STANDARD DATA DICTIONARY #9002313.03 -- BPS RESPONSES FILE 3/24/25 PAGE 1
STORED IN ^BPSR( *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 1.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
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This file stores the response information returned by the third-party payer. Most of the fields have 'raw' NCPCP data so it is
formatted per the NCPDP specifications.
Per VHA Directive 2004-038, this file definition should not be modified.
DD ACCESS: @
RD ACCESS: Pp
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
POINTED TO BY: BPS RESPONSE field (#.17) of the INSURANCE VERIFICATION PROCESSOR File (#355.33)
RESPONSE field (#4) of the BPS LOG OF TRANSACTIONS File (#9002313.57)
REVERSAL RESPONSE field (#402) of the BPS LOG OF TRANSACTIONS File (#9002313.57)
RESPONSE field (#4) of the BPS TRANSACTION File (#9002313.59)
REVERSAL RESPONSE field (#402) of the BPS TRANSACTION File (#9002313.59)
CROSS
REFERENCED BY: HEADER RESPONSE STATUS(AC), DATE RESPONSE RECEIVED(AE), BPS CLAIM(B)
LAST MODIFIED: MAY 22,2023@09:54:20
9002313.03,.01BPS CLAIM 0;1 POINTER TO BPS CLAIMS FILE (#9002313.02) (Required)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Select the BPS Claim.
DESCRIPTION:
Identifier for BPS responses.
CROSS-REFERENCE: 9002313.03^B
1)= S ^BPSR("B",$E(X,1,30),DA)=""
2)= K ^BPSR("B",$E(X,1,30),DA)
9002313.03,.02DATE RESPONSE RECEIVED 0;2 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Enter the date the Response was received.
DESCRIPTION:
Date that response was received on the system.
CROSS-REFERENCE: 9002313.03^AE
1)= S ^BPSR("AE",$E(X,1,30),DA)=""
2)= K ^BPSR("AE",$E(X,1,30),DA)
9002313.03,102VERSION/RELEASE NUMBER 100;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION:
NCPDP Version/Release Number.
9002313.03,103TRANSACTION CODE 100;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION:
Code identifying the type of transaction.
9002313.03,109TRANSACTION COUNT 100;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>4)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 18, 2008
HELP-PROMPT: Type a number between 1 and 4, 0 Decimal Digits
DESCRIPTION:
Count of transactions in the transmission.
9002313.03,115MEDICAID ID NUMBER 100;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 115-N5 (Medicaid ID Number), which is defined as "A unique member
identification number assigned by the Medicaid Agency."
9002313.03,116MEDICAID AGENCY NUMBER 100;16 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-17 characters.
DESCRIPTION: This is used to store NCPDP field 116-N6 (Medicaid Agency Number), which is defined as "Number
assigned by processor to identify the individual Medicaid Agency or representative."
9002313.03,201SERVICE PROVIDER ID 200;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
ID assigned to a pharmacy or provider.
9002313.03,202SERV PROVIDER ID QUALIFIER 200;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Code qualifying the 'Service Provider ID' (2�1)
9002313.03,301GROUP ID 300;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
ID assigned to the cardholder group or employer group.
9002313.03,302CARDHOLDER ID 300;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 302-C2 (Cardholder ID), which is defined as "Insurance ID
assigned to the cardholder or identification number used by the plan."
9002313.03,304DATE OF BIRTH 300;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 304-C4 (Date Of Birth), which is defined as "Date of birth of
patient."
9002313.03,310PATIENT FIRST NAME 300;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-14 characters.
DESCRIPTION: This is used to store NCPDP field 310-CA (Patient First Name), which is defined as "Individual
first name."
9002313.03,311PATIENT LAST NAME 310;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: This is used to store NCPDP field 311-CB (Patient Last Name), which is defined as "Individual last
name."
TECHNICAL DESCR:
REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT.
9002313.03,401DATE OF SERVICE 400;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: JUN 18, 2008
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Identifies date the prescription was filled or professional service rendered.
9002313.03,501HEADER RESPONSE STATUS 500;1 SET
'A' FOR ACCEPTED;
'R' FOR REJECTED;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the status of the response from the payer.
DESCRIPTION:
A code indicating the status of this response.
9002313.03,504MESSAGE 504;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-250 characters in length.
DESCRIPTION:
Free form message.
9002313.03,524PLAN ID 500;24 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION: Assigned by the processor to identify a set of parameters, benefit, or coverage criteria used to
adjudicate a claim.
9002313.03,545NETWORK REIMBURSEMENT ID 540;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION: Field defined by the processor. It identifies the network, for the covered member, used to
calculate the reimbursement to the pharmacy.
9002313.03,568PAYER/HEALTH PLAN ID QUALIFIER 560;8 SET
'01' FOR STANDARD UNIQUE HEALTH PLAN ID;
'02' FOR HIN;
'03' FOR BIN;
'04' FOR NAIC;
'99' FOR OTHER;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a code specifying the type of payer ID.
DESCRIPTION:
Code indicating the type of payer ID.
TECHNICAL DESCR:
NCPDP field 568-J7.
9002313.03,569PAYER/HEALTH PLAN ID 560;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
Payer identification - the payer this claim was submitted to.
9002313.03,1000RESPONSES 1000;0 Multiple #9002313.0301 (Add New Entry without Asking)
LAST EDITED: FEB 07, 2008
DESCRIPTION:
This is the transaction response data returned by the third-party payer.
9002313.0301,.01TRANSACTION ORDER 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>999999999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: OCT 26, 2010
HELP-PROMPT: Type a number between 1 and 999999999, 0 decimal digits.
DESCRIPTION:
This sequential value indicates the number of this transaction within the transaction set.
CROSS-REFERENCE: 9002313.0301^B
1)= S ^BPSR(DA(1),1000,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(1),1000,"B",$E(X,1,30),DA)
9002313.0301,112TRANSACTION RESPONSE STATUS 110;2 SET
'A' FOR APPROVED;
'C' FOR CAPTURED;
'D' FOR DUPLICATE OF PAID;
'F' FOR PA DEFERRED;
'P' FOR PAID;
'Q' FOR DUPLICATE OF CAPTURED;
'R' FOR REJECTED;
'S' FOR DUPLICATE OF APPROVED;
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Enter the status of this transaction.
DESCRIPTION:
Code indicating the status of the transaction.
9002313.0301,114MEDICAID SUBROGATION ICN/TCN 100;14 FREE TEXT
MEDICAID SUBROGATION INTERNAL CONTROL NUMBER/TRANSACTION CONTROL NUMBER (ICN/TCN)
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 114-N4 (Medicaid Subrogation Internal Control
Number/Transaction Control Number (ICN/TCN), which is defined as "Claim number assigned by the
Medicaid Agency."
9002313.0301,128SPENDING ACCOUNT AMT REMAINING 120;8 FREE TEXT
SPENDING ACCOUNT AMOUNT REMAINING
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: JUN 07, 2018
HELP-PROMPT: Answer must be 1-8 characters
DESCRIPTION: This is used to store NCPDP field 128-UC (Spending Account Amount Remaining), which is defined as
"The balance from the patient's spending account after this transaction was applied."
9002313.0301,129HEALTH PLAN-FUNDED ASSIST AMT 120;9 FREE TEXT
HEALTH PLAN-FUNDED ASSISTANCE AMOUNT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 129-UD (Health Plan-funded Assistance Amount), which is defined
as "The amount from the health plan-funded assistance account for the patient that was applied to
reduce Patient Pay Amount (505-F5). This amount is used in Healthcare Reimbursement Account (HRA)
benefits only. This field is always a negative amount or zero."
9002313.0301,130ADDITIONAL MESSAGE INFO COUNT 120;10 FREE TEXT
ADDITIONAL MESSAGE INFORMATION COUNT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 29, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 130-UF (Additional Message Information Count), which is defined
as "Count of the 'Additional Message Information' (526-FQ) occurrences that follow."
9002313.0301,130.01ADDITIONAL MESSAGE MLTPL 130.01;0 Multiple #9002313.13001 (Add New Entry without Asking)
LAST EDITED: AUG 31, 2010
DESCRIPTION:
This sub-file contains Additional Message information.
9002313.13001,.01 ADDITIONAL MESSAGE COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter of the Additional Message occurrences.
TECHNICAL DESCR:
Counter incremented by BPS* software.
CROSS-REFERENCE: 9002313.13001^B
1)= S ^BPSR(DA(2),1000,DA(1),130.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),130.01,"B",$E(X,1,30),DA)
9002313.13001,131 ADDITIONAL MSG INFO CONTINUITY 0;2 FREE TEXT
ADDITIONAL MESSAGE INFORMATION CONTINUITY
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: SEP 29, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION:
This is used to store NCPDP field 131-UG (Additional Message Information Continuity).
TECHNICAL DESCR:
RESPONSE STATUS SEGMENT.
9002313.13001,132 ADDITIONAL MSG INFO QUALIFIER 0;3 FREE TEXT
ADDITIONAL MESSAGE INFORMATION QUALIFIER
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: SEP 29, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION:
This is used to store NCPDP field 132-UH (Additional Message Information Qualifier).
TECHNICAL DESCR:
Qualifies Additional Message Information (526-FQ). RESPONSE STATUS SEGMENT.
9002313.13001,526 ADDITIONAL MESSAGE INFORMATION 1;1 FREE TEXT
ADDITIONAL MESSAGE INFO
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-250 characters.
DESCRIPTION:
This is used to store NCPDP field 526-FQ (Additional Message Information).
TECHNICAL DESCR:
RESPONSE STATUS SEGMENT.
9002313.0301,133AMT ATTR TO PROV NETWORK SLCTN 130;3 FREE TEXT
AMOUNT ATTRIBUTED TO PROVIDER NETWORK SELECTION
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 133-UJ (Amount Attributed to Provider Network Selection),
which is defined as "Amount to be collected from the patient that is included in 'Patient Pay
Amount' (505-F5) that is due to the patient's provider network selection."
