 2011
  • HELP-PROMPT:  Enter between 1 and 3 Submission Clarification Codes separated by "~".
  • DESCRIPTION:  The Submission Clarification Code is entered by the pharmacist and passed by Outpatient Pharmacy to ECME to put into the claim to support/justify the claim request when the payer rejects it. Valid clarification codes are
    selected from BPS NCPDP CLARIFICATION CODES file (#9002313.25). These codes justify an earlier fill date to the payer. For example if a patient needed an early refill due to being on vacation when the prescription would
    normally be filled, a VACATION SUPPLY clarification code can be used as justification to the payer for filling the prescription thereby mitigating any claims rejections.
  • TECHNICAL DESCR:  
    Up to 3 Submission Clarification Codes can be submitted, They are stored in this free text field as follows: SCC1~SCC2~SCC3
2.06 BILL NDC 2;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<5) X
  • LAST EDITED:  JUN 24, 2008
  • HELP-PROMPT:  Answer must be 5-11 characters in length.
  • DESCRIPTION:  
    Valid NDC# used in the prescription/refill and which is passed to ECME to be used for billing.
2.07 PRE AUTH TYPE CODE 2;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  FEB 27, 2008
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    PRIOR AUTHORIZATION TYPE CODE - the first piece of the BPSAUTH parameter passed to ECME engine.
2.08 PRE AUTH NUM SUB 2;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<1) X
  • LAST EDITED:  FEB 27, 2008
  • HELP-PROMPT:  Answer must be 1-11 characters in length.
  • DESCRIPTION:  
    PRIOR AUTHORIZATION NUM SUB - the second piece of the BPSAUTH parameter passed to ECME engine.
2.09 SC AND EI OVERRIDE FLAG 2;9 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 28, 2008
  • HELP-PROMPT:  Enter "Yes" if SC/EI answers should be overridden, "No" if not.
  • DESCRIPTION:  Service Connected and Environmental Indicators override flag. 0 - the system should use the existing answers to SC and EI questions, if there is no answer then SC/EI determination needed and the RX/refill cannot be
    billed. 1 - the user chose to override all SC and EI related answers with "NO", which means the RX/refill should be billed.
2.1 DELAY REASON CODE 2;10 POINTER TO BPS NCPDP DELAY REASON CODE FILE (#9002313.29) BPS NCPDP DELAY REASON CODE(#9002313.29)

  • LAST EDITED:  OCT 19, 2010
  • HELP-PROMPT:  Enter the delay reason code that will be used for NCPDP request.
  • DESCRIPTION:  This is the Delay Reason Code that is entered by the user from the IB Back Billing Option of Claims Tracking and passed to ECME. It will be be put into field 357-NV of the billing request that is created for third-party
    billing.
3 DUR 3;0 Multiple #9002313.771 9002313.771

  • DESCRIPTION:  
    DUR multiple
4.01 QUANTITY 4;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<-1)!(X?.E1"."4.N) X
  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Type a number between -1 and 999999, 3 Decimal Digits
  • DESCRIPTION:  NCPDP quantity (Billing Quantity) - the amount of medication that was dispensed (stored in PRESCRIPTION file (#52)) multiplied by the NCPDP QUANTITY MULTIPLIER (stored in DRUG file (#50)). The negative value -1 indicates
    an invalid drug.
4.02 UNIT PRICE 4;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."7N.N) X
  • LAST EDITED:  OCT 22, 2007
  • HELP-PROMPT:  Type a Number between 0 and 9999999, 6 Decimal Digits
  • DESCRIPTION:  
    Price per unit of prescription.
4.03 NDC 4;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<5) X
  • LAST EDITED:  OCT 22, 2007
  • HELP-PROMPT:  Answer must be 5-11 characters in length.
  • DESCRIPTION:  
    The NDC number of the drug involved in this transaction.
4.04 REFILL 4;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 22, 2007
  • HELP-PROMPT:  Type a Number between 0 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    Refill number. 0-original
4.05 CERTIFY MODE 4;5 SET
  • '0' FOR OFF;
  • '1' FOR ON;

  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Enter null or 0 for certify mode off. Enter 1 for certify mode on.
  • DESCRIPTION:  
    Certify mode is used for certifying software when required by switches and claims end processors.
4.06 CERTIFICATION IEN 4;6 POINTER TO BPS CERTIFICATION FILE (#9002313.31) BPS CERTIFICATION(#9002313.31)

  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Select the certification record
  • DESCRIPTION:  
    This field is used during certification testing, and points to the entry to use to pull certification data.
4.07 UNIT OF MEASURE 4;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  OCT 22, 2007
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Enter the Unit of Measure for the drug. This is usually GR (grams), ML (milliliters), or EA (Each).
4.08 BILLING QUANTITY 4;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Type a number between 0 and 99999999, 3 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.
4.09 BILLING UNIT 4;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JUN 07, 2011
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the billing units associated with the billing quantity.
5 INSURER DATA 5;0 SET Multiple #9002313.772 9002313.772

