STANDARD DATA DICTIONARY #366.02 -- PHARMACY BENEFITS MANAGER (PBM) FILE 6/27/25 PAGE 1
STORED IN ^IBCNR(366.02, (104 ENTRIES) SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This Integrated Billing (IB) file was created for the e-Pharmacy Project. It is maintained centrally, via real time HL7 Table
Update Messages, using the WebMD database. Never maintain locally, except via a designated and secured option that edits selected
APPLICATION Subfile fields, such as LOCAL ACTIVE?.
A Pharmacy Benefits Manager (PBM) administers a plan on behalf of the insurance company payer. A PBM is typically a separate,
contracted entity, but it may be the insurance company payer. A PBM is uniquely identified by its' name.
Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: @
RD ACCESS:
WR ACCESS:
DEL ACCESS:
LAYGO ACCESS:
AUDIT ACCESS:
POINTED TO BY: PHARMACY BENEFITS MANAGER NAME field (#10.01) of the PLAN File (#366.03)
CROSS
REFERENCED BY: PKEY(AB), NAME(B)
366.02,.01 NAME 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1)!'(X'?1P.E) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Pharmacy Benefits Manager's (PBM's) long name. Answer must be 1-40 characters in length.
DESCRIPTION:
The Pharmacy Benefits Manager's (PBM's) long name.
CROSS-REFERENCE: 366.02^B
1)= S ^IBCNR(366.02,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.02,"B",$E(X,1,30),DA)
366.02,.02 DATE/TIME CREATED 0;2 DATE (Required)
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Enter the date and time associated with the creation of Pharmacy Benefits (PBM) file (#366.02)
entry.
DESCRIPTION: The date and time associated with the creation of Pharmacy Benefits Manager (PBM) file (#366.02)
entry.
366.02,1.01 PRIMARY CONTACT NAME 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Pharmacy Benefits Manager's (PBM's) primary contact name in general VA name format
(Family,Given Middle/MI Suffix). Answer must be 1-50 characters in length.
DESCRIPTION: The Pharmacy Benefits Manager's (PBM's) primary contact name in general VA name format
(Family,Given Middle/MI Suffix).
366.02,1.02 PRIMARY CONTACT PREFIX 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Pharmacy Benefits Manager's (PBM's) primary contact prefix / title (e.g. Dr.). Answer
must be 1-3 characters in length.
DESCRIPTION:
The Pharmacy Benefits Manager's (PBM's) primary contact prefix / title (e.g. Dr.).
366.02,1.03 PRIMARY CONTACT DEGREE 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Pharmacy Benefits Manager's (PBM's) primary contact degree code (e.g. MD). Answer must
be 1-3 characters in length.
DESCRIPTION:
Enter the Pharmacy Benefits Manager's (PBM's) primary contact degree code (e.g. MD).
366.02,1.04 ALTERNATE CONTACT NAME 1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Pharmacy Benefits Manager's (PBM's) alternate contact name in general VA name format
(Family,Given Middle/MI Suffix). Answer must be 1-50 characters in length.
DESCRIPTION: The Pharmacy Benefits Manager's (PBM's) alternate contact name in general VA name format
(Family,Given Middle/MI Suffix).
366.02,1.05 ALTERNATE CONTACT PREFIX 1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Pharmacy Benefits Manager's (PBM's) alternate contact prefix / title (e.g. Dr.). Answer
must be 1-3 characters in length.
DESCRIPTION:
The Pharmacy Benefits Manager's (PBM's) alternate contact prefix / title (e.g. Dr.).
366.02,1.06 ALTERNATE CONTACT DEGREE 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Pharmacy Benefits Manager's (PBM's) alternate contact degree code (e.g. MD). Answer must
be 1-3 characters in length.
DESCRIPTION:
The Pharmacy Benefits Manager's (PBM's) alternate contact degree code (e.g. MD).
366.02,2 CONTACT MEANS 2;0 Multiple #366.022
LAST EDITED: OCT 28, 2003
DESCRIPTION: The Pharmacy Benefits Manager's (PBM's) Contact Means sub-file. Applies to both the PBM's primary
and alternate contacts.
