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Sub-Field: 366.141

Package: Integrated Billing

IB NCPDP EVENT LOG(#366.14)-->366.141

Sub-Field: 366.141


Information

Parent File Name Number Package
IB NCPDP EVENT LOG(#366.14) EVENT 366.141 Integrated Billing

Details

Field # Name Loc Type Details
.01 EVENT TYPE 0;1 SET
************************REQUIRED FIELD************************
  • '0' FOR UNKNOWN;
  • '1' FOR BILLABLE STATUS CHECK;
  • '2' FOR SUBMIT;
  • '3' FOR BILL;
  • '4' FOR RELEASE;
  • '5' FOR REVERSE;
  • '6' FOR CLOSE;
  • '7' FOR REOPEN;

  • LAST EDITED:  JUN 21, 2006
  • HELP-PROMPT:  Pharmacy event types
  • DESCRIPTION:  
    The event types represent the various ePharmacy billing events during the processing of outpatient Rx claims.
  • CROSS-REFERENCE:  366.141^B
    1)= S ^IBCNR(366.14,DA(1),1,"B",$E(X,1,30),DA)=""
    2)= K ^IBCNR(366.14,DA(1),1,"B",$E(X,1,30),DA)
.02 NON-BILLABLE REASON 0;2 POINTER TO IB NCPDP NON-BILLABLE REASONS FILE (#366.17) IB NCPDP NON-BILLABLE REASONS(#366.17)

  • LAST EDITED:  OCT 30, 2014
  • HELP-PROMPT:  Enter the Non-Billable Status reason for non-billable prescription
  • DESCRIPTION:  This field is populated by the IB software that supports the processing of ePharmacy Billing events for outpatient prescriptions. It will populated when the IB Billing Status check determines that the request is not
    billable.
.03 PATIENT 0;3 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  JUN 21, 2006
  • HELP-PROMPT:  Internally populated by the IB application (not entered by the user).
  • DESCRIPTION:  
    PATIENT on the Rx claim
  • CROSS-REFERENCE:  366.14^D
    1)= S ^IBCNR(366.14,"D",$E(X,1,30),DA(1),DA)=""
    2)= K ^IBCNR(366.14,"D",$E(X,1,30),DA(1),DA)
.04 JOB 0;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 999999999, 0 Decimal Digits
  • DESCRIPTION:  
    The job number of the job currently executing
.05 TIME 0;5 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Enter date and time
  • DESCRIPTION:  
    Date and time of the event
.06 ePHARMACY USER 0;6 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 21, 2006
  • DESCRIPTION:  System user who triggered the e-pharmacy event. This can be the system user who enters prescription or makes billing operation on e-pharmacy claims. It also can be POSTMASTER if the operation (like claims auto-reversal
    process) was performed by a background job.
  • TECHNICAL DESCR:  
    NEW PERSON file #200 internal entry number
  • CROSS-REFERENCE:  366.14^U
    1)= S ^IBCNR(366.14,"U",$E(X,1,30),DA(1),DA)=""
    2)= K ^IBCNR(366.14,"U",$E(X,1,30),DA(1),DA)
.07 RESULT 0;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<-99999)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between -99999 and 99999, 0 Decimal Digits
  • DESCRIPTION:  
    Result of the event processing - return code
.08 RESULT MESSAGE 0;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    Result of the event processing - message
.09 E-PHARMACY DIVISION 0;9 POINTER TO BPS PHARMACIES FILE (#9002313.56) BPS PHARMACIES(#9002313.56)

  • LAST EDITED:  FEB 16, 2007
  • DESCRIPTION:  
    E-Pharmacy division (BPS PHARMACY).
.11 AUTH # 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    ECME approval/authorization number
.12 BCID 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This field contains the Prescription/Service Reference Number (also known as the ECME#) and the Date of Service separated by a semi-colon.
  • TECHNICAL DESCR:  
    Prescription/Service Reference Number (ECME#);Date of Service Where: Prescription/Service Ref Number (ECME#) is 7 or 12 digits.  Date of Service is in FileMan format.
.13 CLAIMID 1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)'=7&($L(X)'=12) X
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 7 or 12 characters in length.
  • DESCRIPTION:  
    This is a 7 or 12 digit ECME number with leading zero(s).
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  366.14^E^MUMPS
    1)= S ^IBCNR(366.14,"E",$E(X,1,30),$G(^IBCNR(366.14,DA(1),0)),DA)=""
    2)= K ^IBCNR(366.14,"E",$E(X,1,30),$G(^IBCNR(366.14,DA(1),0)),DA)
.14 PATIENT IN IBD 1;4 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  JUN 20, 2006
  • DESCRIPTION:  
    PATIENT identifier passed in IBD ARRAY when outside application calls $$STORESP^IBNCPDP (IA #4299)
  • TECHNICAL DESCR:  
    Pointer to PATIENT file #2 passed into $$STORESP^IBNCPDP in "DFN" node of IBD array.
.15 MEDICAL CENTER DIVISION 1;5 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8) MEDICAL CENTER DIVISION(#40.8)