9002313.0301,134AMT ATTR TO PROD SEL BRND DRUG 130;4 FREE TEXT
AMOUNT ATTRIBUTED TO PRODUCT SELECTION/BRAND DRUG
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 134-UK (Amount Attributed to Product Selection/Brand Drug),
which is defined as "Amount to be collected from the patient that is included in 'Patient Pay
Amount' (505-F5) that is due to the patient's selection of a Brand product."
9002313.0301,135AMT ATTR NON-PREF FRMLRY SEL 130;5 FREE TEXT
AMOUNT ATTRIBUTED TO PRODUCT SELECTION/NON-PREFERRED FORMULARY SELECTION
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 135-UM (Amount Attributed to Product Selection/Non-Preferred
Formulary Selection), which is defined as "Amount to be collected from the patient that is
included in 'Patient Pay Amount' (505-F5) that is due to the patient's selection of a
Non-Preferred Formulary product."
9002313.0301,136AMT ATTR TO N-PREF FRMLRY SEL 130;6 FREE TEXT
AMOUNT ATTRIBUTED TO PRODUCT SELECTION/BRAND NON-PREFERRED FORMULARY SELECTION
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 136-UN (Amount Attributed to Product Selection/Brand
Non-Preferred Formulary Selection), which is defined as "Amount to be collected from the
patient that is included in 'Patient Pay Amount' (505-F5) that is due to the patient's
selection of a Brand Non-Preferred Formulary product."
9002313.0301,137AMOUNT ATTR TO COVERAGE GAP 130;7 FREE TEXT
AMOUNT ATTRIBUTED TO COVERAGE GAP
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 137-UP (Amount Attributed to Coverage Gap), which is defined
as "Amount to be collected from the patient that is included in 'Patient Pay Amount' (505-F5)
that is due to the patient being in the coverage gap (for example Medicare Part D Coverage Gap
(donut hole)). A coverage gap is defined as the period or amount during which the previous
coverage ends and before an additional coverage begins."
9002313.0301,138CMS LICS LEVEL 130;8 FREE TEXT
CMS LOW INCOME COST SHARING (LICS) LEVEL
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 138-UQ (CMS Low Income Cost Sharing (LICS) Level), which is
defined as "Free form text that provides the low-income subsidy copay level for a Part D
patient."
9002313.0301,139MEDICARE PART D COVERAGE CODE 130;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: OCT 26, 2010
HELP-PROMPT: Answer must be 1-2 characters.
DESCRIPTION: This is used to store NCPDP field 139-UR (Medicare Part D Coverage Code), which is defined as
"Code indicating the position of Medicare Part D in the billing order."
9002313.0301,140NEXT MEDICARE PART D EFF DATE 130;10 FREE TEXT
NEXT MEDICARE PART D EFFECTIVE DATE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 140-US (Next Medicare Part D Effective Date), which is
defined as "Future date Part D coverage begins for the patient."
9002313.0301,141NEXT MEDICARE PART D TERM DATE 140;1 FREE TEXT
NEXT MEDICARE PART D TERMINATION DATE
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: AUG 19, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 141-UT (Next Medicare Part D Termination Date), which is
defined as "Future date Part D coverage ends for the patient."
9002313.0301,148INGRED COST CNTRCTD REIMB AMT 140;8 FREE TEXT
INGREDIENT COST CONTRACTED/REIMBURSABLE AMOUNT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: OCT 26, 2010
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 148-U8 (Ingredient Cost Contracted/Reimbursable Amount),
which is defined as "Informational field used when Other Payer-Patient Responsibility Amount
(352-NQ) or Patient Pay Amount (505-F5) is used for reimbursement. Amount is equal to
contracted or reimbursable amount for product being dispensed."
9002313.0301,149DISP FEE CNTRCTD REIMB AMT 140;9 FREE TEXT
DISPENSING FEE CONTRACTED/REIMBURSABLE AMOUNT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 149-U9 (Dispensing Fee Contracted/Reimbursable Amount), which
is defined as "Informational field used when Other Payer-Patient Responsibility Amount (352-NQ)
or Patient Pay Amount (505-F5) is used for reimbursement. Amount is equal to contracted or
reimbursable dispensing fee for product being dispensed."
9002313.0301,240CONTRACT NUMBER 230;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 240-U1 (Contract Number), which is defined as "Account Number
assigned during installation for segments of business."
9002313.0301,346BASIS OF CALC - DISPENSING FEE 340;6 SET
BASIS OF CALCULATION-DISPENSING FEE
'00' FOR NOT SPECIFIED;
'01' FOR QUANTITY DISPENSED;
'02' FOR QUANTITY INTENDED TO BE DISP;
'03' FOR USUAL & CUSTOMARY/PRORATED;
'04' FOR WAIVED DUE TO PARTIAL FILL;
'99' FOR OTHER;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the basis for the dispensing fee paid.
DESCRIPTION: This is used to store NCPDP field 346-HH (Basis Of Calculation-Dispensing Fee), which is
defined as "Code indicating how the reimbursement amount was calculated for Dispensing Fee Paid
(507-F7)."
TECHNICAL DESCR:
RESPONSE PRICING SEGMENT.
9002313.0301,347BASIS OF CALC - COPAY 340;7 SET
'00' FOR NOT SPECIFIED;
'01' FOR QUANTITY DISPENSED;
'02' FOR QUANTITY INTENDED TO BE DISPENSED;
'03' FOR USUAL & CUSTOMARY/PRORATED;
'04' FOR WAIVED DO TO PARTIAL FILL;
'99' FOR OTHER;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the basis for the copayment amount.
DESCRIPTION:
Code indicating how the reimbursement amount was calculated for 'Patient Pay Amount'(5�5).
9002313.0301,348BASIS OF CALC - REGULATORY FEE 340;8 SET
BASIS OF CALCULATION-FLAT SALES TAX
'00' FOR NOT SPECIFIED;
'01' FOR QUANTITY DISPENSED;
'02' FOR QUANTITY INTENDED TO BE DISPENSED;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the basis for the flat tax paid.
DESCRIPTION: This is used to store NCPDP field 348-HK (Basis Of Calculation-Flat Sales Tax), which is
defined as "Code indicating how the reimbursement amount was calculated for Flat Sales Tax
Amount Paid (558-AW)."
TECHNICAL DESCR:
RESPONSE PRICING SEGMENT.
9002313.0301,349BASIS OF CALC - % TAX 340;9 SET
'00' FOR NOT SPECIFIED;
'01' FOR QUANTITY DISPENSED;
'02' FOR QUANTITY INTENDED TO BE DISPENSED;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the basis for the percentage tax paid.
DESCRIPTION: Code indicating how the reimbursement amount was calculated for 'Percentage Sales Tax Amount
Paid' (559).
9002313.0301,355OTHER PAYER ID COUNT 350;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 355-NT (Other Payer ID Count), which is defined as "Count of
other payers with payment responsibility."
9002313.0301,355.01OTHER PAYER ID MLTPL 355.01;0 Multiple #9002313.035501 (Add New Entry without Asking)
LAST EDITED: AUG 31, 2010
DESCRIPTION:
This sub-file contains OTHER PAYER ID values.
9002313.035501,.01OTHER PAYER ID COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter of the Other Payer ID occurrences.
TECHNICAL DESCR:
Counter incremented by BPS* software.
CROSS-REFERENCE: 9002313.035501^B
1)= S ^BPSR(DA(2),1000,DA(1),355.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),355.01,"B",$E(X,1,30),DA)
9002313.035501,127OTHER PAYER HELP DESK PH NUM 0;6 FREE TEXT
OTHER PAYER HELP DESK PHONE NUMBER
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-20 characters.
DESCRIPTION: This is used to store NCPDP field 127-UB (Other Payer Help Desk Phone Number), which is
defined as "Phone number of the other payer's help desk."
TECHNICAL DESCR: Format=AAAEEENNNNXXXXXXXX
AAA=Area Code
EEE=Exchange Code
NNNN=Number
XXXXXXXX=Extension
Examples:
A phone number of 212-555-1212 would reflect: 2125551212.
With an extension of 123 the same number would reflect: 2125551212123 or 2125551212x123 or
2125551212ext123.
RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.035501,142OTHER PAYER PERSON CODE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-5 characters.
DESCRIPTION: This is used to store NCPDP field 142-UV (Other Payer Person Code), which is defined as "Code
assigned by the other payer to a specific person within a family."
TECHNICAL DESCR:
RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.035501,143OTHER PAYER PATIENT REL CODE 0;3 FREE TEXT
OTHER PAYER PATIENT RELATIONSHIP CODE
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 143-UW (Other Payer-Patient Relationship Code), which is
defined as "Code assigned by the other payer to indicate the relationship of patient to
cardholder."
TECHNICAL DESCR:
RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.035501,144OTHER PAYER EFFECTIVE DATE 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION:
This is used to store NCPDP field 144-UX (Other Payer Benefit Effective Date).
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century
YY=Year
MM=Month
DD=Day
RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.035501,145OTHER PAYER TERMINATION DATE 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: AUG 31, 2010
HELP-PROMPT: Answer must be 1-10 characters.
DESCRIPTION: This is used to store NCPDP field 145-UY (Other Payer Benefit Termination Date), which is
defined as "Other Payer's termination date of the patient's benefit."
TECHNICAL DESCR: Format=CCYYMMDD
CC=Century
YY=Year
MM=Month
DD=Day
RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.
9002313.035501,338OTHER PAYER COVERAGE TYPE 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 338-5C (Other Payer Coverage Type), which is defined as
"Code identifying the type of 'Other Payer ID' (340-7C)."
9002313.035501,339OTHER PAYER ID QUALIFIER 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 339-6C (Other Payer ID Qualifier), which is defined as
"Code qualifying the 'Other Payer ID' (340-7C)."
