STANDARD DATA DICTIONARY #9002313.59 -- BPS TRANSACTION FILE 3/24/25 PAGE 1
STORED IN ^BPST( *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 1.0)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
Transactions in progress. When complete (status 99), a copy of the record is placed in 9002313.57.
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: TRANSACTION field (#.08) of the BPS CLAIMS File (#9002313.02)
PROBER CLAIM field (#.04) of the BPS ASLEEP PAYERS File (#9002313.15)
ECME TRANSACTION RECORD field (#.06) of the BPS REQUESTS File (#9002313.77)
ASLEEP PROBER field (#1.11) of the BPS NCPDP FORMATS File (#9002313.92)
CROSS
REFERENCED BY: PATIENT(AC), STATUS(AD), CLAIM(AE), REVERSAL CLAIM(AER), RESPONSE(AF), REVERSAL RESPONSE(AFR), USER(AG),
LAST UPDATE(AH), SUBMIT REQUEST DATE TIME(AS), ASLEEP PAYER(ASL), ENTRY NUMBER(B)
LAST MODIFIED: NOV 21,2024@17:14:09
9002313.59,.01ENTRY NUMBER 0;1 FREE TEXT (Required)
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Transaction entry number.
CROSS-REFERENCE: 9002313.59^B
1)= S ^BPST("B",$E(X,1,30),DA)=""
2)= K ^BPST("B",$E(X,1,30),DA)
9002313.59,1 STATUS 0;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: FEB 27, 2007
HELP-PROMPT: Type a Number between 0 and 99, 0 Decimal Digits
DESCRIPTION: The status of the transaction as a percentage of completion. The text value can be obtained by
running $$STATI^BPSOSU(). Note that 99 indicates complete.
CROSS-REFERENCE: 9002313.59^AD
1)= S ^BPST("AD",$E(X,1,30),DA)=""
2)= K ^BPST("AD",$E(X,1,30),DA)
9002313.59,1.05POLICY NUMBER 1;5 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Enter the policy number that will be processed for this request (0-9999).
DESCRIPTION:
This is the policy number that is being processed for this eligibility verification request.
9002313.59,1.07PHARMACY 1;7 POINTER TO BPS PHARMACIES FILE (#9002313.56)
LAST EDITED: NOV 25, 2003
HELP-PROMPT: Answer with BPS PHARMACIES NAME
DESCRIPTION:
Textual description of the Pharmacy involved with this transaction.
9002313.59,1.08PINS PIECE 1;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 18, 2000
HELP-PROMPT: Type a Number between 1 and 9, 0 Decimal Digits
DESCRIPTION: Pointer to which of the PINS pieces in ^(6) is in use for this claim. Use this to keep track of
where you are in billing down the line to various insurers. (Probably won't automatically roll
over to next insurer, but maybe we will have an option to edit insurance info, try next insurance,
etc.)
9002313.59,1.09PRIOR AUTHORIZATION NUMBER 1;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<1) X
LAST EDITED: MAR 19, 2008
HELP-PROMPT: Enter the prior authorization number (1-11 characters)
DESCRIPTION:
Number assigned by the processor to identify a prior authorized transaction.
9002313.59,1.11PRESCRIPTION NUMBER 1;11 POINTER TO PRESCRIPTION FILE (#52)
LAST EDITED: JUN 03, 2008
HELP-PROMPT: Answer with PRESCRIPTION RX #
DESCRIPTION:
This stores a pointer from the PRESCRIPTION (#52) file.
9002313.59,1.1199RXI INTERNAL ; COMPUTED
MUMPS CODE: S Y(9002313.59,1.1199,1)=$S($D(^BPST(D0,1)):^(1),1:"") S X=$P(Y(9002313.59,1.1199,1),U,11),X=X
ALGORITHM: INTERNAL(ABSBRXI)
LAST EDITED: NOV 25, 2003
DESCRIPTION:
Internal ID to the claims file.
9002313.59,1.12RESUBMIT AFTER REVERSAL 1;12 SET
'1' FOR RESUBMIT AFTER REVERSAL;
'0' FOR DONE;
'2' FOR RESUBMITTING;
LAST EDITED: DEC 07, 2005
HELP-PROMPT: Enter the status of the resubmit
DESCRIPTION:
Indicator that a transaction has been resubmitted after being backed out.
9002313.59,1.13NCPDP OVERRIDES 1;13 POINTER TO BPS NCPDP OVERRIDE FILE (#9002313.511)
LAST EDITED: OCT 19, 2000
HELP-PROMPT: Enter an NCPDP field to be overridden during transmission of this transaction.
DESCRIPTION:
Override information for the NCPDP fields.
9002313.59,1.15PRIOR AUTHORIZATION TYPE CODE 1;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: MAR 14, 2007
HELP-PROMPT: Enter the prior authorization type (1-2 characters)
DESCRIPTION:
Indicates the type of authorization made before transaction was submitted.
9002313.59,2 HL7 MESSAGE ID 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
LAST EDITED: JUN 27, 2011
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION:
This is the unique HL7 message ID used for the NCPDP message created for this transaction.
9002313.59,3 CLAIM 0;4 POINTER TO BPS CLAIMS FILE (#9002313.02)
LAST EDITED: NOV 25, 2003
HELP-PROMPT: Answer with BPS CLAIMS CLAIM ID
DESCRIPTION:
Claim number for this transaction.
