STANDARD DATA DICTIONARY #9002313.31 -- BPS CERTIFICATION FILE 3/24/25 PAGE 1
STORED IN ^BPS(9002313.31, *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 1.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
Data for development use in certifying software when required by switches and claims end processors. Also contains test claim used
by MGR/TEST option. This file is completely overwritten by installation.
DD ACCESS: @
RD ACCESS: Pp
WR ACCESS: @
DEL ACCESS: @
LAYGO ACCESS: @
AUDIT ACCESS: @
APPLICATION GROUP(S): BPS
POINTED TO BY: CERTIFICATION field (#902.23) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.57902) of the BPS LOG OF
TRANSACTIONS File (#9002313.57)
CERTIFICATION field (#902.23) of the PATIENT INSURANCE MULTIPLE sub-field (#9002313.59902) of the BPS TRANSACTION
File (#9002313.59)
CERTIFICATION IEN field (#4.06) of the BPS REQUESTS File (#9002313.77)
CERTIFICATION field (#.06) of the BPS INSURER DATA File (#9002313.78)
CROSS
REFERENCED BY: NAME(B)
9002313.31,.01NAME 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3)!'(X'?1P.E) X
LAST EDITED: JAN 16, 2004
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
Name of the certification - typically whichever Processor the certification is being done for.
CROSS-REFERENCE: 9002313.31^B
1)= S ^BPS(9002313.31,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,"B",$E(X,1,30),DA)
9002313.31,.03CLAIM 0;3 POINTER TO BPS CLAIMS FILE (#9002313.02)
LAST EDITED: MAR 14, 2007
HELP-PROMPT: Enter the BPS Claim number
DESCRIPTION:
This is the last BPS CLAIMS (#9002313.02) record that was created.
9002313.31,.04BILLING PAYER SHEET 0;4 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Enter the billing payer sheet to be used for this certification claim.
DESCRIPTION: This is the payer sheet to be used for Certification Testing when the test claim is a billing
request.
9002313.31,.05REVERSAL PAYER SHEET 0;5 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Enter the reversal payer sheet used for certification testing.
DESCRIPTION:
This is the payer sheet that will be used for certification testing when the test is a reversal.
9002313.31,.06MAX CLAIMS PER TRANSMISSION 0;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>4)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JAN 04, 2011
HELP-PROMPT: Type a number between 1 and 4, 0 decimal digits.
DESCRIPTION: This is the maximum number of claims that can be bundled in a transmission. If not entered, the
certification code will set this to 1.
9002313.31,.07COB INDICATOR 0;7 SET
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Enter whether this claim is for the primary, secondary, or tertiary payer.
DESCRIPTION: This field is used to indicate the order of the payer (first-primary, second-secondary,
third-tertiary).
9002313.31,.08ELIGIBILITY PAYER SHEET 0;8 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: AUG 17, 2011
HELP-PROMPT: Enter the eligibility payer sheet to be used for this certification claim.
DESCRIPTION: This is the payer sheet to be used for Certification Testing when the test claim is an eligibility
verification claim.
9002313.31,1 NCPDP FIELD # 1;0 POINTER Multiple #9002313.311 (Add New Entry without Asking)
DESCRIPTION:
Contains field information for any NCPDP fields which need to be defaulted.
9002313.311,.01 NCPDP FIELD # 0;1 POINTER TO BPS NCPDP FIELD DEFS FILE (#9002313.91) (Multiply asked)
LAST EDITED: SEP 28, 2000
DESCRIPTION: Pointer to the NCPDP fields file, for use in defining special values used only during
certification.
