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Sub-Field: 9002313.0301

Package: E Claims Management Engine

BPS RESPONSES(#9002313.03)-->9002313.0301

Sub-Field: 9002313.0301


Information

Parent File Name Number Package
BPS RESPONSES(#9002313.03) RESPONSES 9002313.0301 E Claims Management Engine

Details

Field # Name Loc Type Details
.01 TRANSACTION ORDER 0;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Type a number between 1 and 999999999, 0 decimal digits.
  • DESCRIPTION:  
    This sequential value indicates the number of this transaction within the transaction set.
  • CROSS-REFERENCE:  9002313.0301^B
    1)= S ^BPSR(DA(1),1000,"B",$E(X,1,30),DA)=""
    2)= K ^BPSR(DA(1),1000,"B",$E(X,1,30),DA)
112 TRANSACTION RESPONSE STATUS 110;2 SET
  • 'A' FOR APPROVED;
  • 'C' FOR CAPTURED;
  • 'D' FOR DUPLICATE OF PAID;
  • 'F' FOR PA DEFERRED;
  • 'P' FOR PAID;
  • 'Q' FOR DUPLICATE OF CAPTURED;
  • 'R' FOR REJECTED;
  • 'S' FOR DUPLICATE OF APPROVED;

  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Enter the status of this transaction.
  • DESCRIPTION:  
    Code indicating the status of the transaction.
114 MEDICAID SUBROGATION ICN/TCN 100;14 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 114-N4 (Medicaid Subrogation Internal Control Number/Transaction Control Number (ICN/TCN), which is defined as "Claim number assigned by the Medicaid Agency."
128 SPENDING ACCOUNT AMT REMAINING 120;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters
  • DESCRIPTION:  
    This is used to store NCPDP field 128-UC (Spending Account Amount Remaining), which is defined as "The balance from the patient's spending account after this transaction was applied."
129 HEALTH PLAN-FUNDED ASSTNCE AMT 120;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 129-UD (Health Plan-funded Assistance Amount), which is defined as "The amount from the health plan-funded assistance account for the patient that was applied to reduce Patient Pay
    Amount (505-F5). This amount is used in Healthcare Reimbursement Account (HRA) benefits only. This field is always a negative amount or zero."
130 ADDITIONAL MESSAGE INFO COUNT 120;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  SEP 29, 2010
  • HELP-PROMPT:  Answer must be 1-4 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 130-UF (Additional Message Information Count), which is defined as "Count of the 'Additional Message Information' (526-FQ) occurrences that follow."
130.01 ADDITIONAL MESSAGE MLTPL 130.01;0 Multiple #9002313.13001 9002313.13001

  • LAST EDITED:  AUG 31, 2010
  • DESCRIPTION:  
    This sub-file contains Additional Message information.
133 AMT ATTRIB TO PRVDR NTWRK SEL 130;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 133-UJ (Amount Attributed to Provider Network Selection), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to
    the patient's provider network selection."
134 AMT ATTR PROD SEL BRAND DRUG 130;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 134-UK (Amount Attributed to Product Selection/Brand Drug), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due
    to the patient's selection of a Brand product."
135 AMT ATTR PRD NON-PREF FRMLRY 130;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 135-UM (Amount Attributed to Product Selection/Non-Preferred Formulary Selection), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount'
    (505-F5) that is due to the patient's selection of a Non-Preferred Formulary product."
136 AMT ATTR BRAND NON-PREF FRMLRY 130;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 136-UN (Amount Attributed to Product Selection/Brand Non-Preferred Formulary Selection), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay
    Amount' (505-F5) that is due to the patient's selection of a Brand Non-Preferred Formulary product."
137 AMOUNT ATTRIB TO COVERAGE GAP 130;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 137-UP (Amount Attributed to Coverage Gap), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient
    being in the coverage gap (for example Medicare Part D Coverage Gap (donut hole)). A coverage gap is defined as the period or amount during which the previous coverage ends and before an additional coverage begins."
138 CMS LICS LEVEL 130;8 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 138-UQ (CMS Low Income Cost Sharing (LICS) Level), which is defined as "Free form text that provides the low-income subsidy copay level for a Part D patient."
139 MEDICARE PART D COVERAGE CODE 130;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-2 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 139-UR (Medicare Part D Coverage Code), which is defined as "Code indicating the position of Medicare Part D in the billing order."
140 NEXT MEDICARE PART D EFFCTV DT 130;10 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 140-US (Next Medicare Part D Effective Date), which is defined as "Future date Part D coverage begins for the patient."
141 NEXT MEDICARE PART D TERM DATE 140;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  AUG 19, 2010
  • HELP-PROMPT:  Answer must be 1-10 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 141-UT (Next Medicare Part D Termination Date), which is defined as "Future date Part D coverage ends for the patient."
148 INGRED COST CNTRCTD REIMB AMT 140;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 148-U8 (Ingredient Cost Contracted/Reimbursable Amount), which is defined as "Informational field used when Other Payer-Patient Responsibility Amount (352-NQ) or Patient Pay Amount
    (505-F5) is used for reimbursement. Amount is equal to contracted or reimbursable amount for product being dispensed."
149 DISP FEE CNTRCTD REIMB AMOUNT 140;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 149-U9 (Dispensing Fee Contracted/Reimbursable Amount), which is defined as "Informational field used when Other Payer-Patient Responsibility Amount (352-NQ) or Patient Pay Amount
    (505-F5) is used for reimbursement. Amount is equal to contracted or reimbursable dispensing fee for product being dispensed."
240 CONTRACT NUMBER 230;10 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 240-U1 (Contract Number), which is defined as "Account Number assigned during installation for segments of business."
346 BASIS OF CALC-DISPENSING FEE 340;6 SET