CROSS-REFERENCE: 9002313.59^AE
1)= S ^BPST("AE",$E(X,1,30),DA)=""
2)= K ^BPST("AE",$E(X,1,30),DA)
9002313.59,3.1CLAIM IEN ; COMPUTED
MUMPS CODE: S Y(9002313.59,3.1,1)=$S($D(^BPST(D0,0)):^(0),1:"") S X=$P(Y(9002313.59,3.1,1),U,4),X=X
ALGORITHM: INTERNAL(CLAIM)
LAST EDITED: NOV 25, 2003
DESCRIPTION:
Claim internal identifier for this transaction.
9002313.59,4 RESPONSE 0;5 POINTER TO BPS RESPONSES FILE (#9002313.03)
LAST EDITED: NOV 25, 2003
HELP-PROMPT: Answer with BPS RESPONSES ID
DESCRIPTION:
Textual description of the response to this submission.
CROSS-REFERENCE: 9002313.59^AF
1)= S ^BPST("AF",$E(X,1,30),DA)=""
2)= K ^BPST("AF",$E(X,1,30),DA)
9002313.59,4.0098RESULT WITH REVERSAL ; COMPUTED
MUMPS CODE: S X=$$CATEG^BPSOSUC(D0,1)
ALGORITHM: S X=$$CATEG^BPSOSUC(D0,1)
DESCRIPTION:
The overall result.
9002313.59,4.0099RESULT ; COMPUTED
MUMPS CODE: S X=$$CATEG^BPSOSUC(D0)
ALGORITHM: S X=$$CATEG^BPSOSUC(D0)
DESCRIPTION:
The result of the transmission.
9002313.59,4.1RESPONSE IEN ; COMPUTED
MUMPS CODE: S Y(9002313.59,4.1,1)=$S($D(^BPST(D0,0)):^(0),1:"") S X=$P(Y(9002313.59,4.1,1),U,5),X=X
ALGORITHM: INTERNAL(RESPONSE)
LAST EDITED: NOV 25, 2003
DESCRIPTION:
Internal identifier for the response.
9002313.59,5 PATIENT 0;6 POINTER TO PATIENT FILE (#2)
LAST EDITED: JUN 09, 2004
HELP-PROMPT: Answer with PATIENT NAME
DESCRIPTION:
Patient name.
CROSS-REFERENCE: 9002313.59^AC
1)= S ^BPST("AC",$E(X,1,30),DA)=""
2)= K ^BPST("AC",$E(X,1,30),DA)
9002313.59,6 SUBMIT DATE 0;7 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Enter the date/time that the claim was submitted
DESCRIPTION:
This is the date/time that the RX/Fill was submitted to ECME
9002313.59,7 LAST UPDATE 0;8 DATE
INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUN 13, 2008
HELP-PROMPT: Enter the Date/Time this Transaction was last updated.
DESCRIPTION:
Last date this record was updated.
CROSS-REFERENCE: 9002313.59^AH
1)= S ^BPST("AH",$E(X,1,30),DA)=""
2)= K ^BPST("AH",$E(X,1,30),DA)
9002313.59,9 FILL NUMBER 1;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Type a number between 0 and 99, 0 Decimal Digits
DESCRIPTION:
Prescription fill/refill number.
9002313.59,10 NDC 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<5) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 5-11 characters in length.
DESCRIPTION:
The NDC number of the drug involved in this transaction.
9002313.59,10.0099USER NUMBER ; COMPUTED
MUMPS CODE: S Y(9002313.59,10.0099,1)=$S($D(^BPST(D0,0)):^(0),1:"") S X=$P(Y(9002313.59,10.0099,1),U,10),X=X
ALGORITHM: INTERNAL(USER)
LAST EDITED: JAN 02, 2008
DESCRIPTION:
The DUZ of the user who sent the transaction.
9002313.59,11 PHARMACY DIVISION 1;4 POINTER TO OUTPATIENT SITE FILE (#59)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Select the Pharmacy Division
DESCRIPTION:
The division ID for the transaction.
9002313.59,13 USER 0;10 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer with NEW PERSON NAME
DESCRIPTION:
User name who entered this transaction.
CROSS-REFERENCE: 9002313.59^AG
1)= S ^BPST("AG",$E(X,1,30),DA)=""
2)= K ^BPST("AG",$E(X,1,30),DA)
9002313.59,14 POSITION IN CLAIM 0;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: NOV 25, 2003
HELP-PROMPT: Type a Number between 1 and 99, 0 Decimal Digits
DESCRIPTION:
Sequential order in the claim transactions.
9002313.59,15 START TIME 0;11 DATE
INPUT TRANSFORM: S %DT="EST" D ^%DT S X=Y K:Y<1 X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Answer with the date/time this transaction was started.
DESCRIPTION:
Time this transaction was started.
9002313.59,16 SUBMIT REQUEST 0;12 POINTER TO BPS REQUESTS FILE (#9002313.77)
LAST EDITED: DEC 12, 2007
HELP-PROMPT: Answer with BPS REQUESTS RX NUMBER
DESCRIPTION:
IEN of the BPS REQUEST file (#9002313.77)
9002313.59,17 SUBMIT REQUEST DATE TIME 0;13 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 12, 2007
HELP-PROMPT: Answer with the date/time this request was submitted.
DESCRIPTION:
Submit Request Date/Time
CROSS-REFERENCE: 9002313.59^AS
1)= S ^BPST("AS",$E(X,1,30),DA)=""
2)= K ^BPST("AS",$E(X,1,30),DA)
Submit Request Date/Time cross-reference - when the request was placed to the queue.
9002313.59,18 COB INDICATOR 0;14 SET
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: DEC 03, 2007
HELP-PROMPT: Answer with a Coordination of Benefits indicator
DESCRIPTION:
COB indicator.
