GLOBAL MAP DATA DICTIONARY #162.1 -- FEE BASIS PHARMACY INVOICE FILE 6/27/25 PAGE 1
STORED IN ^FBAA(162.1, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 3.5)
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Contains Pharmacy invoices and payment data associated with hometown pharmacy payments.
Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: INVOICE STATUS(AC), CHECK NUMBER(ACK), PATIENT(AD), BATCH NUMBER(AE), OLD BATCH NUMBER(AF),
GENERIC DRUG ONLY STATUS(AH), ADJUSTMENT REASON(AI), VENDOR(AN), ASSOCIATED 7078/583(AO), NUMBER(B),
DoD INVOICE NUMBER(DODI), IPAC VENDOR AGREEMENT(IPAC)
INDEXED BY: DATE CERTIFIED FOR PAYMENT & PATIENT (AA), FPPS CLAIM ID (AFC), PATIENT & SUSPEND CODE (AG), BATCH NUMBER & PATIENT
(AJ), DATE PRESCRIPTION FILLED & PATIENT & BATCH NUMBER (AK)
^FBAA(162.1,D0,0)= (#.01) NUMBER [1N] ^ (#1) DATE CORRECT INVOICE RECV'D [2D] ^ (#2) DATA ENTRY CLERK [3P:200] ^ (#3) VENDOR
==>[4P:161.2] ^ (#5) INVOICE STATUS [5S] ^ (#6) TOTAL AMOUNT CLAIMED [6N] ^ (#7) TOTAL AMOUNT PAID [7N] ^ (#1.5)
==>DATE INVOICE ENTERED [8D] ^ (#8) TOTAL LINE COUNT [9N] ^ (#9) GENERIC DRUG NAME STATUS [10S] ^ (#10) BATCH
==>ASSIGNED [11P:161.7] ^ (#12) VENDOR INVOICE DATE [12D] ^ (#13) FPPS CLAIM ID [13F] ^ ^ ^ ^ ^ ^ ^ ^ ^
==>^ (#14) IPAC VENDOR AGREEMENT [23P:161.95] ^
^FBAA(162.1,D0,1)= (#11) PAID TO DATE [E1,245N] ^
^FBAA(162.1,D0,RX,0)=^162.11^^ (#4) PRESCRIPTION NUMBER
^FBAA(162.1,D0,RX,D1,0)= (#.01) PRESCRIPTION NUMBER [1F] ^ (#1) DRUG NAME [2F] ^ (#2) DATE PRESCRIPTION FILLED [3D] ^ (#3) AMOUNT
==>CLAIMED [4N] ^ (#4) PATIENT [5P:161] ^ (#5) RED BOOK COST [6N] ^ (#6) AMOUNT SUSPENDED [7N] ^ (#7)
==>SUSPEND CODE [8P:161.27] ^ (#8) LINE ITEM STATUS [9S] ^ (#9) GENERIC DRUG [10P:50] ^ (#10) PHARMACY
==>DETERMINATION [11S] ^ (#1.5) STRENGTH [12F] ^ (#1.6) QUANTITY [13F] ^ (#11) PHARMACIST [14P:200] ^ (#12)
==>DATE OF DETERMINATION [15D] ^ (#6.5) AMOUNT PAID [16N] ^ (#13) BATCH NUMBER [17P:161.7] ^ (#14)
==>OBLIGATION NUMBER [18F] ^ (#15) DATE CERTIFIED FOR PAYMENT [19D] ^ (#16) PAYMENT TYPE CODE [20S] ^
==>(#8.5) SUBSTITUTE GENERIC DRUG [21S] ^ (#22) PHARMACY REMARKS [22F] ^
^FBAA(162.1,D0,RX,D1,1,0)=^162.12^^ (#20) SUSPENSION DESCRIPTION
^FBAA(162.1,D0,RX,D1,1,D2,0)= (#.01) SUSPENSION DESCRIPTION [1W] ^
^FBAA(162.1,D0,RX,D1,2)= (#21) GENERIC DRUG ONLY STATUS [1S] ^ (#1.4) MANUFACTURER [2F] ^ (#23) VOID PAYMENT [3S] ^ (#24)
==>SUPERVISOR [4P:200] ^ (#25) PRIMARY SERVICE FACILITY [5P:4] ^ (#26) ASSOCIATED 7078/583 [6V] ^ (#27)
==>AUTHORIZATION POINTER [7N] ^ (#28) DATE PAID [8D] ^ (#29) PROMPT PAY TYPE [9S] ^ (#30) CHECK NUMBER
==>[10F] ^ (#31) CANCELLATION DATE [11D] ^ (#32) REASON CODE [12P:162.95] ^ (#33) CANCELLATION ACTIVITY
==>[13S] ^ (#34) DISBURSED AMOUNT [14N] ^ (#35) INTEREST AMOUNT [15N] ^
^FBAA(162.1,D0,RX,D1,3)= (#36) FPPS LINE ITEM [1F] ^ (#40) AUTHORIZATION NUMBER [2F] ^
^FBAA(162.1,D0,RX,D1,4,0)=^162.14P^^ (#37) ADJUSTMENT
^FBAA(162.1,D0,RX,D1,4,D2,0)= (#.01) ADJUSTMENT REASON [1P:161.91] ^ (#1) ADJUSTMENT GROUP [2P:161.92] ^ (#2) ADJUSTMENT AMOUNT
==>[3N] ^
^FBAA(162.1,D0,RX,D1,5,0)=^162.15P^^ (#38) REMITTANCE REMARK
^FBAA(162.1,D0,RX,D1,5,D2,0)= (#.01) REMITTANCE REMARK [1P:161.93] ^ (#1) ADJUSTMENT [2N] ^
^FBAA(162.1,D0,RX,D1,6)= (#39) DoD INVOICE NUMBER [1F] ^
^FBAA(162.1,D0,RX,D1,FBREJ)= (#17) REJECT STATUS [1S] ^ (#18) REJECT REASON [2F] ^ (#19) OLD BATCH NUMBER [3P:161.7] ^ (#19.3)
==>INTERFACE REJECT [4S] ^
^FBAA(162.1,D0,RX,D1,FBREJC,0)=^162.111^^ (#19.6) REJECT CODE
^FBAA(162.1,D0,RX,D1,FBREJC,D2,0)= (#.01) REJECT CODE [1F] ^
^FBAA(162.1,D0,RX,D1,R)= (#23.5) REASON FOR VOIDED PAYMENT [1F] ^
INPUT TEMPLATE(S):
^DIE(1056)= FB ADD RX
PRINT TEMPLATE(S):
^DIPT(589)= FBAA RX PENDING
SORT TEMPLATE(S):
^DIBT(300)= FBAA RX PENDING
FORM(S)/BLOCK(S):