  • LAST EDITED:  NOV 26, 2007
  • DESCRIPTION:  
    Contains set of IB determination data for all billable payers - primary, secondary and tertiary. Should contain at least one entry - usually for the primary payer.
6.01 REQUEST DATE AND TIME 6;1 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Enter date/time
  • DESCRIPTION:  
    The Date and Time when the request record was created.
6.02 USER WHO MADE THE REQUEST 6;2 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Enter the user who made the request
  • DESCRIPTION:  
    The user who created the request
6.03 ACTIVATED DATE TIME 6;3 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Enter the date and time when the request was activated
  • DESCRIPTION:  
    The date and time when the request was activated
6.04 USER WHO ACTIVATED REQUEST 6;4 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Enter the user who activated the request
  • DESCRIPTION:  
    The user who activated the request.
6.05 DATE AND TIME UPDATED 6;5 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Enter the date and time when the request was updated
  • DESCRIPTION:  
    The date and time when the request was updated.
  • CROSS-REFERENCE:  9002313.77^E
    1)= S ^BPS(9002313.77,"E",$E(X,1,30),DA)=""
    2)= K ^BPS(9002313.77,"E",$E(X,1,30),DA)
    The cross-reference to get the select records by the date/time the record was updated
6.06 USER WHO UPDATED THE REQUEST 6;6 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Enter the user who updated the request
  • DESCRIPTION:  
    The user who updated the request.
7.01 CLOSE AFT REV 7;1 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUN 24, 2008
  • HELP-PROMPT:  Should the claim be closed after accepted reversal?
  • DESCRIPTION:  This field indicates whether the claim should be closed after successful reversal. The ECME engine checks this field when it receives a response from the payer. If the field is set to YES and the reversal was accepted by
    the payer then the claim will be closed automatically.
7.02 CLOSE AFT REV REASON 7;2 POINTER TO CLAIMS TRACKING NON-BILLABLE REASONS FILE (#356.8) CLAIMS TRACKING NON-BILLABLE REASONS(#356.8)

  • LAST EDITED:  JUN 20, 2008
  • HELP-PROMPT:  Select NON-BILLABLE reason for the claim
  • DESCRIPTION:  
    The NON-BILLABLE REASON selected by the user to be used in IB CLAIM TRACKING system.
7.03 CLOSE AFT REV COMMENT 7;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  MAY 30, 2008
  • HELP-PROMPT:  Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    Comment for CLOSE action
8 COB OTHER PAYERS 8;0 Multiple #9002313.778 9002313.778

  • LAST EDITED:  JUN 07, 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.
9.01 INACTIVATION REASON 9;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<1) X
  • LAST EDITED:  OCT 18, 2010
  • HELP-PROMPT:  Enter the reason the request was inactivated (1-100 characters).
  • DESCRIPTION:  
    When a request is inactivated, the reason that it was inactivated will be stored here so that the cause of the inactivation can be investigated.

External References

Name Field # of Occurrence
^%DT .08+1, 2.01+1, 6.01+1, 6.03+1, 6.05+1

Global Variables Directly Accessed

Name Line Occurrences  (* Changed,  ! Killed)
^BPS(9002313.77 - [#9002313.77] IXACSL+1*, IXACKL+1!, IXACKEIC+1!, IXANSL+1*, IXANKL+1!, IXANKEIC+1!, IXDSL+1*, IXDKL+1!, IXDKEIC+1!, .01(XREF 1S)
.01(XREF 1K), .06(XREF 1S), .06(XREF 1K), 6.05(XREF 1S), 6.05(XREF 1K)

Local Variables

Legend:

>> Not killed explicitly
* Changed
! Killed
~ Newed

Name Field # of Occurrence
>> %DT .08+1*, 2.01+1*, 6.01+1*, 6.03+1*, 6.05+1*
>> DA IXACSL+1, IXACKL+1, IXANSL+1, IXANKL+1, IXANP1CC+1, IXDSL+1, IXDKL+1, .01(XREF 1S), .01(XREF 1K), .06(XREF 1S)
.06(XREF 1K), 6.05(XREF 1S), 6.05(XREF 1K)
X IXANP1CC+1*, .01+1!, .01(XREF 1S), .01(XREF 1K), .02+1!, .06(XREF 1S), .06(XREF 1K), .08+1*!, 1.01+1!, 1.07+1!
, 1.1+1*!, 1.11+1!, 1.14+1!, 1.16+1!, 2.01+1*!, 2.02+1!, 2.03+1!, 2.05+1!, 2.06+1!, 2.07+1!
, 2.08+1!, 4.01+1!, 4.02+1!, 4.03+1!, 4.04+1!, 4.07+1!, 4.08+1!, 4.09+1!, 6.01+1*!, 6.03+1*!
, 6.05+1*!, 6.05(XREF 1S), 6.05(XREF 1K), 7.03+1!, 9.01+1!
X(1 IXACSL+1, IXACKL+1, IXDSL+1, IXDKL+1
X(2 IXACSL+1, IXACKL+1, IXANSL+1, IXANKL+1, IXDSL+1, IXDKL+1
X(3 IXACSL+1, IXACKL+1, IXANSL+1, IXDSL+1, IXDKL+1
X(4 IXACSL+1, IXANSL+1, IXDSL+1, IXDKL+1
X(5 IXANSL+1
>> Y .08+1, 2.01+1, 6.01+1, 6.03+1, 6.05+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