CROSS-REFERENCE: 9002313.311^B
1)= S ^BPS(9002313.31,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(1),1,"B",$E(X,1,30),DA)
9002313.311,.0199FIELD NAME ; COMPUTED
MUMPS CODE: X ^DD(9002313.311,.0199,9.3) S X=$P(Y(9002313.311,.0199,101),U,3) S D0=Y(9002313.311,.0199,80) S D1
=Y(9002313.311,.0199,81)
9.2 = S Y(9002313.311,.0199,81)=$S($D(D1):D1,1:""),Y(9002313.311,.0199,80)=$S($D(D0):D0,1:""),Y(900
2313.311,.0199,1)=$S($D(^BPS(9002313.31,D0,1,D1,0)):^(0),1:"")
9.3 = X ^DD(9002313.311,.0199,9.2) S D0=$P(Y(9002313.311,.0199,1),U,1) S:'$D(^BPSF(9002313.91,+D0,0
)) D0=-1 S Y(9002313.311,.0199,101)=$S($D(^BPSF(9002313.91,D0,0)):^(0),1:"")
ALGORITHM: NCPDP FIELD #:Name
LAST EDITED: OCT 17, 2000
DESCRIPTION:
The name of the field being used for certification.
9002313.311,.02 VALUE 0;2 FREE TEXT
INPUT TRANSFORM:K:$L(X)>200!($L(X)<1) X
LAST EDITED: SEP 28, 2000
HELP-PROMPT: Answer must be 1-200 characters in length.
DESCRIPTION:
The value (if any) that the certification information should be defaulted to.
9002313.31,2 RX IN POSITION # 2;0 Multiple #9002313.312 (Add New Entry without Asking)
DESCRIPTION:
The prescription order when submitting multiple claims in one transmission.
9002313.312,.01 RX IN POSITION # 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>4)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: SEP 28, 2000
HELP-PROMPT: Type a Number between 1 and 4, 0 Decimal Digits
DESCRIPTION:
The position within the transmission of the particular prescription that is being certified.
CROSS-REFERENCE: 9002313.312^B
1)= S ^BPS(9002313.31,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(1),2,"B",$E(X,1,30),DA)
9002313.312,1 NCPDP FIELD # 1;0 POINTER Multiple #9002313.3121 (Add New Entry without Asking)
DESCRIPTION:
The NCPDP field that needs to be defaulted.
9002313.3121,.01 NCPDP FIELD # 0;1 POINTER TO BPS NCPDP FIELD DEFS FILE (#9002313.91) (Multiply asked)
LAST EDITED: SEP 28, 2000
DESCRIPTION:
The numeric part of the NCPDP field ID.
CROSS-REFERENCE: 9002313.3121^B
1)= S ^BPS(9002313.31,DA(2),2,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(2),2,DA(1),1,"B",$E(X,1,30),DA)
9002313.3121,.0199FIELD NAME ; COMPUTED
MUMPS CODE: X ^DD(9002313.3121,.0199,9.4) S X=$P(Y(9002313.3121,.0199,101),U,3) S D0=Y(9002313.3121,.0199,80) S
D1=Y(9002313.3121,.0199,81) S D2=Y(9002313.3121,.0199,82)
9.2 = S Y(9002313.3121,.0199,82)=$S($D(D2):D2,1:""),Y(9002313.3121,.0199,81)=$S($D(D1):D1,1:""),Y(9
002313.3121,.0199,80)=$S($D(D0):D0,1:"")
9.3 = X ^DD(9002313.3121,.0199,9.2) S Y(9002313.3121,.0199,1)=$S($D(^BPS(9002313.31,D0,2,D1,1,D2,0)
):^(0),1:"")
9.4 = X ^DD(9002313.3121,.0199,9.3) S D0=$P(Y(9002313.3121,.0199,1),U,1) S:'$D(^BPSF(9002313.91,+D0
,0)) D0=-1 S Y(9002313.3121,.0199,101)=$S($D(^BPSF(9002313.91,D0,0)):^(0),1:"")
ALGORITHM: NCPDP FIELD #:Name
DESCRIPTION:
The name of the field being used for certification.
9002313.3121,.02 VALUE 0;2 FREE TEXT
INPUT TRANSFORM:K:$L(X)>200!($L(X)<1) X
LAST EDITED: SEP 28, 2000
HELP-PROMPT: Answer must be 1-200 characters in length.