366.022,.01 PKEY 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: NOV 18, 2003
HELP-PROMPT: Enter the contact means' primary key (PKey). Answer must be 1-10 caracters in length.
DESCRIPTION:
The contact means' primary key (PKey).
CROSS-REFERENCE: 366.022^B
1)= S ^IBCNR(366.02,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.02,DA(1),2,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 366.02^AB
1)= S ^IBCNR(366.02,"AB",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.02,"AB",$E(X,1,30),DA(1),DA)
366.022,.02 TYPE 0;2 SET
'A' FOR Alternate contact means;
'P' FOR Primary contact means;
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the contact means' type.
DESCRIPTION:
The contact means' type.
366.022,.03 TELECOMMUNICATION USE 0;3 SET
TELECOMMUNICATION USE CODE
'ASN' FOR Answering Service Number;
'BPN' FOR Beeper Number;
'EMR' FOR Emergency Number;
'NET' FOR Network (email) Address;
'ORN' FOR Other Residence Number;
'PRN' FOR Primary Residence Number;
'VHN' FOR Vacation Home Number;
'WPN' FOR Work Number;
LAST EDITED: JAN 19, 2004
HELP-PROMPT: Enter the contact means' telecommunication use code from HL7 Table 0201.
DESCRIPTION:
The contact means' telecommunication use code from HL7 Table 0201.
366.022,.04 TELECOMMUNICATION EQUIPMENT 0;4 SET
TELECOMMUNICATION EQUIPMENT TYPE CODE
'BP' FOR Beeper;
'CP' FOR Cellular Phone;
'FX' FOR Fax;
'Internet' FOR Internet Address;
'MD' FOR Modem;
'PH' FOR Telephone;
'X.400' FOR X.400 email address;
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the contact means' telecommunication equipment type code from HL7 Table 0202.
DESCRIPTION:
The contact means' telecommunication equipment type code from HL7 Table 0202.
366.022,.05 EMAIL ADDRESS 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>100!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the contact means' email address. Answer must be 1-100 characters in length.
DESCRIPTION: The contact means' email address. Required if telecommunication use code = NET (Network (email)
Address).
366.022,.06 TELEPHONE NUMBER 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<10) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the contact means' telephone number. Answer must be 10-30 characters in length.
DESCRIPTION: The contact means' telephone number. Required if telecommunication use code is not = NET
(Network (email) Address).
366.022,.07 COMMENT 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the contact means' comment (e.g. Do not call on Friday.). Answer must be 1-40 characters
in length.
DESCRIPTION:
The contact means' comment (e.g. Do not call on Friday.).
366.02,3 APPLICATION 3;0 POINTER Multiple #366.023
DESCRIPTION:
The Pharmacy Benefits Manager's (PBM's) Application (electronic interface application) sub-file.
366.023,.01 APPLICATION 0;1 POINTER TO PHARMACY BENEFITS MANAGER (PBM) APPLICATION FILE (#366.12) (Multiply asked)
LAST EDITED: NOV 10, 2003
HELP-PROMPT: Answer must be 3-30 characters in length, non-numeric, and can not have a leading puncuation
character.
DESCRIPTION:
The application's (electronic interface application) name.
CROSS-REFERENCE: 366.023^B
1)= S ^IBCNR(366.02,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.02,DA(1),3,"B",$E(X,1,30),DA)
366.023,.02 NATIONAL ACTIVE? 0;2 SET
'0' FOR Not Active;
'1' FOR Active;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Are electronic transactions permitted from a national perspective?
Enter 'A' for Active (permitted) or 'N' for Not Active (not permitted).
DESCRIPTION: An application (electronic interface application) flag, controlled by the national Eligibility
Communicator (EC), indicating if the Pharmacy Benefits Manager (PBM) is active (electronic
transactions permitted). Do not edit via FileMan.
366.023,.03 LOCAL ACTIVE? 0;3 SET
'0' FOR Not Active;
'1' FOR Active;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Are electronic transactions permitted from a local perspective? Enter 'A' for Active (permitted)
or 'N' for Not Active (not permitted).
DESCRIPTION: An application (electronic interface application) flag, controlled by the local site, indicating
if the Pharmacy Benefits Manager (PBM) is active (electronic transactions permitted).
