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Sub-Field: 9002313.0401

Package: E Claims Management Engine

BPS CLAIMS(#9002313.02)-->9002313.0201-->9002313.0401

Sub-Field: 9002313.0401


Information

Parent File Name Number Package
9002313.0201 COB OTHER PAYMENTS 9002313.0401 E Claims Management Engine

Details

Field # Name Loc Type Details
.01 COB OTHER PAYMENT COUNTER 0;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>1!($L(X)<1) X
  • LAST EDITED:  JUN 04, 2008
  • HELP-PROMPT:  Answer must be 1 character in length.
  • DESCRIPTION:  
    This is a multiple counter field to store multiple COB payments received from other payers.
  • CROSS-REFERENCE:  9002313.0401^B
    1)= S ^BPSC(DA(2),400,DA(1),337,"B",$E(X,1,30),DA)=""
    2)= K ^BPSC(DA(2),400,DA(1),337,"B",$E(X,1,30),DA)
338 OTHER PAYER COVERAGE TYPE 0;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<4) X
  • LAST EDITED:  JAN 03, 2008
  • HELP-PROMPT:  Answer must be 4 characters in length
  • DESCRIPTION:  
    Code identifying the type of Other Payer ID (340-7C).  NCPDP standard field 338-5C.
  • TECHNICAL DESCR:  
    REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.  RESPONSE COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
339 OTHER PAYER ID QUALIFIER 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<4) X
  • LAST EDITED:  JAN 03, 2008
  • HELP-PROMPT:  Answer must be 4 characters in length
  • DESCRIPTION:  
    Code qualifying the Other Payer ID (340-7C).  NCPDP standard field 339-6C.
  • TECHNICAL DESCR:  
    REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.  RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
340 OTHER PAYER ID 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>12!($L(X)<12) X
  • LAST EDITED:  JAN 03, 2008
  • HELP-PROMPT:  Answer must be 12 characters in length
  • DESCRIPTION:  
    ID assigned to the payer.  NCPDP standard field 340-7C.
  • TECHNICAL DESCR:  
    Qualified by Other Payer ID Qualifier (339-6C).  REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.  RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
341 OTHER PAYER AMOUNT PAID COUNT 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<3) X
  • LAST EDITED:  JAN 03, 2008
  • HELP-PROMPT:  Answer must be 3 characters in length
  • DESCRIPTION:  
    Count of the payer amount paid occurrences.  NCPDP standard field 341-HB.
  • TECHNICAL DESCR:  
    REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
342 OTHER PAYER AMT PAID MULTIPLE 1;0 Multiple #9002313.401342 9002313.401342

  • LAST EDITED:  OCT 14, 2010
  • DESCRIPTION:  
    This sub-file stores Other Paid Amount Qualifier values.
  • TECHNICAL DESCR:  
    REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
353 OTHER PAYER-PAT RESP AMT COUNT 0;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  SEP 01, 2010
  • HELP-PROMPT:  Answer must be 1-4 characters.
  • DESCRIPTION:  This is used to store NCPDP field 353-NR (Other Payer-Patient Responsibility Amount Count), which is defined as "Count of Other Payer-Patient Responsibility Amount (352-NQ) and Other Payer-Patient Responsibility
    Amount Qualifier (351-NP) occurrences."
  • TECHNICAL DESCR:  
    REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
353.01 OTHER PAYER-PATIENT RESP MLTPL 3;0 Multiple #9002313.401353 9002313.401353

  • DESCRIPTION:  
    This sub-file stores OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT values.
392 BENEFIT STAGE COUNT 0;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  SEP 01, 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."
  • TECHNICAL DESCR:  
    REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT RESPONSE PRICING SEGMENT.
392.01 BENEFIT STAGE MLTPL 4;0 Multiple #9002313.401392 9002313.401392

  • DESCRIPTION:  
    This sub-file stores BENEFIT STAGE values.
443 OTHER PAYER DATE 0;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<10) X
  • OUTPUT TRANSFORM:  S Y=$$FM3EXT^BPSOSU1($E(Y,3,10))
  • LAST EDITED:  MAR 09, 2009
  • HELP-PROMPT:  Answer must be 10 characters in length
  • DESCRIPTION:  
    Payment or denial date of the claim submitted to the other payer. Used for coordination of benefits.
  • TECHNICAL DESCR:  Format=CCYYMMDD
    CC=Century
    YY=Year
    MM=Month
    DD=Day
    Examples: If the other payer denial date was August 1,1999, this field would reflect: 19990801.
    REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
471 OTHER PAYER REJECT COUNT 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    Count of 'Other Payer Reject Code' (472) occurrences.
472 OTHER PAYER REJECT CODE MLTPL 2;0 Multiple #9002313.401472 9002313.401472

  • LAST EDITED:  OCT 14, 2010
  • DESCRIPTION:  
    This sub-file is to store reject values received from other payers.
993 INTERNAL CONTROL NUMBER 0;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>32!($L(X)<1) X
  • LAST EDITED:  SEP 01, 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."
  • TECHNICAL DESCR:  REQUEST COORDINATION OF BENEFITS/OTHER PAYMENT SEGMENT.
    RESPONSE STATUS SEGMENT.
2149 OTHER PAYER RECONCILIATION ID 0;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
    MAXIMUM LENGTH:   30
  • LAST EDITED:  MAY 16, 2018
  • HELP-PROMPT:  Enter an ID between 1 and 30 characters.
  • DESCRIPTION:  NCPDP field C49-9V - Other Payer Reconciliation ID. Reconciliation ID (B98-34) as reported by the Other Payer for Paid/Accepted transactions OR for Information Reporting transactions, the designated default
    value for reporting a previous payer's rejected response as designated in the Other Payer Reject Code value(s) reported in the COB claim.
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