STANDARD DATA DICTIONARY #366.14 -- IB NCPDP EVENT LOG FILE 6/27/25 PAGE 1
STORED IN ^IBCNR(366.14, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 2.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
This file contains data which are passed into IB NCPDP APIs by outside applications - E CLAIMS MGMT ENGINE and OUTPATIENT PHARMACY
(see IA # 4299). Data stored in this file are used for IB ECME EVENT report to provide details about E-Pharmacy claims processing
and about communication details between IB and the applications listed above. The data in this file is populated internally by the
IB application (data not directly entered by the user).
Per VHA Directive 10-93-142, this file definition should not be modified.
CROSS
REFERENCED BY: DATE(B), PATIENT(D), CLAIMID(E), PRESCRIPTION(I), RX #(I), RX NO(R), ePHARMACY USER(U)
LAST MODIFIED: MAY 19,2021@16:10:28
366.14,.01 DATE 0;1 DATE (Required)
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 21, 2006
HELP-PROMPT: Represents the date when specific ePharmacy billing events occurred for an outpatient claim.
DESCRIPTION: This date is populated by the IB software That supports the processing of ePharmacy Billing events
for outpatient claims.
CROSS-REFERENCE: 366.14^B
1)= S ^IBCNR(366.14,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.14,"B",$E(X,1,30),DA)
366.14,1 EVENT 1;0 SET Multiple #366.141 (Add New Entry without Asking)
LAST EDITED: MAR 16, 2006
DESCRIPTION: This multiple contains 1 to many records by Event type that can occur on a given date for 1 to many
outpatient prescription claims.
TECHNICAL DESCR: The records in this sub-file are stored by sequence or as they occur in time for a given date.
This sub-file is updated when one of the 2 functions, $$RX^IBNCPDP or $$STORES^IBNCPDP are invoked
by the calling application when processing ePharmacy related billing events.
366.141,.01 EVENT TYPE 0;1 SET (Required)
'0' FOR UNKNOWN;
'1' FOR BILLABLE STATUS CHECK;
'2' FOR SUBMIT;
'3' FOR BILL;
'4' FOR RELEASE;
'5' FOR REVERSE;
'6' FOR CLOSE;
'7' FOR REOPEN;
LAST EDITED: JUN 21, 2006
HELP-PROMPT: Pharmacy event types
DESCRIPTION: The event types represent the various ePharmacy billing events during the processing of
outpatient Rx claims.
CROSS-REFERENCE: 366.141^B
1)= S ^IBCNR(366.14,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.14,DA(1),1,"B",$E(X,1,30),DA)
366.141,.02 NON-BILLABLE REASON 0;2 POINTER TO IB NCPDP NON-BILLABLE REASONS FILE (#366.17)
LAST EDITED: OCT 30, 2014
HELP-PROMPT: Enter the Non-Billable Status reason for non-billable prescription
DESCRIPTION: This field is populated by the IB software that supports the processing of ePharmacy Billing
events for outpatient prescriptions. It will populated when the IB Billing Status check
determines that the request is not billable.
366.141,.03 PATIENT 0;3 POINTER TO PATIENT FILE (#2)
LAST EDITED: JUN 21, 2006
HELP-PROMPT: Internally populated by the IB application (not entered by the user).
DESCRIPTION:
PATIENT on the Rx claim
CROSS-REFERENCE: 366.14^D
1)= S ^IBCNR(366.14,"D",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.14,"D",$E(X,1,30),DA(1),DA)
366.141,.04 JOB 0;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 999999999, 0 Decimal Digits
DESCRIPTION:
The job number of the job currently executing
366.141,.05 TIME 0;5 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Enter date and time
DESCRIPTION:
Date and time of the event
366.141,.06 ePHARMACY USER 0;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 21, 2006
DESCRIPTION: System user who triggered the e-pharmacy event. This can be the system user who enters
prescription or makes billing operation on e-pharmacy claims. It also can be POSTMASTER if the
operation (like claims auto-reversal process) was performed by a background job.
