STANDARD DATA DICTIONARY #351.5 -- TRICARE PHARMACY TRANSACTIONS FILE 6/27/25 PAGE 1
STORED IN ^IBA(351.5, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
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.
DD ACCESS: @
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
POINTED TO BY: ORIGINAL TRANSACTION field (#.02) of the TRICARE PHARMACY REJECTS File (#351.52)
CROSS
REFERENCED BY: COPAYMENT CHARGE(ACC), FISCAL INTERMEDIARY CLAIM(ACL), AUTHORIZATION NUMBER(AUTH), PRESCRIPTION(B)
351.5,.01 PRESCRIPTION 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'(X'?1P.E) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 3-30 characters in length.
CROSS-REFERENCE: 351.5^B
1)= S ^IBA(351.5,"B",$E(X,1,30),DA)=""
2)= K ^IBA(351.5,"B",$E(X,1,30),DA)
351.5,.02 PATIENT 0;2 POINTER TO PATIENT FILE (#2)
LAST EDITED: AUG 16, 1996
351.5,.03 CARD HOLDER SSN 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-12 characters in length.
351.5,.04 NDC 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-11 characters in length.
351.5,.05 AMOUNT TRANSMITTED 0;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 9999999, 2 Decimal Digits
351.5,.06 QUANTITY 0;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Number between 1 and 99999, 0 Decimal Digits
351.5,.07 TRANSACTION DATE 0;7 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: AUG 16, 1996
351.5,.08 COPAYMENT CHARGE 0;8 POINTER TO INTEGRATED BILLING ACTION FILE (#350)
LAST EDITED: AUG 27, 1996
DESCRIPTION: This field points to the copayment charge in the INTEGRATED BILLING ACTION (#350) file which was
actually billed to the patient.
CROSS-REFERENCE: 351.5^ACC
1)= S ^IBA(351.5,"ACC",$E(X,1,30),DA)=""
2)= K ^IBA(351.5,"ACC",$E(X,1,30),DA)
351.5,.09 FISCAL INTERMEDIARY CLAIM 0;9 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: AUG 27, 1996
DESCRIPTION: This field points to the claim in the BILL/CLAIMS (#399) file which was created after the response
from the FI was received. Creation of this claim also establishes a receivable in the ACCOUNTS
RECEIVABLE (#430) file against which the FI payment will be posted.
CROSS-REFERENCE: 351.5^ACL
1)= S ^IBA(351.5,"ACL",$E(X,1,30),DA)=""
2)= K ^IBA(351.5,"ACL",$E(X,1,30),DA)
351.5,.1 PRODUCT SELECTION REASON 0;10 POINTER TO PRODUCT SELECTION REASON FILE (#351.53)
LAST EDITED: AUG 31, 2001
HELP-PROMPT: Choose a Product Selection Reason from those listed.
DESCRIPTION:
This field will store the Product Selection Reason for billing acceptance.
351.5,2.01 COPAY 2;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,2.02 INGREDIENT COST PAID 2;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,2.03 CONTRACT FEE PAID 2;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,2.04 SALES TAX PAID 2;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,2.05 TOTAL AMOUNT PAID 2;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,2.06 AUTHORIZATION NUMBER 2;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
LAST EDITED: AUG 21, 1996
HELP-PROMPT: Answer must be 1-14 characters in length.
CROSS-REFERENCE: 351.5^AUTH
1)= S ^IBA(351.5,"AUTH",$E(X,1,30),DA)=""
2)= K ^IBA(351.5,"AUTH",$E(X,1,30),DA)
351.5,2.07 MESSAGE 2;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-40 characters in length.
351.5,3.01 ACCUMULATED DEDUCTIBLE AMOUNT 3;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 99999999, 2 Decimal Digits
351.5,3.02 REMAINING DEDUCTABLE AMOUNT 3;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 99999999, 2 Decimal Digits
351.5,3.03 REMAINING BENEFIT AMOUNT 3;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 99999999, 2 Decimal Digits
351.5,3.04 ATM APPL TO PER DEDUCTIBLE 3;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,3.05 AMT COPAY/COINSURANCE 3;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,3.06 AMT ATTRIB TO PROD SEL 3;6 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,3.07 AMT EXCEEDING PERIODIC MAX BEN 3;7 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,3.08 INCENTIVE FEE PAID 3;8 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,3.09 BASIS OF REIMB DETERMINATION 3;9 SET
'0' FOR NOT SPECIFIED;
'1' FOR PAID AS SUBMITTED;
'2' FOR REDUCED TO AWP;
'3' FOR AWP-X% PRICING;
'4' FOR USUAL AND CUSTOMARY;
'5' FOR LOWER IF ING. COST PLUS FEES VS U&C;
'6' FOR MAC PRICING;
'7' FOR MAC REDUCED TO MAC;
'8' FOR CONTRACT PRICING;
LAST EDITED: AUG 16, 1996
351.5,3.1 AMOUNT ATTRIB TO SALES TAX 3;10 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Type a Dollar Amount between 1 and 999999, 2 Decimal Digits
351.5,5.01 ERROR CODES 5;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>245!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-245 characters in length.
351.5,6.01 REVERSAL AUTH NUMBER 6;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-14 characters in length.
351.5,6.02 REVERSED BY 6;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: AUG 16, 1996
351.5,6.03 REVERSAL ERROR CODES 6;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>180!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-180 characters in length.
351.5,7.01 DUR RESPONSE DATA 7;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>160!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-160 characters in length.
351.5,8.01 ADDITIONAL MESSAGE INFORMATION 8;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: AUG 16, 1996
HELP-PROMPT: Answer must be 1-80 characters in length.
FILES POINTED TO FIELDS
BILL/CLAIMS (#399) FISCAL INTERMEDIARY CLAIM (#.09)
INTEGRATED BILLING ACTION
(#350) COPAYMENT CHARGE (#.08)
NEW PERSON (#200) REVERSED BY (#6.02)
PATIENT (#2) PATIENT (#.02)
PRODUCT SELECTION REASON
(#351.53) PRODUCT SELECTION REASON (#.1)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):