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Sub-Field: 52.25

Package: Outpatient Pharmacy

PRESCRIPTION(#52)-->52.25

Sub-Field: 52.25


Information

Parent File Name Number Package
PRESCRIPTION(#52) REJECT INFO 52.25 Outpatient Pharmacy

Details

Field # Name Loc Type Details
.01 NCPDP REJECT CODE 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X S DIC(0)="QM",DIC="^BPSF(9002313.93," D ^DIC S X=$P(Y,U,2) K:Y<0 X
  • LAST EDITED:  JUN 29, 2005
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  
    NCPDP Reject Code that indicates the reason for the claim rejection for this prescription.
  • TECHNICAL DESCR:  
    Although this fields does not point to the BPS NCPDP REJECT CODES file (#9002313.93), the value should have a corresponding entry in that file.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  52.25^B
    1)= S ^PSRX(DA(1),"REJ","B",$E(X,1,30),DA)=""
    2)= K ^PSRX(DA(1),"REJ","B",$E(X,1,30),DA)
1 DATE/TIME DETECTED 0;2 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  DEC 13, 2005
  • HELP-PROMPT:  Date/time when the reject was detected by Outpatient Pharmacy or CMOP.
  • DESCRIPTION:  
    Date/Time when the reject was detected by Outpatient Pharmacy.
  • FIELD INDEX:  REJDAT (#652) REGULAR IR LOOKUP & SORTING WHOLE FILE (#52)
    Short Descr: Cross-reference to sort REJECTs by the DATE/TIME DETECTED field.
    Set Logic: S ^PSRX("REJDAT",X,DA(1),DA)=""
    Kill Logic: K ^PSRX("REJDAT",X,DA(1),DA)
    Whole Kill: K ^PSRX("REJDAT")
    X(1): DATE/TIME DETECTED (52.25,1) (Subscr 1) (forwards)
2 PAYER MESSAGE 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>140!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2005
  • HELP-PROMPT:  Answer must be 1-140 characters in length
  • DESCRIPTION:  
    Message from the 3r party payer regarding the rejection of the claim.
3 REASON 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<1) X
  • LAST EDITED:  APR 19, 2005
  • HELP-PROMPT:  Answer must be 1-100 characters in length
  • DESCRIPTION:  
    Reason why the claim is being rejected by the 3rd party payer.
4 PHARMACIST 0;3 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 19, 2005
  • HELP-PROMPT:  Pharmacist using the Outpatient Pharmacy appliction when the REJECT was detected.
  • DESCRIPTION:  
    Pharmacist using the application when the reject was detected.
5 FILL NUMBER 0;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>12)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  APR 19, 2005
  • HELP-PROMPT:  Type a number between 0 and 12, 0 Decimal Digits
  • DESCRIPTION:  
    This field is used to indicate which fill the reject is related to.
6 GROUP NAME 2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2005
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    This is the patient's insurance group name.
7 PLAN CONTACT 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2005
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    This is the patient's insurance company contact information.
8 PLAN PREVIOUS FILL DATE 2;3 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAY 02, 2005
  • HELP-PROMPT:  (No range limit on date)
  • DESCRIPTION:  
    In case of a REFILL TOO SOON reject (#79) and the payer returns the last date the prescription was filled, it will be stored on this field.
9 STATUS 0;5 SET
  • '0' FOR OPEN/UNRESOLVED;
  • '1' FOR CLOSED/RESOLVED;

  • LAST EDITED:  APR 19, 2005
  • HELP-PROMPT:  Status of the REJECT. The null value is the same as 0 (zero).
  • DESCRIPTION:  
    This field indicates whether the reject is OPEN/UNRESOLVED or CLOSED/RESOLVED.
  • FIELD INDEX:  REJSTS (#653) REGULAR IR LOOKUP & SORTING WHOLE FILE (#52)
    Short Descr: Cross-reference for the STATUS field in the REJECT INFO (#52.25) sub-file.
    Set Logic: S ^PSRX("REJSTS",X,DA(1),DA)=""
    Kill Logic: K ^PSRX("REJSTS",X,DA(1),DA)
    Whole Kill: K ^PSRX("REJSTS")
    X(1): STATUS (52.25,9) (Subscr 1) (forwards)
10 CLOSED DATE/TIME 0;6 DATE