9002313.59,19 TRANSACTION TYPE 0;15 SET
'C' FOR CLAIM;
'E' FOR ELIGIBILITY;
'U' FOR UNCLAIM;
'N' FOR NON-BILLABLE;
LAST EDITED: MAY 14, 2015
HELP-PROMPT: Answer with the type of transaction that will be processed for this NCPDP request.
DESCRIPTION: This is the type of transaction that is being processed:
CLAIM - An NCPDP billing request.
UNCLAIM - An NCPDP reversal request.
ELIGIBILITY - An eligibility verification request.
NON-BILLABLE - A TRICARE/CHAMPVA non-billable prescription.
TECHNICAL DESCR:
NON-BILLABLE has been added with patch BPS*1*20.
9002313.59,111COMMENT MULTIPLE 11;0 DATE Multiple #9002313.59111 (Add New Entry without Asking)
LAST EDITED: JUN 27, 2005
HELP-PROMPT: Enter the date/time of a user's comments
DESCRIPTION:
User's comment
9002313.59111,.01DATE 0;1 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAY 03, 2005
HELP-PROMPT: Answer with a date of the comment.
DESCRIPTION:
To store user's comments date
CROSS-REFERENCE: 9002313.59111^B
1)= S ^BPST(DA(1),11,"B",$E(X,1,30),DA)=""
2)= K ^BPST(DA(1),11,"B",$E(X,1,30),DA)
9002313.59111,.02USER 0;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 13, 2008
HELP-PROMPT: Enter the user who entered this comment.
DESCRIPTION:
ECME user
9002313.59111,.03COMMENT 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>74!($L(X)<1) X
LAST EDITED: MAY 03, 2005
HELP-PROMPT: Answer must be 1-74 characters in length.
DESCRIPTION:
Comment text
9002313.59111,.04PHARMACY 0;4 SET
'1' FOR YES;
'0' FOR NO;
LAST EDITED: MAY 08, 2015
HELP-PROMPT: Enter '1' or 'Yes' if this is a pharmacy comment.
DESCRIPTION:
This field is used to determine whether or not this is a pharmacy comment.
9002313.59,201RESULT CODE 2;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999.999)!(X<0)!(X?.E1"."8N.N) X
LAST EDITED: JUN 03, 2008
HELP-PROMPT: Type a Number between 0 and 999.999, 7 Decimal Digits
DESCRIPTION:
Code indicating the result of the adjudication of this claim.
9002313.59,202RESULT TEXT 2;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>200!($L(X)<1) X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Answer must be 1-200 characters in length.
DESCRIPTION:
Textual explanation of the result code.
9002313.59,301NON-BILLABLE REASON 3;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
LAST EDITED: AUG 19, 2015
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION: This is the reason why this prescription is Non-Billable. It is the free text value as returned by
the IB Billing Determination process. This is only for TRICARE or CHAMPVA prescriptions.
TECHNICAL DESCR: This value comes from piece [2] of the return value of $$RX^IBNCPDP when the prescription is
reported as non-billable. This is only for TRICARE or CHAMPVA prescriptions.
9002313.59,302NON-BILLABLE CLOSED 3;2 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: MAY 14, 2015
HELP-PROMPT: Enter Yes if the Non-Billable entry is Closed.
DESCRIPTION: Enter Yes if this Non-Billable entry has been Closed. Enter No if this Non-Billable entry is still
Open. When Non-Billable entries are initially created in the BPS Transaction file, they are
automatically defaulted to Open.
9002313.59,303NON-BILLABLE DATE CLOSED 3;3 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: MAY 14, 2015
HELP-PROMPT: Enter the date and time when this Non-Billable entry was closed.
DESCRIPTION: This field contains the date and time when this Non-Billable entry was closed. It is set by the
system when a user performs this action on the ECME User Screen.
9002313.59,304NON-BILLABLE CLOSED BY 3;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 15, 2015
HELP-PROMPT: Enter the person who closed this non-billable entry.
DESCRIPTION: This is the person who closed this non-billable entry. It is automatically populated when this
close action happens.
9002313.59,305NON-BILLABLE CLOSED COMMENT 3;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: MAY 15, 2015
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
This is a free text comment explaining why this non-billable entry is being closed.
9002313.59,306NON-BILLABLE DATE RE-OPENED 3;6 DATE
INPUT TRANSFORM: S %DT="ESTXR" D ^%DT S X=Y K:X<1 X
LAST EDITED: MAY 15, 2015
HELP-PROMPT: Enter the date and time when the non-billable entry was re-opened.
DESCRIPTION:
This is the date and time when the user re-opened the non-billable entry.
9002313.59,307NON-BILLABLE RE-OPENED BY 3;7 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: MAY 15, 2015
HELP-PROMPT: Enter the user who re-opened this non-billable entry.
DESCRIPTION: This is the user who re-opened this non-billable entry. It is set automatically by the system when
this action is performed.
9002313.59,308NON-BILLABLE RE-OPENED COMMENT 3;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: MAY 15, 2015
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION: This field holds the free-text comments entered by the user for the reason that this non-billable
entry was re-opened.
9002313.59,401REVERSAL CLAIM 4;1 POINTER TO BPS CLAIMS FILE (#9002313.02)
LAST EDITED: NOV 25, 2003
HELP-PROMPT: Answer with BPS CLAIMS CLAIM ID for the reversal.
DESCRIPTION:
Request to reverse this claim.
CROSS-REFERENCE: 9002313.59^AER
1)= S ^BPST("AER",$E(X,1,30),DA)=""
2)= K ^BPST("AER",$E(X,1,30),DA)
^BPST("AER",reversal claim #,IEN59)=""
9002313.59,402REVERSAL RESPONSE 4;2 POINTER TO BPS RESPONSES FILE (#9002313.03)
LAST EDITED: NOV 25, 2003
HELP-PROMPT: Answer with BPS RESPONSES BPS CLAIM for the reversal.
