GLOBAL MAP DATA DICTIONARY #351.5 -- TRICARE PHARMACY TRANSACTIONS FILE                                           3/24/25    PAGE 1
STORED IN ^IBA(351.5,  *** NO DATA STORED YET ***   SITE: WWW.BMIRWIN.COM   UCI: VISTA,VISTA                       (VERSION 2.0)   
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This file is used to store data related to each Pharmacy billing transaction with the Tricare fiscal intermediary.  Each
transaction is submitted to the the RNA/Triad Pharmacy ClaimGuard System, which is a commercial point of sale pharmacy billing
software package, where it is forwarded to the intermediary through an electronic switch company.  All of the information which is
returned from the intermediary is stored in this file.  


CROSS
REFERENCED BY: COPAYMENT CHARGE(ACC), FISCAL INTERMEDIARY CLAIM(ACL), AUTHORIZATION NUMBER(AUTH), PRESCRIPTION(B)



^IBA(351.5,D0,0)= (#.01) PRESCRIPTION [1F] ^ (#.02) PATIENT [2P:2] ^ (#.03) CARD HOLDER SSN [3F] ^ (#.04) NDC [4F] ^ (#.05) 
               ==>AMOUNT TRANSMITTED [5N] ^ (#.06) QUANTITY [6N] ^ (#.07) TRANSACTION DATE [7D] ^ (#.08) COPAYMENT CHARGE 
               ==>[8P:350] ^ (#.09) FISCAL INTERMEDIARY CLAIM [9P:399] ^ (#.1) PRODUCT SELECTION REASON [10P:351.53] ^ 
^IBA(351.5,D0,2)= (#2.01) COPAY [1N] ^ (#2.02) INGREDIENT COST PAID [2N] ^ (#2.03) CONTRACT FEE PAID [3N] ^ (#2.04) SALES TAX 
               ==>PAID [4N] ^ (#2.05) TOTAL AMOUNT PAID [5N] ^ (#2.06) AUTHORIZATION NUMBER [6F] ^ (#2.07) MESSAGE [7F] ^ 
^IBA(351.5,D0,3)= (#3.01) ACCUMULATED DEDUCTIBLE AMOUNT [1N] ^ (#3.02) REMAINING DEDUCTABLE AMOUNT [2N] ^ (#3.03) REMAINING 
               ==>BENEFIT AMOUNT [3N] ^ (#3.04) ATM APPL TO PER DEDUCTIBLE [4N] ^ (#3.05) AMT COPAY/COINSURANCE [5N] ^ (#3.06) 
               ==>AMT ATTRIB TO PROD SEL [6N] ^ (#3.07) AMT EXCEEDING PERIODIC MAX BEN [7N] ^ (#3.08) INCENTIVE FEE PAID [8N] ^ 
               ==>(#3.09) BASIS OF REIMB DETERMINATION [9S] ^ (#3.1) AMOUNT ATTRIB TO SALES TAX [10N] ^ 
^IBA(351.5,D0,5)= (#5.01) ERROR CODES [1F] ^ 
^IBA(351.5,D0,6)= (#6.01) REVERSAL AUTH NUMBER [1F] ^ (#6.02) REVERSED BY [2P:200] ^ (#6.03) REVERSAL ERROR CODES [3F] ^ 
^IBA(351.5,D0,7)= (#7.01) DUR RESPONSE DATA [1F] ^ 
^IBA(351.5,D0,8)= (#8.01) ADDITIONAL MESSAGE INFORMATION [1F] ^ 


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