9002313.035501,340OTHER PAYER ID 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 340-7C (Other Payer ID), which is defined as "ID assigned
to the payer."
9002313.035501,356OTHER PAYER CARDHOLDER ID 1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-22 characters.
DESCRIPTION: This is used to store NCPDP field 356-NU (Other Payer Cardholder ID), which is defined as
"Cardholder ID for this member that is associated with the Payer noted."
9002313.035501,991OTHER PAYER PROC CONTROL NUM 1;4 FREE TEXT
OTHER PAYER PROCESSOR CONTROL NUMBER
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 991-MH (Other Payer Processor Control Number), which is
defined as "A number that uniquely identifies the secondary, tertiary, etc. payer to the
processor."
9002313.035501,992OTHER PAYER GROUP ID 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-17 characters.
DESCRIPTION: This is used to store NCPDP field 992-MJ (Other Payer Group ID), which is defined as "ID
assigned to the cardholder group or employer group by the secondary, tertiary, etc. payer."
9002313.035501,2023OTHER PAYER HELPDESK PHONE EXT 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-8 characters in length.
DESCRIPTION: This is used to store NCPDP field B23-7Q (Other Payer Help Desk Telephone Number Extension),
which is defined as "Extension of the telephone number".
9002313.0301,392BENEFIT STAGE COUNT 390;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-3 characters.
DESCRIPTION: This is used to store NCPDP field 392-MU (Benefit Stage Count), which is defined as "Count of
'Benefit Stage Amount' (394-MW) occurrences."
9002313.0301,392.01BENEFIT STAGE INFO 392.01;0 Multiple #9002313.039201 (Add New Entry without Asking)
LAST EDITED: AUG 18, 2010
DESCRIPTION:
This sub-file contains Benefit Stage values.
9002313.039201,.01BENEFIT STAGE COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter of the Benefit Stage occurrences.
TECHNICAL DESCR:
Counter incremented by BPS* software.
CROSS-REFERENCE: 9002313.039201^B
1)= S ^BPSR(DA(2),1000,DA(1),392.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),392.01,"B",$E(X,1,30),DA)
9002313.039201,393BENEFIT STAGE QUALIFIER 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: AUG 18, 2010
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION:
This is used to store NCPDP field 393-MV (Benefit Stage Qualifier).
9002313.039201,394BENEFIT STAGE AMOUNT 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: OCT 26, 2010
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION:
This is used to store NCPDP field 394-MW (Benefit Stage Amount).
9002313.0301,402PRESCRIPTION/SERVICE REF NO 400;2 FREE TEXT
PRESCRIPTION/SERVICE REFERENCE NUMBER
INPUT TRANSFORM: K:$L(X)>14!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-14 characters.
DESCRIPTION: This is used to store NCPDP field 402-D2 (Prescription/Service Reference Number), which is
defined as "Reference number assigned by the provider for the dispensed drug/product and/or
service provided."
TECHNICAL DESCR: Qualified by Prescription/Service Reference Number Qualifier (455-EM).
REQUEST CLAIM SEGMENT. RESPONSE CLAIM SEGMENT.
9002313.0301,455PRESCRIPTION/SERV REF NO QLFR 450;5 SET
'1' FOR RX BILLING;
'2' FOR SERVICE BILLING;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
Indicates the type of billing submitted.
9002313.0301,498.14PRIOR AUTH NUMBER-ASSIGNED 498;6 FREE TEXT
PRIOR AUTHORIZATION NUMBER-ASSIGNED
INPUT TRANSFORM: K:$L(X)>11!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-11 characters in length.
DESCRIPTION: This is used to store NCPDP field 498-PY (Prior Authorization Number-Assigned), which is
defined as "Unique number identifying the prior authorization assigned by the processor."
9002313.0301,498.51PRIOR AUTH PROCESSED DATE 498;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Date the prior authorization request was processed.
9002313.0301,498.52PRIOR AUTH EFFECTIVE DATE 498;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Date the prior authorization became effective.
9002313.0301,498.53PRIOR AUTH EXPIRATION DATE 498;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Date the prior authorization expires.
9002313.0301,498.54PRIOR AUTH NO REFILLS AUTH 498;4 NUMBER
PRIOR AUTHORIZATION NUMBER OF REFILLS AUTHORIZED
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Type a number between 0 and 99, 0 decimal digits.
DESCRIPTION: This is used to store NCPDP field 498-PW (Prior Authorization Number Of Refills
Authorized), which is defined as "Number of refills authorized by the prior authorization."
TECHNICAL DESCR:
RESPONSE PRIOR AUTHORIZATION SEGMENT.
9002313.0301,498.55PRIOR AUTH QTY ACCUMULATED 498;5 FREE TEXT
PRIOR AUTHORIZATION QUANTITY ACCUMULATED
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 498-PX (Prior Authorization Quantity Accumulated), which
is defined as "Accumulated authorized amount expressed in metric decimal units."
TECHNICAL DESCR: Format=9999999.999 Comments: Provided to the pharmacy by the processor to determine
quantity remaining for billing. RESPONSE PRIOR AUTHORIZATION SEGMENT.
9002313.0301,498.57PRIOR AUTHORIZATION QUANTITY 498;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 498-RA (Prior Authorization Quantity), which is defined
as "Amount authorized expressed in metric decimal units."
TECHNICAL DESCR: Format=9999999.999
Comments: Provided to the pharmacy by the processor to convey the number of units
authorized. RESPONSE PRIOR AUTHORIZATION SEGMENT.
9002313.0301,498.58PRIOR AUTH DOLLARS AUTHORIZED 498;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount authorized in the prior authorization.
9002313.0301,501HEADER RESPONSE STATUS 500;1 SET
'A' FOR ACCEPTED;
'R' FOR REJECTED CLAIM;
'P' FOR CLAIM PAYABLE;
'C' FOR CLAIM CAPTURED;
'D' FOR DUPLICATE CLAIM;
'DP' FOR DUPLICATE OF PAYABLE CLAIM;
'DC' FOR DUPLICATE OF CAPTURED CLAIM;
LAST EDITED: OCT 22, 2010
HELP-PROMPT: Enter the status of the response.
DESCRIPTION:
This is used to store NCPDP field 501-F1 (Header Response Status).
CROSS-REFERENCE: 9002313.03^AC
1)= S ^BPSR("AC",$E(X,1,30),DA(1),DA)=""
2)= K ^BPSR("AC",$E(X,1,30),DA(1),DA)
9002313.0301,503AUTHORIZATION NUMBER 500;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<14) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 14-20 characters in length.
DESCRIPTION:
Number assigned by the processor to identify an authorized transaction.
9002313.0301,504MESSAGE 504;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-250 characters in length.
DESCRIPTION:
Free text message from payer.
9002313.0301,505PATIENT PAY AMOUNT 500;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: JUL 25, 2018
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: Amount that is calculated by the processor and returned to the pharmacy as the TOTAL amount
to be paid by the patient to the pharmacy; the patient's total cost share, including
co-payments, amounts applied to deductible, over maximum amounts, penalties, etc.
9002313.0301,506INGREDIENT COST PAID 500;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION:
Drug ingredient cost paid included in the 'Total Amount Paid' (5�9).
9002313.0301,507DISPENSING FEE PAID 500;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION:
Dispensing fee paid included in the 'Total Amount Paid' (5�9).
9002313.0301,509TOTAL AMOUNT PAID 500;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: Total amount to be paid by the claims processor (i.e. pharmacy receivable). Represents a
sum of 'Ingredient Cost Paid' (5�6), 'Dispensing Fee Paid' (5�7), 'Flat Sales Tax Amount
Paid' (558), 'Percentage Sales Tax Amount Paid' (559), 'Incentive Amount Paid' (521),
'Professional Service Fee Paid' (562), 'Other Amount Paid' (565), less 'Patient Pay Amount'
(5�5) and 'Other Payer Amount Recognized' (566).
9002313.0301,510REJECT COUNT 500;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION:
Count of 'Reject Code' (511) occurrences.
9002313.0301,511REJECT CODE 511;0 Multiple #9002313.03511 (Add New Entry without Asking)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Select a NCPDP reject code
DESCRIPTION:
Multiple rejection codes.
9002313.03511,.01 REJECT CODE 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
OUTPUT TRANSFORM: S Y=$$TRANREJ^BPSECFM(Y)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION:
The code returned in the response indicating the reason(s) why the claim was rejected.
CROSS-REFERENCE: 9002313.03511^B
1)= S ^BPSR(DA(2),1000,DA(1),511,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),511,"B",$E(X,1,30),DA)
9002313.03511,546 REJECT FIELD OCCURRENCE INDCTR 0;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Type a number between 0 and 99, 0 Decimal Digits
DESCRIPTION:
The number of times a particular field caused a rejection to be triggered.
9002313.0301,512ACCUMULATED DEDUCTIBLE AMOUNT 500;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),9,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount in dollars met by the patient/family in a deductible plan.
9002313.0301,513REMAINING DEDUCTIBLE AMOUNT 500;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),9,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount not met by the patient/family in the deductible plan.
9002313.0301,514REMAINING BENEFIT AMOUNT 500;14 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),9,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount remaining in a patient/family plan with a periodic maximum benefit.
9002313.0301,517AMT APPLIED TO PERIODIC DEDUCT 500;17 FREE TEXT
AMOUNT APPLIED TO PERIODIC DEDUCTIBLE
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: This is used to store NCPDP field 517-FH (Amount Applied To Periodic Deductible), which
is defined as "Amount to be collected from a patient that is included in 'Patient Pay
Amount' (505-F5) that is applied to a periodic deductible."
9002313.0301,518AMOUNT OF COPAY 500;18 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: JUN 06, 2018
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: This is used to store NCPDP field 518-FI (Amount Of Copay), which is defined as "Amount
to be collected from the patient that is included in 'Patient Pay Amount' (505-F5) that
is due to a per prescription copay."