  • LAST EDITED:  OCT 25, 2010
  • HELP-PROMPT:  Enter the basis for the dispensing fee paid.
  • DESCRIPTION:  
    This is used to store NCPDP field 346-HH (Basis Of Calculation-Dispensing Fee), which is defined as "Code indicating how the reimbursement amount was calculated for Dispensing Fee Paid (507-F7)."
  • TECHNICAL DESCR:  
    RESPONSE PRICING SEGMENT.
347 BASIS FOR COPAY 340;7 SET

  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Enter the basis for the copayment amount.
  • DESCRIPTION:  
    Code indicating how the reimbursement amount was calculated for 'Patient Pay Amount'(55).
348 BASIS OF CALC-FLAT SALES TAX 340;8 SET

  • LAST EDITED:  SEP 01, 2010
  • HELP-PROMPT:  Enter the basis for the flat tax paid.
  • DESCRIPTION:  
    This is used to store NCPDP field 348-HK (Basis Of Calculation-Flat Sales Tax), which is defined as "Code indicating how the reimbursement amount was calculated for Flat Sales Tax Amount Paid (558-AW)."
  • TECHNICAL DESCR:  
    RESPONSE PRICING SEGMENT.
349 BASIS FOR PERCENTAGE TAX 340;9 SET

  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Enter the basis for the percentage tax paid.
  • DESCRIPTION:  
    Code indicating how the reimbursement amount was calculated for 'Percentage Sales Tax Amount Paid' (559).
355 OTHER PAYER ID COUNT 350;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 355-NT (Other Payer ID Count), which is defined as "Count of other payers with payment responsibility."
355.01 OTHER PAYER ID MLTPL 355.01;0 Multiple #9002313.035501 9002313.035501

  • LAST EDITED:  AUG 31, 2010
  • DESCRIPTION:  
    This sub-file contains OTHER PAYER ID values.
392 BENEFIT STAGE COUNT 390;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-3 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 392-MU (Benefit Stage Count), which is defined as "Count of 'Benefit Stage Amount' (394-MW) occurrences."
392.01 BENEFIT STAGE INFO 392.01;0 Multiple #9002313.039201 9002313.039201

  • LAST EDITED:  AUG 18, 2010
  • DESCRIPTION:  
    This sub-file contains Benefit Stage values.
402 PRESCRIPTION REFERENCE NUMBER 400;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>14!($L(X)<1) X
  • LAST EDITED:  OCT 04, 2010
  • HELP-PROMPT:  Answer must be 1-14 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 402-D2 (Prescription/Service Reference Number), which is defined as "Reference number assigned by the provider for the dispensed drug/product and/or service provided."
  • TECHNICAL DESCR:  Qualified by Prescription/Service Reference Number Qualifier (455-EM).
    REQUEST CLAIM SEGMENT. RESPONSE CLAIM SEGMENT.
455 RX REFERENCE NUMBER QUALIFIER 450;5 SET

  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1 character in length.
  • DESCRIPTION:  
    Indicates the type of billing submitted.
498.14 PRIOR AUTH NUMBER-ASSIGNED 498;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>11!($L(X)<1) X
  • LAST EDITED:  SEP 01, 2010
  • HELP-PROMPT:  Answer must be 1-11 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field 498-PY (Prior Authorization Number-Assigned), which is defined as "Unique number identifying the prior authorization assigned by the processor."
498.51 DATE OF PRIOR AUTHORIZATION 498;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:  
    Date the prior authorization request was processed.
498.52 PRIOR AUTHORIZATION START 498;2 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:  
    Date the prior authorization became effective.
498.53 PRIOR AUTHORIZATION END 498;3 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:  
    Date the prior authorization expires.
498.54 PRIOR AUTH NO REFILLS AUTHRZD 498;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Type a number between 0 and 99, 0 decimal digits.
  • DESCRIPTION:  
    This is used to store NCPDP field 498-PW (Prior Authorization Number Of Refills Authorized), which is defined as "Number of refills authorized by the prior authorization."
  • TECHNICAL DESCR:  
    RESPONSE PRIOR AUTHORIZATION SEGMENT.
498.55 PRIOR AUTH QTY ACCUMULATED 498;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<1) X
  • LAST EDITED:  SEP 01, 2010
  • HELP-PROMPT:  Answer must be 1-12 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 498-PX (Prior Authorization Quantity Accumulated), which is defined as "Accumulated authorized amount expressed in metric decimal units."
  • TECHNICAL DESCR:  
    Format=9999999.999 Comments: Provided to the pharmacy by the processor to determine quantity remaining for billing.  RESPONSE PRIOR AUTHORIZATION SEGMENT.
498.57 PRIOR AUTHORIZATION QUANTITY 498;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<1) X
  • LAST EDITED:  SEP 01, 2010
  • HELP-PROMPT:  Answer must be 1-12 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 498-RA (Prior Authorization Quantity), which is defined as "Amount authorized expressed in metric decimal units."
  • TECHNICAL DESCR:  Format=9999999.999
    Comments: Provided to the pharmacy by the processor to convey the number of units authorized.  RESPONSE PRIOR AUTHORIZATION SEGMENT.
498.58 PRIOR AUTHORIZATION AMOUNT 498;8 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:  
    Amount authorized in the prior authorization.
501 HEADER RESPONSE STATUS 500;1 SET