  • INPUT TRANSFORM:  S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAY 06, 2015
  • HELP-PROMPT:  Enter the date/time the Third Party Reject was closed (resolved) by the user.
  • DESCRIPTION:  
    Date/Time when the reject was marked CLOSED/RESOLVED.
  • FIELD INDEX:  CLSDAT (#1348) REGULAR IR LOOKUP & SORTING WHOLE FILE (#52)
    Short Descr: Cross-reference to sort REJECTs by the CLOSED DATE/TIME field.
    Description: Cross-reference to sort REJECTs by the CLOSED DATE/TIME field.
    Set Logic: S ^PSRX("CLSDAT",X,DA(1),DA)=""
    Kill Logic: K ^PSRX("CLSDAT",X,DA(1),DA)
    Whole Kill: K ^PSRX("CLSDAT")
    X(1): CLOSED DATE/TIME (52.25,10) (Subscr 1) (forwards)
11 CLOSED BY 0;7 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • LAST EDITED:  APR 19, 2005
  • HELP-PROMPT:  User responsible for closing (resolving) the Third Party Reject.
  • DESCRIPTION:  
    User responsible for marking the reject CLOSED/RESOLVED.
12 CLOSE REASON 0;8 SET
  • '1' FOR CLAIM RE-SUBMITTED;
  • '2' FOR RX ON HOLD;
  • '3' FOR RX SUSPENDED;
  • '4' FOR RX RETURNED TO STOCK;
  • '5' FOR RX DELETED;
  • '6' FOR IGNORED - NO RESUBMISSION;
  • '7' FOR RX DISCONTINUED;
  • '8' FOR RX EDITED;
  • '99' FOR OTHER;

  • LAST EDITED:  JUL 08, 2005
  • DESCRIPTION:  
    This field indicates the reason for marking the reject CLOSED/RESOLVED.
13 CLOSE COMMENTS 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<1) X
  • LAST EDITED:  APR 19, 2005
  • HELP-PROMPT:  Answer must be 1-100 characters in length
  • DESCRIPTION:  
    User entered comments.
14 REASON FOR SERVICE CODE 0;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  MAY 18, 2005
  • HELP-PROMPT:  Answer must be 1-4 characters in length
  • DESCRIPTION:  
    NCPDP field indicating the resason for service code. See NCPDP REASON FOR SERVICE CODE file (#9002313.23) for possible values.
15 PROFESSIONAL SERVICE CODE 0;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  MAY 18, 2005
  • HELP-PROMPT:  Answer must be 1-4 characters in length
  • DESCRIPTION:  
    NCPDP field indicating the professional service code. See NCPDP PROFESSIONAL SERVICE CODE file (#9002313.21) for possible values.
16 RESPONSE ID 0;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 12, 2005
  • HELP-PROMPT:  Type a number between 0 and 9999999999, 0 Decimal Digits
  • DESCRIPTION:  
    This field is used to make sure the reject is recorded only once.
17 OTHER REJECTS 0;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  APR 25, 2005
  • HELP-PROMPT:  Answer must be 1-15 characters in length
  • DESCRIPTION:  
    List of other reject codes that were returned at the same time.
18 DUR TEXT 4;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<1) X
  • LAST EDITED:  APR 29, 2005
  • HELP-PROMPT:  Answer must be 1-100 characters in length
  • DESCRIPTION:  
    In case of a DUR reject (#88) the 3rd party payer returns an explanation of the DUR (Drug Usability Review).
19 RESULT OF SERVICE CODE 0;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  MAY 18, 2005
  • HELP-PROMPT:  Answer must be 1-4 characters in length
  • DESCRIPTION:  
    NCPDP field indicating the result of service code. See NCPDP RESULT OF SERVICE CODE file (#9002313.22) for possible values.
20 INSURANCE NAME 2;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2005
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Patient's insurance company name.
21 GROUP NUMBER 2;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2005
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    Patient's insurance group number.
22 CARDHOLDER ID 2;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 16, 2005
  • HELP-PROMPT:  Answer must be 1-20 characters in length
  • DESCRIPTION:  
    ID number assigned to Cardholder/Subscriber.
23 RE-OPENED 0;14 SET
  • '1' FOR YES;