9002313.0301,519AMT ATTRIBUTED TO PRODUCT SEL 500;19 FREE TEXT
AMOUNT ATTRIBUTED TO PRODUCT SELECTION
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: This is used to store NCPDP field 519-FJ (Amount Attributed To Product Selection), which
is defined as "Amount to be collected from the patient that is included in 'Patient Pay
Amount' (505-F5) that is due to the patients selection of drug product."
9002313.0301,520AMOUNT EXCEEDING PERIODIC MAX 500;20 FREE TEXT
AMOUNT EXCEEDING PERIODIC BENEFIT MAXIMUM
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: This is used to store NCPDP field 520-FK (Amount Exceeding Periodic Benefit Maximum),
which is defined as "Amount to be collected from the patient that is included in 'Patient
Pay Amount' (505-F5) that is due to the patient exceeding a periodic benefit maximum."
9002313.0301,521INCENTIVE AMOUNT PAID 500;21 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: Amount represents the contractually agreed upon incentive fee paid for specific services
rendered. Amount is included in the 'Total Amount Paid' (5�9).
9002313.0301,522BASIS OF REIMB DETERMINATION 500;22 FREE TEXT
BASIS OF REIMBURSEMENT DETERMINATION
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: SEP 01, 2010
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION: This is used to store NCPDP field 522-FM (Basis Of Reimbursement Determination), which is
defined as "Code identifying how the reimbursement amount was calculated for Ingredient
Cost Paid (506-F6)."
TECHNICAL DESCR:
RESPONSE PRICING SEGMENT.
9002313.0301,523AMOUNT ATTRIBUTED TO SALES TAX 500;23 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: Amount to be collected from the patient that is included in 'Patient Pay Amount' (5�5)
that is due to sales tax paid.
9002313.0301,525DUR RESPONSE DATA 525;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-250 characters in length.
DESCRIPTION:
Text that provides additional detail regarding a DUR conflict.
9002313.0301,526ADDITIONAL MESSAGE INFORMATION 526;1 FREE TEXT
*ADDITIONAL MESSAGE INFORMATION
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-250 characters in length.
DESCRIPTION:
* This field is no longer used in NCPDP vD.0. *
TECHNICAL DESCR: In BPS*1.0*10, this data for this field was moved to the ADDITIONAL MESSAGE MLTPL
(#9002313.13001) subfile.
9002313.0301,547APPROVED MESSAGE CODE COUNT 540;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
Count of the 'Approved Message Code' (548-6F) occurrences.
9002313.0301,548APPROVED MESSAGE CODE 548;0 Multiple #9002313.301548 (Add New Entry without Asking)
LAST EDITED: FEB 07, 2008
9002313.301548,.01APPROVED MESSAGE CODE 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-3 characters in length.
DESCRIPTION: Message code, on an approved claim/service, communicating the need for an additional
follow-up.
CROSS-REFERENCE: 9002313.301548^B
1)= S ^BPSR(DA(2),1000,DA(1),548,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),548,"B",$E(X,1,30),DA)
9002313.0301,549HELP DESK PHONE NUMBER QUAL 540;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Code qualifying the phone number in the 'Help Desk Phone Number' (55�).
9002313.0301,550HELP DESK TELEPHONE NUMBER 540;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>18!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-18 characters in length.
DESCRIPTION: This is used to store NCPDP field 550-8F (Help Desk Telephone Number), which is defined
as "Phone number of the help desk".
9002313.0301,551FORMULARY ALT PRODUCT COUNT 550;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Type a number between 1 and 9, 0 Decimal Digits
DESCRIPTION:
Count of preferred product occurrences.
9002313.0301,551.01PREFERRED PRODUCT REPEATING 551.01;0 Multiple #9002313.1301 (Add New Entry without Asking)
LAST EDITED: FEB 07, 2008
9002313.1301,.01 PREFERRED PRODUCT COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 18, 2008
HELP-PROMPT: Type a number between 1 and 9, 0 Decimal Digits
DESCRIPTION:
Sequential counter of the Preferred Product occurrences.
CROSS-REFERENCE: 9002313.1301^B
1)= S ^BPSR(DA(2),1000,DA(1),551.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),551.01,"B",$E(X,1,30),DA)
9002313.1301,552 FORMULARY ALT ID QUALIFIER 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Code qualifying the type of product ID submitted in 'Preferred Product ID' (553).
9002313.1301,553 FORMULARY ALTERNATIVE ID 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>19!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-19 characters in length.
DESCRIPTION:
Alternate product recommended by the plan.
9002313.1301,554 FORMULARY ALT INCENTIVE 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount of pharmacy incentive available for substitution of preferred product.
9002313.1301,555 FRMULRY ALT ESTMTD PT COST SHR 1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount of patient's copay/cost-share incentive for preferred product.
9002313.1301,556 FORMULARY ALT DESCRIPTION 1;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
Free text message.
9002313.0301,557PERCENT TAX EXEMPT INDICATOR 550;7 SET
'1' FOR PAYER/PLAN IS TAX EXEMPT;
'2' FOR NOT TAX EXEMPT;
'3' FOR PATIENT IS TAX EXEMPT;
'4' FOR PAYER/PLAN AND PATIENT TAX EXEMPT;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a code specifying tax exempt status.
DESCRIPTION:
Code indicating the payer and/or patient is exempt from taxes.
9002313.0301,558REGULATORY FEE AMOUNT PAID 550;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Flat sales tax paid which is included in the 'Total Amount Paid' (5�9).
9002313.0301,559PERCENTAGE TAX AMOUNT PAID 550;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y=$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION: Amount of percentage sales tax paid which is included in the 'Total Amount Paid'
(5�9).
9002313.0301,560PERCENTAGE TAX RATE PAID 550;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>7!($L(X)<7) X
OUTPUT TRANSFORM: S Y=$J($$DFF2EXT^BPSECFM(Y)/100,7,4)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 7 characters in length.
DESCRIPTION:
Percentage sales tax rate used to calculate 'Percentage Sales Tax Amount Paid' (559).
9002313.0301,561PERCENTAGE TAX BASIS PAID 560;1 SET
PERCENTAGE SALES TAX BASIS PAID
'01' FOR GROSS AMOUNT DUE;
'02' FOR INGREDIENT COST;
'03' FOR INGREDIENT COST + DISPENSING FEE;
'04' FOR PROFESSIONAL SERVICE FEE;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the basis for the percentage sales tax paid.
DESCRIPTION: This is used to store NCPDP field 561-AZ (Percentage Sales Tax Basis Paid), which is
defined as "Code indicating the percentage sales tax paid basis."
TECHNICAL DESCR:
RESPONSE PRICING SEGMENT.
9002313.0301,562PROFESSIONAL SERVICE FEE PAID 560;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount submitted by the provider for professional services rendered.
9002313.0301,563OTHER AMOUNT PAID COUNT 560;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>1!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1 character in length.
DESCRIPTION:
Count of the other amount paid occurrences.
9002313.0301,563.01OTHER AMOUNTS PAID 563.01;0 Multiple #9002313.1401 (Add New Entry without Asking)
LAST EDITED: FEB 07, 2008
9002313.1401,.01 OTHER AMOUNT PAID COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 18, 2008
HELP-PROMPT: Type a number between 1 and 9, 0 Decimal Digits
DESCRIPTION:
Count of the other amount paid occurrences.
CROSS-REFERENCE: 9002313.1401^B
1)= S ^BPSR(DA(2),1000,DA(1),563.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),563.01,"B",$E(X,1,30),DA)
9002313.1401,564 OTHER AMOUNT PAID QUALIFIER 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Code clarifying the value in the 'Other Amount Paid' (565).
9002313.1401,565 OTHER AMOUNT PAID 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Amount paid for additional costs claimed in 'Other Amount Claimed Submitted' (48�).
9002313.0301,566OTHER PAYER AMOUNT RECOGNIZED 560;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Total dollar amount of any payment from another source including coupons.
9002313.0301,567.01DUR PPS 567.01;0 Multiple #9002313.1101 (Add New Entry without Asking)
LAST EDITED: FEB 07, 2008
9002313.1101,.01 DUR PPS RESPONSE 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 18, 2008
HELP-PROMPT: Type a number between 1 and 9, 0 Decimal Digits
DESCRIPTION:
Counter number for each DUR/PPS set/logical grouping.
CROSS-REFERENCE: 9002313.1101^B
1)= S ^BPSR(DA(2),1000,DA(1),567.01,"B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),567.01,"B",$E(X,1,30),DA)
9002313.1101,439 REASON FOR SERVICE CODE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
OUTPUT TRANSFORM: S Y=$$TRANSCD^BPSECFM(Y)
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION: Code identifying the type of utilization conflict detected or the reason for the
pharmacist's professional service.
9002313.1101,528 CLINICAL SIGNIFICANCE CODE 0;3 SET
'1' FOR MAJOR;
'2' FOR MODERATE;
'3' FOR MINOR;
'9' FOR UNDETERMINED;
LAST EDITED: JUN 17, 2008
HELP-PROMPT: Enter a code indicating the clinical significance.
DESCRIPTION: Code identifying the significance or severity level of a clinical event as
contained in the originating data base.
9002313.1101,529 OTHER PHARMACY INDICATOR 0;4 SET
'0' FOR NOT SPECIFIED;
'1' FOR YOUR PHARMACY;
'2' FOR OTHER PHARMACY SAME CHAIN;
'3' FOR OTHER PHARMACY;
LAST EDITED: JUN 17, 2008
HELP-PROMPT: Enter a code for the type of pharmacy dispensing the conflicting drug.
DESCRIPTION: Indicator telling whether the medication that caused the DUR to be triggered came
from the current pharmacy, or an outside pharmacy.
9002313.1101,530 PREVIOUS DATE OF SERVICE 0;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Date prescription was previously filled.
