STANDARD DATA DICTIONARY #366.03 -- PLAN FILE 6/27/25 PAGE 1
STORED IN ^IBCNR(366.03, (7676 ENTRIES) SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
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 Plan is a Payer's medical health care insurance product that defines benefits and their delivery to organizations and individuals
that enroll in the Plan. A Plan is uniquely identified by its' identifier (VA National Plan ID).
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:
IDENTIFIED BY: NAME (#.02)[R], BANKING IDENTIFICATION NUMBER (#10.02), PROCESSOR CONTROL NUMBER (PCN) (#10.03)
POINTED TO BY: PLAN ID field (#6.01) of the GROUP INSURANCE PLAN File (#355.3)
CROSS
REFERENCED BY: PKEY(AB), PKEY(AC), ID(B), NAME(C), BANKING IDENTIFICATION NUMBER(D), PROCESSOR CONTROL NUMBER (PCN)(E)
INDEXED BY: BANKING IDENTIFICATION NUMBER & PROCESSOR CONTROL NUMBER (PCN) (F)
366.03,.01 ID 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's identifier (ID / VA National Plan ID). Answer must be 1-30 characters in length.
DESCRIPTION:
The Plan's identifier (ID / VA National Plan ID).
CROSS-REFERENCE: 366.03^B
1)= S ^IBCNR(366.03,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.03,"B",$E(X,1,30),DA)
366.03,.02 NAME 0;2 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: NOV 20, 2003
HELP-PROMPT: Enter the Plan's long name (VA National Plan Name). Answer must be 1-40 characters in length.
DESCRIPTION:
The Plan's long name (VA National Plan Name).
CROSS-REFERENCE: 366.03^C
1)= S ^IBCNR(366.03,"C",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.03,"C",$E(X,1,30),DA)
366.03,.04 NAME - SHORT 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's short name. Answer must be 1-20 characters in length.
DESCRIPTION:
The Plan's short name.
366.03,.05 TYPE 0;5 SET
'BC' FOR Blue Cross;
'CO' FOR Commercial;
'TC' FOR TRICARE;
'UC' FOR Uncategorized;
LAST EDITED: AUG 03, 2011
HELP-PROMPT: Enter the Plan's type code.
DESCRIPTION:
The Plan's type code.
366.03,.06 REGION 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's geographical region (e.g. MD). Answer must be 1-20 characters in length.
DESCRIPTION:
The Plan's geographical region (e.g. MD).
366.03,.07 DATE/TIME CREATED 0;7 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 Plan File entry.
DESCRIPTION:
The date and time associated with the creation of Plan file (#366.03) entry.
366.03,1.01 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 Plan's primary contact name in general VA name format (Family,Given Middle/MI Suffix).
Answer must be 1-50 characters in length.
DESCRIPTION:
The Plan's primary contact name in general VA name format (Family,Given Middle/MI Suffix).
366.03,1.02 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 Plan's primary contact prefix / title (e.g. Dr.). Answer must be 1-3 characters in
length.
DESCRIPTION:
The Plan's primary contact prefix / title (e.g. Dr.).
366.03,1.03 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 Plan's primary contact degree code (e.g. MD). Answer must be 1-3 characters in length.
DESCRIPTION:
The Plan's primary contact degree code (e.g. MD).
366.03,1.04 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 Plan's alternate contact name in general VA name format (Family,Given Middle/MI Suffix).
Answer must be 1-50 characters in length.
DESCRIPTION:
The Plan's alternate contact name in general VA name format (Family,Given Middle/MI Suffix).
366.03,1.05 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 Plan's alternate contact prefix / title (e.g. Dr.). Answer must be 1-3 characters in
length.
DESCRIPTION:
The Plan's alternate contact prefix / title (e.g. Dr.).
366.03,1.06 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 Plan's alternate contact degree code (e.g. MD). Answer must be 1-3 characters in length.
DESCRIPTION:
The Plan's alternate contact degree code (e.g. MD).
366.03,2 CONTACT MEANS 2;0 Multiple #366.032
LAST EDITED: OCT 28, 2003
DESCRIPTION:
The Plan's Contact Means sub-file. Applies to both the Plan's primary and alternate contacts.
