GLOBAL MAP DATA DICTIONARY #162 -- FEE BASIS PAYMENT FILE 6/27/25 PAGE 1
STORED IN ^FBAAC( *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 3.5)
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Contains all Fee Outpatient medical payment data. Include's payment ancillary data for Contract Hospital as of version 2. Does NOT
include Pharmacy payment data.
Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: VENDOR(AB), BATCH NUMBER(AC), CHECK NUMBER(ACK), CHECK NUMBER(ACKT), CONTRACT(ACN), TRAVEL BATCH NUMBER(AD),
CPT MODIFIER(AE), *AUTHORIZATION POINTER(AF), AUTHORIZATION POINTER(AFN), OLD BATCH NUMBER(AG),
OLD BATCH NUMBER(AH), SUSPEND CODE(AI), DATE FINALIZED(AK), DATE FINALIZED(AL), ASSOCIATED 7078/583(AM),
FEE PROGRAM(AN), ADJUSTMENT REASON(AO), DATE FINALIZED(AP), INITIAL TREATMENT DATE(AX), PATIENT(B),
INVOICE NUMBER(C), DoD INVOICE NUMBER(DODI), IPAC AGREEMENT(IPAC)
INDEXED BY: FPPS CLAIM ID (AFC), BATCH NUMBER & INVOICE NUMBER (AJ)
^FBAAC(D0,0)= (#.01) PATIENT [1P:2] ^
^FBAAC(D0,1,0)=^162.01P^^ (#6) VENDOR
^FBAAC(D0,1,D1,0)= (#.01) VENDOR [1P:161.2] ^
^FBAAC(D0,1,D1,1,0)=^162.02DA^^ (#1) INITIAL TREATMENT DATE
^FBAAC(D0,1,D1,1,D2,0)= (#.01) INITIAL TREATMENT DATE [1D] ^ ^ (#1.5) *FEE PROGRAM [3P:161.8] ^ (#3) *AUTHORIZATION POINTER [4N]
==>^
^FBAAC(D0,1,D1,1,D2,1,0)=^162.03IPA^^ (#2) SERVICE PROVIDED
^FBAAC(D0,1,D1,1,D2,1,D3,0)= (#.01) SERVICE PROVIDED [1P:81] ^ (#1) AMOUNT CLAIMED [2N] ^ (#2) AMOUNT PAID [3N] ^ (#3) AMOUNT
==>SUSPENDED [4N] ^ (#4) SUSPEND CODE [5P:161.27] ^ (#5) DATE FINALIZED [6D] ^ (#6) CLERK [7P:200] ^
==>(#7) BATCH NUMBER [8P:161.7] ^ (#23) FEE PROGRAM [9P:161.8] ^ (#8) OBLIGATION NUMBER [10F] ^ (#3.5)
==>DATE SUSPENDED [11D] ^ (#26) PRIMARY SERVICE FACILITY [12P:4] ^ (#27) ASSOCIATED 7078/583 [13V] ^
==>(#12) DATE PAID [14D] ^ (#13) DATE CORRECT INVOICE RECEIVED [15D] ^ (#14) INVOICE NUMBER [16N] ^
==>(#15) PATIENT TYPE CODE [17S] ^ (#16) PURPOSE OF VISIT [18P:161.82] ^ (#17) TREATMENT TYPE CODE
==>[19S] ^ (#18) PAYMENT TYPE CODE [20S] ^ (#24) VOID PAYMENT [21S] ^ (#25) SUPERVISOR [22P:200] ^
==>(#28) PRIMARY DIAGNOSIS [23P:80] ^ (#29) VA TYPE OF SERVICE [24P:163.85] ^ (#30) PLACE OF SERVICE
==>[25P:353.1] ^ (#31) HCFA TYPE OF SERVICE [26P:353.2] ^ (#32) SERVICE CONNECTED CONDITION? [27F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,1,0)=^162.05^^ (#22) DESCRIPTION OF SUSPENSION
^FBAAC(D0,1,D1,1,D2,1,D3,1,D4,0)= (#.01) DESCRIPTION OF SUSPENSION [1W] ^
