GLOBAL MAP DATA DICTIONARY #9002313.03 -- BPS RESPONSES FILE 3/24/25 PAGE 1
STORED IN ^BPSR( *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 1.0)
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This file stores the response information returned by the third-party payer. Most of the fields have 'raw' NCPCP data so it is
formatted per the NCPDP specifications.
Per VHA Directive 2004-038, this file definition should not be modified.
CROSS
REFERENCED BY: HEADER RESPONSE STATUS(AC), DATE RESPONSE RECEIVED(AE), BPS CLAIM(B)
^BPSR(D0,0)= (#.01) BPS CLAIM [1P:9002313.02] ^ (#.02) DATE RESPONSE RECEIVED [2D] ^
^BPSR(D0,100)= ^ (#102) VERSION/RELEASE NUMBER [2F] ^ (#103) TRANSACTION CODE [3F] ^ ^ ^ ^ ^ ^ (#109) TRANSACTION COUNT
==>[9N] ^ ^ ^ ^ ^ ^ (#115) MEDICAID ID NUMBER [15F] ^ (#116) MEDICAID AGENCY NUMBER [16F] ^
^BPSR(D0,200)= (#201) SERVICE PROVIDER ID [1F] ^ (#202) SERV PROVIDER ID QUALIFIER [2F] ^
^BPSR(D0,300)= (#301) GROUP ID [1F] ^ (#302) CARDHOLDER ID [2F] ^ ^ (#304) DATE OF BIRTH [4F] ^ ^ ^ ^ ^ ^ (#310) PATIENT
==>FIRST NAME [10F] ^
^BPSR(D0,310)= (#311) PATIENT LAST NAME [1F] ^
^BPSR(D0,400)= (#401) DATE OF SERVICE [1F] ^
^BPSR(D0,500)= (#501) HEADER RESPONSE STATUS [1S] ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ (#524) PLAN
==>ID [24F] ^
^BPSR(D0,504)= (#504) MESSAGE [1F] ^
^BPSR(D0,540)= ^ ^ ^ ^ (#545) NETWORK REIMBURSEMENT ID [5F] ^
^BPSR(D0,560)= ^ ^ ^ ^ ^ ^ ^ (#568) PAYER/HEALTH PLAN ID QUALIFIER [8S] ^ (#569) PAYER/HEALTH PLAN ID [9F] ^
^BPSR(D0,1000,0)=^9002313.0301A^^ (#1000) RESPONSES
^BPSR(D0,1000,D1,0)= (#.01) TRANSACTION ORDER [1N] ^
^BPSR(D0,1000,D1,100)= ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ (#114) MEDICAID SUBROGATION ICN/TCN [14F] ^
^BPSR(D0,1000,D1,110)= ^ (#112) TRANSACTION RESPONSE STATUS [2S] ^
^BPSR(D0,1000,D1,120)= ^ ^ ^ ^ ^ ^ ^ (#128) SPENDING ACCOUNT AMT REMAINING [8F] ^ (#129) HEALTH PLAN-FUNDED ASSIST AMT
==>[9F] ^ (#130) ADDITIONAL MESSAGE INFO COUNT [10F] ^
^BPSR(D0,1000,D1,130)= ^ ^ (#133) AMT ATTR TO PROV NETWORK SLCTN [3F] ^ (#134) AMT ATTR TO PROD SEL BRND DRUG [4F] ^ (#135) AMT
==>ATTR NON-PREF FRMLRY SEL [5F] ^ (#136) AMT ATTR TO N-PREF FRMLRY SEL [6F] ^ (#137) AMOUNT ATTR TO COVERAGE
