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Sub-Field: 9002313.59902

Package: E Claims Management Engine

BPS TRANSACTION(#9002313.59)-->9002313.59902

Sub-Field: 9002313.59902


Information

Parent File Name Number Package
BPS TRANSACTION(#9002313.59) PATIENT INSURANCE MULTIPLE 9002313.59902 E Claims Management Engine

Details

Field # Name Loc Type Details
.01 PLAN ID 0;1 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) GROUP INSURANCE PLAN(#355.3)

  • LAST EDITED:  JUL 27, 2005
  • HELP-PROMPT:  Enter Group Insurance record
  • DESCRIPTION:  
    ID assigned to the insurance plan.
  • CROSS-REFERENCE:  9002313.59902^B
    1)= S ^BPST(DA(1),10,"B",$E(X,1,30),DA)=""
    2)= K ^BPST(DA(1),10,"B",$E(X,1,30),DA)
902.02 B1 PAYER SHEET 0;2 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Answer with a billing payer sheet to be used for this payer.
  • DESCRIPTION:  
    This is the payer sheet used to submit billing request for this particular insurer. Billing request transmissions will be formatted per the specifications in this payer sheet.
902.03 BIN 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    Card Issuer ID or Bank ID Number used for network routing.
902.04 PCN 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    The processor control number for this claim.
902.05 GROUP ID 1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>17!($L(X)<1) X
  • LAST EDITED:  SEP 13, 2005
  • HELP-PROMPT:  Answer must be 1-17 characters in length
  • DESCRIPTION:  
    ID assigned to the cardholder group or employer group.
902.06 CARDHOLDER ID 1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    ID number assigned to Cardholder/Subscriber.
902.07 PATIENT RELATIONSHIP CODE 1;5 SET
  • '0' FOR NOT SPECIFIED;
  • '1' FOR CARDHOLDER (SELF);
  • '2' FOR SPOUSE;
  • '3' FOR CHILD;
  • '4' FOR OTHER;

  • LAST EDITED:  APR 22, 2011
  • HELP-PROMPT:  Enter the relationship of the patient to the insured.
  • DESCRIPTION:  
    This stores the relationship of the patient to insurance subscriber and will be used to populate the NCPDP 306-C6 (PATIENT RELATIONSHIP CODE) field.
902.08 CARDHOLDER FIRST NAME 1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JAN 19, 2005
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    First name of the Cardholder/Subscriber.
902.09 CARDHOLDER LAST NAME 1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Last name of the Cardholder/Subscriber.
902.1 PERSON CODE 1;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Enter the person code for the NCPDP request (1-3 characters).
  • DESCRIPTION:  
    This is the Person Code that will be placed in NCPDP field 303-C3 (Person Code). This value is specified by the third-party payer and is found on the patient's insurance card.
902.11 HOME PLAN STATE 1;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  NOV 26, 2003
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Usually the state where the member lives or purchased their coverage.
902.12 DISPENSING FEE SUBMITTED 2;1 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:  JAN 02, 2008
  • HELP-PROMPT:  Type a Dollar amount between 0 and 99999, 2 Decimal Digits
  • DESCRIPTION:  
    Fee amount submitted for the cost associated with dispensing this prescription.
902.13 BASIS OF COST DETERMINATION 2;2 SET
  • '01' FOR AWP;
  • '05' FOR Cost Calculations;
  • '07' FOR Usual & Customary;

  • LAST EDITED:  JUN 03, 2008
  • HELP-PROMPT:  Answer with the basis code for which the cost was determined.
  • DESCRIPTION:  
    Code indicating the method by which 'Ingredient Cost Submitted' was calculated.
902.14 USUAL CUSTOMARY CHARGE 2;3 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:  JAN 02, 2008
  • HELP-PROMPT:  Type a Dollar amount between 0 and 99999, 2 Decimal Digits
  • DESCRIPTION:  
    Amount charged cash customers for the prescription exclusive of sales tax or other amounts claimed.
902.15 GROSS AMOUNT DUE 2;4 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:  JAN 02, 2008
  • HELP-PROMPT:  Type a Dollar amount between 0 and 99999, 2 Decimal Digits
  • DESCRIPTION:  Total price claimed from all sources. For prescription claim request, field represents a sum of 'Ingredient Cost Submitted' (49-D9), 'Dispensing Fee Submitted' (412-DC), 'Flat Sales Tax Amount Submitted'(481-HA),
    'Percentage Sales Tax Amount Submitted' (482-GE), 'Incentive Amount Submitted' (438-E3), 'Other Amount Claimed' (48-H9). For service claim request, field represents a sum of 'Professional Services Fee Submitted'
    (477-BE), 'Flat Sales Tax Amount Submitted'(481-HA), 'Percentage Sales Tax Amount Submitted'(482-GE), 'Other Amount Claimed' (48-H9).
902.16 ADMINISTRATIVE FEE 2;5 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:  JAN 02, 2008
  • HELP-PROMPT:  Type a Dollar amount between 0 and 99999, 2 Decimal Digits
  • DESCRIPTION:  
    Fee charged for any costs related to preparing the prescription.
902.17 VA FILL NUMBER 2;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Type a number between 0 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    Which fill number this transaction is in reference to. Starts with '0' for the original fill.
902.18 SOFTWARE VENDOR CERT ID 2;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JAN 02, 2008
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  
    Certification number assigned by the payer for submission of claims.
902.19 B2 PAYER SHEET 0;3 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  MAR 19, 2008
  • HELP-PROMPT:  Enter the reversal payer sheet IEN.
  • DESCRIPTION:  
    Enter the Reversal Payer sheet IEN.
902.2 INGREDIENT COST 2;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Type a number between 0 and 999999, 2 decimal digits.
  • DESCRIPTION:  
    This is the INGREDIENT COST that will be placed in the NCPDP field 409-D9 (INGREDIENT COST SUBMITTED) field of the NCPDP submission.
902.21 B3 PAYER SHEET 0;4 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter the rebill payer sheet used for this payer.
  • DESCRIPTION:  
    This is the payer sheet to be used for a rebill request for this insurer. Rebill transmission will be formatted per the specifications in this payer sheet.
902.22 CERTIFY MODE 0;5 SET
  • '0' FOR CERTIFY MODE OFF;
  • '1' FOR CERTFIY MODE ON;