  • LAST EDITED:  FEB 16, 2007
  • HELP-PROMPT:  Select a division
  • DESCRIPTION:  
    Division identifier
.16 RESPONSE 1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Response from the payer: ACCEPTED PAYABLE REJECTED DUPLICATE
.17 REVERSAL REASON 1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  FEB 14, 2006
  • HELP-PROMPT:  Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    Reversal reason
.18 RTS-DEL 1;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    Return to Stock-Delete status
.19 STATUS 1;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Bill status - one of the following values: "PAID","REJECTED","REVERSED", "CLOSED", "RELEASED", or "SUBMITTED"
.201 PRESCRIPTION 2;1 POINTER TO PRESCRIPTION FILE (#52) PRESCRIPTION(#52)

  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Enter a prescription
  • DESCRIPTION:  
    Pointer TO PRESCRIPTION FILE (#52) as passed into $$STORESP^ IBNCPDP (IA # 4299) in "PRESCRIPTION" node
  • CROSS-REFERENCE:  366.14^I
    1)= S ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)=""
    2)= K ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)
.202 RX NO 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    RX Number from file #52 passed into $$STORESP^IBNCPDP (IA # 4299) in the "RX NO" node
  • CROSS-REFERENCE:  366.14^R
    1)= S ^IBCNR(366.14,"R",$E(X,1,30),DA(1),DA)=""
    2)= K ^IBCNR(366.14,"R",$E(X,1,30),DA(1),DA)
.203 FILL NUMBER 2;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 99999, 0 Decimal Digits
  • DESCRIPTION:  
    Refill # 0 - for original refill 1...n - for other refills
.204 DRUG 2;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  JUN 21, 2006
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    Prescription Drug on the claim
.205 NDC 2;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    National Drug Code number
.206 DATE OF SERVICE 2;6 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Enter the date of service.
  • DESCRIPTION:  
    Date of Service of the outpatient pharmacy Rx.
.207 RELEASE DATE 2;7 DATE

  • INPUT TRANSFORM:  S %DT="EST" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Enter Rx release date.
  • DESCRIPTION:  
    This is the date the Rx was released.  This field is populated only if the Rx was released.
.208 QTY 2;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Type a number between 0 and 99999999, 3 decimal digits.
  • DESCRIPTION:  
    This is the prescription billed quantity.  This may be different than the NCPDP quantity.
  • TECHNICAL DESCR:  
    RX Quantity
.209 DAYS SUPPLY 2;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 999999, 0 Decimal Digits
  • DESCRIPTION:  
    RX Days Supply
.21 DEA 2;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    Drug Enforcement Agency number
.211 FILLED BY 2;11 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Enter a user who filled RX
  • DESCRIPTION:  
    Person, who filled the RX refill.
  • TECHNICAL DESCR:  
    Pointer to the NEW PERSON FILE (#200)
.212 RX # 2;12 POINTER TO PRESCRIPTION FILE (#52) PRESCRIPTION(#52)