9002313.1101,531 QTY OF PREVIOUS DISPENSING 0;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 531-FV (Quantity Of Previous Fill), which is
defined as "Amount expressed in metric decimal units of the conflicting agent
that was previously filled."
TECHNICAL DESCR: Format=9999999.999
RESPONSE DUR/PPS SEGMENT.
9002313.1101,532 DATABASE INDICATOR 0;7 SET
'1' FOR FIRST DATABANK;
'2' FOR MEDI-SPAN PRODUCT LINE;
'3' FOR MICROMEDEX/MEDICAL ECONOMICS;
'4' FOR PROCESSOR DEVELOPED;
'5' FOR OTHER;
'6' FOR REDBOOK;
'7' FOR MULTUM;
LAST EDITED: JUN 18, 2008
HELP-PROMPT: Enter a code identifying the source of DUR information.
DESCRIPTION:
Code identifying the source of drug information used for DUR processing.
9002313.1101,533 OTHER PRESCRIBER INDICATOR 0;8 SET
'0' FOR NOT SPECIFIED;
'1' FOR SAME PRESCRIBER;
'2' FOR OTHER PRESCRIBER;
LAST EDITED: JUN 18, 2008
HELP-PROMPT: Enter a code for the prescriber of the previously filled conflicting
prescription.
DESCRIPTION: Code comparing the prescriber of the current prescription to the prescriber of
the previously filled conflicting prescription.
9002313.1101,544 DUR/DUE FREE TEXT MESSAGE 0;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: MAR 31, 2021
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Text that provides additional detail regarding a DUR conflict.
9002313.1101,570 DUR ADDITIONAL TEXT 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>102!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-102 characters.
DESCRIPTION: This is used to store NCPDP field 570-NS (DUR Additional Text), which is defined
as "Descriptive information that further defines the referenced DUR alert."
9002313.0301,571AMOUNT ATTRIB TO PROCESSOR FEE 570;1 FREE TEXT
AMOUNT ATTRIBUTED TO PROCESSOR FEE
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 571-NZ (Amount Attributed to Processor Fee),
which is defined as "Amount to be collected from the patient that is included in
Patient Pay Amount (505-F5) that is due to the processing fee imposed by the
processor."
9002313.0301,572AMOUNT OF COINSURANCE 570;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: OCT 26, 2010
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 572-4U (Amount of Coinsurance), which is
defined as "Amount to be collected from the patient that is included in 'Patient
Pay Amount' (505-F5) that is due to a per prescription coinsurance."
9002313.0301,573BASIS OF CALC - COINSURANCE 570;3 FREE TEXT
BASIS OF CALCULATION-COINSURANCE
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-4 characters.
DESCRIPTION: This is used to store NCPDP field 573-4V (Basis of Calculation-Coinsurance),
which is defined as "Code indicating how the Coinsurance reimbursement amount was
calculated for 'Patient Pay Amount' (505-F5)."
9002313.0301,574PLAN SALES TAX AMOUNT 570;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: OCT 26, 2010
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 574-2Y (Plan Sales Tax Amount), which is
defined as "Plan sales tax responsibility. This field is not a component of the
Patient Pay Amount (505-F5) formula."
9002313.0301,575PATIENT PERCENTAGE TAX AMOUNT 570;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),8,2)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 1-8 characters.
DESCRIPTION: This is used to store NCPDP field 575-EQ (Patient Sales Tax Amount), which is
defined as "Patient sales tax responsibility. This field is not a component of
the Patient Pay Amount (505-F5) formula."
9002313.0301,577ESTIMATED GENERIC SAVINGS 570;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
OUTPUT TRANSFORM: NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!
LAST EDITED: OCT 27, 2010
HELP-PROMPT: Answer must be 1-8 characters in length.
DESCRIPTION: This is used to store NCPDP field 577-G3 (Estimated Generic Savings), which is
defined as "The amount, not included in the Total Amount Paid (509-F9), that the
patient would have saved if they had chosen the generic drug instead of the brand
drug."
9002313.0301,757BENEFIT ID 750;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-17 characters.
DESCRIPTION: This is used to store NCPDP field 757-U6 (Benefit ID), which is defined as
"Assigned by processor to identify a set of parameters, benefits, or coverage
criteria used to adjudicate a claim."
9002313.0301,880TRANSACTION REFERENCE NUMBER 870;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: AUG 18, 2010
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION:
This is used to store NCPDP field 880-K5 (Transaction Reference Number).
9002313.0301,926FORMULARY ID 920;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>12!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-12 characters.
DESCRIPTION: This is used to store NCPDP field 926-FF (Formulary ID), which is defined as "ID
for the formulary list."
9002313.0301,931MAXIMUM AGE QUALIFIER 930;1 SET
'D' FOR DAYS;
'M' FOR MONTHS;
'Y' FOR YEARS;
LAST EDITED: AUG 30, 2022
HELP-PROMPT: Enter a maximum age qualifier. D, M or Y.
DESCRIPTION:
Qualifies Maximum Age (932-GA).
9002313.0301,932MAXIMUM AGE 930;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter an age, a number between 1 and 999.
DESCRIPTION: Maximum age at which the product/service is covered (inclusive). Qualified by
Maximum Age Qualifier (931-F80).
9002313.0301,933MAXIMUM AMOUNT 930;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5) X
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: S Y=$J($$NFF^BPSECFM(Y,10),10,3)
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter an amount, must be 5-10 characters in length.
DESCRIPTION:
Qualified by Maximum Amount Qualifier (934-GC).
9002313.0301,934MAXIMUM AMOUNT QUALIFIER 930;4 SET
'DL' FOR DOLLAR AMOUNT;
'DS' FOR DAYS SUPPLY;
'FL' FOR FILLS;
'QY' FOR QUANTITY;
LAST EDITED: JUL 17, 2018
HELP-PROMPT: Enter a maximum account qualifier code: DL, DS, FL or QY.
DESCRIPTION:
Qualifies Maximum Amount (933-GB).
9002313.0301,935MAXIMUM AMOUNT TIME PERIOD 930;5 SET
'CM' FOR CALENDAR MONTH;
'CQ' FOR CALENDAR QUARTER;
'CY' FOR CALENDAR YEAR;
'DY' FOR DAYS;
'LT' FOR LIFETIME;
'PD' FOR PER DISPENSING;
'SP' FOR SPECIFIC DATE RANGE;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a maximum amount time period code: CM, CQ, CY, DY, LT, PD or SP.
DESCRIPTION: Type of time period associated with the overall Maximum Amount Qualifier
(934-GC).
9002313.0301,936MAX AMT TIME PERIOD START DATE 930;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
MAXIMUM LENGTH: 8
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: MAY 24, 2018
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Starting date of Specific Date Range.
9002313.0301,937MAX AMT TIME PERIOD END DATE 930;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
MAXIMUM LENGTH: 8
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: MAY 24, 2018
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
Ending date of Specific Date Range.
9002313.0301,938MAX AMT TIME PERIOD UNITS 930;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 11, 2018
HELP-PROMPT: Enter the number of units between 0 and 9999, 0 decimal digits.
DESCRIPTION:
Number of units associated with the overall Maximum Amount Time Period (935-GF).
9002313.0301,943MINIMUM AGE QUALIFIER 940;3 SET
'D' FOR DAYS;
'M' FOR MONTHS;
'Y' FOR YEARS;
LAST EDITED: AUG 30, 2022
HELP-PROMPT: Enter a minimum age qualifier. D, M or Y.
DESCRIPTION:
Qualifies Minimum Age (944-GR).
9002313.0301,944MINIMUM AGE 940;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the minimum age, a number between 1 and 999.
DESCRIPTION:
Qualified by Minimum Age Qualifier (943-GQ).
9002313.0301,987URL 987;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>250!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-250 characters.
DESCRIPTION: This is used to store NCPDP field 987-MA (URL), which is defined as "The web page
address."
9002313.0301,993INTERNAL CONTROL NUMBER 990;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1) X
LAST EDITED: JUL 22, 2010
HELP-PROMPT: Answer must be 1-32 characters.
DESCRIPTION: This is used to store NCPDP field 993-A7 (Internal Control Number), which is
defined as "Number assigned by the processor to identify an adjudicated claim
when supplied in payer-to-payer coordination of benefits only."
9002313.0301,1000DUPLICATE RESPONSE DATA 1000;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>85!($L(X)<1) X
LAST EDITED: FEB 07, 2008
HELP-PROMPT: Answer must be 1-85 characters in length.
DESCRIPTION:
Response text to indicate duplicated data.
9002313.0301,1028ADJUDICATED PROGRAM TYPE A20;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<2) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 2 characters in length.
DESCRIPTION:
This is used to store NCPDP field A28-ZR (Adjudicated Payment Type)
9002313.0301,2004NEXT AVAILABLE FILL DATE B00;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Answer must be 8 characters in length.
DESCRIPTION:
This is used to store NCPDP field B04-BT (Next Available Fill Date)
9002313.0301,2022HELP DESK TELEPHONE NUMBER EXT B20;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-8 characters in length.
DESCRIPTION: This is used to store NCPDP field B22-7P (Help Desk Telephone Number Extension),
which is defined as "Extension of the telephone number".
9002313.0301,2033PRO SERVICE FEE CONT/REIM AMT B30;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: This is used to store NCPDP field B33-6G (Professional Service Fee
Contracted/Reimbursement Amount), which is defined as "Informational field used
with service billings when Other Payer-Patient Responsibility Amount (352-NQ) or
Patient Pay Amount (505-F5) is used for reimbursement. Amount is equal to
contracted or reimbursable amount for service being rendered".
9002313.0301,2052RESPONSE INTERMEDIARY AUTH CNT B50;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION: This is used to store NCPDP field B52-8R (Response Intermediary Authorization
Count), which is defined as "Count of Response Intermediary Authorization Type ID
(B53-8S), Response Intermediary Authorization Type ID and Intermediary Message".