==>GAP [7F] ^ (#138) CMS LICS LEVEL [8F] ^ (#139) MEDICARE PART D COVERAGE CODE [9F] ^ (#140) NEXT MEDICARE
==>PART D EFF DATE [10F] ^
^BPSR(D0,1000,D1,130.01,0)=^9002313.13001A^^ (#130.01) ADDITIONAL MESSAGE MLTPL
^BPSR(D0,1000,D1,130.01,D2,0)= (#.01) ADDITIONAL MESSAGE COUNTER [1N] ^ (#131) ADDITIONAL MSG INFO CONTINUITY [2F] ^ (#132)
==>ADDITIONAL MSG INFO QUALIFIER [3F] ^
^BPSR(D0,1000,D1,130.01,D2,1)= (#526) ADDITIONAL MESSAGE INFORMATION [1F] ^
^BPSR(D0,1000,D1,140)= (#141) NEXT MEDICARE PART D TERM DATE [1F] ^ ^ ^ ^ ^ ^ ^ (#148) INGRED COST CNTRCTD REIMB AMT [8F] ^
==>(#149) DISP FEE CNTRCTD REIMB AMT [9F] ^
^BPSR(D0,1000,D1,230)= ^ ^ ^ ^ ^ ^ ^ ^ ^ (#240) CONTRACT NUMBER [10F] ^
^BPSR(D0,1000,D1,340)= ^ ^ ^ ^ ^ (#346) BASIS OF CALC - DISPENSING FEE [6S] ^ (#347) BASIS OF CALC - COPAY [7S] ^ (#348)
==>BASIS OF CALC - REGULATORY FEE [8S] ^ (#349) BASIS OF CALC - % TAX [9S] ^
^BPSR(D0,1000,D1,350)= ^ ^ ^ ^ (#355) OTHER PAYER ID COUNT [5F] ^
^BPSR(D0,1000,D1,355.01,0)=^9002313.035501A^^ (#355.01) OTHER PAYER ID MLTPL
^BPSR(D0,1000,D1,355.01,D2,0)= (#.01) OTHER PAYER ID COUNTER [1N] ^ (#142) OTHER PAYER PERSON CODE [2F] ^ (#143) OTHER PAYER
==>PATIENT REL CODE [3F] ^ (#144) OTHER PAYER EFFECTIVE DATE [4F] ^ (#145) OTHER PAYER TERMINATION
==>DATE [5F] ^ (#127) OTHER PAYER HELP DESK PH NUM [6F] ^ (#2023) OTHER PAYER HELPDESK PHONE EXT [7F]
==>^
^BPSR(D0,1000,D1,355.01,D2,1)= (#338) OTHER PAYER COVERAGE TYPE [1F] ^ (#339) OTHER PAYER ID QUALIFIER [2F] ^ (#340) OTHER PAYER
==>ID [3F] ^ (#991) OTHER PAYER PROC CONTROL NUM [4F] ^ (#356) OTHER PAYER CARDHOLDER ID [5F] ^
==>(#992) OTHER PAYER GROUP ID [6F] ^
^BPSR(D0,1000,D1,390)= ^ (#392) BENEFIT STAGE COUNT [2F] ^
^BPSR(D0,1000,D1,392.01,0)=^9002313.039201A^^ (#392.01) BENEFIT STAGE INFO
^BPSR(D0,1000,D1,392.01,D2,0)= (#.01) BENEFIT STAGE COUNTER [1N] ^ (#393) BENEFIT STAGE QUALIFIER [2F] ^ (#394) BENEFIT STAGE
==>AMOUNT [3F] ^
^BPSR(D0,1000,D1,400)= ^ (#402) PRESCRIPTION/SERVICE REF NO [2F] ^
^BPSR(D0,1000,D1,450)= ^ ^ ^ ^ (#455) PRESCRIPTION/SERV REF NO QLFR [5S] ^
^BPSR(D0,1000,D1,498)= (#498.51) PRIOR AUTH PROCESSED DATE [1F] ^ (#498.52) PRIOR AUTH EFFECTIVE DATE [2F] ^ (#498.53) PRIOR AUTH
==>EXPIRATION DATE [3F] ^ (#498.54) PRIOR AUTH NO REFILLS AUTH [4N] ^ (#498.55) PRIOR AUTH QTY ACCUMULATED
