STANDARD DATA DICTIONARY #344.6 -- RCDPE AUTO-PAY EXCLUSION FILE 3/24/25 PAGE 1 STORED IN ^RCY(344.6, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 4.5) DATA NAME GLOBAL DATA ELEMENT TITLE LOCATION TYPE ----------------------------------------------------------------------------------------------------------------------------------- This file is populated based on the data in the ELECTRONIC REMITTANCE ADVICE file (#344.4). Initially, a post-installation process created a record for each unique PAYER NAME/PAYER ID combination. Afterwards, this file is populated by the EDI Lockbox (ePayments) nightly batch job. Whenever the nightly batch job encounters a new PAYER NAME/PAYER ID combination, a new record will be added to this file. The file will be maintained via the EDI Lockbox Parameters [RCDPE EDI LOCKBOX PARAMETERS] option. IDENTIFIED BY: PAYER ID (#.02) CROSS REFERENCED BY: CHAMPVA PAYER(ACH), PHARMACY PAYER(ARX), TRICARE PAYER(ATR), EXCLUDE MED CLAIMS DECREASE(EXMDDECR), EXCLUDE MED CLAIMS POSTING(EXMDPOST), EXCLUDE PHARM CLAIMS DECREASE(EXRXDECR), EXCLUDE RX CLAIM POSTING(EXRXPOST), EXCLUDE TRICARE CLAIM DECREASE(EXTRDECR), EXCLUDE TRICARE CLAIM POSTING(EXTRPOST) INDEXED BY: PHARMACY PAYER & TRICARE PAYER & CHAMPVA PAYER (AC), PAYER NAME (B), PAYER ID (C), PAYER NAME & PAYER ID (CPID) LAST MODIFIED: NOV 21,2024@17:15:20 344.6,.01 PAYER NAME 0;1 FREE TEXT (Required) INPUT TRANSFORM: K:$L(X)>60!($L(X)<3)!'(X'?1P.E) X LAST EDITED: JUL 06, 2018 HELP-PROMPT: Answer must be 3 to 60 characters. This field should only be populated programmatically. DESCRIPTION: This is the payer name whose settings are defined by this entry. This field is programmatically generated and should never be updated by a user. FIELD INDEX: B (#1520) REGULAR IR LOOKUP & SORTING Short Descr: Index by Name (full 60) Description: This index allows lookup using the full 60 character long PAYER NAME field. Set Logic: S ^RCY(344.6,"B",$E(X,1,60),DA)="" Kill Logic: K ^RCY(344.6,"B",$E(X,1,60),DA) Whole Kill: K ^RCY(344.6,"B") X(1): PAYER NAME (344.6,.01) (Subscr 1) (Len 60) (forwards) RECORD INDEXES: CPID (#1214) 344.6,.02 PAYER ID 0;2 FREE TEXT INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X LAST EDITED: AUG 27, 2014 HELP-PROMPT: Answer must be 1 to 30 characters. This field should only be updated programmatically. DESCRIPTION: The PAYER ID contained here along with the PAYER NAME provide a unique identifier for this entry. This field is programmatically updated. It should never be edited by a user. FIELD INDEX: C (#1213) MUMPS IR LOOKUP & SORTING Short Descr: Used to find entry by PAYER ID. Description: This cross-reference is used for looking up an entry by the PAYER ID. This field is free text and a PAYER ID may be just numbers. This cross-reference appends a space as a suffix to the PAYER ID and this allows for a lookup by a partial PAYER ID in all cases, that is, whether or not the PAYER ID is just numbers or numbers and letters. Set Logic: Q:X="" S ^RCY(344.6,"C",$E(X,1,30)_" ",DA)="" Kill Logic: Q:X="" K ^RCY(344.6,"C",$E(X,1,30)_" ",DA) Whole Kill: K ^RCY(344.6,"C") X(1): PAYER ID (344.6,.02) (Subscr 1) (Len 31) (forwards) RECORD