DESCRIPTION:
The default value for the field.
9002313.312,2 SUB CLARIFICATION CODE MULT 2;0 Multiple #9002313.3122 (Add New Entry without Asking)
LAST EDITED: DEC 20, 2010
DESCRIPTION: This multiple will store the submission clarification codes, which will be used to populate the
NCPDP field 420-DK.
9002313.3122,.01 SUBMISSION CLARIFICATION CODE 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM:K:$L(X)>2!($L(X)<1) X
LAST EDITED: DEC 20, 2010
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION: This will be used to populate the 420-DK field, which is the code indicating that the pharmacist
is clarifying the submission.
CROSS-REFERENCE:9002313.3122^B
1)= S ^BPS(9002313.31,DA(2),2,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(2),2,DA(1),2,"B",$E(X,1,30),DA)
9002313.312,3 COB MULTIPLE 3;0 Multiple #9002313.3123 (Add New Entry without Asking)
DESCRIPTION: This multiple structure stores information about each of the other payers involved in the payment
or rejection of the claim.
9002313.3123,.01 OTHER PAYER COUNTER 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM:K:+X'=X!(X>9)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Type a number between 1 and 9, 0 decimal digits.
DESCRIPTION:
This is a counter field to store the count of the other payers.
CROSS-REFERENCE:9002313.3123^B
1)= S ^BPS(9002313.31,DA(2),2,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(2),2,DA(1),3,"B",$E(X,1,30),DA)
9002313.3123,.02 OTHER PAYER COVERAGE TYPE 0;2 SET
'01' FOR PRIMARY;
'02' FOR SECONDARY;
'03' FOR TERTIARY;
LAST EDITED: APR 01, 2013
HELP-PROMPT: Select the other payer coverage type.
DESCRIPTION: This stores the value for NCPDP field 338-5C, which is the code indicating whether the other
payer is primary, secondary, etc.
9002313.3123,.03 OTHER PAYER ID QUALIFIER 0;3 SET
'01' FOR STANDARD UNIQUE HEALTH PLAN ID;
'02' FOR HEALTH INDUSTRY NUMBER (HIN);
'03' FOR BANK IDENTIFICATION NUMBER (BIN);
'04' FOR NAT. ASSOC. OF INS. COM. (NAIC);
'05' FOR MEDICARE CARRIER NUMBER;
'09' FOR COUPON;
'99' FOR OTHER;
LAST EDITED: NOV 25, 2014
HELP-PROMPT: Select the Other Payer ID Qualifier.
DESCRIPTION: This value will be placed in the NCPDP field 339-6C, which is the code qualifying the 'Other
Payer ID' (340-7C) field.
9002313.3123,.04 OTHER PAYER ID 0;4 FREE TEXT
INPUT TRANSFORM:K:$L(X)>10!($L(X)<1) X
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Enter the Other Payer ID (1-10 characters).
DESCRIPTION: This will be used for the value in NCPDP field 340-7C, which is the ID assigned to the Other
Payer.
9002313.3123,.05 OTHER PAYER DATE 0;5 DATE
INPUT TRANSFORM:S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: FEB 10, 2011
HELP-PROMPT: Enter the payment/denial date of the claim submitted to the other payer.
DESCRIPTION: This will be used for NCPDP field 443-E8, which is the payment or denial date of the claim
submitted to the other payer.
9002313.3123,.06 OTHER PAYER AMOUNT PAID COUNT 0;6 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Enter the count (0-9) of the Other Payer Paid Amount occurrences.
DESCRIPTION: This will be used for NCPDP field 341-HB, which is the count of the Other Payer Paid Amount
occurrences.
9002313.3123,.07 OTHER PAYER REJECT COUNT 0;7 NUMBER
INPUT TRANSFORM:K:+X'=X!(X>20)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Enter the count (0-20) of the Other Payer Reject Code occurrences.