DESCRIPTION:
Response to reversal message.
CROSS-REFERENCE: 9002313.59^AFR
1)= S ^BPST("AFR",$E(X,1,30),DA)=""
2)= K ^BPST("AFR",$E(X,1,30),DA)
^BPST("AFR",reversal response,IEN59)=""
9002313.59,404REVERSAL REASON 4;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: MAY 25, 2005
HELP-PROMPT: Answer must be 1-40 characters in length
DESCRIPTION:
Reason for the reversal
9002313.59,405REVERSAL REQUEST 4;5 POINTER TO BPS REQUESTS FILE (#9002313.77)
LAST EDITED: DEC 12, 2007
HELP-PROMPT: Answer with BPS REQUESTS RX NUMBER for the reversal.
DESCRIPTION:
Reversal Request IEN
9002313.59,406REVERSAL REQUEST DATE TIME 4;6 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: DEC 12, 2007
HELP-PROMPT: Answer with the Reversal Request Date/Time
DESCRIPTION:
Reversal Request Date/Time
9002313.59,501QUANTITY 5;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Type a number between 0 and 9999999, 3 decimal digits.
DESCRIPTION: This is the quantity that will be used for the NCPDP field 442-E7 (QUANTITY DISPENSED) of the NCPDP
submission.
9002313.59,502UNIT PRICE 5;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."7N.N) X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Type a Number between 0 and 9999999, 6 Decimal Digits
DESCRIPTION:
Price per unit of prescription.
9002313.59,503SUBTOTAL 5;3 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."7N.N) X
LAST EDITED: MAR 13, 2000
HELP-PROMPT: Type a Number between 0 and 999999, 6 Decimal Digits
DESCRIPTION: = QUANTITY * UNIT PRICE This is probably what we want to send as the INGREDIENT COST field in the
NCPDP message.
9002313.59,504DISPENSING FEE 5;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99)!(X<0) X
LAST EDITED: MAR 13, 2000
HELP-PROMPT: Type a Dollar Amount between 0 and 99, 2 Decimal Digits
DESCRIPTION: Storing it here, since it can vary by insurer (or maybe by Pharmacy, too? maybe we want to put a
field in 9002313.56)
9002313.59,505TOTAL PRICE 5;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
OUTPUT TRANSFORM: S X=$J(X,0,2)
LAST EDITED: JAN 16, 2004
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION:
=SUBTOTAL + DISPENSING FEE
9002313.59,507ADMINISTRATIVE FEE 5;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
Any fee charged for handling of the paperwork.
9002313.59,508UNIT OF MEASURE 5;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUN 27, 2007
HELP-PROMPT: Enter the Unit of Measure (1-2 characters)
DESCRIPTION: Enter the Unit of Measure for the drug. This is usually GR (grams), ML (milliliters), or EA
(Each).
9002313.59,509BILLING QUANTITY 5;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Type a number between 0 and 999999, 2 decimal digits.
DESCRIPTION: This is the quantity from the prescription and is used to calculate the ingredient cost. It may be
different than the quantity used in the actual NCPDP submission.
9002313.59,510BILLING UNIT 5;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 03, 2011
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the billing units associated with the billing quantity.
9002313.59,801ASLEEP PAYER 8;1 POINTER TO BPS ASLEEP PAYERS FILE (#9002313.15)
LAST EDITED: JUN 13, 2008
HELP-PROMPT: Specify a payer that is identified as being asleep.
DESCRIPTION:
This field identifies an asleep payer for this transaction.
CROSS-REFERENCE: 9002313.59^ASL
1)= S ^BPST("ASL",$E(X,1,30),DA)=""
2)= K ^BPST("ASL",$E(X,1,30),DA)
9002313.59,901CURRENT VA INSURER 9;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: JUN 26, 2003
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION: The insurer being submitted to currently, if there are Primary, Secondary, and tertiary insurers
defined.
9002313.59,901.04ELIGIBILITY 9;4 SET
'V' FOR VETERAN;
'T' FOR TRICARE;
'C' FOR CHAMPVA;
LAST EDITED: OCT 24, 2007
HELP-PROMPT: Enter (V)eteran, (T)ricare, or (C)hampVA.
DESCRIPTION:
The insurance eligibility type of the claim.
9002313.59,902PATIENT INSURANCE MULTIPLE 10;0 POINTER Multiple #9002313.59902 (Add New Entry without Asking)
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer with GROUP INSURANCE PLAN.
DESCRIPTION:
List of the insurers for the patient.
9002313.59902,.01PLAN ID 0;1 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) (Multiply asked)
LAST EDITED: JUL 27, 2005
HELP-PROMPT: Enter Group Insurance record
DESCRIPTION:
ID assigned to the insurance plan.
CROSS-REFERENCE: 9002313.59902^B
1)= S ^BPST(DA(1),10,"B",$E(X,1,30),DA)=""
2)= K ^BPST(DA(1),10,"B",$E(X,1,30),DA)
9002313.59902,902.02B1 PAYER SHEET 0;2 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Answer with a billing payer sheet to be used for this payer.
DESCRIPTION: This is the payer sheet used to submit billing request for this particular insurer. Billing
request transmissions will be formatted per the specifications in this payer sheet.
9002313.59902,902.03BIN 1;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
Card Issuer ID or Bank ID Number used for network routing.
9002313.59902,902.04PCN 1;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
The processor control number for this claim.
9002313.59902,902.05GROUP ID 1;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: SEP 13, 2005
HELP-PROMPT: Answer must be 1-17 characters in length
DESCRIPTION:
ID assigned to the cardholder group or employer group.