INDEXES: CPID (#1214) 344.6,.03 DATE ADDED 0;3 DATE INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:Y<1 X LAST EDITED: MAY 05, 2014 HELP-PROMPT: Answer must be a date with optional time, imprecise dates allowed. This field should only be updated programmatically. DESCRIPTION: This is the date the payer first sent an ERA into the system. This field date will be programmatically updated. It should never be modified by a user. 344.6,.04 UPDATED BY 0;4 POINTER TO NEW PERSON FILE (#200) LAST EDITED: JAN 08, 2014 HELP-PROMPT: Enter the user who last modified the parameters. DESCRIPTION: This is the last user to modify this record. If the value is POSTMASTER, then the last modification was performed by the nightly batch job, or by post-installation processing when the file was initially populated. TECHNICAL DESCR: This field has a trigger from two fields. WRITE AUTHORITY: ^ NOTES: TRIGGERED by the EXCLUDE MED CLAIMS DECREASE field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE MED CLAIMS POSTING field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE PHARM CLAIMS DECREASE field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE TRICARE CLAIM POSTING field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE TRICARE CLAIM DECREASE field of the RCDPE AUTO-PAY EXCLUSION File 344.6,.05 DATE LAST UPDATED 0;5 DATE INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:Y<1 X LAST EDITED: MAY 05, 2014 HELP-PROMPT: Enter the date and optional time of the last update. This field is populated automatically and should not be edited. DESCRIPTION: The date this record was last updated or created. TECHNICAL DESCR: This field is populated by a trigger. WRITE AUTHORITY: ^ NOTES: TRIGGERED by the EXCLUDE MED CLAIMS POSTING field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE MED CLAIMS DECREASE field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE PHARM CLAIMS DECREASE field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE TRICARE CLAIM POSTING field of the RCDPE AUTO-PAY EXCLUSION File TRIGGERED by the EXCLUDE TRICARE CLAIM DECREASE field of the RCDPE AUTO-PAY EXCLUSION File 344.6,.06 EXCLUDE MED CLAIMS POSTING 0;6 SET '0' FOR No; '1' FOR Yes; LAST EDITED: FEB 24, 2014 HELP-PROMPT: Enter Yes to disable auto-posting of medical claims for this payer. Otherwise enter No. DESCRIPTION: This field is used to enable or disable auto-posting of medical claims for a specified payer. When set to Yes (1) auto-posting is disabled. When No (0) auto-posting is enabled. CROSS-REFERENCE: 344.6^EXMDPOST 1)= S ^RCY(344.6,"EXMDPOST",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"EXMDPOST",$E(X,1,30),DA) Used to locate entries by the auto-posting status. CROSS-REFERENCE: ^^TRIGGER^344.6^.05 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,5)=DI V,DIH=344.6,DIG=.05 D ^DICR 2)= Q CREATE VALUE)= NOW DELETE VALUE)= NO EFFECT FIELD)= DATE LAST UPDATED Sets the DATE LAST UPDATED to NOW. CROSS-REFERENCE: ^^TRIGGER^344.6^.04 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=344.6,DIG=.04 D ^DICR 2)= Q CREATE VALUE)= S X=DUZ DELETE VALUE)= NO EFFECT FIELD)= UPDATED BY Used to set UPDATED BY to the User who changed the status. 