^FBAAC(D0,1,D1,1,D2,1,D3,2)= (#33) VENDOR INVOICE DATE [1D] ^ (#34) PROMPT PAY TYPE [2S] ^ (#35) CHECK NUMBER [3F] ^ (#36)
==>CANCELLATION DATE [4D] ^ (#37) REASON CODE [5P:162.95] ^ (#38) CANCELLATION ACTIVITY [6S] ^ (#82)
==>PAYMENT METHODOLOGY [7P:163.98] ^ (#40) DISBURSED AMOUNT [8N] ^ (#41) INTEREST AMOUNT [9N] ^ (#42)
==>SITE OF SERVICE ZIP CODE [10F] ^ (#43) ANESTHESIA TIME (MINUTES) [11N] ^ (#44) FEE SCHEDULE AMOUNT
==>[12N] ^ (#45) FEE SCHEDULE [13S] ^ (#47) UNITS PAID [14N] ^ (#48) REVENUE CODE [15P:399.2] ^ (#49)
==>PATIENT ACCOUNT NUMBER [16F] ^ (#55) ROUTING NUMBER [17F] ^ (#56) ACCOUNT NUMBER [18F] ^ (#57)
==>FINANCIAL INSTITUTION [19F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,3)= (#50) FPPS CLAIM ID [1F] ^ (#51) FPPS LINE ITEM [2F] ^ (#73) LI RENDERING PROV NAME [3F] ^ (#74) LI
==>RENDERING PROV NPI [4F] ^ (#75) LI RENDERING PROV TAXONOMY [5F] ^ (#.05) IPAC AGREEMENT [6P:161.95]
==>^ (#.055) DoD INVOICE NUMBER [7F] ^ (#54) CONTRACT [8P:161.43] ^ (#15.5) AUTHORIZATION POINTER [9N]
==>^
^FBAAC(D0,1,D1,1,D2,1,D3,4)= (#58) ATTENDING PROV NAME [1F] ^ (#59) ATTENDING PROV NPI [2F] ^ (#60) ATTENDING PROV TAXONOMY CODE
==>[3F] ^ (#61) OPERATING PROV NAME [4F] ^ (#62) OPERATING PROV NPI [5F] ^ (#63) RENDERING PROV NAME
==>[6F] ^ (#64) RENDERING PROV NPI [7F] ^ (#65) RENDERING PROV TAXONOMY CODE [8F] ^ (#66) SERVICING
==>PROV NAME [9F] ^ (#67) SERVICING PROV NPI [10F] ^ (#68) REFERRING PROV NAME [11F] ^ (#69) REFERRING
==>PROV NPI [12F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,5)= (#76) SERVICING FACILITY ADDRESS [1F] ^ (#77) SERVICING FACILITY CITY [2F] ^ (#78) SERVICING
==>FACILITY STATE [3P:5] ^ (#79) SERVICING FACILITY ZIP [4F] ^ (#81) UNIQUE CLAIM IDENTIFIER [5F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,0)=^162.09A^^ (#70) OHI OTHER SUBSCRIBER INFO
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,0)= (#.01) PAYER RESP SEQUENCE CODE [1F] ^ (#.02) INDIVIDUAL RELATIONSHIP CODE [2F] ^ (#.03)
==>INSURED GROUP OR POL NUMBER [3F] ^ (#.04) OTHER INSUR GROUP NAME [4F] ^ (#.05) INSURANCE TYPE
==>CODE [5F] ^ (#.06) CLAIM FILING INDICATOR CODE [6F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,1,0)=^162.13A^^ (#1) CLAIM LEVEL ADJUSTMENTS
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,1,D5,0)= (#.01) CLAIM ADJUSTMENT GROUP CODE [1F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,1,D5,1)= (#1.01) ADJ REASON CODE 1 [1F] ^ (#1.02) ADJ REASON CODE 2 [2F] ^ (#1.03) ADJ REASON CODE