==>[5F] ^ (#498.14) PRIOR AUTH NUMBER-ASSIGNED [6F] ^ (#498.57) PRIOR AUTHORIZATION QUANTITY [7F] ^ (#498.58)
==>PRIOR AUTH DOLLARS AUTHORIZED [8F] ^
^BPSR(D0,1000,D1,500)= (#501) HEADER RESPONSE STATUS [1S] ^ ^ (#503) AUTHORIZATION NUMBER [3F] ^ ^ (#505) PATIENT PAY AMOUNT
==>[5F] ^ (#506) INGREDIENT COST PAID [6F] ^ (#507) DISPENSING FEE PAID [7F] ^ ^ (#509) TOTAL AMOUNT PAID
==>[9F] ^ (#510) REJECT COUNT [10F] ^ ^ (#512) ACCUMULATED DEDUCTIBLE AMOUNT [12F] ^ (#513) REMAINING
==>DEDUCTIBLE AMOUNT [13F] ^ (#514) REMAINING BENEFIT AMOUNT [14F] ^ ^ ^ (#517) AMT APPLIED TO PERIODIC
==>DEDUCT [17F] ^ (#518) AMOUNT OF COPAY [18F] ^ (#519) AMT ATTRIBUTED TO PRODUCT SEL [19F] ^ (#520) AMOUNT
==>EXCEEDING PERIODIC MAX [20F] ^ (#521) INCENTIVE AMOUNT PAID [21F] ^ (#522) BASIS OF REIMB DETERMINATION
==>[22F] ^ (#523) AMOUNT ATTRIBUTED TO SALES TAX [23F] ^
^BPSR(D0,1000,D1,504)= (#504) MESSAGE [1F] ^
^BPSR(D0,1000,D1,511,0)=^9002313.03511A^^ (#511) REJECT CODE
^BPSR(D0,1000,D1,511,D2,0)= (#.01) REJECT CODE [1F] ^ (#546) REJECT FIELD OCCURRENCE INDCTR [2N] ^
^BPSR(D0,1000,D1,525)= (#525) DUR RESPONSE DATA [1F] ^
^BPSR(D0,1000,D1,526)= (#526) ADDITIONAL MESSAGE INFORMATION [1F] ^
^BPSR(D0,1000,D1,540)= ^ ^ ^ ^ ^ ^ (#547) APPROVED MESSAGE CODE COUNT [7F] ^ ^ (#549) HELP DESK PHONE NUMBER QUAL [9F] ^
==>(#550) HELP DESK TELEPHONE NUMBER [10F] ^
^BPSR(D0,1000,D1,548,0)=^9002313.301548A^^ (#548) APPROVED MESSAGE CODE
^BPSR(D0,1000,D1,548,D2,0)= (#.01) APPROVED MESSAGE CODE [1F] ^
^BPSR(D0,1000,D1,550)= (#551) FORMULARY ALT PRODUCT COUNT [1N] ^ ^ ^ ^ ^ ^ (#557) PERCENT TAX EXEMPT INDICATOR [7S] ^ (#558)
==>REGULATORY FEE AMOUNT PAID [8F] ^ (#559) PERCENTAGE TAX AMOUNT PAID [9F] ^ (#560) PERCENTAGE TAX RATE PAID
==>[10F] ^
^BPSR(D0,1000,D1,551.01,0)=^9002313.1301A^^ (#551.01) PREFERRED PRODUCT REPEATING
^BPSR(D0,1000,D1,551.01,D2,0)= (#.01) PREFERRED PRODUCT COUNTER [1N] ^
^BPSR(D0,1000,D1,551.01,D2,1)= (#552) FORMULARY ALT ID QUALIFIER [1F] ^ (#553) FORMULARY ALTERNATIVE ID [2F] ^ (#554) FORMULARY
==>ALT INCENTIVE [3F] ^ (#555) FRMULRY ALT ESTMTD PT COST SHR [4F] ^ (#556) FORMULARY ALT DESCRIPTION
==>[5F] ^
^BPSR(D0,1000,D1,560)= (#561) PERCENTAGE TAX BASIS PAID [1S] ^ (#562) PROFESSIONAL SERVICE FEE PAID [2F] ^ (#563) OTHER AMOUNT