366.023,.04 USER EDITED LOCAL 0;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Enter the user's name associated with the last edit of the Application (electronic interface
application) Local Active? field.
DESCRIPTION: The user's name associated with the last edit of the Application (electronic interface
application) Local Active? field.
366.023,.05 DATE/TIME LOCAL EDITED 0;5 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Enter the date and time associated with the last edit of the Application (electronic interface
application) Local Active? field.
DESCRIPTION: The date and time associated with the last edit of the Application (electronic interface
application) Local Active? field.
366.023,.06 DATE/TIME NATIONAL EDITED 0;6 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan. Enter the date and time associated with the last edit of the
Application (electronic interface application) National Active? field.
DESCRIPTION: The date and time associated with the last edit of the Application (electronic interface
application) National Active? field. Do not edit via FileMan.
366.023,.07 AUTO-ACCEPT? 0;7 SET
'0' FOR No;
'1' FOR Yes;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Automatically accept incoming information? Enter 'N' for No or 'Y' for Yes.
DESCRIPTION: An application (electronic interface application) flag, indicating whether the site will
automatically accept incoming information and file it in the VistA System, rather than storing
the information in a temporary file for manual intervention.
366.023,.08 IDENT REQUIRES SUBSCRIBER ID? 0;8 SET
'0' FOR No;
'1' FOR Yes;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Subscriber ID required for identification? Enter 'N' for No or 'Y' for
Yes.
DESCRIPTION: An application (electronic interface application) flag, controlled by the national Eligibility
Communicator (EC), indicating if a Subscriber ID is required for identification. Do not edit via
FileMan.
366.023,.09 USE SSN FOR SUBSCRIBER ID? 0;9 SET
'0' FOR No;
'1' FOR Yes;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Use SSN for subscriber ID? Enter 'N' for No or 'Y" for Yes.
DESCRIPTION: An application (electronic interface application) flag, controlled by the national Eligibility
Communicator (EC), indicating if a patient's Social Security Number (SSN) is a valid Subscriber
ID. Do not edit via FileMan.
366.023,.1 TRANSMIT SSN? 0;10 SET
'0' FOR No;
'1' FOR Yes;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Transmit SSN? Enter 'N' for No or 'Y' for Yes.
DESCRIPTION: An application (electronic interface application) flag, controlled by the national Eligibility
Communicator (EC), indicating if a patient's Social Security Number (SSN) can be transmitted. Do
not edit via FileMan.
366.023,.11 DEACTIVATED? 0;11 SET
'0' FOR No;
'1' FOR Yes;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Pharmacy Benefits Manager (PBM) deactivated from a national
perspective? Enter 'N' for No or 'Y' for Yes.
DESCRIPTION: An application (electronic interface application) flag, controlled by the national Eligibility
Communicator (EC), indicating if the Pharmacy Benefits Manager (PBM) has been deactivated
(electronic transactions not permitted). Do not edit via FileMan.
366.023,.12 DATE/TIME DEACTIVATED 0;12 DATE
INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Enter the date and time associated with the last edit of the
Application (electronic interface application) Deactivated? field.
DESCRIPTION: The date and time associated with the last edit of the Application (electronic interface
application) Deactivated? field. Do not edit via FileMan.
366.023,.13 DATE/TIME CREATED 0;13 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Enter the date and time associated with the creation of the Application
(electronic interface application) sub-file entry.
DESCRIPTION: The date and time associated with the creation of the Application (electronic interface
application) sub-file entry. Do not edit via FileMan.
366.023,.14 FUTURE SERVICE DAYS 0;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Enter the maximum number of days (0-9999) before the service date for an acceptable claim
submission.
DESCRIPTION: The application's (electronic interface application) maximum number of days before the service
date for an acceptable claim submission.
366.023,.15 PAST SERVICE DAYS 0;15 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Enter the maximum number of days (0-9999) after the service date for an acce
DESCRIPTION: The application's (electronic interface application) maximum number of days after the service
date for an acceptable claim submission.
FILES POINTED TO FIELDS
NEW PERSON (#200) APPLICATION:USER EDITED LOCAL (#.04)
PHARMACY BENEFITS MANAGER (PBM
(#366.12) APPLICATION:APPLICATION (#.01)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):