9002313.0301,2052.01INTERMEDIARY MULTIPLE B52;0 Multiple #9002313.032052
LAST EDITED: JAN 14, 2015
DESCRIPTION: This multiple is used to hold the NCPDP values for the Response Intermediary
repeating group.
9002313.032052,.01RESPONSE INTERMEDIARY COUNTER 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Type a number between 1 and 99, 0 decimal digits.
DESCRIPTION:
This is a sequential counter of Response Intermediary occurrences
CROSS-REFERENCE: 9002313.032052^B
1)= S ^BPSR(DA(2),1000,DA(1),"B52","B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),"B52","B",$E(X,1,30),DA)
9002313.032052,2051INTERMEDIARY MESSAGE 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>200!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-200 characters in length.
DESCRIPTION: This is used to store NCPDP field B51-8Q (Intermediary Message), which is
defined as "Free form message".
9002313.032052,2053RESPONSE INTERMED AUTH TYPE ID 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION: This is used to store NCPDP field B53-8S (Response Intermediary Authorization
Type ID), which is defined as "Value indicating the authorization type from
intermediary processing".
9002313.032052,2054RESPONSE INTERMEDIARY AUTH ID 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: DEC 31, 2014
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: This is used to store NCPDP field B54-8T (Response Intermediary Authorization
ID), which is defined as "Value indicating intermediary authorization".
9002313.0301,2087QUAN LIMIT PER SPC TM PD COUNT B80;7 NUMBER
QUANTITY LIMIT PER SPECIFIC TIME PERIOD COUNT
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of quantity limit per specific time period.
TECHNICAL DESCR:
NCPDP field B87-3P.
9002313.0301,2087.01QUAN LIMIT TIME PERIOD MLTPL B87;0 Multiple #9002313.032087 (Add New Entry without Asking)
LAST EDITED: SEP 15, 2015
DESCRIPTION: This multiple is used to hold the Quantity Limit Per Specific Time Period
repeating group fields.
9002313.032087,.01QUANTITY LIMIT TIME PD COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION: This is a sequential counter of the Quantity Limit Per Specific Time Period
occurrences.
CROSS-REFERENCE: 9002313.032087^B
1)= S ^BPSR(DA(2),1000,DA(1),"B87","B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),"B87","B",$E(X,1,30),DA)
9002313.032087,2088QUAN LIMIT PER SPC TIME PERIOD 0;2 NUMBER
QUANTITY LIMIT PER SPECIFIC TIME PERIOD
INPUT TRANSFORM: K:+X'=X!(X>9999999.999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 9999999.999, 3 decimal digits.
DESCRIPTION:
Maximum quantity allowed over the designated time period.
TECHNICAL DESCR:
NCPDP field B88-3R.
9002313.032087,2089QUANTITY LIMIT TIME PERIOD 0;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 99999, 0 decimal digits.
DESCRIPTION:
Number of days to which the maximum quantity is allowed.
TECHNICAL DESCR:
NCPDP field B89-3S.
9002313.0301,2090DAYS SUP LIM PER SPC TM PD CNT B80;10 NUMBER
DAYS SUPPLY LIMIT PER SPECIFIC TIME PERIOD COUNT
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of days supply limit per specific time period.
TECHNICAL DESCR:
NCPDP field B90-3T.
9002313.0301,2090.01DAYS SUPPLY LIM TM PD MULTIPLE B90;0 Multiple #9002313.032091 (Add New Entry without Asking)
LAST EDITED: SEP 15, 2015
DESCRIPTION: This multiple is used to hold the Days Supply Limit Per Specific Time Period
repeating group fields.
9002313.032091,.01DAYS SUPPLY LIM TM PD COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION: This is a sequential counter of the Days Supply Limit Per Specific Time
Period occurrences.
CROSS-REFERENCE: 9002313.032091^B
1)= S ^BPSR(DA(2),1000,DA(1),"B90","B",$E(X,1,30),DA)=""
2)= K ^BPSR(DA(2),1000,DA(1),"B90","B",$E(X,1,30),DA)
9002313.032091,2091DAYS SUP LIM PER SPC TM PERIOD 0;2 NUMBER
DAYS SUPPLY LIMIT PER SPECIFIC TIME PERIOD
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 999, 0 decimal digits.
DESCRIPTION:
Maximum days supply allowed over the designated time period.
TECHNICAL DESCR:
NCPDP field B91-3W.
9002313.032091,2092DAYS SUPPLY LIMIT TIME PERIOD 0;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: SEP 15, 2015
HELP-PROMPT: Type a number between 0 and 99999, 0 decimal digits.
DESCRIPTION: This is an informational field to convey the maximum days supply over a set
number of days for this medication.
TECHNICAL DESCR:
NCPDP field B92-3X.
9002313.0301,2098RECONCILIATION ID B98;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: JUL 25, 2018
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
This will be used to store NCPDP field B98-34 (Reconciliation ID).
9002313.0301,2147OTHER PAYER PROGRAM TYPE C40;7 POINTER TO BPS NCPDP OTHER PAYER PROGRAM TYPE FILE (#9002313.38)
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the value of the Other Payer Adjudicated Program Type.
DESCRIPTION: The type of prescription benefit plan/program associated with the Other
Payer.
9002313.0301,2150BENEFIT STAGE INDICATOR COUNT C40;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 11, 2018
HELP-PROMPT: Enter a count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of Benefit Stage Indicator (C51-9X) occurrences.
9002313.0301,2151BENEFIT STAGE INDICATOR C50;1 POINTER TO BPS NCPDP BENEFIT STAGE INDICATOR FILE (#9002313.35)
LAST EDITED: MAY 14, 2018
HELP-PROMPT: Enter the Benefit Stage Indicator.
DESCRIPTION: Code identifying the Benefit Stage(s) which applied to the claim at the
time of adjudication.
9002313.0301,2158BENEFIT TYPE OPPORTUNITY C50;8 SET
'1' FOR FLU VACCINE BENEFIT;
'2' FOR EXTENDED DAYS SUPPLY ALLOWED AT RETAIL;
LAST EDITED: SEP 29, 2021
HELP-PROMPT: Enter the Benefit Type, 1 or 2.
DESCRIPTION:
The type of additional benefit the patient is eligible for.
9002313.0301,2159BENEFIT TYPE OPPORTUNITY COUNT C50;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 11, 2018
HELP-PROMPT: Enter a count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of Benefit Type Opportunity (C58-AE) that follow.
9002313.0301,2166HELP DESK BUSINESS UNIT TYPE C60;6 SET
'1' FOR PHARMACY HELP DESK;
'2' FOR CLINICAL/PA;
'3' FOR HEALTH PLAN;
'4' FOR ELIG-3RD PARTY LIABILITY;
'5' FOR OTHER;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the help desk support type, a number between 1-5.
DESCRIPTION:
The type of help desk support that is available.
9002313.0301,2167HELP DESK BUS UNIT TYPE COUNT C60;7 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the number of types, a number between 0 and 99, 0 decimal digits.
DESCRIPTION:
The number of Help Desk Business Unit Types (C66-BA).
9002313.0301,2168HELP DESK CONTACT INFORMATION C60;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>255!($L(X)<1) X
MAXIMUM LENGTH: 255
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the help desk contact info, between 1 and 255 characters.
DESCRIPTION: Value of the specific help desk contact information (e.g.: Telephone
Number, Fax Number, URL).
9002313.0301,2169HELP DESK CONTACT INFO EXT C60;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
MAXIMUM LENGTH: 8
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the help desk contact info extension between 1-8 characters in
length.
DESCRIPTION:
Extension of the help desk contact information.
9002313.0301,2170HELP DESK CONTACT INFO QUAL C60;10 SET
'1' FOR TELEPHONE NUMBER;
'2' FOR FAX NUMBER;
'3' FOR URL;
'4' FOR OTHER;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter Help Desk Contact Information qualifier code, a number between 1-4.
DESCRIPTION:
Code qualifying the value in the Help Desk Contact Information (C68-BC).
9002313.0301,2171HELP DESK SUPPORT TYPE C70;1 SET
'1' FOR PHARMACY;
'2' FOR PRESCRIBER;
'3' FOR MEMBER SERVICES;
'4' FOR OTHER PAYER-N1 REPORTING;
'5' FOR OTHER;
LAST EDITED: JUL 17, 2018
HELP-PROMPT: Enter a Help Desk Support type code, a number between 1-5.
DESCRIPTION:
The intended entity responsible for contacting the help desk.
9002313.0301,2172HELP DESK SUPPORT TYPE COUNT C70;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the help desk support type count between 0 and 99, 0 decimal digits.
DESCRIPTION:
The number of Help Desk Contact Support Types.
9002313.0301,2180INTERMEDIARY HELP DESK TYPE C70;10 SET
'1' FOR INTERMEDIARY/SWITCH;
'2' FOR REMS-Risk Evaluation Mitigation Strategy;
'3' FOR PDMP-Prescription Drug Monitor Program;
'4' FOR Other;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a Intermediary Help Desk Support Type code, a number between 1-4.
DESCRIPTION:
The type of intermediary help desk support that is available.
9002313.0301,2181INTERMEDIARY HLPDSK BUS COUNT C80;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the number of intermediary help desk business unit types between 0
and 99, 0 decimal digits.
DESCRIPTION:
The number of Intermediary Help Desk Business Unit Types (C80-G8).
9002313.0301,2182INTERMEDIARY HLPDSK CONTACT C80;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>255!($L(X)<1) X
MAXIMUM LENGTH: 255
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the intermediary help desk contact info, must be 1-255 characters in
length.
DESCRIPTION: Value of the specific intermediary help desk contact information (e.g.:
Telephone Number, Fax Number, URL).
9002313.0301,2183INTERMEDIARY HLPDSK EXTENSION C80;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
MAXIMUM LENGTH: 8
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the intermediary help desk extension, must be 1-8 characters in
length.