344.6,.07 EXCLUDE MED CLAIMS DECREASE 0;7 SET '0' FOR No; '1' FOR Yes; LAST EDITED: JAN 09, 2014 HELP-PROMPT: Enter Yes to disable auto-decreasing of medical claims for this payer. Otherwise enter No. DESCRIPTION: This field is used to enable or disable auto-decreasing of medical claims for a specified payer. When set to Yes (1) auto-decreasing is disabled. When No (0) auto-decreasing is enabled. CROSS-REFERENCE: 344.6^EXMDDECR 1)= S ^RCY(344.6,"EXMDDECR",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"EXMDDECR",$E(X,1,30),DA) Used to locate entries by the EXCLUDE MED CLAIMS DECREASE status. CROSS-REFERENCE: ^^TRIGGER^344.6^.05 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,5)=DI V,DIH=344.6,DIG=.05 D ^DICR 2)= Q CREATE VALUE)= NOW DELETE VALUE)= NO EFFECT FIELD)= DATE LAST Sets DATE LAST UPDATED to NOW. CROSS-REFERENCE: ^^TRIGGER^344.6^.04 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=344.6,DIG=.04 D ^DICR 2)= Q CREATE VALUE)= S X=DUZ DELETE VALUE)= NO EFFECT FIELD)= UPDATED BY Sets UPDATED BY to the User who edited the status. 344.6,.08 EXCLUDE RX CLAIM POSTING 0;8 SET '0' FOR No; '1' FOR Yes; LAST EDITED: APR 03, 2015 HELP-PROMPT: Enter Yes to disable auto-posting of pharmacy claims for this payer. Otherwise, enter No. DESCRIPTION: This field is used to enable or disable auto-posting for Pharmacy claims for a specified payer. When set to Yes (1), auto-posting is disabled. When No (0), auto-posting is enabled. CROSS-REFERENCE: 344.6^EXRXPOST 1)= S ^RCY(344.6,"EXRXPOST",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"EXRXPOST",$E(X,1,30),DA) Used to locate entries by Pharmacy auto-posting status. 344.6,.09 PHARMACY PAYER 0;9 SET (BOOLEAN Data Type) LAST EDITED: JUN 25, 2024 HELP-PROMPT: Enter 'Yes' to flag this payer as a pharmacy payer. DESCRIPTION: This field is used to flag a specified payer as a pharmacy payer. CROSS-REFERENCE: 344.6^ARX 1)= S ^RCY(344.6,"ARX",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"ARX",$E(X,1,30),DA) RECORD INDEXES: AC (#847) 344.6,.1 TRICARE PAYER 0;10 SET (BOOLEAN Data Type) LAST EDITED: JUN 25, 2024 HELP-PROMPT: Enter 'Yes' to flag this payer as a Tricare payer. DESCRIPTION: This field is used to flag a specified payer as a Tricare payer. CROSS-REFERENCE: 344.6^ATR 1)= S ^RCY(344.6,"ATR",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"ATR",$E(X,1,30),DA) RECORD INDEXES: AC (#847) 344.6,.11 PAYER ADDED FROM EFT 0;11 SET '1' FOR YES; LAST EDITED: AUG 06, 2018 HELP-PROMPT: Enter 'YES' if this payer was added from payer/TIN on an EFT 344.6,.12 EXCLUDE PHARM CLAIMS DECREASE 0;12 SET '0' FOR No; '1' FOR Yes; LAST EDITED: FEB 06, 2019 HELP-PROMPT: Enter 'Yes' to disable auto-decreasing of pharmacy claims for this payer. Enter 'No' to enable. DESCRIPTION: This field is used to enable or disable auto-decreasing of pharmacy claims for a specified payer. When set to Yes (1) auto-decreasing is disabled. When No (0) auto-decreasing is enabled. CROSS-REFERENCE: 344.6^EXRXDECR 1)= S ^RCY(344.6,"EXRXDECR",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"EXRXDECR",$E(X,1,30),DA) Used to locate entries by the EXCLUDE PHARM CLAIMS DECREASE status. CROSS-REFERENCE: ^^TRIGGER^344.6^.05 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,5)=DI V,DIH=344.6,DIG=.05 D ^DICR 2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,5)=DI V,DIH=344.6,DIG=.05 D ^DICR CREATE VALUE)= NOW DELETE VALUE)= NOW FIELD)= DATE LAST UPDATED Sets DATE LAST UPDATED to NOW. CROSS-REFERENCE: ^^TRIGGER^344.6^.04 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=344.6,DIG=.04 D ^DICR 2)= Q CREATE VALUE)= S X=DUZ DELETE VALUE)= NO EFFECT FIELD)= UPDATED BY Sets UPDATED BY to the User who edited the status. 344.6,.13 EXCLUDE TRICARE CLAIM POSTING 0;13 SET '0' FOR No; '1' FOR Yes; LAST EDITED: MAR 12, 2019 HELP-PROMPT: Enter Yes to disable auto-posting of pharmacy claims for this payer. Otherwise, enter No. DESCRIPTION: This field is used to enable or disable auto-posting of TRICARE claims for a specified payer. When set to Yes (1), auto-posting is disabled. When No (0), auto-posting is enabled. CROSS-REFERENCE: 344.6^EXTRPOST 1)= S ^RCY(344.6,"EXTRPOST",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"EXTRPOST",$E(X,1,30),DA) Used to locate entries by TRICARE auto-posting status. CROSS-REFERENCE: ^^TRIGGER^344.6^.05 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,5)=DI V,DIH=344.6,DIG=.05 D ^DICR 2)= Q CREATE VALUE)= NOW DELETE VALUE)= NO EFFECT FIELD)= DATE LAST UPDATED Sets DATE LAST UPDATED to NOW. CROSS-REFERENCE: ^^TRIGGER^344.6^.04 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=344.6,DIG=.04 D ^DICR 2)= Q CREATE VALUE)= S X=DUZ DELETE VALUE)= NO EFFECT FIELD)= UPDATED BY Sets UPDATED BY to the User who edited the status. 344.6,.14 EXCLUDE TRICARE CLAIM DECREASE 0;14 SET EXCLUDE TRICARE CLAIMS DECREASE '0' FOR No; '1' FOR Yes; LAST EDITED: MAR 12, 2019 HELP-PROMPT: Enter Yes to disable auto-decreasing of TRICARE claims for this payer. Otherwise enter No. DESCRIPTION: This field is used to enable or disable auto-decreasing of TRICARE claims for a specified payer. When set to Yes (1) auto-decreasing is disabled. When No (0) auto-decreasing is enabled. CROSS-REFERENCE: 344.6^EXTRDECR 1)= S ^RCY(344.6,"EXTRDECR",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"EXTRDECR",$E(X,1,30),DA) Used to locate entries by the EXCLUDE TRICARE CLAIMS DECREASE status. CROSS-REFERENCE: ^^TRIGGER^344.6^.05 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,5),X=X S DIU=X K Y S X=DIV N %I,%H,% D NOW^%DTC S X=% S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,5)=DI V,DIH=344.6,DIG=.05 D ^DICR 2)= Q CREATE VALUE)= NOW DELETE VALUE)= NO EFFECT FIELD)= DATE LAST UPDATED Sets DATE LAST UPDATED to NOW. CROSS-REFERENCE: ^^TRIGGER^344.6^.04 1)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(1)=$S($D(^RCY(344.6,D0,0)):^(0),1:"") S X=$P(Y(1),U,4),X=X S DIU=X K Y S X=DIV S X=DUZ S DIH=$G(^RCY(344.6,DIV(0),0)),DIV=X S $P(^(0),U,4)=DIV,DIH=344.6,DIG=.04 D ^DICR 2)= Q CREATE VALUE)= S X=DUZ DELETE VALUE)= NO EFFECT FIELD)= UPDATED BY Sets UPDATED BY to the User who edited the status. 344.6,.15 CHAMPVA PAYER 0;15 SET (BOOLEAN Data Type) LAST EDITED: JUN 25, 2024 HELP-PROMPT: Enter 'Yes' to flag this payer as a CHAMPVA payer. DESCRIPTION: This field is used to flag a specified payer as a CHAMPVA payer. CROSS-REFERENCE: 344.6^ACH 1)= S ^RCY(344.6,"ACH",$E(X,1,30),DA)="" 2)= K ^RCY(344.6,"ACH",$E(X,1,30),DA) RECORD INDEXES: AC (#847) 344.6,1 AUTO-POST COMMENT 1;1 FREE TEXT INPUT TRANSFORM: K:$L(X)>72!