==>3 [3F] ^ (#1.04) ADJ REASON CODE 4 [4F] ^ (#1.05) ADJ REASON CODE 5 [5F] ^ (#1.06) ADJ
==>REASON CODE 6 [6F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,1,D5,2)= (#2.01) ADJ AMOUNT 1 [1F] ^ (#2.02) ADJ AMOUNT 2 [2F] ^ (#2.03) ADJ AMOUNT 3 [3F] ^
==>(#2.04) ADJ AMOUNT 4 [4F] ^ (#2.05) ADJ AMOUNT 5 [5F] ^ (#2.06) ADJ AMOUNT 6 [6F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,1,D5,3)= (#3.01) ADJ QUANTITY 1 [1F] ^ (#3.02) ADJ QUANTITY 2 [2F] ^ (#3.03) ADJ QUANTITY 3 [3F] ^
==>(#3.04) ADJ QUANTITY 4 [4F] ^ (#3.05) ADJ QUANTITY 5 [5F] ^ (#3.06) ADJ QUANTITY 6 [6F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,2)= (#2.01) COB PAYER PAID AMT QUAL CODE [1F] ^ (#2.02) COB PAYER PAID AMOUNT [2F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,3)= (#3.01) REMAIN PAT LIAB AMT QUAL CODE [1F] ^ (#3.02) REMAIN PAT LIAB AMOUNT [2F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,4)= (#4.01) COB TOT NON-COV AMT QUAL CODE [1F] ^ (#4.02) COB TOT NON-COV AMOUNT [2F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,5)= (#5.01) OTH INS BENEF ASSIGN CERT INFO [1F] ^ (#5.02) OTH INS PAT SIGNAT SOURCE CODE [2F] ^
==>(#5.03) OTH INS ROI CODE [3F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,6)= (#6.01) INP ADJ QUANT COV DAYS VIS CNT [1F] ^ (#6.02) INP ADJ LIFETIME PSYCH CNT [2F] ^ (#6.03)
==>INP ADJ REM PAT LIAB AMOUNT [3F] ^ (#6.04) INP ADJ REF ID-REM CODE MIA05 [4F] ^ (#6.05) INP ADJ
==>AMT-CLM DISPR SHARE [5F] ^ (#6.06) INP ADJ AMT-CLM MSP PASS [6F] ^ (#6.07) INP ADJ AMT-CLM PPS
==>CAPITAL [7F] ^ (#6.08) INP ADJ AMT-PPS CAP FSP DRG [8F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,7)= (#7.01) INP ADJ AMT-PPS CAP HSP DRG [1F] ^ (#7.02) INP ADJ AMT-PPS CAP DSH DRG [2F] ^ (#7.03)
==>INP ADJ AMT-OLD CAPITAL AMN [3F] ^ (#7.04) INP ADJ AMT-PPS CAPIT IME AMT [4F] ^ (#7.05) INP ADJ
==>AMT-PPS OPER HOSP DRG [5F] ^ (#7.06) INP ADJ COST REPORT DAY COUNT [6F] ^ (#7.07) INP ADJ
==>AMT-PPS OP FED SPE DRG [7F] ^ (#7.08) INP ADJ AMT-CLM PPS CAPIT OUTL [8F] ^ (#7.09) INP ADJ
==>AMT-CLM INDIR TEACHING [9F] ^ (#7.1) INP ADJ AMT-NON-PAY PROF BILLD [10F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,8)= (#8.01) INP ADJ REF ID-REM CODE MIA20 [1F] ^ (#8.02) INP ADJ REF ID-REM CODE MIA21 [2F] ^
==>(#8.03) INP ADJ REF ID-REM CODE MIA22 [3F] ^ (#8.04) INP ADJ REF ID-REM CODE MIA23 [4F] ^