DESCRIPTION:
Extension of the intermediary help desk contact information.
9002313.0301,2184INTERMEDIARY HLPDSK QUALIFIER C80;4 SET
'1' FOR TELEPHONE NUMBER;
'2' FOR FAX NUMBER;
'3' FOR URL;
'4' FOR OTHER;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a Intermediary Help Desk Contact Information code, a number between
1-4.
DESCRIPTION: Code qualifying the value in the Intermediary Help Desk Contact Information
(C82-JP).
9002313.0301,2185INTERMEDIARY HLPDSK SUPPT TYPE C80;5 SET
'1' FOR PHARMACY;
'2' FOR PRESCRIBER;
'3' FOR MEMBER SERVICES;
'4' FOR OTHER;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a intended entity type between 1-4.
DESCRIPTION:
The intended entity responsible for contacting the intermediary help desk.
9002313.0301,2186INTERMEDIARY HLPDSK TYP COUNT C80;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the number of intermediary help desk contact support types between 0
and 99, 0 decimal digits.
DESCRIPTION:
The number of Intermediary Help Desk Contact Support Types.
9002313.0301,2193PATIENT PAY COMPONENT AMOUNT C90;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<6) X
MAXIMUM LENGTH: 8
OUTPUT TRANSFORM: S Y="$"_$J($$DFF2EXT^BPSECFM(Y),7,2)
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Answer must be 6-8 characters in length.
DESCRIPTION: The cost share amount attributed to the component of Patient Pay Amount
(505-F5).
9002313.0301,2194PATIENT PAY COMPONENT COUNT C90;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 11, 2018
HELP-PROMPT: Enter a count between 0 and 99, 0 decimal digits.
DESCRIPTION: Count of Patient Pay Component Qualifier(s) (C95-KQ) AND Patient Pay
Component Amount(s) (C93-KN) occurrences.
9002313.0301,2195PATIENT PAY COMPONENT QUAL C90;5 POINTER TO BPS NCPDP PATIENT PAY COMPONENT QUALIFIER FILE (#9002
313.37)
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a qualifier, must be 1-2 characters in length.
DESCRIPTION:
Code qualifying the Patient Pay Component Amount (C93-KN).
9002313.0301,2196PAYER/HEALTH PLAN ID COUNT C90;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAY 11, 2018
HELP-PROMPT: Enter a count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of Payer/Health Plan ID Occurrences.
9002313.0301,2215SUBROGTN REQUESTR RECONCIL ID D10;5 FREE TEXT
SUBROGATION REQUESTORS RECONCILIATION ID
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: MAY 17, 2018
HELP-PROMPT: Enter the Reconciliation ID returned to the pharmacy, 1-30 characters in
length.
DESCRIPTION: The Reconciliation ID returned to the pharmacy on the paid claim
transaction from the original/requesting payer.
9002313.0301,2219MINIMUM AMOUNT D10;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5) X
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: S Y=$J($$NFF^BPSECFM(Y,10),10,3)
LAST EDITED: JUN 14, 2018
HELP-PROMPT: Enter an amount, must be 5-10 characters in length.
DESCRIPTION: Minimum amount for a quantity limit as specified in the Minimum Amount
Qualifier (D20-M2).
9002313.0301,2220MINIMUM AMOUNT QUALIFIER D10;10 SET
'MDL' FOR MIN DOLLAR AMT;
'MDS' FOR MIN DAY SUPPLY;
'MFL' FOR MIN FILLS;
'MQY' FOR MIN QTY;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a minimum amount code: MDL, MDS, MFL or MQY.
DESCRIPTION:
Qualifies the amount in the Minimum Amount (D19-M1) field.
9002313.0301,2223OTHER PAYER NAME D20;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>70!($L(X)<1) X
MAXIMUM LENGTH: 70
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the Other Payer Name between 1-70 characters.
DESCRIPTION:
Name of the other payer.
9002313.0301,2224REMAINING AMOUNT D20;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<5) X
MAXIMUM LENGTH: 10
OUTPUT TRANSFORM: S Y=$J($$NFF^BPSECFM(Y,10),10,3)
LAST EDITED: JUN 14, 2018
HELP-PROMPT: Enter an amount, must be 5-10 characters in length.
DESCRIPTION: Qualified by Remaining Amount Qualifier (D25-M7). Remaining Benefit Amount
as it relates to benefit dollars is represented in Remaining Benefit Amount
(514-FE) field.
9002313.0301,2225REMAINING AMOUNT QUALIFIER D20;5 SET
'RFL' FOR REMAINING FILLS;
'RQY' FOR REMAINING QTY;
'RDS' FOR REMAINING DAYS SUPPLY;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a remaining amount qualifier: RFL, RQY or RDS.
DESCRIPTION:
Qualifies Remaining Amount (D24-M6).
9002313.0301,2241OTHER PAYER RELATIONSHIP TYPE D40;1 SET
'CP' FOR COB COVERAGE PRIOR TO RESPONDING PAYER;
'CS' FOR COB COVERAGE SUBSEQUENT TO RESPONDING PAYER;
'MX' FOR MUTALLY EXCLUSIVE BENEITS;
'CC' FOR CHANGE IN COVERAGE;
'RP' FOR RESPONDING PAYER;
'CE' FOR CENTRALIZED ELIGIBILITY;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a payer relationship type code: CP, CS, MX, CC, RP or CE.
DESCRIPTION: Identifies the relationship of the other payer information returned by the
reporting payer or entity for coordination with the Other Payer Coverage
Type (338-5C) value for that payer.
9002313.0301,2242FORMULARY ALT BENEFIT TIER D40;2 SET
'1' FOR TIER 1;
'2' FOR TIER 2;
'3' FOR TIER 3;
'4' FOR TIER 4;
'5' FOR TIER 5;
'6' FOR TIER 6;
'7' FOR TIER 7;
'8' FOR TIER 8;
'9' FOR TIER 9;
'X' FOR OTHER;
LAST EDITED: SEP 30, 2021
HELP-PROMPT: Enter a formulary benefit tier code.
DESCRIPTION:
Patient cost share tier applied to the formulary alternative product.
9002313.0301,2243FORMULARY ALT REASON CODE D40;3 SET
'1' FOR STEP THERAPY REQUIRED;
'2' FOR PRESCRIBED DRUG IS NON FORMULARY;
'3' FOR PRESCRIBED DRUG REQUIRES PRIOR AUTH;
'4' FOR PREFERRED PRODUCT;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a formulary reason code.
DESCRIPTION:
Reason for formulary alternative option(s).
9002313.0301,2244FORMLRY ALT REQ THERAPY COUNT D40;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
MAXIMUM LENGTH: 2
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the count between 1 and 99.
DESCRIPTION:
Count of Formulary Alternative Required Therapy Indicator Occurrences.
9002313.0301,2245FORMLRY ALT THERAPY INDICATOR D40;5 SET
'1' FOR REQUIRED TREATMENT NOT OTHERWISE SPECIFIED;
'2' FOR REQUIRED TREATMENT, MINIMUM TIME PERIO DURATION REQUIRED;
'3' FOR REQUIRED TREATMENT, WITHIN SPECIFIED TIME PERIOD RANGE;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a formulary alternative therapy indicator.
DESCRIPTION:
Code identifying required treatment with specified formulary alternative.
9002313.0301,2246FORMLRY ALT THERAPY TIME QUAL D40;6 SET
'1' FOR DAYS;
'2' FOR CALENDAR MONTH;
'3' FOR CALENDAR QUARTERS;
'4' FOR CALENDAR YEARS;
'5' FOR SPECIFIED DATE RANGE;
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a formulary alternative therapy time qualifying code.
DESCRIPTION: Code qualifying Formulary Alternative Required Therapy Time Period
Duration.
9002313.0301,2247FORMLRY ALT THERAPY DURATION D40;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
MAXIMUM LENGTH: 3
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter time period, 1-3 characters in length.
DESCRIPTION: Minimum amount of time period duration for required therapy. Qualified by
Formulary Alternative Required Therapy Time Period Qualifier (D46-P2).
9002313.0301,2248FORMLRY ALT THERAPY START DATE D40;8 DATE
FORMULARY ALT THERAPY START DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a start date.
9002313.0301,2249FORMLRY ALT THERAPY END DATE D40;9 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the end date.
DESCRIPTION:
End date for the required therapy time period range.
9002313.0301,2250OTHER PAYER BENEFIT CLASS D40;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter the other payer benefit classification, must be 1-10 characters in
length.
DESCRIPTION: Identifies the benefit classification for other payer information
associated to the patient (D50-P6).
9002313.0301,2254PLAN OVERRIDE INDICATOR D50;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>6!($L(X)<1) X
MAXIMUM LENGTH: 6
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the plan override indicator, must be 1-6 characters in length.
DESCRIPTION: Restricted to valid NCPDP Telecommunication request fields (field
number-ID). Example: 420-DK, 462-EV, etc.
9002313.0301,2255PLAN OVERRIDE VALUE COUNT D50;5 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: MAR 30, 2021
HELP-PROMPT: Enter a count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of plan benefit override values.
9002313.0301,2256PLAN BENEFIT OVERRIDE VALUE D50;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
MAXIMUM LENGTH: 10
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a plan benefit override value, must be 1-10 characters in length.
DESCRIPTION: Identifies the plan supported value(s) for the field identified in the Plan
Benefit Override Indicator (D54-RC).
9002313.0301,2260REGULATORY FEE COUNT D50;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter the regulatory fee count between 0 and 9, 0 decimal digits.
DESCRIPTION:
Count of Regulatory Fee Type Code (D61-RL).
9002313.0301,2261REGULATORY FEE TYPE CODE D60;1 SET
'AA' FOR LA RS 46-2625;
'AB' FOR OTHER;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a regulatory fee type code.
DESCRIPTION:
Code identifying the type of regulatory fee.