366.032,.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: 366.032^B
1)= S ^IBCNR(366.03,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.03,DA(1),2,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 366.03^AB
1)= S ^IBCNR(366.03,"AB",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.03,"AB",$E(X,1,30),DA(1),DA)
366.032,.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.
366.032,.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.
366.032,.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.
366.032,.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).
366.032,.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).
366.032,.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.).
366.03,3 APPLICATION 3;0 POINTER Multiple #366.033
DESCRIPTION:
The Plan's Application (electronic interface application) sub-file.
366.033,.01 APPLICATION 0;1 POINTER TO PLAN APPLICATION FILE (#366.13) (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: 366.033^B
1)= S ^IBCNR(366.03,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.03,DA(1),3,"B",$E(X,1,30),DA)
366.033,.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 Plan is active (electronic transactions permitted). Do not
edit via FileMan.
366.033,.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 Plan is active (electronic transactions permitted).
366.033,.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.
366.033,.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.
366.033,.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.
366.033,.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.
366.033,.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.
366.033,.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.
366.033,.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.
366.033,.11 DEACTIVATED? 0;11 SET
'0' FOR No;
'1' FOR Yes;
LAST EDITED: NOV 07, 2003
HELP-PROMPT: Do not edit via FileMan! Plan 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 Plan has been deactivated (electronic transactions not
permitted). Do not edit via FileMan.
366.033,.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.
366.033,.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.
366.033,.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.
366.033,.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.
366.03,10.01 PHARMACY BENEFITS MANAGER NAME 10;1 POINTER TO PHARMACY BENEFITS MANAGER (PBM) FILE (#366.02)
PHARMACY BENEFITS MANAGER (PBM) NAME
LAST EDITED: NOV 10, 2003
HELP-PROMPT: Enter the Plan's Pharmacy Benefits Manager (PBM) Name.
DESCRIPTION:
The Plan's Pharmacy Benefits Manager (PBM) Name.
GROUP: PHARMACY
366.03,10.02 BANKING IDENTIFICATION NUMBER 10;2 FREE TEXT
BANKING IDENTIFICATION NUMBER (BIN)
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: NOV 20, 2003
HELP-PROMPT: Enter the Plan's Banking Identification Number (BIN). Answer must be 1-10 characters in length.
DESCRIPTION:
The Plan's Banking Identification Number (BIN). Used for NCPDP transmissions.
GROUP: PHARMACY
CROSS-REFERENCE: 366.03^D
1)= S ^IBCNR(366.03,"D",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.03,"D",$E(X,1,30),DA)
RECORD INDEXES: F (#417)
366.03,10.03 PROCESSOR CONTROL NUMBER (PCN) 10;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 20, 2003
HELP-PROMPT: Enter the Plan's Processor Control Number (PCN). Answer must be 1-20 characters in length.
DESCRIPTION:
The Plan's Processor Control Number (PCN). Used for NCPDP transmissions.
GROUP: PHARMACY
CROSS-REFERENCE: 366.03^E
1)= S ^IBCNR(366.03,"E",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.03,"E",$E(X,1,30),DA)
RECORD INDEXES: F (#417)
366.03,10.04 NCPDP PROCESSOR NAME 10;4 POINTER TO NCPDP PROCESSOR FILE (#366.01)
LAST EDITED: NOV 10, 2003
HELP-PROMPT: Enter the Plan's NCPDP Processor Name.
DESCRIPTION:
The Plan's NCPDP Processor Name.
GROUP: PHARMACY
366.03,10.05 ENABLED? 10;5 SET
'0' FOR No;
'1' FOR Yes;
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Is the Plan enabled for NCPDP transmissions?
DESCRIPTION:
Is the Plan enabled for NCPDP transmissions?
GROUP: PHARMACY
366.03,10.06 SOFTWARE VENDOR ID 10;6 FREE TEXT
SOFTWARE VENDOR / CERTIFICATION ID
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's software vendor / certification identifier (ID). Answer must be 1-10 characters
in length.
DESCRIPTION:
The Plan's software vendor / certification identifier (ID). Used for NCPDP transmissions.
GROUP: PHARMACY
366.03,10.07 BILLING PAYER SHEET NAME 10;7 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: DEC 03, 2003
HELP-PROMPT: Enter the Plan's Billing Payer Sheet Name.