  • LAST EDITED:  NOV 14, 2005
  • DESCRIPTION:  
    This flag indicates that the user has manually re-opened another reject and this one was created.
  • TECHNICAL DESCR:  
    In order to identify the original reject, use the RESPONSED ID field. It should match with the RESPONSED ID from the re-opened reject.
24 CLARIFICATION CODE 0;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • LAST EDITED:  MAY 03, 2011
  • HELP-PROMPT:  Enter between 1 and 3 Submission Clarification Codes separated by "~".
  • DESCRIPTION:  
    This field contains up to 3 NCPDP Clarification Codes for the reject. Clarification codes are copied from the CODE (#.01) field of the BPS NCPDP CLARIFICATION CODES (#9002313.25) file.
  • TECHNICAL DESCR:  
    Up to 3 Submission Clarification Codes can be submitted. They are stored in this free text field as follows: SCC1~SCC2~SCC3
25 PRIOR AUTHORIZATION TYPE 0;16 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 21, 2010
  • HELP-PROMPT:  Type a number between 0 and 99, 0 decimal digits.
  • DESCRIPTION:  
    This is the Prior Authorization Type that will be sent to ECME and placed in NCPDP field 461-EU (Prior Authorization Type) on the NCPDP claim that is sent to the third-party payer.
26 PRIOR AUTHORIZATION NUMBER 0;17 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  FEB 21, 2007
  • HELP-PROMPT:  Type a number between 0 and 999999999999, 0 Decimal Digits
  • DESCRIPTION:  
    NCPDP Prior Authorization Number. This field may be left blank if the claim does not require a number.
27 COORDINATION OF BENEFITS 2;7 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  AUG 31, 2010
  • HELP-PROMPT:  Enter the Coordination of Benefits indicator.
  • DESCRIPTION:  
    This field contains the Coordination of Benefits indicator for the third party insurance rejection for the fill.
  • TECHNICAL DESCR:  
    This field is set automatically to store the Coordination of Benefits indicator for the reject third party claim.
28 DUR ADD MSG TEXT 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>100!($L(X)<1) X
  • LAST EDITED:  AUG 27, 2010
  • HELP-PROMPT:  Answer must be 1-100 characters in length.
  • DESCRIPTION:  
    In case of a DUR reject (#88) the 3rd party payer may return additional text in the DUR Additional Message NCPDP field (570-NS).
29 BIN 2;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<6) X
  • LAST EDITED:  JUN 21, 2011
  • HELP-PROMPT:  Answer must be 6 characters in length.
  • DESCRIPTION:  
    Card Issuer ID or Bank ID Number used for network routing.
  • TECHNICAL DESCR:  
    Data from BPS CLAIMS (#9002313.02) file, BIN NUMBER (#101) field.
30 RRR FLAG 0;18 SET
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  MAY 19, 2013
  • HELP-PROMPT:  Enter "Yes" if this is a Reject Resolution Required reject.
  • DESCRIPTION:  The Reject Resolution Required (RRR) Flag is used to indicate that priority action is required to resolve the rejected ECME claim in the Third Party Rejects Worklist.
    The flag is used only for Veteran Eligibility claims where the value of the claim is at or above a site specified threshold.
    RRR rejects are displayed in a separate 'Reject Resolution Required' section of the Third Party Rejects Worklist.
  • TECHNICAL DESCR:  For each Pharmacy site a list of Reject Resolution Required (RRR) reject codes and code specific dollar threshold value is maintained in the BPS SITE PARAMETERS (#52.86) file.
    The Reject Resolution Required (RRR) Flag is set to 1 in ECME response processing if a rejected ECME claim has an RRR reject code and the gross value of the ECME claim is greater or equal the dollar threshold for that
    reject code.
    If the reject code is not an RRR code, or if it is an RRR code but the gross value of the claim is less than the dollar threshold for that code, then the reject will not be flagged as RRR in this field.
    Rejected ECME claims with RRR Flag set to 1 are displayed in a separate 'Reject Resolution Required' section of the Third Party Rejects Worklist.
31 RRR DOLLAR THRESHOLD 0;19 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  MAY 20, 2013
  • HELP-PROMPT:  Type a dollar amount between 0 and 99999, 2 decimal digits.
  • DESCRIPTION:  This is the value of the 'DOLLAR THRESHOLD' (#.02) field of the RESOLUTION REQUIRED REJ CODE (#52.865) subfile of the EPHARMACY SITE PARAMETERS (#52.86) file. It is the dollar threshold value at the time of the
    prescription processing through the ePharmacy system in which the reject was flagged as a Resolution Required Reject code.
  • TECHNICAL DESCR:  If a rejected ECME claim is flagged as Reject Resolution Required in ECME response processing then the value of DOLLAR THRESHOLD (#.02) field for the reject code from the BPS SITE PARAMETERS (#52.865) subfile is stored
    in this field.
32 RRR GROSS AMOUNT DUE 0;20 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".5N!(X>99999)!(X<0)!(X?.E1"."6.N) X
  • LAST EDITED:  MAY 20, 2013
  • HELP-PROMPT:  Type a dollar amount between 0 and 99999, 5 decimal digits.
  • DESCRIPTION:  If this rejection is flagged as a Reject Resolution Required reject, then this field is the gross amount due of the prescription. The value is copied from the GROSS AMOUNT DUE (#902.15) field of the PATIENT INSURANCE
    MULTIPLE (#9002313.59902) subfile of the BPS TRANSACTION (#9002313.59) file.
  • TECHNICAL DESCR:  If a rejected ECME claim is flagged as Reject Resolution Required in ECME response processing then the gross amount of the claim is stored in this field.
    The value is copied from GROSS AMOUNT DUE (#902.15) field of the PATIENT INSURANCE MULTIPLE (#9002313.59902) subfile of the BPS TRANSACTION (#9002313.59) file.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
33 INSURANCE COMPANY 2;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  DEC 09, 2014
  • HELP-PROMPT:  Type a number between 1 and 999999999999, 0 decimal digits.
  • DESCRIPTION:  
    This is the IEN of the INSURANCE COMPANY (#36) file. It is a 'soft' pointer as Insurance companies may be deleted if there are no bills assigned to them.
34 PCN 2;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    Number which will uniquely identify the submitter of the claim.
51 COMMENTS COM;0 DATE Multiple #52.2551 52.2551
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