9002313.0301,2262REGULATORY FEE EXMPT INDICATOR D60;2 SET
'1' FOR PAYER/PLAN IN REGULATORY FEE EXEMPT;
'2' FOR RELIGIOUS ORGANIZATION;
'3' FOR REGULATORY FEE EXEMPT CERTIFICATE;
LAST EDITED: JUL 16, 2018
HELP-PROMPT: Enter a regulatory fee exempt indicator code.
DESCRIPTION:
Code indicating the source of the regulatory fee exempt status of claim.
9002313.0301,2265PATIENT REGULATORY FEE AMOUNT D60;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: MAY 21, 2018
HELP-PROMPT: Enter a dollar amount between 0 and 99999999, 2 decimal digits.
DESCRIPTION: Patient regulatory fee amount obligation or portion thereof when benefit is
set up to directly pass regulatory fee onto the patient.
9002313.0301,2387INVALID PROVIDER DATA SOURCE E80;7 POINTER TO BPS NCPDP INVALID PROVIDER DATA SOURCE FILE (#9002313
.42)
LAST EDITED: MAY 21, 2020
HELP-PROMPT: Enter the data source of the Invalid Provider Determination.
DESCRIPTION:
Data Source of Invalid Provider Determination, NCPDP standard field E87-ZV.
9002313.0301,2388INVALID PROVIDER SOURCE-STATE E80;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
MAXIMUM LENGTH: 2
LAST EDITED: JUL 23, 2020
HELP-PROMPT: Enter the state code of the Invalid Provider Determination, 1 to 2
characters in length.
DESCRIPTION: State Code for Data Source of Invalid Provider Determination, NCPDP
standard field E88-ZZ.
9002313.0301,2389FORMULARY ALTERNATIVE EFF DATE E80;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<8) X
MAXIMUM LENGTH: 8
OUTPUT TRANSFORM: S Y=$$FM3EXT^BPSOSU1(Y)
LAST EDITED: JUL 23, 2020
HELP-PROMPT: Enter the Formulary Alt Effective Date in CCYYMMDD format
(CC=Century,YY=Year,MM=Month,DD=Day).
DESCRIPTION:
Formulary Alternative Effective Date, NCPDP standard field E89-ZO.
9002313.0301,2393DUR/DUE CO-AGENT DESCRIPTION E90;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
MAXIMUM LENGTH: 40
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the DUR/DUE Co-Agent Description, 1-40 characters in length.
DESCRIPTION:
DUR/DUE Co-Agent Description, NCPDP standard field E93-ZC.
9002313.0301,2394UNIT OF PRIOR DISPENSED QTY E90;4 SET
'EA' FOR Each;
'GM' FOR Grams;
'ML' FOR Milliliters;
LAST EDITED: JUN 08, 2020
HELP-PROMPT: Enter the Unit of Measure for the Previous Dispensed Quantity.
DESCRIPTION: Unit of Measure for Previous Dispensed Quantity, NCPDP standard field
E94-ZA.
9002313.0301,2395OTHER PHARMACY ID QUALIFIER E90;5 POINTER TO BPS NCPDP OTHER PHARMACY ID QUALIFIER FILE (#9002313.
4)
LAST EDITED: APR 09, 2020
HELP-PROMPT: Enter the code that qualifies the Other Pharmacy ID.
DESCRIPTION:
Other Pharmacy ID Qualifier, NCPDP standard field E95-Z9.
9002313.0301,2396OTHER PHARMACY ID E90;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the Other Pharmacy ID, 1-35 characters in length.
DESCRIPTION:
Other Pharmacy ID, NCPDP standard field E96-Z8.
9002313.0301,2397OTHER PHARMACY NAME E90;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>70!($L(X)<1) X
MAXIMUM LENGTH: 70
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the Other Pharmacy Name, 1-70 characters in length.
DESCRIPTION:
Other Pharmacy Name, NCPDP standard field E97-Z7.
9002313.0301,2398OTHER PHARMACY TELEPHONE E90;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1.N) X
LAST EDITED: MAY 01, 2020
HELP-PROMPT: Enter the Other Pharmacy Telephone, must be a 10-digit number.
DESCRIPTION:
Other Pharmacy Telephone, NCPDP standard field E98-Z6.
9002313.0301,2399OTHER PRESCRIBER LAST NAME E90;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the Other Prescriber Last Name, 1-35 characters in length.
DESCRIPTION:
Other Prescriber Last Name, NCPDP standard field E99-Z5.
9002313.0301,2401OTHER PRESCRIBER ID QUALIFIER F00;1 POINTER TO BPS NCPDP OTHER PRESCRIBER ID QUALIFIER FILE (#900231
3.41)
LAST EDITED: APR 09, 2020
HELP-PROMPT: Enter the code that qualifies the Other Prescriber ID.
DESCRIPTION:
Other Prescriber ID Qualifier, NCPDP standard field F01-Z4.
9002313.0301,2402OTHER PRESCRIBER ID F00;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>35!($L(X)<1) X
MAXIMUM LENGTH: 35
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the Other Prescriber ID, 1-35 characters in length.
DESCRIPTION:
Other Prescriber ID, NCPDP standard field F02-Z3.
9002313.0301,2403OTHER PRESCRIBER PHONE NUMBER F00;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1.N) X
LAST EDITED: MAY 01, 2020
HELP-PROMPT: Enter the Other Prescriber Telephone, must be a 10-digit number.
DESCRIPTION:
Other Prescriber Telephone number, NCPDP standard field F03-Z2.
9002313.0301,2404DUR/DUE COMPOUND PRODUCT ID F00;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
MAXIMUM LENGTH: 40
LAST EDITED: JUN 08, 2020
HELP-PROMPT: Enter the Compound Product ID, 1 to 40 characters.
DESCRIPTION:
DUR/DUE Compound Product ID, NCPDP standard field F04-Z1.
9002313.0301,2405DUR/DUE CMPND PRDUCT ID QUALIF F00;5 POINTER TO BPS NCPDP COMPOUND PROD ID QUALIFIER FILE (#9002313.3
9)
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the code the qualifies the Compound Product ID.
DESCRIPTION:
DUR/DUE Compound Product ID Qualifier, NCPDP standard field F05-Z0.
9002313.0301,2406DUR/DUE MAXIMUM DAILY DOSE QTY F00;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999.999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the DUR/DUE Maximum Daily Dose Quantity, between 0 and 9999999.999, 3
decimal digits.
DESCRIPTION:
DUR/DUE Maximum Daily Dose Quantity, NCPDP standard field F06-YO.
9002313.0301,2407DUR/DUE MAX DAILY DOSE - UNIT F00;7 SET
'MME' FOR Morphine Milligram Equivalent(s) (MME) ;
'GM' FOR Gram(s);
'EA' FOR Each(es);
'MG' FOR Milligram(s);
'UN' FOR Unit(s);
'ML' FOR Milliliter(s);
'INH' FOR Inhalation(s);
'DRP' FOR Drop(s);
LAST EDITED: MAY 21, 2020
HELP-PROMPT: Select the Unit of Measure for the DUR/DUE Maximum Daily Dose Qty.
DESCRIPTION:
DUR/DUE Maximum Daily Dose Unit of Measure, NCPDP standard field F07-YL.
9002313.0301,2408DUR/DUE MINIMUM DAILY DOSE QTY F00;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999.999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: APR 28, 2020
HELP-PROMPT: Enter the DUR/DUE Minimum Daily Dose Quantity, between 0 and 9999999.999, 3
decimal digits.
DESCRIPTION:
DUR/DUE Minimum Daily Dose Quantity, NCPDP standard field F08-YJ.
9002313.0301,2409DUR/DUE MIN DAILY DOSE - UNIT F00;9 SET
'MME' FOR Morphine Milligram Equivalent(s) (MME) ;
'GM' FOR Gram(s);
'EA' FOR Each(es);
'MG' FOR Milligram(s);
'UN' FOR Unit(s);
'ML' FOR Milliliter(s);
'INH' FOR Inhalation(s);
'DRP' FOR Drop(s);
LAST EDITED: MAY 12, 2020
HELP-PROMPT: Select the Unit of Measure for the DUR/DUE Minimum Daily Dose Qty.
DESCRIPTION:
DUR/DUE Minimum Daily Dose Unit of Measure, NCPDP standard field F09-YI.
9002313.03,9999RAW DATA RECEIVED M;0 WORD-PROCESSING #9002313.39999 (NOWRAP)
HELP-PROMPT: Enter the raw NCPDP data received from the payer.
DESCRIPTION:
This is to store the raw data received from the payer.
LAST EDITED: JUN 18, 2008
DESCRIPTION: A copy of the raw data packet received. This could be of use in diagnosing weird problems, such
as the time a packet was apparently shifted two places.
FILES POINTED TO FIELDS
BPS CLAIMS (#9002313.02) BPS CLAIM (#.01)
BPS NCPDP BENEFIT STAGE INDICA
(#9002313.35) RESPONSES:BENEFIT STAGE INDICATOR (#2151)
BPS NCPDP COMPOUND PROD ID QUA
(#9002313.39) RESPONSES:DUR/DUE CMPND PRDUCT ID QUALIF (#2405)
BPS NCPDP INVALID PROVIDER DAT
(#9002313.42) RESPONSES:INVALID PROVIDER DATA SOURCE (#2387)
BPS NCPDP OTHER PAYER PROGRAM
(#9002313.38) RESPONSES:OTHER PAYER PROGRAM TYPE (#2147)
BPS NCPDP OTHER PHARMACY ID QU
(#9002313.4) RESPONSES:OTHER PHARMACY ID QUALIFIER (#2395)
BPS NCPDP OTHER PRESCRIBER ID
(#9002313.41) RESPONSES:OTHER PRESCRIBER ID QUALIFIER (#2401)
BPS NCPDP PATIENT PAY COMPONEN
(#9002313.37) RESPONSES:PATIENT PAY COMPONENT QUAL (#2195)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):