  • LAST EDITED:  JUN 21, 2006
  • HELP-PROMPT:  Enter a prescription
  • DESCRIPTION:  
    Pointer TO PRESCRIPTION FILE (#52) as passed into $$RX^IBNCPDP (IA # 4299) in "IEN" node
  • CROSS-REFERENCE:  366.14^I
    1)= S ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)=""
    2)= K ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)
.213 BILLING UNITS 2;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the type of billing units associated with the billing quantity.  Examples include "TAB", "CAP", "EA", "ML", "VI", "GM", and so forth.
.214 NCPDP QTY 2;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Type a number between 0 and 99999999, 3 decimal digits.
  • DESCRIPTION:  
    This is the NCPDP Quantity for the prescription. This may be different than the billed quantity.
.215 NCPDP UNITS 2;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JUN 21, 2011
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  This is the NCPDP standard for unit type:
    EA - each
    ML - milliliters
    GM - grams
    This is the type of unit associated with the NCPDP quantity.
.301 BILL 3;1 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Enter IB bill
  • DESCRIPTION:  
    IB bill
  • TECHNICAL DESCR:  
    Pointer TO BILL/CLAIMS FILE (#399)
.302 BILLED 3;2 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
  • DESCRIPTION:  
    Amount billed to the insurance
.303 PLAN 3;3 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) GROUP INSURANCE PLAN(#355.3)

  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Enter a group plan
  • DESCRIPTION:  
    Group insurance plan
.304 COST 3;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."5N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 9999999, 4 Decimal Digits
  • DESCRIPTION:  
    Cost - dollar amount per Dispensed Unit
.305 PAID BY INSURANCE 3;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    Amount paid by the Insurance
.306 CLOSE/REOPEN COMMENT 3;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-70 characters in length.
  • DESCRIPTION:  
    Close or reopen comment
.307 CLOSE REASON 3;7 POINTER TO CLAIMS TRACKING NON-BILLABLE REASONS FILE (#356.8) CLAIMS TRACKING NON-BILLABLE REASONS(#356.8)

  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Select a close reason
  • DESCRIPTION:  
    Close reason
.308 DROP TO PAPER 3;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 9999999, 0 Decimal Digits
  • DESCRIPTION:  
    Drop to Paper flag.
  • TECHNICAL DESCR:  
    1 (TRUE) for certain Close Claim Reasons indicates that the closed episode still may be "dropped to paper" - passed to the Autobiller.
.309 RELEASE COPAY 3;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 9999999, 0 Decimal Digits
  • DESCRIPTION:  
    Release Copay flag.
  • TECHNICAL DESCR:  
    1 (TRUE) indicates that the patients copay should be released off hold.
.31 ECME USER IN IBD 3;10 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  JUN 20, 2006
  • DESCRIPTION:  System user who triggered the ECME event and whose identifier was passed in IBD ARRAY when outside application calls $$STORESP^IBNCPDP (IA #4299). This can be the system user who enters prescription or makes billing
    operation on e-pharmacy claims. It also can be POSTMASTER if the operation (like claims auto-reversal process) was performed by a background job.
  • TECHNICAL DESCR:  
    System User's ID as is passed inside IBD array into IB APIs.
.311 COPAY AMOUNT 3;11 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999.99)!(X<0) X
  • LAST EDITED:  AUG 03, 2011
  • HELP-PROMPT:  Type a dollar amount between 0 and 999999.99, 2 decimal digits.
  • DESCRIPTION:  
    This is to store the copayment amount specified by the payer for amounts that are to be charge for non-Veteran copayment charges such as TRICARE or CHAMPVA.
.312 INGREDIENT COST PAID 3;12 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Type a dollar amount between 0 and 99999999, 2 decimal digits.
  • DESCRIPTION:  
    This is the amount of the ingredient cost paid as reported by the payer.
  • TECHNICAL DESCR:  
    NCPDP Field 506-F6.
.313 DISPENSING FEE PAID 3;13 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Type a dollar amount between 0 and 99999999, 2 decimal digits.
  • DESCRIPTION:  
    This is the amount of the dispensing fee paid as reported by the payer.
  • TECHNICAL DESCR:  
    NCPDP Field 507-F7.
.314 PATIENT RESPONSIBILITY (INS) 3;14 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  JUN 20, 2011
  • HELP-PROMPT:  Type a dollar amount between 0 and 99999999, 2 decimal digits.
  • DESCRIPTION:  
    This is the amount for which the patient is responsible as reported by the payer.
  • TECHNICAL DESCR:  
    NCPDP Field 505-F5.
.401 AO 4;1 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter Agent Orange indicator
  • DESCRIPTION:  
    Agent Orange indicator
.402 CV 4;2 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter Combat Veteran indicator
  • DESCRIPTION:  
    Combat Veteran indicator
.403 SWA 4;3 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter Southwest Asia indicator
  • DESCRIPTION:  
    Southwest Asia indicator.
.404 IR 4;4 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter Ionizing radiation exposure indicator
  • DESCRIPTION:  
    Ionizing radiation exposure indicator
.405 MST 4;5 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter Military Sexual trauma indicator
  • DESCRIPTION:  
    Military Sexual trauma indicator
.406 HNC 4;6 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter Head/neck cancer indicator
  • DESCRIPTION:  
    Head/neck cancer indicator
.407 SC 4;7 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  JUL 30, 2007
  • HELP-PROMPT:  Enter Service Connected indicator
  • DESCRIPTION:  
    Service Connected indicator
.408 SHAD 4;8 SET
  • '0' FOR NO;
  • '1' FOR YES;
  • '2' FOR NO ANSWER;
  • '3' FOR OVERRIDDEN;

