GLOBAL MAP DATA DICTIONARY #9002313.32 -- BPS PAYER RESPONSE OVERRIDES FILE 3/24/25 PAGE 1
STORED IN ^BPS(9002313.32, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 1.0)
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This file is used to store Payer Response Overrides. This file should not be populated on production systems, only on test
systems.
Per VHA Directive 2004-038, this file definition should not be modified.
CROSS
REFERENCED BY: TRANSACTION NUMBER(B)
^BPS(9002313.32,D0,0)= (#.01) TRANSACTION NUMBER [1N] ^ (#.02) TYPE [2S] ^ (#.03) SUBMISSION RESPONSE [3S] ^ (#.04) TOTAL AMOUNT
==>PAID [4N] ^ (#.05) REVERSAL RESPONSE [5S] ^ (#.06) AMOUNT OF COPAY [6N] ^ (#.07) DELAY [7N] ^ (#.08)
==>ELIGIBILITY RESPONSE [8S] ^ (#.09) NEXT AVAILABLE FILL DATE [9D] ^ (#.1) ADJUDICATED PROGRAM TYPE [10S] ^
==>(#.11) QUAN LIMIT PER SPC TIME PERIOD [11N] ^ (#.12) QUANTITY LIMIT TIME PERIOD [12N] ^ (#.13) DAYS SUP
==>LIM PER SPC TM PERIOD [13N] ^ (#.14) DAYS SUPPLY LIMIT TIME PERIOD [14N] ^ (#.15) INGREDIENT COST PAID
==>[15N] ^ (#.16) DISPENSING FEE PAID [16N] ^ (#.17) REMAINING DEDUCTIBLE AMOUNT [17N] ^ (#.18) AMT APPLIED
==>TO PERIODIC DEDUCT [18N] ^
^BPS(9002313.32,D0,1,0)=^9002313.321P^^ (#1) REJECT CODES
^BPS(9002313.32,D0,1,D1,0)= (#.01) REJECT CODES [1P:9002313.93] ^
^BPS(9002313.32,D0,2)= (#2.01) PERCENTAGE TAX BASIS PAID [1S] ^ (#2.02) OTHER AMOUNT PAID QUALIFIER [2F] ^ (#2.03) PAYER/HEALTH
==>PLAN ID QUALIFIER [3S] ^ (#2.04) HELP DESK TELEPHONE NUMBER EXT [4F] ^ (#2.05) PRO SERVICE FEE CONT/REIM
==>AMT [5N] ^ (#2.06) OTHER PAYER HELPDESK PHONE EXT [6N] ^ (#2.07) RESPONSE INTERMED AUTH TYPE ID [7F] ^
==>(#2.08) RESPONSE INTERMEDIARY AUTH ID [8F] ^ (#2.09) RECONCILIATION ID [9F] ^ (#2.1) PATIENT PAY AMOUNT
==>[10N] ^ (#2.11) REASON FOR SERVICE CODE [11P:9002313.23] ^
^BPS(9002313.32,D0,3)= (#3.01) INTERMEDIARY MESSAGE [1F] ^
^BPS(9002313.32,D0,4)= (#4.01) MAXIMUM AGE QUALIFIER [1S] ^ (#4.02) MAXIMUM AGE [2N] ^ (#4.03) MAXIMUM AMOUNT [3N] ^ (#4.04)
==>MAXIMUM AMOUNT QUALIFIER [4S] ^ (#4.05) MAXIMUM AMOUNT TIME PERIOD [5S] ^ (#4.06) MAX AMT TIME PERIOD
==>START DATE [6D] ^ (#4.07) MAX AMT TIME PERIOD END DATE [7D] ^ (#4.08) MAX AMT TIME PERIOD UNITS [8N] ^
==>(#4.09) MINIMUM AGE QUALIFIER [9S] ^ (#4.1) MINIMUM AGE [10N] ^ (#4.11) OTHER PAYER PROGRAM TYPE
==>[11P:9002313.38] ^ (#4.12) PATIENT PAY COMPONENT AMOUNT [12N] ^ (#4.13) PATIENT PAY COMPONENT COUNT [13N]
==>^ (#4.14) PATIENT PAY COMPONENT QUAL [14P:9002313.37] ^ (#4.15) MINIMUM AMOUNT [15N] ^ (#4.16) MINIMUM
==>AMOUNT QUALIFIER [16S] ^ (#4.17) OTHER PAYER NAME [17F] ^ (#4.18) REMAINING AMOUNT [18N] ^ (#4.19)
==>REMAINING AMOUNT QUALIFIER [19S] ^ (#4.2) OTHER PAYER RELATIONSHIP TYPE [20S] ^
^BPS(9002313.32,D0,5)= (#5.01) INVALID PROVIDER DATA SOURCE [1P:9002313.42] ^ (#5.02) FORMULARY ALTERNATIVE EFF DATE [2D] ^
==>(#5.03) DUR/DUE CO-AGENT DESCRIPTION [3F] ^ (#5.04) UNIT OF PRIOR DISPENSED QTY [4S] ^ (#5.05) OTHER
==>PHARMACY ID QUALIFIER [5P:9002313.4] ^ (#5.06) OTHER PHARMACY NAME [6F] ^ (#5.07) OTHER PHARMACY TELEPHONE
==>[7N] ^ (#5.08) OTHER PRESCRIBER LAST NAME [8F] ^ (#5.09) OTHER PRESCRIBER ID QUALIFIER [9P:9002313.41] ^
==>(#5.1) OTHER PRESCRIBER ID [10F] ^ (#5.11) OTHER PRESCRIBER PHONE NUMBER [11N] ^ (#5.12) DUR/DUE COMPOUND
==>PRODUCT ID [12F] ^ (#5.13) DUR/DUE CMPND PRDUCT ID QUALIF [13P:9002313.39] ^ (#5.14) DUR/DUE MAXIMUM DAILY
==>DOSE QTY [14N] ^ (#5.15) DUR/DUE MAX DAILY DOSE - UNIT [15S] ^ (#5.16) DUR/DUE MINIMUM DAILY DOSE QTY
==>[16N] ^ (#5.17) DUR/DUE MIN DAILY DOSE - UNIT [17S] ^
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):