TECHNICAL DESCR:
NEW PERSON file #200 internal entry number
CROSS-REFERENCE: 366.14^U
1)= S ^IBCNR(366.14,"U",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.14,"U",$E(X,1,30),DA(1),DA)
366.141,.07 RESULT 0;7 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<-99999)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between -99999 and 99999, 0 Decimal Digits
DESCRIPTION:
Result of the event processing - return code
366.141,.08 RESULT MESSAGE 0;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
Result of the event processing - message
366.141,.09 E-PHARMACY DIVISION 0;9 POINTER TO BPS PHARMACIES FILE (#9002313.56)
LAST EDITED: FEB 16, 2007
DESCRIPTION:
E-Pharmacy division (BPS PHARMACY).
366.141,.11 AUTH # 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
ECME approval/authorization number
366.141,.12 BCID 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: This field contains the Prescription/Service Reference Number (also known as the ECME#) and the
Date of Service separated by a semi-colon.
TECHNICAL DESCR: Prescription/Service Reference Number (ECME#);Date of Service Where: Prescription/Service Ref
Number (ECME#) is 7 or 12 digits. Date of Service is in FileMan format.
366.141,.13 CLAIMID 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)'=7&($L(X)'=12) X
LAST EDITED: OCT 26, 2010
HELP-PROMPT: Answer must be 7 or 12 characters in length.
DESCRIPTION:
This is a 7 or 12 digit ECME number with leading zero(s).
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 366.14^E^MUMPS
1)= S ^IBCNR(366.14,"E",$E(X,1,30),$G(^IBCNR(366.14,DA(1),0)),DA)=""
2)= K ^IBCNR(366.14,"E",$E(X,1,30),$G(^IBCNR(366.14,DA(1),0)),DA)
366.141,.14 PATIENT IN IBD 1;4 POINTER TO PATIENT FILE (#2)
LAST EDITED: JUN 20, 2006
DESCRIPTION: PATIENT identifier passed in IBD ARRAY when outside application calls $$STORESP^IBNCPDP (IA
#4299)
TECHNICAL DESCR:
Pointer to PATIENT file #2 passed into $$STORESP^IBNCPDP in "DFN" node of IBD array.
366.141,.15 MEDICAL CENTER DIVISION 1;5 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8)
LAST EDITED: FEB 16, 2007
HELP-PROMPT: Select a division
DESCRIPTION:
Division identifier
366.141,.16 RESPONSE 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Response from the payer: ACCEPTED PAYABLE REJECTED DUPLICATE
366.141,.17 REVERSAL REASON 1;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: FEB 14, 2006
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
Reversal reason
366.141,.18 RTS-DEL 1;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 99, 0 Decimal Digits
DESCRIPTION:
Return to Stock-Delete status
366.141,.19 STATUS 1;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: Bill status - one of the following values: "PAID","REJECTED","REVERSED", "CLOSED", "RELEASED", or
"SUBMITTED"
366.141,.201 PRESCRIPTION 2;1 POINTER TO PRESCRIPTION FILE (#52)
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Enter a prescription
DESCRIPTION: Pointer TO PRESCRIPTION FILE (#52) as passed into $$STORESP^ IBNCPDP (IA # 4299) in
"PRESCRIPTION" node
CROSS-REFERENCE: 366.14^I
1)= S ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)
366.141,.202 RX NO 2;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
RX Number from file #52 passed into $$STORESP^IBNCPDP (IA # 4299) in the "RX NO" node
CROSS-REFERENCE: 366.14^R
1)= S ^IBCNR(366.14,"R",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.14,"R",$E(X,1,30),DA(1),DA)
366.141,.203 FILL NUMBER 2;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 99999, 0 Decimal Digits
DESCRIPTION:
Refill # 0 - for original refill 1...n - for other refills
366.141,.204 DRUG 2;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: JUN 21, 2006
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
Prescription Drug on the claim
366.141,.205 NDC 2;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
National Drug Code number
366.141,.206 DATE OF SERVICE 2;6 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Enter the date of service.
DESCRIPTION:
Date of Service of the outpatient pharmacy Rx.
366.141,.207 RELEASE DATE 2;7 DATE
INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUN 20, 2011
HELP-PROMPT: Enter Rx release date.
DESCRIPTION:
This is the date the Rx was released. This field is populated only if the Rx was released.
366.141,.208 QTY 2;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: JUN 20, 2011
HELP-PROMPT: Type a number between 0 and 99999999, 3 decimal digits.
DESCRIPTION:
This is the prescription billed quantity. This may be different than the NCPDP quantity.