==>PAID COUNT [3F] ^ ^ ^ (#566) OTHER PAYER AMOUNT RECOGNIZED [6F] ^
^BPSR(D0,1000,D1,563.01,0)=^9002313.1401A^^ (#563.01) OTHER AMOUNTS PAID
^BPSR(D0,1000,D1,563.01,D2,0)= (#.01) OTHER AMOUNT PAID COUNTER [1N] ^
^BPSR(D0,1000,D1,563.01,D2,1)= (#564) OTHER AMOUNT PAID QUALIFIER [1F] ^ (#565) OTHER AMOUNT PAID [2F] ^
^BPSR(D0,1000,D1,567.01,0)=^9002313.1101A^^ (#567.01) DUR PPS
^BPSR(D0,1000,D1,567.01,D2,0)= (#.01) DUR PPS RESPONSE [1N] ^ (#439) REASON FOR SERVICE CODE [2F] ^ (#528) CLINICAL SIGNIFICANCE
==>CODE [3S] ^ (#529) OTHER PHARMACY INDICATOR [4S] ^ (#530) PREVIOUS DATE OF SERVICE [5F] ^ (#531)
==>QTY OF PREVIOUS DISPENSING [6F] ^ (#532) DATABASE INDICATOR [7S] ^ (#533) OTHER PRESCRIBER
==>INDICATOR [8S] ^ (#544) DUR/DUE FREE TEXT MESSAGE [9F] ^
^BPSR(D0,1000,D1,567.01,D2,1)= (#570) DUR ADDITIONAL TEXT [1F] ^
^BPSR(D0,1000,D1,570)= (#571) AMOUNT ATTRIB TO PROCESSOR FEE [1F] ^ (#572) AMOUNT OF COINSURANCE [2F] ^ (#573) BASIS OF CALC -
==>COINSURANCE [3F] ^ (#574) PLAN SALES TAX AMOUNT [4F] ^ (#575) PATIENT PERCENTAGE TAX AMOUNT [5F] ^ ^
==>(#577) ESTIMATED GENERIC SAVINGS [7F] ^
^BPSR(D0,1000,D1,750)= ^ ^ ^ ^ ^ ^ (#757) BENEFIT ID [7F] ^
^BPSR(D0,1000,D1,870)= ^ ^ ^ ^ ^ ^ ^ ^ ^ (#880) TRANSACTION REFERENCE NUMBER [10F] ^
^BPSR(D0,1000,D1,920)= ^ ^ ^ ^ ^ (#926) FORMULARY ID [6F] ^
^BPSR(D0,1000,D1,930)= (#931) MAXIMUM AGE QUALIFIER [1S] ^ (#932) MAXIMUM AGE [2N] ^ (#933) MAXIMUM AMOUNT [3F] ^ (#934) MAXIMUM
==>AMOUNT QUALIFIER [4S] ^ (#935) MAXIMUM AMOUNT TIME PERIOD [5S] ^ (#936) MAX AMT TIME PERIOD START DATE
==>[6F] ^ (#937) MAX AMT TIME PERIOD END DATE [7F] ^ (#938) MAX AMT TIME PERIOD UNITS [8N] ^
^BPSR(D0,1000,D1,940)= ^ ^ (#943) MINIMUM AGE QUALIFIER [3S] ^ (#944) MINIMUM AGE [4N] ^
^BPSR(D0,1000,D1,987)= (#987) URL [1F] ^
^BPSR(D0,1000,D1,990)= ^ ^ (#993) INTERNAL CONTROL NUMBER [3F] ^
^BPSR(D0,1000,D1,1000)= (#1000) DUPLICATE RESPONSE DATA [1F] ^
^BPSR(D0,1000,D1,A20)= ^ ^ ^ ^ ^ ^ ^ (#1028) ADJUDICATED PROGRAM TYPE [8F] ^
^BPSR(D0,1000,D1,B00)= ^ ^ ^ (#2004) NEXT AVAILABLE FILL DATE [4F] ^
^BPSR(D0,1000,D1,B20)= ^ (#2022) HELP DESK TELEPHONE NUMBER EXT [2F] ^
^BPSR(D0,1000,D1,B30)= ^ ^ (#2033) PRO SERVICE FEE CONT/REIM AMT [3F] ^
^BPSR(D0,1000,D1,B50)= ^ (#2052) RESPONSE INTERMEDIARY AUTH CNT [2N] ^