9002313.59902,902.06CARDHOLDER ID 1;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
ID number assigned to Cardholder/Subscriber.
9002313.59902,902.07PATIENT RELATIONSHIP CODE 1;5 SET
'0' FOR NOT SPECIFIED;
'1' FOR CARDHOLDER (SELF);
'2' FOR SPOUSE;
'3' FOR CHILD;
'4' FOR OTHER;
LAST EDITED: APR 22, 2011
HELP-PROMPT: Enter the relationship of the patient to the insured.
DESCRIPTION: This stores the relationship of the patient to insurance subscriber and will be used to populate
the NCPDP 306-C6 (PATIENT RELATIONSHIP CODE) field.
9002313.59902,902.08CARDHOLDER FIRST NAME 1;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JAN 19, 2005
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
First name of the Cardholder/Subscriber.
9002313.59902,902.09CARDHOLDER LAST NAME 1;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>15!($L(X)<1) X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Answer must be 1-15 characters in length.
DESCRIPTION:
Last name of the Cardholder/Subscriber.
9002313.59902,902.1PERSON CODE 1;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Enter the person code for the NCPDP request (1-3 characters).
DESCRIPTION: This is the Person Code that will be placed in NCPDP field 303-C3 (Person Code). This value is
specified by the third-party payer and is found on the patient's insurance card.
9002313.59902,902.11HOME PLAN STATE 1;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: NOV 26, 2003
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Usually the state where the member lives or purchased their coverage.
9002313.59902,902.12DISPENSING FEE SUBMITTED 2;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Type a Dollar amount between 0 and 99999, 2 Decimal Digits
DESCRIPTION:
Fee amount submitted for the cost associated with dispensing this prescription.
9002313.59902,902.13BASIS OF COST DETERMINATION 2;2 SET
'01' FOR AWP;
'05' FOR Cost Calculations;
'07' FOR Usual & Customary;
LAST EDITED: JUN 03, 2008
HELP-PROMPT: Answer with the basis code for which the cost was determined.
DESCRIPTION:
Code indicating the method by which 'Ingredient Cost Submitted' was calculated.
9002313.59902,902.14USUAL CUSTOMARY CHARGE 2;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Type a Dollar amount between 0 and 99999, 2 Decimal Digits
DESCRIPTION: Amount charged cash customers for the prescription exclusive of sales tax or other amounts
claimed.
9002313.59902,902.15GROSS AMOUNT DUE 2;4 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Type a Dollar amount between 0 and 99999, 2 Decimal Digits
DESCRIPTION: Total price claimed from all sources. For prescription claim request, field represents a sum of
'Ingredient Cost Submitted' (4�9-D9), 'Dispensing Fee Submitted' (412-DC), 'Flat Sales Tax
Amount Submitted'(481-HA), 'Percentage Sales Tax Amount Submitted' (482-GE), 'Incentive Amount
Submitted' (438-E3), 'Other Amount Claimed' (48�-H9). For service claim request, field represents
a sum of 'Professional Services Fee Submitted' (477-BE), 'Flat Sales Tax Amount
Submitted'(481-HA), 'Percentage Sales Tax Amount Submitted'(482-GE), 'Other Amount Claimed'
(48�-H9).
9002313.59902,902.16ADMINISTRATIVE FEE 2;5 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Type a Dollar amount between 0 and 99999, 2 Decimal Digits
DESCRIPTION:
Fee charged for any costs related to preparing the prescription.
9002313.59902,902.17VA FILL NUMBER 2;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Type a number between 0 and 99, 0 Decimal Digits
DESCRIPTION:
Which fill number this transaction is in reference to. Starts with '0' for the original fill.
9002313.59902,902.18SOFTWARE VENDOR CERT ID 2;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JAN 02, 2008
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Certification number assigned by the payer for submission of claims.
9002313.59902,902.19B2 PAYER SHEET 0;3 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: MAR 19, 2008
HELP-PROMPT: Enter the reversal payer sheet IEN.
DESCRIPTION:
Enter the Reversal Payer sheet IEN.
9002313.59902,902.2INGREDIENT COST 2;10 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Type a number between 0 and 999999, 2 decimal digits.
DESCRIPTION: This is the INGREDIENT COST that will be placed in the NCPDP field 409-D9 (INGREDIENT COST
SUBMITTED) field of the NCPDP submission.
9002313.59902,902.21B3 PAYER SHEET 0;4 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Enter the rebill payer sheet used for this payer.
DESCRIPTION: This is the payer sheet to be used for a rebill request for this insurer. Rebill transmission
will be formatted per the specifications in this payer sheet.
9002313.59902,902.22CERTIFY MODE 0;5 SET
'0' FOR CERTIFY MODE OFF;
'1' FOR CERTFIY MODE ON;
LAST EDITED: JUN 03, 2008
HELP-PROMPT: Enter null or 0 for certify mode off. Enter 1 for Certify mode on.
DESCRIPTION:
Enter null or 0 for certify mode off. Enter 1 for certify mode on.
9002313.59902,902.23CERTIFICATION 0;6 POINTER TO BPS CERTIFICATION FILE (#9002313.31)
LAST EDITED: MAR 19, 2008
HELP-PROMPT: Enter the Certification record
DESCRIPTION: This field is used during certification testing, and points to the entry to use to pull
certification data.
9002313.59902,902.24INSURANCE NAME 0;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: JUN 03, 2008
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION: This is the free text name of the Insurance Company as determined by Integrated Billing insurance
files.