TECHNICAL DESCR:
RX Quantity
366.141,.209 DAYS SUPPLY 2;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 999999, 0 Decimal Digits
DESCRIPTION:
RX Days Supply
366.141,.21 DEA 2;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
Drug Enforcement Agency number
366.141,.211 FILLED BY 2;11 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Enter a user who filled RX
DESCRIPTION:
Person, who filled the RX refill.
TECHNICAL DESCR:
Pointer to the NEW PERSON FILE (#200)
366.141,.212 RX # 2;12 POINTER TO PRESCRIPTION FILE (#52)
LAST EDITED: JUN 21, 2006
HELP-PROMPT: Enter a prescription
DESCRIPTION:
Pointer TO PRESCRIPTION FILE (#52) as passed into $$RX^IBNCPDP (IA # 4299) in "IEN" node
CROSS-REFERENCE: 366.14^I
1)= S ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)=""
2)= K ^IBCNR(366.14,"I",$E(X,1,30),DA(1),DA)
366.141,.213 BILLING UNITS 2;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 20, 2011
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: This is the type of billing units associated with the billing quantity. Examples include "TAB",
"CAP", "EA", "ML", "VI", "GM", and so forth.
366.141,.214 NCPDP QTY 2;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: JUN 20, 2011
HELP-PROMPT: Type a number between 0 and 99999999, 3 decimal digits.
DESCRIPTION:
This is the NCPDP Quantity for the prescription. This may be different than the billed quantity.
366.141,.215 NCPDP UNITS 2;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUN 21, 2011
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION: This is the NCPDP standard for unit type:
EA - each
ML - milliliters
GM - grams
This is the type of unit associated with the NCPDP quantity.
366.141,.301 BILL 3;1 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Enter IB bill
DESCRIPTION:
IB bill
TECHNICAL DESCR:
Pointer TO BILL/CLAIMS FILE (#399)
366.141,.302 BILLED 3;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
DESCRIPTION:
Amount billed to the insurance
366.141,.303 PLAN 3;3 POINTER TO GROUP INSURANCE PLAN FILE (#355.3)
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Enter a group plan
DESCRIPTION:
Group insurance plan
366.141,.304 COST 3;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."5N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 9999999, 4 Decimal Digits
DESCRIPTION:
Cost - dollar amount per Dispensed Unit
366.141,.305 PAID BY INSURANCE 3;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION:
Amount paid by the Insurance
366.141,.306 CLOSE/REOPEN COMMENT 3;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>70!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-70 characters in length.
DESCRIPTION:
Close or reopen comment
366.141,.307 CLOSE REASON 3;7 POINTER TO CLAIMS TRACKING NON-BILLABLE REASONS FILE (#356.8)
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Select a close reason
DESCRIPTION:
Close reason
366.141,.308 DROP TO PAPER 3;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 9999999, 0 Decimal Digits
DESCRIPTION:
Drop to Paper flag.
TECHNICAL DESCR: 1 (TRUE) for certain Close Claim Reasons indicates that the closed episode still may be "dropped
to paper" - passed to the Autobiller.
366.141,.309 RELEASE COPAY 3;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 9999999, 0 Decimal Digits
DESCRIPTION:
Release Copay flag.
TECHNICAL DESCR:
1 (TRUE) indicates that the patients copay should be released off hold.
366.141,.31 ECME USER IN IBD 3;10 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 20, 2006
DESCRIPTION: System user who triggered the ECME event and whose identifier was passed in IBD ARRAY when
outside application calls $$STORESP^IBNCPDP (IA #4299). This can be the system user who enters
prescription or makes billing operation on e-pharmacy claims. It also can be POSTMASTER if the
operation (like claims auto-reversal process) was performed by a background job.
TECHNICAL DESCR:
System User's ID as is passed inside IBD array into IB APIs.
366.141,.311 COPAY AMOUNT 3;11 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999.99)!(X<0) X
LAST EDITED: AUG 03, 2011
HELP-PROMPT: Type a dollar amount between 0 and 999999.99, 2 decimal digits.
DESCRIPTION: This is to store the copayment amount specified by the payer for amounts that are to be charge
for non-Veteran copayment charges such as TRICARE or CHAMPVA.
366.141,.312 INGREDIENT COST PAID 3;12 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JUN 20, 2011
HELP-PROMPT: Type a dollar amount between 0 and 99999999, 2 decimal digits.