  • LAST EDITED:  OCT 22, 2010
  • HELP-PROMPT:  Enter the status of the response.
  • DESCRIPTION:  
    This is used to store NCPDP field 501-F1 (Header Response Status).
  • CROSS-REFERENCE:  9002313.03^AC
    1)= S ^BPSR("AC",$E(X,1,30),DA(1),DA)=""
    2)= K ^BPSR("AC",$E(X,1,30),DA(1),DA)
503 AUTHORIZATION NUMBER 500;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<14) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 14-20 characters in length.
  • DESCRIPTION:  
    Number assigned by the processor to identify an authorized transaction.
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 text message from payer.
505 PATIENT PAY AMOUNT 500;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  Amount that is calculated by the processor and returned to the pharmacy as the TOTAL amount to be paid by the patient to the pharmacy; the patient's total cost share, including co-payments, amounts applied to
    deductible, over maximum amounts, penalties, etc.
506 INGREDIENT COST PAID 500;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  
    Drug ingredient cost paid included in the 'Total Amount Paid' (59).
507 DISPENSING FEE PAID 500;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  
    Dispensing fee paid included in the 'Total Amount Paid' (59).
509 TOTAL AMOUNT PAID 500;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  Total amount to be paid by the claims processor (i.e. pharmacy receivable). Represents a sum of 'Ingredient Cost Paid' (56), 'Dispensing Fee Paid' (57), 'Flat Sales Tax Amount Paid' (558), 'Percentage Sales Tax
    Amount Paid' (559), 'Incentive Amount Paid' (521), 'Professional Service Fee Paid' (562), 'Other Amount Paid' (565), less 'Patient Pay Amount' (55) and 'Other Payer Amount Recognized' (566).
510 REJECT COUNT 500;10 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:  
    Count of 'Reject Code' (511) occurrences.
511 REJECT CODE 511;0 Multiple #9002313.03511 9002313.03511

  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Select a NCPDP reject code
  • DESCRIPTION:  
    Multiple rejection codes.
512 ACCUMULATED DEDUCTIBLE AMOUNT 500;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),9,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Amount in dollars met by the patient/family in a deductible plan.
513 REMAINING DEDUCTIBLE AMOUNT 500;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),9,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Amount not met by the patient/family in the deductible plan.
514 REMAINING BENEFIT AMOUNT 500;14 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),9,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Amount remaining in a patient/family plan with a periodic maximum benefit.
517 AMT APPLD PERIODIC DEDUCTIBLE 500;17 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  This is used to store NCPDP field 517-FH (Amount Applied To Periodic Deductible), which is defined as "Amount to be collected from a patient that is included in 'Patient Pay Amount' (505-F5) that is applied to a
    periodic deductible."
518 AMOUNT OF COPAY 500;18 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field 518-FI (Amount Of Copay), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to a per prescription copay."
519 AMT ATTRIB TO PROD SELECTION 500;19 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  This is used to store NCPDP field 519-FJ (Amount Attributed To Product Selection), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to the
    patients selection of drug product."
520 AMT EXCEEDING PERIOD BNFT MAX 500;20 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  This is used to store NCPDP field 520-FK (Amount Exceeding Periodic Benefit Maximum), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to
    the patient exceeding a periodic benefit maximum."
521 INCENTIVE AMOUNT PAID 500;21 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  
    Amount represents the contractually agreed upon incentive fee paid for specific services rendered. Amount is included in the 'Total Amount Paid' (59).
522 BASIS OF REIMB DETERMINATION 500;22 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  SEP 01, 2010
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field 522-FM (Basis Of Reimbursement Determination), which is defined as "Code identifying how the reimbursement amount was calculated for Ingredient Cost Paid (506-F6)."
  • TECHNICAL DESCR:  
    RESPONSE PRICING SEGMENT.
523 AMOUNT ATTRIBUTED TO SALES TAX 500;23 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  
    Amount to be collected from the patient that is included in 'Patient Pay Amount' (55) that is due to sales tax paid.
525 DUR RESPONSE DATA 525;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:  
    Text that provides additional detail regarding a DUR conflict.
526 *ADDITIONAL MESSAGE INFORMATIO 526;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>250!($L(X)<1) X
  • LAST EDITED:  OCT 25, 2010
  • HELP-PROMPT:  Answer must be 1-250 characters in length.
  • DESCRIPTION:  
    * This field is no longer used in NCPDP vD.0. *
  • TECHNICAL DESCR:  
    In BPS*1.0*10, this data for this field was moved to the ADDITIONAL MESSAGE MLTPL (#9002313.13001) subfile.
547 APPROVED MESSAGE CODE COUNT 540;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>1!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1 character in length.
  • DESCRIPTION:  
    Count of the 'Approved Message Code' (548-6F) occurrences.
548 APPROVED MESSAGE CODE 548;0 Multiple #9002313.301548 9002313.301548