  • LAST EDITED:  AUG 03, 2007
  • HELP-PROMPT:  Enter Project 112/SHAD indicator
  • DESCRIPTION:  
    Project 112/SHAD indicator
2 INSURANCE 5;0 Multiple #366.1412 366.1412

  • DESCRIPTION:  
    Insurance data
  • TECHNICAL DESCR:  
    Insurance data stored in "INS" node of the array which is passed into $$RX^IBNCPDP API (IA #4299)
7.01 RX COB 7;1 SET

  • LAST EDITED:  AUG 30, 2010
  • HELP-PROMPT:  Select COB indicator for the claim.
  • DESCRIPTION:  
    The Coordination Of Benefits (COB) indicator designates the payer sequence for the claim.
7.02 PRIMARY BILL 7;2 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  JAN 08, 2009
  • HELP-PROMPT:  Select the primary bill for the prescription.
  • DESCRIPTION:  
    This field will hold the Primary bill associated with the original prescription/refill related to this claim.
7.03 PRIOR PAYMENT 7;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
  • LAST EDITED:  JAN 08, 2009
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
  • DESCRIPTION:  
    This field will store a prior payment amount that the primary insurer agreed to pay for the original prescription/refill related to this claim.
7.04 RATE TYPE SELECTED BY USER 7;4 POINTER TO RATE TYPE FILE (#399.3) RATE TYPE(#399.3)

  • LAST EDITED:  AUG 30, 2010
  • HELP-PROMPT:  Select the appropriate Rate Type.
  • DESCRIPTION:  
    This is the Rate Type selected by the user for ECME Pharmacy billing purposes.  Users may select the rate type in the option "Process Secondary/TRICARE Rx to ECME" [BPS COB PROCESS SECOND TRICARE].
7.05 ELIGIBILITY 7;5 SET

  • LAST EDITED:  MAY 02, 2011
  • HELP-PROMPT:  Enter the patient's eligibility.
  • DESCRIPTION:  
    This is the patient's eligibility as determined by IB billing determination during the finish event.
7.06 DRUG ECME BILLABLE 7;6 SET

  • LAST EDITED:  JAN 27, 2016
  • HELP-PROMPT:  Enter 'YES' if the drug for this prescription was ECME billable, else enter 'NO'.
  • DESCRIPTION:  
    This field records whether or not the drug was ECME billable at the time of Billing Determination for this prescription/fill.
7.07 DRUG ECME BILLABLE TRICARE 7;7 SET

  • LAST EDITED:  JAN 27, 2016
  • HELP-PROMPT:  Enter 'YES' if the drug was ECME billable for TRICARE prescriptions, else enter 'NO'.
  • DESCRIPTION:  
    This field records whether or not the drug was ECME billable for TRICARE prescriptions at the time of Billing Determination for this prescription/fill.
7.08 DRUG ECME BILLABLE CHAMPVA 7;8 SET

  • LAST EDITED:  JAN 27, 2016
  • HELP-PROMPT:  Enter 'YES' if the drug was ECME billable for CHAMPVA prescriptions, else enter 'NO'.
  • DESCRIPTION:  
    This field records whether or not the drug was ECME billable for CHAMPVA prescriptions at the time of Billing Determination for this prescription/fill.
7.09 DRUG SENSITIVE DIAGNOSIS 7;9 SET

  • LAST EDITED:  JAN 27, 2016
  • HELP-PROMPT:  Enter 'YES' if the drug for this prescription was a sensitive diagnosis drug, else enter 'NO'.
  • DESCRIPTION:  
    This field records whether or not the drug was identified as a Sensitive Diagnosis Drug at the time of Billing Determination for this prescription/fill.
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