DESCRIPTION:
This is used for NCPDP field 471-5E, which is the count of Other Payer Reject Code occurrences.
9002313.3123,1 OTHER PAYER AMT PAID MULTIPLE 1;0 Multiple #9002313.31231 (Add New Entry without Asking)
DESCRIPTION:
This multiple can contain up to 9 occurrences of paid amounts from the other payer.
9002313.31231,.01 OTHER PAYER AMT PAID 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Type a dollar amount between 0 and 999999, 2 decimal digits.
DESCRIPTION: This will be used for NCPDP field 431-DV, which is the amount of any payment from the other
payer.
CROSS-REFERENCE:9002313.31231^B
1)= S ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),1,"B",$E(X,1,30),DA)
9002313.31231,.02 OTHER PAYER AMT PAID QUALIFIER 0;2 POINTER TO BPS NCPDP OTHER PAYER AMT PAID QUAL FILE (#9002313.2)
LAST EDITED: NOV 26, 2014
HELP-PROMPT: Enter the qualifier for the Other Amount Paid.
DESCRIPTION: This will go into NCPDP field 342-HC, which qualifies the payment amount in the Other Payer
Amount Paid.
9002313.3123,2 OTHER PAYER REJECT MULTIPLE 2;0 Multiple #9002313.31232 (Add New Entry without Asking)
DESCRIPTION: This multiple will store the reject codes returned by the other payer. There can be up to 20
occurrences per the NCPDP documentation.
9002313.31232,.01 OTHER PAYER REJECT CODE 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM:K:$L(X)>3!($L(X)<1) X
LAST EDITED: JAN 05, 2011
HELP-PROMPT: Enter a reject code returned by the Other Payer.
DESCRIPTION:
This will be used for field 472-6E, which is the reject code returned by the other payer.
CROSS-REFERENCE:9002313.31232^B
1)= S ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),2,"B",$E(X,1,30),DA)
9002313.3123,3 OTHER PAYER PATIENT RESP MULT 3;0 Multiple #9002313.31233 (Add New Entry without Asking)
DESCRIPTION: This multiple holds the paid amounts that are the responsibility of the patient from a
previous payer.
9002313.31233,.01 OTHER PAYER PATIENT PAID AMT 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: DEC 17, 2010
HELP-PROMPT: Type a dollar amount between 0 and 999999, 2 decimal digits.
DESCRIPTION: This field has the data for NCPDP field 352-NQ, which is the patient's cost share from a
previous payer.
CROSS-REFERENCE:9002313.31233^B
1)= S ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),3,"B",$E(X,1,30),DA)
9002313.31233,.02 OTHER PAYER PATIENT RESP QUAL 0;2 SET
'01' FOR DEDUCTIBLE;
'02' FOR BRAND DRUG;
'03' FOR SALES TAX;
'04' FOR PERIODIC BENEFIT;
'05' FOR COPAY;
'06' FOR PATIENT PAY AMOUNT;
'07' FOR COINSURANCE;
'08' FOR NON-PREF;
'09' FOR HPAA;
'10' FOR PROV NETWORK SEL;
'11' FOR BRAND NON-PREF;
'12' FOR COVERAGE GAP;
'13' FOR PROCESSOR FEE;
LAST EDITED: APR 01, 2013
HELP-PROMPT: Enter the qualifier for the Other Payer Patient Responsibility Amount.
DESCRIPTION: This will be used for NCPDP field 351-NP, which qualifies the payment in the Other
Payer-Patient Responsibility Paid Amount.
9002313.3123,4 BENEFIT STAGE MULT 4;0 Multiple #9002313.31234 (Add New Entry without Asking)
DESCRIPTION: This multiple can contain up to four occurrences of Medicare Part D beneficiary benefit
stages.
9002313.31234,.01 BENEFIT STAGE AMOUNT 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: AUG 09, 2011
HELP-PROMPT: Type a dollar amount between 0 and 999999, 2 decimal digits.