DESCRIPTION:
This is the amount of the ingredient cost paid as reported by the payer.
TECHNICAL DESCR:
NCPDP Field 506-F6.
366.141,.313 DISPENSING FEE PAID 3;13 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JUN 20, 2011
HELP-PROMPT: Type a dollar amount between 0 and 99999999, 2 decimal digits.
DESCRIPTION:
This is the amount of the dispensing fee paid as reported by the payer.
TECHNICAL DESCR:
NCPDP Field 507-F7.
366.141,.314 PATIENT RESPONSIBILITY (INS) 3;14 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JUN 20, 2011
HELP-PROMPT: Type a dollar amount between 0 and 99999999, 2 decimal digits.
DESCRIPTION:
This is the amount for which the patient is responsible as reported by the payer.
TECHNICAL DESCR:
NCPDP Field 505-F5.
366.141,.401 AO 4;1 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter Agent Orange indicator
DESCRIPTION:
Agent Orange indicator
366.141,.402 CV 4;2 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter Combat Veteran indicator
DESCRIPTION:
Combat Veteran indicator
366.141,.403 SWA 4;3 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter Southwest Asia indicator
DESCRIPTION:
Southwest Asia indicator.
366.141,.404 IR 4;4 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter Ionizing radiation exposure indicator
DESCRIPTION:
Ionizing radiation exposure indicator
366.141,.405 MST 4;5 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter Military Sexual trauma indicator
DESCRIPTION:
Military Sexual trauma indicator
366.141,.406 HNC 4;6 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter Head/neck cancer indicator
DESCRIPTION:
Head/neck cancer indicator
366.141,.407 SC 4;7 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: JUL 30, 2007
HELP-PROMPT: Enter Service Connected indicator
DESCRIPTION:
Service Connected indicator
366.141,.408 SHAD 4;8 SET
'0' FOR NO;
'1' FOR YES;
'2' FOR NO ANSWER;
'3' FOR OVERRIDDEN;
LAST EDITED: AUG 03, 2007
HELP-PROMPT: Enter Project 112/SHAD indicator
DESCRIPTION:
Project 112/SHAD indicator
366.141,.409 ADO 4;9 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUL 22, 2020
HELP-PROMPT: Enter YES if the RX contains the Active Duty Override.
DESCRIPTION: This field is used by the Billing Events Log to display if the Rx contains the Active Duty
Override.
366.141,2 INSURANCE 5;0 Multiple #366.1412 (Add New Entry without Asking)
DESCRIPTION:
Insurance data
TECHNICAL DESCR:
Insurance data stored in "INS" node of the array which is passed into $$RX^IBNCPDP API (IA #4299)
366.1412,.01 INSURANCE 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 999, 0 Decimal Digits
DESCRIPTION:
Sequential number for patients insurances.
CROSS-REFERENCE: 366.1412^B
1)= S ^IBCNR(366.14,DA(2),1,DA(1),5,"B",$E(X,1,30),DA)=""
2)= K ^IBCNR(366.14,DA(2),1,DA(1),5,"B",$E(X,1,30),DA)
366.1412,.02 GROUP INSURANCE PLAN 0;2 POINTER TO GROUP INSURANCE PLAN FILE (#355.3)
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Enter Group Insurance Plan
DESCRIPTION:
Group Insurance Plan
366.1412,.03 BIN 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-10 characters in length
DESCRIPTION:
Bank Identification Number
366.1412,.04 PCN 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>16!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-16 characters in length.
DESCRIPTION:
Processor Control Number
366.1412,.05 PAYER SHEET B1 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Payer sheet B1
366.1412,.06 GROUP ID 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>55!($L(X)<1) X
MAXIMUM LENGTH: 55
LAST EDITED: SEP 27, 2017
HELP-PROMPT: Answer must be 1-55 characters in length.
366.1412,.07 CARDHOLDER ID 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
MAXIMUM LENGTH: 80
LAST EDITED: SEP 27, 2017
HELP-PROMPT: Answer must be 1-80 characters in length.