($L(X)<3) X LAST EDITED: MAY 05, 2014 HELP-PROMPT: Comment must be 3-72 characters in length. DESCRIPTION: Required comment when payer is excluded from auto-posting. This is cleared when the auto-post exclusion is reset. 344.6,2 AUTO-DECREASE COMMENT 2;1 FREE TEXT INPUT TRANSFORM: K:$L(X)>72!($L(X)<3) X LAST EDITED: MAY 05, 2014 HELP-PROMPT: Comment must be 3-72 characters in length. DESCRIPTION: Required comment when payer is excluded from auto-decreasing. This is cleared when the auto-decreasing exclusion is reset. 344.6,3 PHARMACY AUTO-POST COMMENT 3;1 FREE TEXT INPUT TRANSFORM: K:$L(X)>72!($L(X)<3) X LAST EDITED: MAR 18, 2015 HELP-PROMPT: Comment must be 3-72 characters in length DESCRIPTION: Required comment when payer is excluded from auto-posting. This is cleared when the auto-post exclusion is reset. 344.6,4 PHARMACY AUTO-DECREASE COMMENT 3;2 FREE TEXT INPUT TRANSFORM: K:$L(X)>72!($L(X)<3) X MAXIMUM LENGTH: 72 LAST EDITED: FEB 12, 2019 HELP-PROMPT: Answer must be 3-72 characters in length. DESCRIPTION: Required comment when payer is excluded from pharmacy auto-decrease. This comment is cleared when the auto-post exclusion is reset. 344.6,5 TRICARE AUTO-POST COMMENT 4;1 FREE TEXT INPUT TRANSFORM: K:$L(X)>72!($L(X)<3) X MAXIMUM LENGTH: 72 LAST EDITED: MAR 18, 2019 HELP-PROMPT: Answer must be 3-72 characters in length. DESCRIPTION: Required comment when payer is excluded from auto-posting. This is cleared when the auto-post exclusion is reset. 344.6,6 TRICARE AUTO-DECREASE COMMENT 4;2 FREE TEXT INPUT TRANSFORM: K:$L(X)>72!($L(X)<3) X MAXIMUM LENGTH: 72 LAST EDITED: MAR 18, 2019 HELP-PROMPT: Answer must be 3-72 characters in length. DESCRIPTION: Required comment when payer is excluded from auto-decrease. This is cleared when the auto-decrease exclusion is reset. FILES POINTED TO FIELDS NEW PERSON (#200) UPDATED BY (#.04) File #344.6 Record Indexes: AC (#847) RECORD MUMPS IR ACTION Short Descr: Update last updated field Description: When a payer is flagged or unflagged as Pharmacy, Tricare or CHAMPVA, this index causes the "UPDATED BY" and "DATE LAST UPDATED" fields to be set. Set Logic: N FDA,MSG,DIERR S FDA(344.6,DA_",",.05)="NOW" D FILE^DIE("E","FDA","MSG") S FDA(344.6,DA_",",.04)=DUZ D FILE^DI E("","FDA","MSG") Q Kill Logic: Q X(1): PHARMACY PAYER (344.6,.09) (forwards) X(2): TRICARE PAYER (344.6,.1) (forwards) X(3): CHAMPVA PAYER (344.6,.15) (forwards) NO RE-INDEXING ALLOWED! CPID (#1214) RECORD REGULAR IR LOOKUP & SORTING Short Descr: Combination of the PAYER NAME and PAYER ID Description: This index is used to ensure that the PAYER NAME /PAYER ID combination is unique. Set Logic: S ^RCY(344.6,"CPID",$E(X(1),1,60),$E(X(2),1,30),DA)="" Kill Logic: K ^RCY(344.6,"CPID",$E(X(1),1,60),$E(X(2),1,30),DA) Whole Kill: K ^RCY(344.6,"CPID") X(1): PAYER NAME (344.6,.01) (Subscr 1) (Len 60) (forwards) X(2): PAYER ID (344.6,.02) (Subscr 2) (Len 30) (forwards) INPUT TEMPLATE(S): PRINT TEMPLATE(S): SORT TEMPLATE(S): FORM(S)/BLOCK(S):