  • LAST EDITED:  JUN 03, 2008
  • HELP-PROMPT:  Enter null or 0 for certify mode off. Enter 1 for Certify mode on.
  • DESCRIPTION:  
    Enter null or 0 for certify mode off. Enter 1 for certify mode on.
902.23 CERTIFICATION 0;6 POINTER TO BPS CERTIFICATION FILE (#9002313.31) BPS CERTIFICATION(#9002313.31)

  • LAST EDITED:  MAR 19, 2008
  • HELP-PROMPT:  Enter the Certification record
  • DESCRIPTION:  
    This field is used during certification testing, and points to the entry to use to pull certification data.
902.24 INSURANCE NAME 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
  • LAST EDITED:  JUN 03, 2008
  • HELP-PROMPT:  Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    This is the free text name of the Insurance Company as determined by Integrated Billing insurance files.
902.25 GROUP NAME 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<2) X
  • LAST EDITED:  SEP 13, 2005
  • HELP-PROMPT:  Answer must be 2-20 characters in length
  • DESCRIPTION:  
    This is the group name from the Group Insurance File
902.26 INSURANCE CO PHONE 3;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<7) X
  • LAST EDITED:  MAR 19, 2008
  • HELP-PROMPT:  Answer must be 7-20 characters in length
  • DESCRIPTION:  
    This is the Claim (RX) phone number from the Insurance Company file
902.27 PHARMACY PLAN ID 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  JUN 17, 2005
  • HELP-PROMPT:  Answer must be 1-30 characters in length
  • DESCRIPTION:  
    This is a ID of the plan file
902.28 ELIGIBILITY 3;4 SET
  • 'V' FOR VETERAN;
  • 'T' FOR TRICARE;
  • 'C' FOR CHAMPVA;

  • LAST EDITED:  AUG 04, 2011
  • HELP-PROMPT:  Enter eligibility of the claim.
  • DESCRIPTION:  
    The insurance eligibility type of the claim.
902.29 RATE TYPE 0;8 POINTER TO RATE TYPE FILE (#399.3) RATE TYPE(#399.3)

  • LAST EDITED:  JAN 09, 2009
  • HELP-PROMPT:  Select Rate Type for billing
  • DESCRIPTION:  
    The Rate Type selected by the user for billing.
902.3 PRIMARY PAYER BILL 2;8 POINTER TO BILL/CLAIMS FILE (#399) BILL/CLAIMS(#399)

  • LAST EDITED:  JAN 09, 2009
  • HELP-PROMPT:  Select Primary bill for secondary billing.
  • DESCRIPTION:  
    Primary bill which should be used to create the secondary bill. This field is used for secondary billing only.
902.31 PRIOR PAYMENT 2;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
  • LAST EDITED:  MAR 26, 2009
  • HELP-PROMPT:  Enter a Dollar Amount (between 0 and 999999, 2 Decimal Digits) paid by primary insurer.
  • DESCRIPTION:  
    Dollar amount paid by the Primary insurer. This field is used for secondary billing only.
902.32 PLAN COB 3;6 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  MAR 26, 2009
  • HELP-PROMPT:  Enter Coordination Of Benefits indicator for the insurance plan.
  • DESCRIPTION:  
    The Coordination of Benefits value as it is stored in (#.2) COB field of the (#.3121) Insurance Type multiple of the Patient file (#2).
902.33 INSURANCE COMPANY 3;5 POINTER TO INSURANCE COMPANY FILE (#36) INSURANCE COMPANY(#36)

  • LAST EDITED:  JAN 16, 2009
  • HELP-PROMPT:  Select the insurance carrier for this claim.
  • DESCRIPTION:  
    This is the INSURANCE COMPANY from file #36.
902.34 E1 PAYER SHEET 0;9 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter the eligibility verification payer sheet for the payer.
  • DESCRIPTION:  
    This is the payer sheet to be used for eligibility verification requests for this insurer. Eligibility verification transmissions will be formatted per the specifications in this payer sheet.
902.35 POLICY NUMBER 0;12 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter the policy number for this insurer (0-9999).
  • DESCRIPTION:  
    This is the policy number assigned for this particular patient and insurer.
902.36 MAXIMUM NCPDP TRANSACTIONS 1;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 14, 2010
  • HELP-PROMPT:  Enter the maximum number of transactions allowed in a request (1-9999).
  • DESCRIPTION:  
    This is the maximum number of transactions that can be bundled in a transmission. It is specified by the NCPDP processor.
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