^BPSR(D0,1000,D1,B52,0)=^9002313.032052^^ (#2052.01) INTERMEDIARY MULTIPLE
^BPSR(D0,1000,D1,B52,D2,0)= (#.01) RESPONSE INTERMEDIARY COUNTER [1N] ^ (#2053) RESPONSE INTERMED AUTH TYPE ID [2F] ^ (#2054)
==>RESPONSE INTERMEDIARY AUTH ID [3F] ^
^BPSR(D0,1000,D1,B52,D2,1)= (#2051) INTERMEDIARY MESSAGE [1F] ^
^BPSR(D0,1000,D1,B80)= ^ ^ ^ ^ ^ ^ (#2087) QUAN LIMIT PER SPC TM PD COUNT [7N] ^ ^ ^ (#2090) DAYS SUP LIM PER SPC TM PD
==>CNT [10N] ^
^BPSR(D0,1000,D1,B87,0)=^9002313.032087A^^ (#2087.01) QUAN LIMIT TIME PERIOD MLTPL
^BPSR(D0,1000,D1,B87,D2,0)= (#.01) QUANTITY LIMIT TIME PD COUNTER [1N] ^ (#2088) QUAN LIMIT PER SPC TIME PERIOD [2N] ^ (#2089)
==>QUANTITY LIMIT TIME PERIOD [3N] ^
^BPSR(D0,1000,D1,B90,0)=^9002313.032091A^^ (#2090.01) DAYS SUPPLY LIM TM PD MULTIPLE
^BPSR(D0,1000,D1,B90,D2,0)= (#.01) DAYS SUPPLY LIM TM PD COUNTER [1N] ^ (#2091) DAYS SUP LIM PER SPC TM PERIOD [2N] ^ (#2092)
==>DAYS SUPPLY LIMIT TIME PERIOD [3N] ^
^BPSR(D0,1000,D1,B98)= (#2098) RECONCILIATION ID [1F] ^
^BPSR(D0,1000,D1,C40)= ^ ^ ^ ^ ^ ^ (#2147) OTHER PAYER PROGRAM TYPE [7P:9002313.38] ^ ^ ^ (#2150) BENEFIT STAGE INDICATOR
==>COUNT [10N] ^
^BPSR(D0,1000,D1,C50)= (#2151) BENEFIT STAGE INDICATOR [1P:9002313.35] ^ ^ ^ ^ ^ ^ ^ (#2158) BENEFIT TYPE OPPORTUNITY [8S]
==>^ (#2159) BENEFIT TYPE OPPORTUNITY COUNT [9N] ^
^BPSR(D0,1000,D1,C60)= ^ ^ ^ ^ ^ (#2166) HELP DESK BUSINESS UNIT TYPE [6S] ^ (#2167) HELP DESK BUS UNIT TYPE COUNT [7N] ^
==>(#2168) HELP DESK CONTACT INFORMATION [8F] ^ (#2169) HELP DESK CONTACT INFO EXT [9F] ^ (#2170) HELP DESK
==>CONTACT INFO QUAL [10S] ^
^BPSR(D0,1000,D1,C70)= (#2171) HELP DESK SUPPORT TYPE [1S] ^ (#2172) HELP DESK SUPPORT TYPE COUNT [2N] ^ ^ ^ ^ ^ ^ ^ ^
==>(#2180) INTERMEDIARY HELP DESK TYPE [10S] ^
^BPSR(D0,1000,D1,C80)= (#2181) INTERMEDIARY HLPDSK BUS COUNT [1N] ^ (#2182) INTERMEDIARY HLPDSK CONTACT [2F] ^ (#2183)
==>INTERMEDIARY HLPDSK EXTENSION [3F] ^ (#2184) INTERMEDIARY HLPDSK QUALIFIER [4S] ^ (#2185) INTERMEDIARY
==>HLPDSK SUPPT TYPE [5S] ^ (#2186) INTERMEDIARY HLPDSK TYP COUNT [6N] ^
^BPSR(D0,1000,D1,C90)= ^ ^ (#2193) PATIENT PAY COMPONENT AMOUNT [3F] ^ (#2194) PATIENT PAY COMPONENT COUNT [4N] ^ (#2195)
==>PATIENT PAY COMPONENT QUAL [5P:9002313.37] ^ (#2196) PAYER/HEALTH PLAN ID COUNT [6N] ^