DESCRIPTION: This will be used for NCPDP field 394-MW (Benefit Stage Amount), which is the amount of
claim allocated to the Medicare stage identified by field 393-MV (Benefit Stage
Qualifier).
CROSS-REFERENCE:9002313.31234^B
1)= S ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),4,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(3),2,DA(2),3,DA(1),4,"B",$E(X,1,30),DA)
9002313.31234,.02 BENEFIT STAGE QUALIFIER 0;2 SET
'1' FOR DEDUCT;
'2' FOR INIT BEN;
'3' FOR COV GAP;
'4' FOR CAT. COV;
'50' FOR MA-PD PLAN;
'60' FOR OLD SUPP BENEFIT;
'61' FOR PART D DRUG CO-ADMIN;
'62' FOR NON-QUAL DRUG CO-ADMIN;
'63' FOR NON-PART D BEN UNDER MMP PLAN;
'70' FOR PART D DRUG BEN;
'80' FOR NON-QUAL DRUG BEN;
'90' FOR OTC DRUG;
LAST EDITED: DEC 01, 2014
HELP-PROMPT: Enter the code that describes the Benefit Stage Amount.
DESCRIPTION: This is used for NCPDP field 393-MV (Benefit Stage Qualifier), which is used to qualify
the Benefit Stage Amount.
9002313.312,4 OTHER AMT CLAIMED MULT 4;0 Multiple #9002313.3124 (Add New Entry without Asking)
DESCRIPTION:
This multiple can contain up to three occurrences of less common charges.
9002313.3124,.01 OTHER AMOUNT CLAIMED SUBMITTED 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM:S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: AUG 17, 2011
HELP-PROMPT: Type a dollar amount between 0 and 999999, 2 decimal digits.
DESCRIPTION: This will be used for NCPDP field 480-H9 (Other Claim Amount Submitted), which holds
the dollar amount that represents the additional incurred costs for a dispensed
prescription.
CROSS-REFERENCE:9002313.3124^B
1)= S ^BPS(9002313.31,DA(2),2,DA(1),4,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.31,DA(2),2,DA(1),4,"B",$E(X,1,30),DA)
9002313.3124,.02 OTHER AMOUNT CLAIMED QUALIFIER 0;2 SET
'01' FOR DELIVERY COST;
'02' FOR SHIPPING COST;
'03' FOR POSTAGE COST;
'04' FOR ADMINISTRATIVE COST;
'09' FOR COMPOUND PREP COST SUBMITTED;
'11' FOR MEDICATION ADMINISTRATION;
'99' FOR OTHER;
LAST EDITED: NOV 25, 2014
HELP-PROMPT: Enter the code that describes the Other Amount Claimed Submitted.
DESCRIPTION: This will be used for NCPDP field 479-H8 (Other Amount Claimed Submitted Qualifier),
which is used to describe the dollar amount in the 480-H9 field.
9002313.31,903PATIENT IEN 4;2 POINTER TO PATIENT FILE (#2)
LAST EDITED: NOV 05, 2003
DESCRIPTION: Pointer to the patient file to link the patient being used for certification to the certification
being performed.
FILES POINTED TO FIELDS
BPS CLAIMS (#9002313.02) CLAIM (#.03)
BPS NCPDP FIELD DEFS (#9002313.91) NCPDP FIELD #:NCPDP FIELD # (#.01)
NCPDP FIELD #:NCPDP FIELD # (#.01)
BPS NCPDP FORMATS (#9002313.92) BILLING PAYER SHEET (#.04)
REVERSAL PAYER SHEET (#.05)
ELIGIBILITY PAYER SHEET (#.08)
BPS NCPDP OTHER PAYER AMT PAID
(#9002313.2) OTHER PAYER AMT PAID MULTIPLE:OTHER PAYER AMT PAID QUALIFIER (#.02)
PATIENT (#2) PATIENT IEN (#903)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):