9002313.59902,902.25GROUP NAME 3;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<2) X
LAST EDITED: SEP 13, 2005
HELP-PROMPT: Answer must be 2-20 characters in length
DESCRIPTION:
This is the group name from the Group Insurance File
9002313.59902,902.26INSURANCE CO PHONE 3;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<7) X
LAST EDITED: MAR 19, 2008
HELP-PROMPT: Answer must be 7-20 characters in length
DESCRIPTION:
This is the Claim (RX) phone number from the Insurance Company file
9002313.59902,902.27PHARMACY PLAN ID 3;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: JUN 17, 2005
HELP-PROMPT: Answer must be 1-30 characters in length
DESCRIPTION:
This is a ID of the plan file
9002313.59902,902.28ELIGIBILITY 3;4 SET
'V' FOR VETERAN;
'T' FOR TRICARE;
'C' FOR CHAMPVA;
LAST EDITED: AUG 04, 2011
HELP-PROMPT: Enter eligibility of the claim.
DESCRIPTION:
The insurance eligibility type of the claim.
9002313.59902,902.29RATE TYPE 0;8 POINTER TO RATE TYPE FILE (#399.3)
LAST EDITED: JAN 09, 2009
HELP-PROMPT: Select Rate Type for billing
DESCRIPTION:
The Rate Type selected by the user for billing.
9002313.59902,902.3PRIMARY PAYER BILL 2;8 POINTER TO BILL/CLAIMS FILE (#399)
LAST EDITED: JAN 09, 2009
HELP-PROMPT: Select Primary bill for secondary billing.
DESCRIPTION: Primary bill which should be used to create the secondary bill. This field is used for secondary
billing only.
9002313.59902,902.31PRIOR PAYMENT 2;9 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAR 26, 2009
HELP-PROMPT: Enter a Dollar Amount (between 0 and 999999, 2 Decimal Digits) paid by primary insurer.
DESCRIPTION:
Dollar amount paid by the Primary insurer. This field is used for secondary billing only.
9002313.59902,902.32PLAN COB 3;6 SET
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: MAR 26, 2009
HELP-PROMPT: Enter Coordination Of Benefits indicator for the insurance plan.
DESCRIPTION: The Coordination of Benefits value as it is stored in (#.2) COB field of the (#.3121) Insurance
Type multiple of the Patient file (#2).
9002313.59902,902.33INSURANCE COMPANY 3;5 POINTER TO INSURANCE COMPANY FILE (#36)
LAST EDITED: JAN 16, 2009
HELP-PROMPT: Select the insurance carrier for this claim.
DESCRIPTION:
This is the INSURANCE COMPANY from file #36.
9002313.59902,902.34E1 PAYER SHEET 0;9 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Enter the eligibility verification payer sheet for the payer.
DESCRIPTION: This is the payer sheet to be used for eligibility verification requests for this insurer.
Eligibility verification transmissions will be formatted per the specifications in this payer
sheet.
9002313.59902,902.35POLICY NUMBER 0;12 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Enter the policy number for this insurer (0-9999).
DESCRIPTION:
This is the policy number assigned for this particular patient and insurer.
9002313.59902,902.36MAXIMUM NCPDP TRANSACTIONS 1;9 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: OCT 14, 2010
HELP-PROMPT: Enter the maximum number of transactions allowed in a request (1-9999).
DESCRIPTION: This is the maximum number of transactions that can be bundled in a transmission. It is
specified by the NCPDP processor.
9002313.59,1201RX ACTION 12;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: FEB 10, 2011
HELP-PROMPT: Enter the mnemonic that indicates what type of action should be performed (1-4 characters).
DESCRIPTION: This is the action that is being performed on this request. It is either the BWHERE parameter
passed into BPSNCPDP or 'ELIG' for an eligibility verification request. The list of BWHERE values
are documented at the top of routine BPSNCPD3.
9002313.59,1202DATE OF SERVICE 12;2 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X
LAST EDITED: MAY 25, 2005
HELP-PROMPT: (No range limit on date)
DESCRIPTION:
Date to be used for the 401-D1 (DATE OF SERVICE) field for the claim
9002313.59,1203SUBMISSION CLARIFICATION CODE 12;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JAN 19, 2007
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
Submission Clarification Code
9002313.59,1204COB OTHER PAYMENTS COUNT 12;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter a number between 0 and 9 for a count of other payment occurrences.
DESCRIPTION: NCPDP field 337-4C - Coordination of Benefits/Other Payments Count
This value corresponds to the number of multiple entries in the #1400 multiple field - COB OTHER
PAYERS.
9002313.59,1205OTHER COVERAGE CODE 12;5 SET
'00' FOR NOT SPECIFIED;
'01' FOR NO OTH COVERAGE;
'02' FOR PYMT COLLECT/OTH PAYER;
'03' FOR CLAIM NOT COVER/OTH PAYER;
'04' FOR PYMT NOT COLLECT/OTH PAYER;
'05' FOR ZZPLAN DENIAL;
'06' FOR ZZNONPART PROV/OTH PAYER;
'07' FOR ZZOTH COVER NOT EFFECT ON DOS;
'08' FOR COPAY BILLING;
LAST EDITED: MAR 02, 2023
HELP-PROMPT: Select the Other Coverage Code.
DESCRIPTION:
NCPDP field 308-C8 - code indicating whether or not the patient has other insurance coverage.
9002313.59,1300DUR DATA 13;0 Multiple #9002313.5913
HELP-PROMPT: Enter a DUR Data Counter.
DESCRIPTION: This multiple will track the Drug Utilization Review (DUR) information passed by Outpatient
Pharmacy to ECME and that will eventually be put in the DUR segment of the NCPDP claim.