^BPSR(D0,1000,D1,D10)= ^ ^ ^ ^ (#2215) SUBROGTN REQUESTR RECONCIL ID [5F] ^ ^ ^ ^ (#2219) MINIMUM AMOUNT [9F] ^ (#2220)
==>MINIMUM AMOUNT QUALIFIER [10S] ^
^BPSR(D0,1000,D1,D20)= ^ ^ (#2223) OTHER PAYER NAME [3F] ^ (#2224) REMAINING AMOUNT [4F] ^ (#2225) REMAINING AMOUNT QUALIFIER
==>[5S] ^
^BPSR(D0,1000,D1,D40)= (#2241) OTHER PAYER RELATIONSHIP TYPE [1S] ^ (#2242) FORMULARY ALT BENEFIT TIER [2S] ^ (#2243) FORMULARY
==>ALT REASON CODE [3S] ^ (#2244) FORMLRY ALT REQ THERAPY COUNT [4F] ^ (#2245) FORMLRY ALT THERAPY INDICATOR
==>[5S] ^ (#2246) FORMLRY ALT THERAPY TIME QUAL [6S] ^ (#2247) FORMLRY ALT THERAPY DURATION [7F] ^ (#2248)
==>FORMLRY ALT THERAPY START DATE [8D] ^ (#2249) FORMLRY ALT THERAPY END DATE [9D] ^ (#2250) OTHER PAYER
==>BENEFIT CLASS [10F] ^
^BPSR(D0,1000,D1,D50)= ^ ^ ^ (#2254) PLAN OVERRIDE INDICATOR [4F] ^ (#2255) PLAN OVERRIDE VALUE COUNT [5N] ^ (#2256) PLAN
==>BENEFIT OVERRIDE VALUE [6F] ^ ^ ^ ^ (#2260) REGULATORY FEE COUNT [10N] ^
^BPSR(D0,1000,D1,D60)= (#2261) REGULATORY FEE TYPE CODE [1S] ^ (#2262) REGULATORY FEE EXMPT INDICATOR [2S] ^ ^ ^ (#2265)
==>PATIENT REGULATORY FEE AMOUNT [5N] ^
^BPSR(D0,1000,D1,E80)= ^ ^ ^ ^ ^ ^ (#2387) INVALID PROVIDER DATA SOURCE [7P:9002313.42] ^ (#2388) INVALID PROVIDER
==>SOURCE-STATE [8F] ^ (#2389) FORMULARY ALTERNATIVE EFF DATE [9F] ^
^BPSR(D0,1000,D1,E90)= ^ ^ (#2393) DUR/DUE CO-AGENT DESCRIPTION [3F] ^ (#2394) UNIT OF PRIOR DISPENSED QTY [4S] ^ (#2395) OTHER
==>PHARMACY ID QUALIFIER [5P:9002313.4] ^ (#2396) OTHER PHARMACY ID [6F] ^ (#2397) OTHER PHARMACY NAME [7F] ^
==>(#2398) OTHER PHARMACY TELEPHONE [8N] ^ (#2399) OTHER PRESCRIBER LAST NAME [9F] ^
^BPSR(D0,1000,D1,F00)= (#2401) OTHER PRESCRIBER ID QUALIFIER [1P:9002313.41] ^ (#2402) OTHER PRESCRIBER ID [2F] ^ (#2403) OTHER
==>PRESCRIBER PHONE NUMBER [3N] ^ (#2404) DUR/DUE COMPOUND PRODUCT ID [4F] ^ (#2405) DUR/DUE CMPND PRDUCT ID
==>QUALIF [5P:9002313.39] ^ (#2406) DUR/DUE MAXIMUM DAILY DOSE QTY [6N] ^ (#2407) DUR/DUE MAX DAILY DOSE -
==>UNIT [7S] ^ (#2408) DUR/DUE MINIMUM DAILY DOSE QTY [8N] ^ (#2409) DUR/DUE MIN DAILY DOSE - UNIT [9S] ^
^BPSR(D0,M,0)=^9002313.39999^^ (#9999) RAW DATA RECEIVED
^BPSR(D0,M,D1,0)= (#.01) RAW DATA RECEIVED [1W] ^
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):