DESCRIPTION:
The Plan's Billing Payer Sheet Name. Defines the NCPDP Billing (B1) Record format.
GROUP: PHARMACY
366.03,10.08 REVERSAL PAYER SHEET NAME 10;8 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: DEC 03, 2003
HELP-PROMPT: Enter the Plan's Reversal Payer Sheet Name.
DESCRIPTION:
The Plan's Reversal Payer Sheet Name. Defines the NCPDP Reversal (B2) Record format.
GROUP: PHARMACY
366.03,10.09 REBILL PAYER SHEET NAME 10;9 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: DEC 03, 2003
HELP-PROMPT: Enter the Plan's Rebill Payer Sheet Name.
DESCRIPTION:
The Plan's Rebill Payer Sheet Name. Defines the NCPDP Rebill (B3) Record format.
GROUP: PHARMACY
366.03,10.1 MAXIMUM NCPDP TRANSACTIONS 10;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's maximum NCPDP transactions permitted within an NCPDP transmission. Answer must be
between 1-99999 (inclusive).
DESCRIPTION:
The Plan's maximum NCPDP transactions permitted within an NCPDP transmission.
GROUP: PHARMACY
366.03,10.11 TEST BILLING PAYER SHEET 10;11 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: DEC 16, 2003
HELP-PROMPT: Enter the Plan's Test Billing Payer Sheet Name.
DESCRIPTION:
The Plan's Test Billing Payer Sheet Name. Defines the Test NCPDP Billing (B1) Record format.
GROUP: PHARMACY
366.03,10.12 TEST REVERSAL PAYER SHEET NAME 10;12 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: DEC 03, 2003
HELP-PROMPT: Enter the Plan's Test Reversal Payer Sheet Name.
DESCRIPTION:
The Plan's Test Reversal Payer Sheet Name. Defines the Test NCPDP Reversal (B2) Record format.
GROUP: PHARMACY
366.03,10.13 TEST REBILL PAYER SHEET NAME 10;13 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: DEC 03, 2003
HELP-PROMPT: Enter the Plan's Test Rebill Payer Sheet Name.
DESCRIPTION:
The Plan's Test Rebill Payer Sheet Name. Defines the Test NCPDP Rebill (B3) Record format.
GROUP: PHARMACY
366.03,10.14 TEST ELIGIBILITY SHEET NAME 10;14 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: OCT 22, 2010
HELP-PROMPT: Enter the Test Eligibility Verification Payer Sheet Name for the plan.
DESCRIPTION: This is the Plan's Test Eligibility Verification Payer Sheet Name, which gives the specifications
for a Eligibility Verification request sent for this plan. This payer sheet is manually entered by
the user to override the normal Eligibility Payer sheet in the ELIGIBILITY PAYER SHEET NAME
(#10.15) field and is used when the site needs to use a payer sheet other than the 'standard' one.
366.03,10.15 ELIGIBILITY PAYER SHEET NAME 10;15 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: OCT 21, 2010
HELP-PROMPT: Enter the Eligibility Verification Payer Sheet Name for this plan.
DESCRIPTION: This is the Plan's Eligibility Verification Payer Sheet Name, which gives the specifications for a
Eligibility Verification request sent for this plan.
366.03,11.01 RX PRIMARY CONTACT NAME 11;1 FREE TEXT
PHARMACY (RX) PRIMARY CONTACT NAME
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's pharmacy (RX) primary contact name in general VA name format (Family,Given
Middle/MI Suffix). Answer must be 1-50 characters in length.
DESCRIPTION: The Plan's pharmacy (RX) primary contact name in general VA name format (Family,Given Middle/MI
Suffix).
GROUP: PHARMACY
366.03,11.02 RX PRIMARY CONTACT PREFIX 11;2 FREE TEXT
PHARMACY (RX) PRIMARY CONTACT PREFIX
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's pharmacy (RX) primary contact prefix / title (e.g. Dr.). Answer must be 1-3
characters in length.
DESCRIPTION:
The Plan's pharmacy (RX) primary contact prefix / title (e.g. Dr.).
