STANDARD DATA DICTIONARY #9002313.77 -- BPS REQUESTS FILE 3/24/25 PAGE 1
STORED IN ^BPS(9002313.77, *** 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 is used to store data for queued requests before the ECME engine un-queues them and during their processing. The data
stored in this file are used to create a record in BPS TRANSACTION file (#9002313.59) to build a claim request or reversal and send
it to the insurer (payer). Generally there should be few or no entries in this file unless there are stranded claims/reversal or
requests that need to be un-stranded by the user.
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: SUBMIT REQUEST field (#16) of the BPS LOG OF TRANSACTIONS File (#9002313.57)
REVERSAL REQUEST field (#405) of the BPS LOG OF TRANSACTIONS File (#9002313.57)
SUBMIT REQUEST field (#16) of the BPS TRANSACTION File (#9002313.59)
REVERSAL REQUEST field (#405) of the BPS TRANSACTION File (#9002313.59)
NEXT REQUEST field (#.05) of the BPS REQUESTS File (#9002313.77)
CROSS
REFERENCED BY: KEY1(B), ECME TRANSACTION RECORD(C), DATE AND TIME UPDATED(E)
INDEXED BY: PROCESS FLAG & KEY1 & KEY2 & ACTING COB (AC), NEXT REQUEST & PROCESS FLAG & TRANSACTION TYPE & ACTING COB (AN), KEY1
& KEY2 & ACTING COB & PROCESS FLAG (D)
LAST MODIFIED: DEC 18,2023@14:42:35
9002313.77,.01KEY1 0;1 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>9999999999999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the first key of the request (1-9999999999999).
DESCRIPTION: For claim requests and reversals, this is the prescription IEN that will be processed. For
Eligibility Verification requests, this is the Patient IEN that will be processed.
CROSS-REFERENCE: 9002313.77^B
1)= S ^BPS(9002313.77,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,"B",$E(X,1,30),DA)
RECORD INDEXES: AC (#804), D (#806)
9002313.77,.02KEY2 0;2 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: OCT 18, 2010
HELP-PROMPT: Enter the second key of the request (0-9999).
DESCRIPTION: For billing requests and reversals, this is the fill number where 0 is the original fill and 1-999
are refills. For eligibility verification requests, this is the policy number plus 9000. So, for
policy number 4, this would be 9004.
RECORD INDEXES: AC (#804), D (#806)
9002313.77,.03ACTING COB 0;3 SET
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: JUN 23, 2008
HELP-PROMPT: Answer with a Coordination of Benefits indicator
DESCRIPTION: This field indicates for which insurer (in terms of coordination of benefits) this particular
request was created. For example, if the patient has three insurances then three separate requests
can be created for the same prescription/refill in order to bill patient's Primary, Secondary and
Tertiary insurers. This field indicates for which insurer this request is for.
RECORD INDEXES: AC (#804), AN (#805), D (#806)
9002313.77,.04PROCESS FLAG 0;4 SET (Required)
'0' FOR SCHEDULED;
'1' FOR ACTIVATED;
'2' FOR IN PROCESS;
'3' FOR COMPLETED;
'4' FOR CANCELLED;
'5' FOR INACTIVE;
LAST EDITED: JUN 25, 2008
HELP-PROMPT: Select a process flag for the request
DESCRIPTION: State of the request.
SCHEDULED - scheduled for the future (for example : the secondary claim is scheduled to be
processed after the primary is completed)
ACTIVATED - ready to be processed
IN PROCESS - currently in process
COMPLETED - has been completed
CANCELLED - cancelled
INACTIVE - the system marks the records with "bad" data as inactive instead of removing them - to
keep them for repair or for investigation
RECORD INDEXES: AC (#804), AN (#805), D (#806)
9002313.77,.05NEXT REQUEST 0;5 POINTER TO BPS REQUESTS FILE (#9002313.77)
LAST EDITED: JUN 19, 2008
HELP-PROMPT: Answer with the request that follows this one
DESCRIPTION:
To store the pointer to the next request which should be processed.