DESCRIPTION:
Cardholder ID
366.1412,.08 PATIENT RELATIONSHIP CODE 0;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Number between 0 and 99, 0 Decimal Digits
DESCRIPTION:
Patient Relationship code
366.1412,.09 PHARMACY PERSON CODE 0;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUN 21, 2011
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION: This is the pharmacy person code value at the time of IB billing determination. This field is
stored and maintained with the patient insurance policy data. This is the code that is
assigned by the payer to identify the patient. The payer may use a unique person code to
identify each specific person on the pharmacy insurance policy. This code may also describe the
patient's relationship to the cardholder.
Enrollment Standard Examples:
001 = Cardholder
002 = Spouse
003 - 999 = Dependents and Others (including second spouses, etc.)
TECHNICAL DESCR: This corresponds with field# 4.06 in subfile 2.312 of the PATIENT (#2) file. NCPDP field
303-C3 - Person Code
366.1412,.101 CARDHOLDER FIRST NAME 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: SEP 27, 2017
HELP-PROMPT: Answer must be 1-35 characters in length.
DESCRIPTION:
Cardholder First Name
366.1412,.102 CARDHOLDER LAST NAME 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
MAXIMUM LENGTH: 60
LAST EDITED: SEP 27, 2017
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION:
Cardholder Last Name
366.1412,.103 STATE 1;3 POINTER TO STATE FILE (#5)
LAST EDITED: JUN 20, 2006
DESCRIPTION:
State
366.1412,.104 PAYER SHEET B2 1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Payer sheet B2
366.1412,.105 PAYER SHEET B3 1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Payer sheet B3
366.1412,.106 SOFTWARE/VENDOR CERT ID 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Software/Vendor Certification ID
366.1412,.107 INSURANCE NAME 1;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
Insurance Name
366.1412,.201 DISPENSING FEE 2;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION:
Dispensing Fee Submitted
366.1412,.202 BASIS OF COST DETERMINATION 2;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION:
Basis of Cost Determination
TECHNICAL DESCR: for basis of cost determination the following is used: "07" would be sent for Usual & Customary
"01" would be sent for AWP "05" would be sent for Cost calculations
366.1412,.203 AWP OR TORT RATE OR COST 2;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION:
Average Wholesale Price OR Tort dollar amount rate OR Cost amount
366.1412,.204 GROSS AMOUNT DUE 2;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION:
Gross Amount Due. Base price plus Dispense fee/Administrative fee.
366.1412,.205 ADMINISTRATIVE FEE 2;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
DESCRIPTION:
Administrative Fee
366.1412,.206 INGREDIENT COST 2;6 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: MAY 17, 2011
HELP-PROMPT: Type a dollar amount between 0 and 9999999, 2 decimal digits.
DESCRIPTION:
The ingredient cost is the calculation of quantity times unit price. No fees included.
366.1412,.207 USUAL AND CUSTOMARY CHARGE 2;7 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: MAY 26, 2011
HELP-PROMPT: Type a dollar amount between 0 and 9999999, 2 decimal digits.
DESCRIPTION:
Usual & Customary Charges. Gross Amount Due less the administrative fees.
366.1412,.301 GROUP NAME 3;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
MAXIMUM LENGTH: 80
LAST EDITED: SEP 27, 2017
HELP-PROMPT: Answer must be 1-80 characters in length.
DESCRIPTION:
Group Name
366.1412,.302 INSURANCE PHONE NUMBER 3;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Insurance Phone Number
366.1412,.303 PLAN ID 3;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>50!($L(X)<1) X
LAST EDITED: JUN 20, 2006
HELP-PROMPT: Answer must be 1-50 characters in length.
DESCRIPTION:
Plan ID
366.1412,.304 PT INSURANCE POLICY 3;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 21, 2011
HELP-PROMPT: Type a number between 0 and 99999999, 0 decimal digits.
DESCRIPTION: This is the insurance policy at the time of IB billing determination. This is the internal
entry number to the 2.312 subfile of the PATIENT (#2) file.
366.141,7.01 RX COB 7;1 SET
'0' FOR UNKNOWN;
'1' FOR PRIMARY;
'2' FOR SECONDARY;
LAST EDITED: AUG 30, 2010
HELP-PROMPT: Select COB indicator for the claim.
DESCRIPTION:
The Coordination Of Benefits (COB) indicator designates the payer sequence for the claim.
366.141,7.02 PRIMARY BILL 7;2 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: JAN 08, 2009
HELP-PROMPT: Select the primary bill for the prescription.