  • LAST EDITED:  FEB 07, 2008
549 HELP DESK PHONE QUALIFIER 540;9 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 phone number in the 'Help Desk Phone Number' (55).
550 HELP DESK TELEPHONE NUMBER 540;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field 550-8F (Help Desk Telephone Number), which is defined as "Phone number of the help desk".
551 PREFERRED PRODUCT COUNT 550;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  JUN 18, 2008
  • HELP-PROMPT:  Type a number between 1 and 9, 0 Decimal Digits
  • DESCRIPTION:  
    Count of preferred product occurrences.
551.01 PREFERRED PRODUCT REPEATING 551.01;0 Multiple #9002313.1301 9002313.1301

  • LAST EDITED:  FEB 07, 2008
557 TAX EXEMPT INDICATOR 550;7 SET

  • LAST EDITED:  JUN 17, 2008
  • HELP-PROMPT:  Enter a code specifying tax exempt status.
  • DESCRIPTION:  
    Code indicating the payer and/or patient is exempt from taxes.
558 FLAT SALES TAX PAID 550;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Flat sales tax paid which is included in the 'Total Amount Paid' (59).
559 PERCENTAGE SALES TAX PAID 550;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y=$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Amount of percentage sales tax paid which is included in the 'Total Amount Paid' (59).
560 PERCENTAGE SALES TAX RATE PAID 550;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>7!($L(X)<7) X
  • OUTPUT TRANSFORM:  S Y=$J($$DFF2EXT^BPSECFM(Y)/100,7,4)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 7 characters in length.
  • DESCRIPTION:  
    Percentage sales tax rate used to calculate 'Percentage Sales Tax Amount Paid' (559).
561 PERCENTAGE SALES TAX BASIS PD 560;1 SET

  • LAST EDITED:  NOV 25, 2014
  • HELP-PROMPT:  Enter the basis for the percentage sales tax paid.
  • DESCRIPTION:  
    This is used to store NCPDP field 561-AZ (Percentage Sales Tax Basis Paid), which is defined as "Code indicating the percentage sales tax paid basis."
  • TECHNICAL DESCR:  
    RESPONSE PRICING SEGMENT.
562 PROFESSIONAL SERVICE FEE PAID 560;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Amount submitted by the provider for professional services rendered.
563 OTHER AMOUNT PAID COUNT 560;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>1!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1 character in length.
  • DESCRIPTION:  
    Count of the other amount paid occurrences.
563.01 OTHER AMOUNTS PAID 563.01;0 Multiple #9002313.1401 9002313.1401

  • LAST EDITED:  FEB 07, 2008
566 OTHER PAYER AMOUNT RECOGNIZED 560;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Total dollar amount of any payment from another source including coupons.
567.01 DUR PPS 567.01;0 Multiple #9002313.1101 9002313.1101

  • LAST EDITED:  FEB 07, 2008
571 AMOUNT ATTRIBUTED TO PROC FEE 570;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 571-NZ (Amount Attributed to Processor Fee), which is defined as "Amount to be collected from the patient that is included in Patient Pay Amount (505-F5) that is due to
    the processing fee imposed by the processor."
572 AMOUNT OF COINSURANCE 570;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  This is used to store NCPDP field 572-4U (Amount of Coinsurance), which is defined as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that is due to a per
    prescription coinsurance."
573 BASIS OF CALC-COINSURANCE 570;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  SEP 29, 2010
  • HELP-PROMPT:  Answer must be 1-4 characters.
  • DESCRIPTION:  This is used to store NCPDP field 573-4V (Basis of Calculation-Coinsurance), which is defined as "Code indicating how the Coinsurance reimbursement amount was calculated for 'Patient Pay Amount'
    (505-F5)."
574 PLAN SALES TAX AMOUNT 570;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 574-2Y (Plan Sales Tax Amount), which is defined as "Plan sales tax responsibility. This field is not a component of the Patient Pay Amount (505-F5) formula."
575 PATIENT SALES TAX 570;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 575-EQ (Patient Sales Tax Amount), which is defined as "Patient sales tax responsibility. This field is not a component of the Patient Pay Amount (505-F5) formula."
577 ESTIMATED GENERIC SAVINGS 570;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • OUTPUT TRANSFORM:  NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!
  • LAST EDITED:  OCT 27, 2010
  • HELP-PROMPT:  Answer must be 1-8 characters in length.
  • DESCRIPTION:  This is used to store NCPDP field 577-G3 (Estimated Generic Savings), which is defined as "The amount, not included in the Total Amount Paid (509-F9), that the patient would have saved if they had chosen
    the generic drug instead of the brand drug."
757 BENEFIT ID 750;7 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 757-U6 (Benefit ID), which is defined as "Assigned by processor to identify a set of parameters, benefits, or coverage criteria used to adjudicate a claim."
880 TRANSACTION REFERENCE NUMBER 870;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<1) X
  • LAST EDITED:  AUG 18, 2010
  • HELP-PROMPT:  Answer must be 1-12 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 880-K5 (Transaction Reference Number).
926 FORMULARY ID 920;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-12 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 926-FF (Formulary ID), which is defined as "ID for the formulary list."
931 MAXIMUM AGE QUALIFIER 930;1 SET
  • LAST EDITED: JUL 16, 2018
  • HELP-PROMPT: Enter a maximum age qualifier, D or Y.
  • DESCRIPTION:

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a maximum age qualifier, D or Y.
  • DESCRIPTION:  
    Qualifies Maximum Age (932-GA).
932 MAXIMUM AGE 930;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter an age, a number between 1 and 999.
  • DESCRIPTION:  
    Maximum age at which the product/service is covered (inclusive). Qualified by Maximum Age Qualifier (931-F80).
933 MAXIMUM AMOUNT 930;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5) X
    MAXIMUM LENGTH:   10
  • OUTPUT TRANSFORM:  S Y=$J($$NFF^BPSECFM(Y,10),10,3)
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter an amount, must be 5-10 characters in length.
  • DESCRIPTION:  
    Qualified by Maximum Amount Qualifier (934-GC).
934 MAXIMUM AMOUNT QUALIFIER 930;4 SET
  • LAST EDITED: JUL 17, 2018
  • HELP-PROMPT: Enter a maximum account qualifier code: DL, DS, FL or QY.
  • DESCRIPTION:

  • LAST EDITED:  JUL 17, 2018
  • HELP-PROMPT:  Enter a maximum account qualifier code: DL, DS, FL or QY.
  • DESCRIPTION:  
    Qualifies Maximum Amount (933-GB).
935 MAXIMUM AMOUNT TIME PERIOD 930;5 SET
  • LAST EDITED: JUL 16, 2018
  • HELP-PROMPT: Enter a maximum amount time period code: CM, CQ, CY, DY, LT, PD or SP.
  • DESCRIPTION:

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a maximum amount time period code: CM, CQ, CY, DY, LT, PD or SP.
  • DESCRIPTION:  
    Type of time period associated with the overall Maximum Amount Qualifier (934-GC).
936 MAX AMT TIME PERIOD START DATE 930;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
    MAXIMUM LENGTH:   8
  • OUTPUT TRANSFORM:  S Y=$$FM3EXT^BPSOSU1(Y)
  • LAST EDITED:  MAY 24, 2018
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Starting date of Specific Date Range.
937 MAX AMT TIME PERIOD END DATE 930;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
    MAXIMUM LENGTH:   8
  • OUTPUT TRANSFORM:  S Y=$$FM3EXT^BPSOSU1(Y)
  • LAST EDITED:  MAY 24, 2018
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    Ending date of Specific Date Range.
938 MAX AMT TIME PERIOD UNITS 930;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 11, 2018
  • HELP-PROMPT:  Enter the number of units between 0 and 9999, 0 decimal digits.
  • DESCRIPTION:  
    Number of units associated with the overall Maximum Amount Time Period (935-GF).
943 MINIMUM AGE QUALIFIER 940;3 SET
  • LAST EDITED: JUL 16, 2018
  • HELP-PROMPT: Enter a minimum age qualifier, D-Days or Y-Years.
  • DESCRIPTION:

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a minimum age qualifier, D-Days or Y-Years.
  • DESCRIPTION:  
    Qualifies Minimum Age (944-GR).
944 MINIMUM AGE 940;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the minimum age, a number between 1 and 999.
  • DESCRIPTION:  
    Qualified by Minimum Age Qualifier (943-GQ).
987 URL 987;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>250!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-250 characters.
  • DESCRIPTION:  
    This is used to store NCPDP field 987-MA (URL), which is defined as "The web page address."
993 INTERNAL CONTROL NUMBER 990;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<1) X
  • LAST EDITED:  JUL 22, 2010
  • HELP-PROMPT:  Answer must be 1-32 characters.
  • DESCRIPTION:  This is used to store NCPDP field 993-A7 (Internal Control Number), which is defined as "Number assigned by the processor to identify an adjudicated claim when supplied in payer-to-payer coordination of
    benefits only."
1000 DUPLICATE RESPONSE DATA 1000;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>85!($L(X)<1) X
  • LAST EDITED:  FEB 07, 2008
  • HELP-PROMPT:  Answer must be 1-85 characters in length.
  • DESCRIPTION:  
    Response text to indicate duplicated data.
1028 ADJUDICATED PAYMENT TYPE A20;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  MAR 20, 2013
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field A28-ZR (Adjudicated Payment Type)
2004 NEXT AVAIL FILL DATE B00;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<8) X
  • OUTPUT TRANSFORM:  S Y=$$FM3EXT^BPSOSU1(Y)
  • LAST EDITED:  FEB 22, 2013
  • HELP-PROMPT:  Answer must be 8 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field B04-BT (Next Available Fill Date)
2022 HELP DESK TELEPHONE NUMBER EXT B20;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Answer must be 1-8 characters in length.
  • DESCRIPTION:  
    This is used to store NCPDP field B22-7P (Help Desk Telephone Number Extension), which is defined as "Extension of the telephone number".
2033 PRO SERVICE FEE CONT/REIM AMT B30;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  This is used to store NCPDP field B33-6G (Professional Service Fee Contracted/Reimbursement Amount), which is defined as "Informational field used with service billings when Other Payer-Patient
    Responsibility Amount (352-NQ) or Patient Pay Amount (505-F5) is used for reimbursement. Amount is equal to contracted or reimbursable amount for service being rendered".
2052 RESPONSE INTERMEDIARY AUTH CNT B50;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  DEC 31, 2014
  • HELP-PROMPT:  Type a number between 1 and 99, 0 decimal digits.
  • DESCRIPTION:  This is used to store NCPDP field B52-8R (Response Intermediary Authorization Count), which is defined as "Count of Response Intermediary Authorization Type ID (B53-8S), Response Intermediary
    Authorization Type ID and Intermediary Message".
2052.01 INTERMEDIARY MULTIPLE B52;0 Multiple #9002313.032052 9002313.032052