==>(#8.05) INP ADJ AMT-PPS CAPITAL EXCEPT [5F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,9)= (#9.01) OUTP ADJ REIMBURSE RATE [1F] ^ (#9.02) OUTP ADJ HCPCS PAYABLE AMT [2F] ^ (#9.03) OUTP
==>ADJ REF ID-REM COD MOA03 [3F] ^ (#9.04) OUTP ADJ REF ID-REM COD MOA04 [4F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,10)= (#10.01) OUTP ADJ REF ID-REM COD MOA05 [1F] ^ (#10.02) OUTP ADJ REF ID-REM COD MOA06 [2F] ^
==>(#10.03) OUTP ADJ REF ID-REM COD MOA07 [3F] ^ (#10.04) OUTP ADJ ESRD PAYM AMT [4F] ^ (#10.05)
==>OUTP ADJ NON PAY PROF BILLED [5F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,11)= (#11.01) OTH SUB ENTITY ID CODE [1F] ^ (#11.02) OTH SUB ENTITY TYPE QUAL [2F] ^ (#11.03) OTH
==>SUB LAST NAME [3F] ^ (#11.04) OTH SUB FIRST NAME [4F] ^ (#11.05) OTH SUB MIDDLE NAME [5F] ^
==>(#11.06) OTH SUB NAME SUFFIX [6F] ^ (#11.07) OTH SUB ID CODE QUAL [7F] ^ (#11.08) OTH SUB
==>INSURED ID [8F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,12)= (#12.01) OTH SUB ADDR LINE 1 [1F] ^ (#12.02) OTH SUB ADDR LINE 2 [2F] ^ (#12.03) OTH SUB CITY
==>NAME [3F] ^ (#12.04) OTH SUB STATE CODE [4F] ^ (#12.05) OTH SUB POSTAL ZIP [5F] ^ (#12.06) OTH
==>SUB COUNTRY CODE [6F] ^ (#12.07) OTH SUB COUNTRY SUBDIV CODE [7F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,13)= (#13.01) OTH SUB 2ND ID REF QUAL 1 [1F] ^ (#13.02) OTH SUB 2ND ID-ADDTNL ID 1 [2F] ^ (#13.03)
==>OTH SUB 2ND ID REF QUAL 2 [3F] ^ (#13.04) OTH SUB 2ND ID-ADDTNL ID 2 [4F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,14)= (#14.01) OTH PAYER ENTITY ID CODE [1F] ^ (#14.02) OTH PAYER ENTITY TYPE QUAL [2F] ^ (#14.03)
==>OTH PAYER LAST OR ORG NAME [3F] ^ (#14.04) OTH PAYER ID CODE QUALIFIER [4F] ^ (#14.05) OTH
==>PAYER PRIMARY IDENTIFIER [5F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,15)= (#15.01) OTH PAYER ADDR LINE 1 [1F] ^ (#15.02) OTH PAYER ADDR LINE 2 [2F] ^ (#15.03) OTH PAYER
==>CITY NAME [3F] ^ (#15.04) OTH PAYER STATE CODE [4F] ^ (#15.05) OTH PAYER POSTAL ZIP [5F] ^
==>(#15.06) OTH PAYER COUNTRY CODE [6F] ^ (#15.07) OTH PAYER COUNTRY SUBDIV CODE [7F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,16)= (#16.01) OTH PAYER DATE TIME QUAL [1F] ^ (#16.02) OTH PAYER DTIME PER FORM QUAL [2F] ^
==>(#16.03) OTH PAYER ADJ OR PAYMENT DATE [3F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,17)= (#17.01) OTH PAYER 2ND REF ID QUAL 1 [1F] ^ (#17.02) OTH PAYER 2NDARY ID 1 [2F] ^ (#17.03) OTH