RECORD INDEXES: AN (#805)
9002313.77,.06ECME TRANSACTION RECORD 0;6 POINTER TO BPS TRANSACTION FILE (#9002313.59)
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the transaction record from the BPS Transaction file.
DESCRIPTION: This is the BPS Transaction. It is not initially populated but is populated after the request is
activated and the BPS Transaction record is created.
CROSS-REFERENCE: 9002313.77^C
1)= S ^BPS(9002313.77,"C",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,"C",$E(X,1,30),DA)
9002313.77,.07WAITING RESOLUTION? 0;7 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUN 23, 2008
HELP-PROMPT: Is this request awaiting resolution?
DESCRIPTION:
Flag to mark requests with problems.
9002313.77,.08DONT PROCESS UNTIL 0;8 DATE
INPUT TRANSFORM: S %DT="ET" D ^%DT S X=Y K:X<1 X
LAST EDITED: NOV 13, 2008
HELP-PROMPT: Enter Date/Time
DESCRIPTION: The request cannot be processed until the date and time specified in this field. If null then it
can be processed at any time (immediately).
9002313.77,1.01RX ACTION 1;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.
TECHNICAL DESCR:
The RX Actions are documented at the top of routine BPSNCPD3.
9002313.77,1.02OUTPATIENT SITE 1;2 POINTER TO OUTPATIENT SITE FILE (#59)
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the Outpatient Site associated with the request.
DESCRIPTION: This is the outpatient site that will be used to generate the NPI number for the Service Provider
ID (201-B1) field of a NCPDP request.
9002313.77,1.04TRANSACTION TYPE 1;4 SET
'C' FOR CLAIM;
'E' FOR ELIGIBILITY;
'U' FOR UNCLAIM;
LAST EDITED: OCT 18, 2010
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.
RECORD INDEXES: AN (#805)
9002313.77,1.05BILLING DETERMINATION 1;5 SET
'0' FOR NOT BILLABLE;
'1' FOR BILLABLE;
LAST EDITED: JUN 23, 2008
HELP-PROMPT: Is this claim billable?
DESCRIPTION:
Billing determination result
9002313.77,1.06ELIGIBILITY 1;6 SET
'V' FOR VETERAN;
'T' FOR TRICARE;
'C' FOR CHAMPVA;
LAST EDITED: JUN 24, 2008
HELP-PROMPT: Enter eligibility of the claim.
DESCRIPTION:
The insurance eligibility type of the claim.
9002313.77,1.07CLAIM STATUS 1;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>99!($L(X)<1) X
LAST EDITED: JUN 19, 2008
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.
9002313.77,1.08RATE TYPE 1;8 POINTER TO RATE TYPE FILE (#399.3)
LAST EDITED: MAR 27, 2009
HELP-PROMPT: Select Rate Type for billing.
DESCRIPTION:
The Rate Type selected by the user for billing.
9002313.77,1.09PRIMARY PAYER BILL 1;9 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.
9002313.77,1.1PRIOR PAYMENT 1;10 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: MAR 27, 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.
9002313.77,1.11COB OTHER PAYMENTS COUNT 1;11 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 07, 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 #8 multiple field - COB OTHER
PAYERS.
9002313.77,1.12OTHER COVERAGE CODE 1;12 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.
9002313.77,1.13RX NUMBER 1;13 POINTER TO PRESCRIPTION FILE (#52)
LAST EDITED: OCT 18, 2010
HELP-PROMPT: Enter the prescription to be processed for this request.
DESCRIPTION: For billing requests and reversal, this is the prescription that will be processed for the request.
If an eligibility verification request is initiated from the ECME User Screen, this field will also
be populated and will be used to get the Prescriber information from the prescription.
9002313.77,1.14FILL NO 1;14 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the fill number that will be processed for this request (1-99).