  • LAST EDITED:  JAN 14, 2015
  • DESCRIPTION:  
    This multiple is used to hold the NCPDP values for the Response Intermediary repeating group.
2087 QUAN LIMIT PER SPC TM PD COUNT B80;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  SEP 15, 2015
  • HELP-PROMPT:  Type a number between 0 and 9, 0 decimal digits.
  • DESCRIPTION:  
    Count of quantity limit per specific time period.
  • TECHNICAL DESCR:  
    NCPDP field B87-3P.
2087.01 QUAN LIMIT TIME PERIOD MLTPL B87;0 Multiple #9002313.032087 9002313.032087

  • LAST EDITED:  SEP 15, 2015
  • DESCRIPTION:  
    This multiple is used to hold the Quantity Limit Per Specific Time Period repeating group fields.
2090 DAYS SUP LIM PER SPC TM PD CNT B80;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  SEP 15, 2015
  • HELP-PROMPT:  Type a number between 0 and 9, 0 decimal digits.
  • DESCRIPTION:  
    Count of days supply limit per specific time period.
  • TECHNICAL DESCR:  
    NCPDP field B90-3T.
2090.01 DAYS SUPPLY LIM TM PD MULTIPLE B90;0 Multiple #9002313.032091 9002313.032091

  • LAST EDITED:  SEP 15, 2015
  • DESCRIPTION:  
    This multiple is used to hold the Days Supply Limit Per Specific Time Period repeating group fields.
2098 RECONCILIATION ID B98;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
    MAXIMUM LENGTH:   30
  • LAST EDITED:  MAY 30, 2017
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    This will be used to store NCPDP field B98-34 (Reconciliation ID).
2147 OTHER PAYER PROGRAM TYPE C40;7 POINTER TO BPS NCPDP OTHER PAYER PROGRAM TYPE FILE (#9002313.38) BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the value of the Other Payer Adjudicated Program Type.
  • DESCRIPTION:  
    The type of prescription benefit plan/program associated with the Other Payer.
2150 BENEFIT STAGE INDICATOR COUNT C40;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 11, 2018
  • HELP-PROMPT:  Enter a count between 0 and 9, 0 decimal digits.
  • DESCRIPTION:  
    Count of Benefit Stage Indicator (C51-9X) occurrences.
2151 BENEFIT STAGE INDICATOR C50;1 POINTER TO BPS NCPDP BENEFIT STAGE INDICATOR FILE (#9002313.35) BPS NCPDP BENEFIT STAGE INDICATOR(#9002313.35)

  • LAST EDITED:  MAY 14, 2018
  • HELP-PROMPT:  Enter the Benefit Stage Indicator.
  • DESCRIPTION:  
    Code identifying the Benefit Stage(s) which applied to the claim at the time of adjudication.
2158 BENEFIT TYPE OPPORTUNITY C50;8 SET

  • LAST EDITED:  MAY 11, 2018
  • HELP-PROMPT:  Enter the Benefit Type, 1 or 2.
  • DESCRIPTION:  
    The type of additional benefit the patient is eligible for.
2159 BENEFIT TYPE OPPORTUNITY COUNT C50;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 11, 2018
  • HELP-PROMPT:  Enter a count between 0 and 9, 0 decimal digits.
  • DESCRIPTION:  
    Count of Benefit Type Opportunity (C58-AE) that follow.
2166 HELP DESK BUS UNIT TYPE C60;6 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the help desk support type, a number between 1-5.
  • DESCRIPTION:  
    The type of help desk support that is available.
2167 HELP DESK BUS UNIT TYPE COUNT C60;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the number of types, a number between 0 and 99, 0 decimal digits.
  • DESCRIPTION:  
    The number of Help Desk Business Unit Types (C66-BA).
2168 HELP DESK CONTACT INFORMATION C60;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>255!($L(X)<1) X
    MAXIMUM LENGTH:   255
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the help desk contact info, between 1 and 255 characters.
  • DESCRIPTION:  
    Value of the specific help desk contact information (e.g.: Telephone Number, Fax Number, URL).
2169 HELP DESK CONTACT INFO EXT C60;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
    MAXIMUM LENGTH:   8
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the help desk contact info extension between 1-8 characters in length.
  • DESCRIPTION:  
    Extension of the help desk contact information.
2170 HELP DESK CONTACT INFO QUAL C60;10 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter Help Desk Contact Information qualifier code, a number between 1-4.
  • DESCRIPTION:  
    Code qualifying the value in the Help Desk Contact Information (C68-BC).
2171 HELP DESK SUPPORT TYPE C70;1 SET