GROUP: PHARMACY
366.03,11.03 RX PRIMARY CONTACT DEGREE 11;3 FREE TEXT
PHARMACY (RX) PRIMARY CONTACT DEGREE
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's pharmacy (RX) primary contact degree code (e.g. MD). Answer must be 1-3
characters in length.
DESCRIPTION:
The Plan's pharmacy (RX) primary contact degree code (e.g. MD).
GROUP: PHARMACY
366.03,11.04 RX ALTERNATE CONTACT NAME 11;4 FREE TEXT
PHARMACY (RX) ALTERNATE CONTACT NAME
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's pharmacy (RX) alternate contact name in general VA name format (Family,Given
Middle/MI Suffix). Answer must be 1-50 characters in length.
DESCRIPTION: The Plan's pharmacy (RX) alternate contact name in general VA name format (Family,Given Middle/MI
Suffix).
GROUP: PHARMACY
366.03,11.05 RX ALTERNATE CONTACT PREFIX 11;5 FREE TEXT
PHARMACY (RX) ALTERNATE CONTACT PREFIX
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's pharmacy (RX) alternate contact prefix / title (e.g. Dr.). Answer must be 1-3
characters in length.
DESCRIPTION:
The Plan's pharmacy (RX) alternate contact prefix / title (e.g. Dr.).
GROUP: PHARMACY
366.03,11.06 RX ALTERNATE CONTACT DEGREE 11;6 FREE TEXT
PHARMACY (RX) ALTERNATE CONTACT DEGREE
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: OCT 28, 2003
HELP-PROMPT: Enter the Plan's pharmacy (RX) alternate contact degree code (e.g. MD). Answer must be 1-3
characters in length.
DESCRIPTION:
The Plan's pharmacy (RX) alternate contact degree code (e.g. MD).
GROUP: PHARMACY
366.03,12 RX CONTACT MEANS 12;0 Multiple #366.0312
LAST EDITED: OCT 28, 2003
DESCRIPTION: The Plan's Pharmacy (RX) Contact Means sub-file. Applies to both the Plan's pharmacy (RX) primary
and alternate contacts.
GROUP: PHARMACY
366.0312,.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: 366.0312^B
1)= S ^IBCNR(366.03,DA(1),12,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.03,DA(1),12,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 366.03^AC
1)= S ^IBCNR(366.03,"AC",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.03,"AC",$E(X,1,30),DA(1),DA)
366.0312,.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.
366.0312,.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.
366.0312,.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.
366.0312,.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).
366.0312,.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).
366.0312,.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.).
FILES POINTED TO FIELDS
BPS NCPDP FORMATS (#9002313.92) BILLING PAYER SHEET NAME (#10.07)
REVERSAL PAYER SHEET NAME (#10.08)
REBILL PAYER SHEET NAME (#10.09)
TEST BILLING PAYER SHEET (#10.11)
TEST REVERSAL PAYER SHEET NAME (#10.12)
TEST REBILL PAYER SHEET NAME (#10.13)
TEST ELIGIBILITY SHEET NAME (#10.14)
ELIGIBILITY PAYER SHEET NAME (#10.15)
NCPDP PROCESSOR (#366.01) NCPDP PROCESSOR NAME (#10.04)
NEW PERSON (#200) APPLICATION:USER EDITED LOCAL (#.04)
PHARMACY BENEFITS MANAGER (PBM
(#366.02) PHARMACY BENEFITS MANAGER NAME (#10.01)
PLAN APPLICATION (#366.13) APPLICATION:APPLICATION (#.01)
File #366.03
Record Indexes:
F (#417) RECORD REGULAR IR LOOKUP & SORTING
Short Descr: lookup by either value
Set Logic: S ^IBCNR(366.03,"F",$E(X(1),1,30),$E(X(2),1,30),DA)=""
Kill Logic: K ^IBCNR(366.03,"F",$E(X(1),1,30),$E(X(2),1,30),DA)
Whole Kill: K ^IBCNR(366.03,"F")
X(1): BANKING IDENTIFICATION NUMBER (366.03,10.02) (Subscr 1) (Len 30) (forwards)
X(2): PROCESSOR CONTROL NUMBER (PCN) (366.03,10.03) (Subscr 2) (Len 30) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):