==>PAYER 2ND REF ID QUAL 2 [3F] ^ (#17.04) OTH PAYER 2NDARY ID 2 [4F] ^ (#17.05) OTH PAYER PR
==>AUTH REF ID QUAL [5F] ^ (#17.06) OTH PAYER PRIOR AUTH NUM [6F] ^ (#17.07) OTH PAYER REFFERL
==>REF ID QUAL [7F] ^ (#17.08) OTH PAYER REFFERAL NUMBER [8F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,6,D4,18)= (#18.01) OTH PAYER CLM ADJ REF ID QUAL [1F] ^ (#18.02) OTH PAYER CLAIM ADJ INDICATOR [2F] ^
==>(#18.03) OTH PAYER CLM CTRL REF ID QUAL [3F] ^ (#18.04) OTH PAYER CLAIM CTRL NUMBER [4F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,7,0)=^162.07PA^^ (#52) ADJUSTMENT
^FBAAC(D0,1,D1,1,D2,1,D3,7,D4,0)= (#.01) ADJUSTMENT REASON [1P:161.91] ^ (#1) ADJUSTMENT GROUP [2P:161.92] ^ (#2) ADJUSTMENT
==>AMOUNT [3N] ^
^FBAAC(D0,1,D1,1,D2,1,D3,8,0)=^162.08P^^ (#53) REMITTANCE REMARK
^FBAAC(D0,1,D1,1,D2,1,D3,8,D4,0)= (#.01) REMITTANCE REMARK [1P:161.93] ^ (#1) ADJUSTMENT [2N] ^
^FBAAC(D0,1,D1,1,D2,1,D3,9)= (#83) AUTHORIZATION NUMBER [1F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,10,0)=^162.0384A^^ (#84) ATTACHMENT ID
^FBAAC(D0,1,D1,1,D2,1,D3,10,D4,0)= (#.01) ATTACHMENT ID [1F] ^ (#.02) ATTACHMENT REPORT TYPE [2P:353.3] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,0)=^162.371A^^ (#71) OHI SERVICE LINE INFO
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,0)= (#.01) SERVICE LINE NUMBER [1F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,0)=^162.3711A^^ (#1) LINE ADJUDICATION INFORMATION
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,0)= (#.01) OTHER PRIMARY PAYER ID [1F] ^ (#.02) SERVICE LINE PAID AMT [2F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,1)= (#1.01) PROD OR SERV ID QUAL [1F] ^ (#1.02) PROCEDURE CODE [2F] ^ (#1.03) PROC MODIF
==>SVD03-3 [3F] ^ (#1.04) PROC MODIF SVD03-4 [4F] ^ (#1.05) PROC MODIF SVD03-5 [5F] ^
==>(#1.06) PROC MODIF SVD03-6 [6F] ^ (#1.07) PROC CODE DESCRIPTION [7F] ^ (#1.08) PRODUCT OR
==>SERV ID [8F] ^ (#1.09) PAID SERV UNIT CNT [9F] ^ (#1.1) BUNDL OR UNBUNDL LINE NUM [10F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,2,0)=^162.37112A^^ (#2) LINE ADJUSTMENT
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,2,D6,0)= (#.01) CLAIM ADJUSTMENT GROUP CODE [1F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,2,D6,1)= (#1.01) ADJ REASON CODE 1 [1F] ^ (#1.02) ADJ REASON CODE 2 [2F] ^ (#1.03) ADJ REASON
==>CODE 3 [3F] ^ (#1.04) ADJ REASON CODE 4 [4F] ^ (#1.05) ADJ REASON CODE 5 [5F] ^