  • LAST EDITED:  JUL 17, 2018
  • HELP-PROMPT:  Enter a Help Desk Support type code, a number between 1-5.
  • DESCRIPTION:  
    The intended entity responsible for contacting the help desk.
2172 HELP DESK SUPPORT TYPE COUNT C70;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the help desk support type count between 0 and 99, 0 decimal digits.
  • DESCRIPTION:  
    The number of Help Desk Contact Support Types.
2180 INTERMEDIARY HELP DESK TYPE C70;10 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a Intermediary Help Desk Support Type code, a number between 1-4.
  • DESCRIPTION:  
    The type of intermediary help desk support that is available.
2181 INTERMEDIARY HLPDSK BUS COUNT C80;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the number of intermediary help desk business unit types between 0 and 99, 0 decimal digits.
  • DESCRIPTION:  
    The number of Intermediary Help Desk Business Unit Types (C80-G8).
2182 INTERMEDIARY HLPDSK CONTACT C80;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>255!($L(X)<1) X
    MAXIMUM LENGTH:   255
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the intermediary help desk contact info, must be 1-255 characters in length.
  • DESCRIPTION:  
    Value of the specific intermediary help desk contact information (e.g.: Telephone Number, Fax Number, URL).
2183 INTERMEDIARY HLPDSK EXTENSION C80;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
    MAXIMUM LENGTH:   8
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the intermediary help desk extension, must be 1-8 characters in length.
  • DESCRIPTION:  
    Extension of the intermediary help desk contact information.
2184 INTERMEDIARY HLPDSK QUALIFIER C80;4 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a Intermediary Help Desk Contact Information code, a number between 1-4.
  • DESCRIPTION:  
    Code qualifying the value in the Intermediary Help Desk Contact Information (C82-JP).
2185 INTERMEDIARY HLPDSK SUPPT TYPE C80;5 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a intended entity type between 1-4.
  • DESCRIPTION:  
    The intended entity responsible for contacting the intermediary help desk.
2186 INTERMEDIARY HLPDSK TYP COUNT C80;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the number of intermediary help desk contact support types between 0 and 99, 0 decimal digits.
  • DESCRIPTION:  
    The number of Intermediary Help Desk Contact Support Types.
2193 PATIENT PAY COMPONENT AMOUNT C90;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<6) X
    MAXIMUM LENGTH:   8
  • OUTPUT TRANSFORM:  S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Answer must be 6-8 characters in length.
  • DESCRIPTION:  
    The cost share amount attributed to the component of Patient Pay Amount (505-F5).
2194 PATIENT PAY COMPONENT COUNT C90;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 11, 2018
  • HELP-PROMPT:  Enter a count between 0 and 99, 0 decimal digits.
  • DESCRIPTION:  
    Count of Patient Pay Component Qualifier(s) (C95-KQ) AND Patient Pay Component Amount(s) (C93-KN) occurrences.
2195 PATIENT PAY COMPONENT QUAL C90;5 POINTER TO BPS NCPDP PATIENT PAY COMPONENT QUALIFIER FILE (#9002313.37) BPS NCPDP PATIENT PAY COMPONENT QUALIFIER(#9002313.37)