9002313.5913,.01DUR COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<1)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2005
HELP-PROMPT: Enter the DUR counter for the claim
DESCRIPTION:
This is the counter that will be used for field 473-7E of the claim
CROSS-REFERENCE: 9002313.5913^B
1)= S ^BPST(DA(1),13,"B",$E(X,1,30),DA)=""
2)= K ^BPST(DA(1),13,"B",$E(X,1,30),DA)
9002313.5913,1 DUR PROFESSIONAL SERVICE CODE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUN 14, 2005
HELP-PROMPT: Enter the professional service code for the claim
DESCRIPTION:
This will be used for field 439-E4 of the claim
9002313.5913,2 DUR REASON FOR SERVICE CODE 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUN 14, 2005
HELP-PROMPT: Enter the DUR Reason for the Service Code for the claim
DESCRIPTION:
This will be used for field 440-E5 of the claim
9002313.5913,3 DUR RESULT OF SERVICE CODE 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: JUN 14, 2005
HELP-PROMPT: Enter the Result of Service Code for the claim
DESCRIPTION:
This will be used for field 441-E6 of the claim
9002313.59,1400COB OTHER PAYERS 14;0 Multiple #9002313.5914 (Add New Entry without Asking)
LAST EDITED: JUN 14, 2010
DESCRIPTION: This multiple structure stores information about each of the other payers involved in the payment
or rejection of the claim.
NCPDP has a maximum of 9 occurrences here with a recommendation of less than or equal to 3
occurrences. However, VA only stores data for at most 3 insurance policies for any given claim.
So at most there will only be 2 occurrences of this other payer multiple.
9002313.5914,.01OTHER PAYER COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION:
This is a multiple counter field to store the count of the other payers.
CROSS-REFERENCE: 9002313.5914^B
1)= S ^BPST(DA(1),14,"B",$E(X,1,30),DA)=""
2)= K ^BPST(DA(1),14,"B",$E(X,1,30),DA)
9002313.5914,.02OTHER PAYER COVERAGE TYPE 0;2 SET
'01' FOR PRIMARY;
'02' FOR SECONDARY;
'03' FOR TERTIARY;
'98' FOR ZZCOUPON;
'99' FOR ZZCOMPOSITE;
LAST EDITED: MAR 02, 2023
HELP-PROMPT: Select other payer coverage type.
DESCRIPTION:
NCPDP field 338-5C - Code identifying the type of 'Other Payer ID'
9002313.5914,.03OTHER PAYER ID QUALIFIER 0;3 SET
'01' FOR STANDARD UNIQUE HEALTH PLAN ID;
'02' FOR HEALTH INDUSTRY NUMBER (HIN);
'03' FOR BIN/IIN BANK IDENTIFICATION NO/ISSUER IDENTIFICATION NO;
'04' FOR NAT. ASSOC. OF INS. COM.(NAIC);
'05' FOR MEDICARE CARRIER NUMBER;
'09' FOR COUPON;
'99' FOR OTHER;
LAST EDITED: JUL 16, 2024
HELP-PROMPT: Select Other Payer ID Qualifier.
DESCRIPTION:
This field corresponds to NCPDP field 339-6C, Other Payer ID Qualifier.
9002313.5914,.04OTHER PAYER ID 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter Other Payer ID (1-10 characters).
DESCRIPTION:
NCPDP field 340-7C - ID assigned to the payer.
9002313.5914,.05OTHER PAYER DATE 0;5 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter the payment/denial date of the claim submitted to the other payer.
DESCRIPTION: NCPDP field 443-E8 - Payment or denial date of the claim submitted to the other payer. Used for
coordination of benefits.
9002313.5914,.06OTHER PAYER AMOUNT PAID COUNT 0;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter the count (0-9) of the payer amount paid occurrences.
DESCRIPTION:
NCPDP field 341-HB - Count of the payer amount paid occurrences.
9002313.5914,.07OTHER PAYER REJECT COUNT 0;7 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>20)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter the count (0-20) of the other payer reject code occurrences.
DESCRIPTION:
NCPDP field 471-5E - Count of 'Other Payer Reject Code' occurrences.
9002313.5914,.11OTHER PAYER RECONCILIATION ID 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: MAY 16, 2018
HELP-PROMPT: Enter an ID between 1 and 30 characters.
DESCRIPTION: NCPDP field C49-9V - Other Payer Reconciliation ID. Reconciliation ID (B98-34) as reported by the
Other Payer for Paid/Accepted transactions OR for Information Reporting transactions, the
designated default value for reporting a previous payer's rejected response as designated in the
Other Payer Reject Code value(s) reported in the COB claim.
9002313.5914,1 OTHER PAYER AMT PAID MULTIPLE 1;0 Multiple #9002313.59141 (Add New Entry without Asking)
LAST EDITED: JUN 14, 2010
DESCRIPTION: This multiple stores the NCPDP fields:
431-DV - Other Payer Amount Paid
342-HC - Other Payer Amount Paid Qualifier
Up to 9 occurrences are allowed by the NCPDP standard. This limit is dictated by the NCPDP
standard and enforced within the ECME claim building process (i.e. the ECME application
software). There are no such limits built into this data dictionary.
9002313.59141,.01 OTHER PAYER AMOUNT PAID 0;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Type a dollar amount between 0 and 999999, 2 decimal digits.
DESCRIPTION: NCPDP field 431-DV - Amount of any payment known by the pharmacy from other sources (including
coupons).
CROSS-REFERENCE: 9002313.59141^B
1)= S ^BPST(DA(2),14,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^BPST(DA(2),14,DA(1),1,"B",$E(X,1,30),DA)
9002313.59141,.02 OTHER PAYER AMT PAID QUALIFIER 0;2 POINTER TO BPS NCPDP OTHER PAYER AMT PAID QUAL FILE (#9002313.2)
LAST EDITED: NOV 26, 2014
HELP-PROMPT: Enter the type of Other Payer Amount Paid.