==>(#1.06) ADJ REASON CODE 6 [6F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,2,D6,2)= (#2.01) ADJ AMOUNT 1 [1F] ^ (#2.02) ADJ AMOUNT 2 [2F] ^ (#2.03) ADJ AMOUNT 3 [3F] ^
==>(#2.04) ADJ AMOUNT 4 [4F] ^ (#2.05) ADJ AMOUNT 5 [5F] ^ (#2.06) ADJ AMOUNT 6 [6F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,2,D6,3)= (#3.01) ADJ QUANTITY 1 [1F] ^ (#3.02) ADJ QUANTITY 2 [2F] ^ (#3.03) ADJ QUANTITY 3
==>[3F] ^ (#3.04) ADJ QUANTITY 4 [4F] ^ (#3.05) ADJ QUANTITY 5 [5F] ^ (#3.06) ADJ
==>QUANTITY 6 [6F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,3)= (#3.01) LN CHK DATE TIME QUALIFIER [1F] ^ (#3.02) LN CHK DATE TIME PER FORM QUAL [2F] ^
==>(#3.03) LN CHK ADJ OR PAYMENT DATE [3F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,11,D4,1,D5,4)= (#4.01) REMAIN PAT LIAB AMT QUAL CODE [1F] ^ (#4.02) REMAIN PAT LIABILITY AMOUNT [2F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,FBREJ)= (#19) REJECT STATUS [1S] ^ (#20) REJECT REASON [2F] ^ (#21) OLD BATCH NUMBER [3P:161.7] ^
==>(#21.3) INTERFACE REJECT [4S] ^
^FBAAC(D0,1,D1,1,D2,1,D3,FBREJC,0)=^162.031^^ (#21.6) REJECT CODE
^FBAAC(D0,1,D1,1,D2,1,D3,FBREJC,D4,0)= (#.01) REJECT CODE [1F] ^
^FBAAC(D0,1,D1,1,D2,1,D3,M,0)=^162.06P^^ (#46) CPT MODIFIER
^FBAAC(D0,1,D1,1,D2,1,D3,M,D4,0)= (#.01) CPT MODIFIER [1P:81.3] ^
^FBAAC(D0,1,D1,1,D2,1,D3,R)= (#24.5) REASON FOR VOIDED PAYMENT [1F] ^
^FBAAC(D0,3,0)=^162.04DA^^ (#7) TRAVEL PAYMENT DATE
^FBAAC(D0,3,D1,0)= (#.01) TRAVEL PAYMENT DATE [1D] ^ (#1) TRAVEL BATCH NUMBER [2P:161.7] ^ (#2) TRAVEL AMOUNT [3N] ^ (#3) TRAVEL
==>OBLIGATION NUMBER [4F] ^ (#7) DATE FINALIZED [5D] ^ (#8) DATE PAID [6D] ^ (#9) CHECK NUMBER [7F] ^ (#10)
==>CANCELLATION DATE [8D] ^ (#11) REASON CODE [9P:162.95] ^ (#12) CANCELLATION ACTIVITY [10S] ^ (#13) DISBURSED
==>AMOUNT [11N] ^ (#14) INTEREST AMOUNT [12N] ^ (#3.5) PAYMENT TYPE CODE [13S] ^
^FBAAC(D0,3,D1,1)= (#15) AUTHORIZATION POINTER [1N] ^
^FBAAC(D0,3,D1,FBREJ)= (#4) REJECT STATUS [1S] ^ (#5) REJECT REASON [2F] ^ (#6) OLD BATCH NUMBER [3P:161.7] ^ (#6.3) INTERFACE
==>REJECT [4S] ^
^FBAAC(D0,3,D1,FBREJC,0)=^162.041^^ (#6.6) REJECT CODE
^FBAAC(D0,3,D1,FBREJC,D2,0)= (#.01) REJECT CODE [1F] ^
^FBAAC(D0,PURGE,0)=^162.099DA^^ (#99) DATE OF PURGE
^FBAAC(D0,PURGE,D1,0)= (#.01) PURGE DATE [1D] ^ (#1) OPT MEDICAL DATA PURGED [2S] ^ (#2) PHARMACY DATA PURGED [3S] ^ (#3) TRAVEL
==>DATA PURGED [4S] ^
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
^DIPT(1529)= FB UCID PAYMENT
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):