DESCRIPTION: This field will hold the Primary bill associated with the original prescription/refill related
to this claim.
366.141,7.03 PRIOR PAYMENT 7;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0) X
LAST EDITED: JAN 08, 2009
HELP-PROMPT: Type a Dollar Amount between 0 and 99999999, 2 Decimal Digits
DESCRIPTION: This field will store a prior payment amount that the primary insurer agreed to pay for the
original prescription/refill related to this claim.
366.141,7.04 RATE TYPE SELECTED BY USER 7;4 POINTER TO RATE TYPE FILE (#399.3)
LAST EDITED: AUG 30, 2010
HELP-PROMPT: Select the appropriate Rate Type.
DESCRIPTION: This is the Rate Type selected by the user for ECME Pharmacy billing purposes. Users may
select the rate type in the option "Process Secondary/TRICARE Rx to ECME" [BPS COB PROCESS
SECOND TRICARE].
366.141,7.05 ELIGIBILITY 7;5 SET
'V' FOR VETERAN;
'T' FOR TRICARE;
'C' FOR CHAMPVA;
LAST EDITED: MAY 02, 2011
HELP-PROMPT: Enter the patient's eligibility.
DESCRIPTION: This is the patient's eligibility as determined by IB billing determination during the finish
event.
366.141,7.06 DRUG ECME BILLABLE 7;6 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: JAN 27, 2016
HELP-PROMPT: Enter 'YES' if the drug for this prescription was ECME billable, else enter 'NO'.
DESCRIPTION: This field records whether or not the drug was ECME billable at the time of Billing
Determination for this prescription/fill.
366.141,7.07 DRUG ECME BILLABLE TRICARE 7;7 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: JAN 27, 2016
HELP-PROMPT: Enter 'YES' if the drug was ECME billable for TRICARE prescriptions, else enter 'NO'.
DESCRIPTION: This field records whether or not the drug was ECME billable for TRICARE prescriptions at the
time of Billing Determination for this prescription/fill.
366.141,7.08 DRUG ECME BILLABLE CHAMPVA 7;8 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: JAN 27, 2016
HELP-PROMPT: Enter 'YES' if the drug was ECME billable for CHAMPVA prescriptions, else enter 'NO'.
DESCRIPTION: This field records whether or not the drug was ECME billable for CHAMPVA prescriptions at the
time of Billing Determination for this prescription/fill.
366.141,7.09 DRUG SENSITIVE DIAGNOSIS 7;9 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: JAN 27, 2016
HELP-PROMPT: Enter 'YES' if the drug for this prescription was a sensitive diagnosis drug, else enter 'NO'.
DESCRIPTION: This field records whether or not the drug was identified as a Sensitive Diagnosis Drug at the
time of Billing Determination for this prescription/fill.
FILES POINTED TO FIELDS
BILL/CLAIMS (#399) FIELD^NL^7.09^66:BILL (#.301)
PRIMARY BILL (#7.02)
BPS PHARMACIES (#9002313.56) FIELD^NL^7.09^66:E-PHARMACY DIVISION (#.09)
CLAIMS TRACKING NON-BILLABLE R
(#356.8) FIELD^NL^7.09^66:CLOSE REASON (#.307)
GROUP INSURANCE PLAN (#355.3) FIELD^NL^7.09^66:PLAN (#.303)
INSURANCE:GROUP INSURANCE PLAN (#.02)
IB NCPDP NON-BILLABLE REASONS
(#366.17) FIELD^NL^7.09^66:NON-BILLABLE REASON (#.02)
MEDICAL CENTER DIVISION (#40.8) FIELD^NL^7.09^66:MEDICAL CENTER DIVISION (#.15)
NEW PERSON (#200) FIELD^NL^7.09^66:ePHARMACY USER (#.06)
FILLED BY (#.211)
ECME USER IN IBD (#.31)
PATIENT (#2) FIELD^NL^7.09^66:PATIENT (#.03)
PATIENT IN IBD (#.14)
PRESCRIPTION (#52) FIELD^NL^7.09^66:PRESCRIPTION (#.201)
RX # (#.212)
RATE TYPE (#399.3) FIELD^NL^7.09^66:RATE TYPE SELECTED BY USER (#7.04)
STATE (#5) INSURANCE:STATE (#.103)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):