STANDARD DATA DICTIONARY #52.87 -- PSO AUDIT LOG FILE 3/24/25 PAGE 1
STORED IN ^PS(52.87, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 7.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file (#52.87) is used to capture TRICARE/CHAMPVA bypass and override audit information for Outpatient Pharmacy related
prescriptions. The bypass function circumvents ePharmacy processing for TRICARE/CHAMPVA eligible inpatients. The override function
allows continued processing of prescriptions for non-billable products for TRICARE/CHAMPVA eligible outpatients as well as
prescriptions that reject.
DD ACCESS: @
RD ACCESS: Pp
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
CROSS
REFERENCED BY: AUDIT ID(B), PRESCRIPTION(C), DIVISION(D), DATE OF ACTION(E), PROVIDER(F)
52.87,.01 AUDIT ID 0;1 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>999999999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Type a number between 1 and 999999999, 0 Decimal Digits.
DESCRIPTION:
This is the Audit ID that represents this specific audit record.
CROSS-REFERENCE: 52.87^B
1)= S ^PS(52.87,"B",$E(X,1,30),DA)=""
2)= K ^PS(52.87,"B",$E(X,1,30),DA)
52.87,1 PRESCRIPTION 0;2 POINTER TO PRESCRIPTION FILE (#52)
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Select a Prescription.
DESCRIPTION:
This is the prescription number associated with this audit record.
CROSS-REFERENCE: 52.87^C
1)= S ^PS(52.87,"C",$E(X,1,30),DA)=""
2)= K ^PS(52.87,"C",$E(X,1,30),DA)
52.87,2 FILL 0;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Type a number between 0 and 999, 0 Decimal Digits
DESCRIPTION:
This is the Refill number associated with the prescription. The original fill is always '0'.
52.87,3 PATIENT 0;4 POINTER TO PATIENT FILE (#2)
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Select a Patient.
DESCRIPTION:
This is the Patient for whom the medication was prescribed.
52.87,4 DIVISION 0;5 POINTER TO OUTPATIENT SITE FILE (#59)
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Select an Outpatient Pharmacy Division.
DESCRIPTION:
This the Outpatient Pharmacy Division from which the RX/Fill was dispensed.
CROSS-REFERENCE: 52.87^D
1)= S ^PS(52.87,"D",$E(X,1,30),DA)=""
2)= K ^PS(52.87,"D",$E(X,1,30),DA)
52.87,5 PROVIDER 0;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Select a Provider.
DESCRIPTION:
This is the Provider who prescribed the medication.
CROSS-REFERENCE: 52.87^F
1)= S ^PS(52.87,"F",$E(X,1,30),DA)=""
2)= K ^PS(52.87,"F",$E(X,1,30),DA)
52.87,6 NDC 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<5) X
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Enter 5-13 free text characters.
DESCRIPTION:
This is the National Drug Code (NDC) of the drug identified in the DRUG field.
52.87,7 DRUG 0;8 POINTER TO DRUG FILE (#50)
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Select the medication prescribed.
DESCRIPTION:
This is the drug prescribed to the patient.
52.87,8 BILL COST 0;9 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: AUG 17, 2010
HELP-PROMPT: Type a Dollar amount between 0 and 99999, 2 Decimal Digits.
DESCRIPTION:
This is the total bill cost for the TRICARE prescription being audited.
52.87,9 ECME NUMBER 0;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>13!($L(X)<7) X
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Enter 7-13 characters in length.
DESCRIPTION: This is the Electronic Claims Management Engine (ECME) number associated with the ePharmacy billing
transaction.
52.87,10 QTY 0;11 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Enter a number between 1 and 99999999, 0 Decimal Digits
DESCRIPTION:
This is the quantity of medication dispensed.
52.87,11 PATIENT STATUS 1;1 POINTER TO RX PATIENT STATUS FILE (#53)
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Select the RX Patient Status.
DESCRIPTION: This is the RX PATIENT STATUS that represents the authorization for the RX. This is independent of
the eligibility code assigned to the patient by Medical Administration Service (MAS)
representative.
52.87,12 AUDIT TYPE 1;2 SET
'R' FOR NCPDP REJECT;
'N' FOR NON BILLABLE;
'I' FOR INPATIENT;
'P' FOR PARTIAL FILL;
LAST EDITED: JAN 22, 2015
HELP-PROMPT: Choose the Audit Type associated with the audit event.
DESCRIPTION:
This is the type of audit associated with a TRICARE/CHAMPVA Bypass or Override event.
52.87,13 NCPDP REJECT CODE 3;0 Multiple #52.8713
DESCRIPTION: This multiple is used to store the NCPDP Rject Code(s) returned in the ECME response from the
TRICARE payer indicating the reason(s) why the claim was rejected.
52.8713,.01 NCPDP REJECT CODE 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
OUTPUT TRANSFORM: S Y(0)=Y S Y=$$TRANREJ^BPSECFM(Y)
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Enter a 1-3 character NCPDP Reject Code.
DESCRIPTION:
This is an NCPDP Reject Code that was returned from the TRICARE payer.
CROSS-REFERENCE: 52.8713^B
1)= S ^PS(52.87,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^PS(52.87,DA(1),3,"B",$E(X,1,30),DA)
52.87,14 USER 1;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Select a Pharmacy system user or Postmaster.
DESCRIPTION: The person who is responsible for creating the audit record. This would either be a Pharmacy system
user or Postmaster if the audit is created by a background process.
52.87,15 DATE OF ACTION 1;5 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: AUG 16, 2010
HELP-PROMPT: Enter a valid date/time or enter NOW.
DESCRIPTION:
This is the Date/Time that the event that generated the audit record occurred.
CROSS-REFERENCE: 52.87^E
1)= S ^PS(52.87,"E",$E(X,1,30),DA)=""
2)= K ^PS(52.87,"E",$E(X,1,30),DA)
52.87,16 DATE OF SERVICE 1;6 DATE
INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUL 20, 2010
HELP-PROMPT: Enter a valid date or enter NOW.
DESCRIPTION:
This is the Date the prescription was filled or professional service rendered.
52.87,17 JUSTIFICATION 2;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: AUG 01, 2011
HELP-PROMPT: Answer must be 1-250 characters in length.
DESCRIPTION: This is used to hold the free-text explanation why the TRICARE or CHAMPVA prescription was bypassed
or overridden. For partial fills, the reason is hard-coded to [TRICARE or CHAMPVA] "Partial Fill".
For 'Inpatient Meds (Bypass)',the justification is hard-coded to [TRICARE or CHAMPVA]
"INPATIENT/DISCHARGE" or [TRICARE or CHAMPVA] "INPATIENT AUTO-REVERSAL". Overrides
(TRICARE/CHAMPVA rejects and TRICARE/CHAMPVA non-billables) come from user entry.
52.87,18 ELIGIBILITY 1;3 SET
'T' FOR TRICARE;
'C' FOR CHAMPVA;
LAST EDITED: APR 22, 2011
HELP-PROMPT: Enter the eligibility code for this event.
DESCRIPTION:
This field is the eligibility indicator of the event type.
FILES POINTED TO FIELDS
DRUG (#50) DRUG (#7)
NEW PERSON (#200) PROVIDER (#5)
USER (#14)
OUTPATIENT SITE (#59) DIVISION (#4)
PATIENT (#2) PATIENT (#3)
PRESCRIPTION (#52) PRESCRIPTION (#1)
RX PATIENT STATUS (#53) PATIENT STATUS (#11)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):