DESCRIPTION:
NCPDP field 342-HC - Code qualifying the 'Other Payer Amount Paid' (431-DV).
9002313.59141,.03 OTHER PAYER-PATIENT RESP AMT 0;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99) X
LAST EDITED: DEC 15, 2017
HELP-PROMPT: Type a dollar amount between -99999.99 and 99999.99, 2 decimal digits.
DESCRIPTION: NCPDP field 352-NQ - Other Payer-Patient Responsibility Amount. This is the 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.
9002313.5914,2 OTHER PAYER REJECT MULTIPLE 2;0 Multiple #9002313.59142 (Add New Entry without Asking)
LAST EDITED: JUN 14, 2010
DESCRIPTION: This multiple stores the NCPDP field:
NCPDP field 472-6E - Other Payer Reject Code
Up to 20 occurrences are allowed by the NCPDP standard. This limit is dictated by the NCPDP
standard and enforced within the ECME claim building process (i.e. the ECME application
software). There are no such limits built into this data dictionary.
9002313.59142,.01 OTHER PAYER REJECT CODE 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter a reject code returned by the Other Payer.
DESCRIPTION: NCPDP field 472-6E - The error encountered by the previous "Other Payer" in 'Reject Code'
(511-FB).
CROSS-REFERENCE: 9002313.59142^B
1)= S ^BPST(DA(2),14,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^BPST(DA(2),14,DA(1),2,"B",$E(X,1,30),DA)
9002313.59,9999.96NET PAID BY INSURER ; COMPUTED
MUMPS CODE: N RESP,POSITION S X=$G(^BPSTL(D0,0)),RESP=$P(X,U,5),POSITION=$P(X,U,9),X=$S(RESP&POSITION:$$NETPAID
1^BPSOS03(RESP,POSITION),1:"")
ALGORITHM: N RESP,POSITION S X=$G(^BPSTL(D0,0)),RESP=$P(X,U,5),POSITION=$P(X,U,9),X=$S(RESP&POSITION:$$NETPAID
1^BPSOS03(RESP,POSITION),1:"")
LAST EDITED: JAN 02, 2008
DESCRIPTION:
Amount paid after the discounts and deductible have been subtracted.
9002313.59,9999.97ELAPSED TIME (PRINTABLE) ; COMPUTED
MUMPS CODE: S X=$$TIMEDIF^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
ALGORITHM: S X=$$TIMEDIF^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
LAST EDITED: JAN 02, 2008
DESCRIPTION: The elapsed time between the filling of the prescription and the return of the response from the
payer.
9002313.59,9999.98ELAPSED TIME (SECONDS) ; COMPUTED
MUMPS CODE: S X=$$TIMEDIFI^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
ALGORITHM: S X=$$TIMEDIFI^BPSOSUD($P(^BPST(D0,0),U,11),$P(^BPST(D0,0),U,8))
LAST EDITED: OCT 20, 2000
DESCRIPTION:
The number of seconds between the placing of the order and the receipt of the response.
9002313.59,9999.99RESULT CATEGORY ; COMPUTED
MUMPS CODE: S X=$$CATEG^BPSOSUC(D0)
ALGORITHM: S X=$$CATEG^BPSOSUC(D0)
LAST EDITED: APR 05, 2004
DESCRIPTION: The category of the response.
"P"aid "R"ejected "A"ccepted
FILES POINTED TO FIELDS
BILL/CLAIMS (#399) PATIENT INSURANCE MULTIPLE:PRIMARY PAYER BILL (#902.3)
BPS ASLEEP PAYERS (#9002313.15) ASLEEP PAYER (#801)
BPS CERTIFICATION (#9002313.31) PATIENT INSURANCE MULTIPLE:CERTIFICATION (#902.23)
BPS CLAIMS (#9002313.02) CLAIM (#3)
REVERSAL CLAIM (#401)
BPS NCPDP FORMATS (#9002313.92) PATIENT INSURANCE MULTIPLE:B1 PAYER SHEET (#902.02)
B2 PAYER SHEET (#902.19)
B3 PAYER SHEET (#902.21)
E1 PAYER SHEET (#902.34)
BPS NCPDP OTHER PAYER AMT PAID
(#9002313.2) FIELD^NL^.03^3:OTHER PAYER AMT PAID QUALIFIER (#.02)
BPS NCPDP OVERRIDE (#9002313.511) NCPDP OVERRIDES (#1.13)
BPS PHARMACIES (#9002313.56) PHARMACY (#1.07)
BPS REQUESTS (#9002313.77) SUBMIT REQUEST (#16)
REVERSAL REQUEST (#405)
BPS RESPONSES (#9002313.03) RESPONSE (#4)
REVERSAL RESPONSE (#402)
GROUP INSURANCE PLAN (#355.3) PATIENT INSURANCE MULTIPLE:PLAN ID (#.01)
INSURANCE COMPANY (#36) PATIENT INSURANCE MULTIPLE:INSURANCE COMPANY (#902.33)
NEW PERSON (#200) USER (#13)
NON-BILLABLE CLOSED BY (#304)
NON-BILLABLE RE-OPENED BY (#307)
COMMENT MULTIPLE:USER (#.02)
OUTPATIENT SITE (#59) PHARMACY DIVISION (#11)
PATIENT (#2) PATIENT (#5)
PRESCRIPTION (#52) PRESCRIPTION NUMBER (#1.11)
RATE TYPE (#399.3) PATIENT INSURANCE MULTIPLE:RATE TYPE (#902.29)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):