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a qualifier, must be 1-2 characters in length.
  • DESCRIPTION:  
    Code qualifying the Patient Pay Component Amount (C93-KN).
2196 PAYER/HEALTH PLAN ID COUNT C90;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 11, 2018
  • HELP-PROMPT:  Enter a count between 0 and 9, 0 decimal digits.
  • DESCRIPTION:  
    Count of Payer/Health Plan ID Occurrences.
2215 SUBROGTN REQUESTR RECONCIL ID D10;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
    MAXIMUM LENGTH:   30
  • LAST EDITED:  MAY 17, 2018
  • HELP-PROMPT:  Enter the Reconciliation ID returned to the pharmacy, 1-30 characters in length.
  • DESCRIPTION:  
    The Reconciliation ID returned to the pharmacy on the paid claim transaction from the original/requesting payer.
2219 MINIMUM AMOUNT D10;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5) X
    MAXIMUM LENGTH:   10
  • OUTPUT TRANSFORM:  S Y=$J($$NFF^BPSECFM(Y,10),10,3)
  • LAST EDITED:  JUN 14, 2018
  • HELP-PROMPT:  Enter an amount, must be 5-10 characters in length.
  • DESCRIPTION:  
    Minimum amount for a quantity limit as specified in the Minimum Amount Qualifier (D20-M2).
2220 MINIMUM AMOUNT QUALIFIER D10;10 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a minimum amount code: MDL, MDS, MFL or MQY.
  • DESCRIPTION:  
    Qualifies the amount in the Minimum Amount (D19-M1) field.
2223 OTHER PAYER NAME D20;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<1) X
    MAXIMUM LENGTH:   70
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the Other Payer Name between 1-70 characters.
  • DESCRIPTION:  
    Name of the other payer.
2224 REMAINING AMOUNT D20;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<5) X
    MAXIMUM LENGTH:   10
  • OUTPUT TRANSFORM:  S Y=$J($$NFF^BPSECFM(Y,10),10,3)
  • LAST EDITED:  JUN 14, 2018
  • HELP-PROMPT:  Enter an amount, must be 5-10 characters in length.
  • DESCRIPTION:  
    Qualified by Remaining Amount Qualifier (D25-M7).  Remaining Benefit Amount as it relates to benefit dollars is represented in Remaining Benefit Amount (514-FE) field.
2225 REMAINING AMOUNT QUALIFIER D20;5 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a remaining amount qualifier: RFL, RQY or RDS.
  • DESCRIPTION:  
    Qualifies Remaining Amount (D24-M6).
2241 OTHER PAYER RELATIONSHIP TYPE D40;1 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a payer relationship type code: CP, CS, MX, CC, RP or CE.
  • DESCRIPTION:  
    Identifies the relationship of the other payer information returned by the reporting payer or entity for coordination with the Other Payer Coverage Type (338-5C) value for that payer.
2242 FORMULARY ALT BENEFIT TIER D40;2 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a formulary benefit tier code.
  • DESCRIPTION:  
    Patient cost share tier applied to the formulary alternative product.
2243 FORMULARY ALT REASON CODE D40;3 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a formulary reason code.
  • DESCRIPTION:  
    Reason for formulary alternative option(s).
2244 FORMULRY ALT REQ THERAPY COUNT D40;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
    MAXIMUM LENGTH:   2
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the count between 1 and 99.
  • DESCRIPTION:  
    Count of Formulary Alternative Required Therapy Indicator Occurrences.
2245 FORMULRY ALT THERAPY INDICATOR D40;5 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a formulary alternative therapy indicator.
  • DESCRIPTION:  
    Code identifying required treatment with specified formulary alternative.
2246 FORMULRY ALT THERAPY TIME QUAL D40;6 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a formulary alternative therapy time qualifying code.
  • DESCRIPTION:  
    Code qualifying Formulary Alternative Required Therapy Time Period Duration.
2247 FORMULRY ALT THERAPY DURATION D40;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
    MAXIMUM LENGTH:   3
  • LAST EDITED:  MAY 29, 2018
  • HELP-PROMPT:  Enter time period, 1-3 characters in length.
  • DESCRIPTION:  
    Minimum amount of time period duration for required therapy. Qualified by Formulary Alternative Required Therapy Time Period Qualifier (D46-P2).
2248 FORMULRY ALT THERAPY START DT D40;8 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a start date.
2249 FORMULRY ALT THERAPY END DATE D40;9 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the end date.
  • DESCRIPTION:  
    End date for the required therapy time period range.
2250 OTHER PAYER BENEFIT CLASS D40;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH:   10
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the other payer benefit classification, must be 1-10 characters in length.
  • DESCRIPTION:  
    Identifies the benefit classification for other payer information associated to the patient (D50-P6).
2254 PLAN OVERRIDE INDICATOR D50;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>6!($L(X)<1) X
    MAXIMUM LENGTH:   6
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the plan override indicator, must be 1-6 characters in length.
  • DESCRIPTION:  
    Restricted to valid NCPDP Telecommunication request fields (field number-ID). Example: 420-DK, 462-EV, etc.
2255 PLAN OVERRIDE VALUE COUNT D50;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 22, 2018
  • HELP-PROMPT:  Enter a count between 0 and 9, 0 decimal digits.
  • DESCRIPTION:  
    Count of plan benefit override values.
2256 PLAN BENEFIT OVERRIDE VALUE D50;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH:   10
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a plan benefit override value, must be 1-10 characters in length.
  • DESCRIPTION:  
    Identifies the plan supported value(s) for the field identified in the Plan Benefit Override Indicator (D54-RC).
2261 REGULATORY FEE TYPE CODE D60;1 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a regulatory fee type code.
  • DESCRIPTION:  
    Code identifying the type of regulatory fee.
2262 REGULATORY FEE EXMPT INDICATOR D60;2 SET

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a regulatory fee exempt indicator code.
  • DESCRIPTION:  
    Code indicating the source of the regulatory fee exempt status of claim.
2265 PATIENT REGULATORY FEE AMOUNT D60;5 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:  MAY 21, 2018
  • HELP-PROMPT:  Enter a dollar amount between 0 and 99999999, 2 decimal digits.
  • DESCRIPTION:  
    Patient regulatory fee amount obligation or portion thereof when benefit is set up to directly pass regulatory fee onto the patient.
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