DESCRIPTION: For billing requests and reversals, this is the fill number to be processed, where 0 is the
original fill and 1-99 are refills. If an eligibility verification request is initiated from the
ECME User Screen, this field will also be populated and will be used to get the Prescriber
information from the prescription.
9002313.77,1.15PATIENT 1;15 POINTER TO PATIENT FILE (#2)
LAST EDITED: MAY 11, 2011
HELP-PROMPT: Enter the patient associated with this request.
DESCRIPTION: For billing requests and reversals, this is the patient associated with the prescription. For
eligibility verification requests, this is the patient for which the insurance is being verified.
9002313.77,1.16POLICY NUMBER 1;16 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: OCT 18, 2010
HELP-PROMPT: Enter the policy number for the request (0-9999).
DESCRIPTION: This is the policy number of the patient that is being verified in an eligibility verification
request.
9002313.77,2.01DATE OF SERVICE 2;1 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Enter the date of service to be used on this NCPDP request.
DESCRIPTION: This is the date of service that will be used to populate the 401-D1 field of the NCPDP request.
It is generally the fill/refill date of the prescription but may also be the release date.
9002313.77,2.02REVERSAL REASON 2;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
LAST EDITED: JUN 19, 2008
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION:
Reversal Reason as a free text. Examples: ECME RESUBMIT, RX EDITED, RX DISCONTINUED
9002313.77,2.03DURREC 2;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>80!($L(X)<1) X
LAST EDITED: JUN 19, 2008
HELP-PROMPT: Answer must be 1-80 characters in length
DESCRIPTION:
Drug Utilization Review (DUR) information passed by Outpatient Pharmacy to ECME.
9002313.77,2.04OVERRIDE CODE 2;4 POINTER TO BPS NCPDP OVERRIDE FILE (#9002313.511)
LAST EDITED: JUN 24, 2008
HELP-PROMPT: Select a record of the BPS NCPDP OVERRIDE file
DESCRIPTION: This is used to store overrides entered by the user via the Resubmit with Edits (RED) option in the
ECME User Screen to change certain data elements sent to the payer during resubmission of the
claim.
9002313.77,2.05CLARIFICATION CODE 2;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>8!($L(X)<1) X
LAST EDITED: FEB 22, 2011
HELP-PROMPT: Enter between 1 and 3 Submission Clarification Codes separated by "~".
DESCRIPTION: The Submission Clarification Code is entered by the pharmacist and passed by Outpatient Pharmacy to
ECME to put into the claim to support/justify the claim request when the payer rejects it. Valid
clarification codes are selected from BPS NCPDP CLARIFICATION CODES file (#9002313.25). These
codes justify an earlier fill date to the payer. For example if a patient needed an early refill
due to being on vacation when the prescription would normally be filled, a VACATION SUPPLY
clarification code can be used as justification to the payer for filling the prescription thereby
mitigating any claims rejections.
TECHNICAL DESCR: Up to 3 Submission Clarification Codes can be submitted, They are stored in this free text field as
follows: SCC1~SCC2~SCC3
9002313.77,2.06BILL NDC 2;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<5) X
LAST EDITED: JUN 24, 2008
HELP-PROMPT: Answer must be 5-11 characters in length.
DESCRIPTION:
Valid NDC# used in the prescription/refill and which is passed to ECME to be used for billing.
9002313.77,2.07PRE AUTH TYPE CODE 2;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: FEB 27, 2008
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION:
PRIOR AUTHORIZATION TYPE CODE - the first piece of the BPSAUTH parameter passed to ECME engine.
9002313.77,2.08PRE AUTH NUM SUB 2;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<1) X
LAST EDITED: FEB 27, 2008
HELP-PROMPT: Answer must be 1-11 characters in length.
DESCRIPTION:
PRIOR AUTHORIZATION NUM SUB - the second piece of the BPSAUTH parameter passed to ECME engine.
9002313.77,2.09SC AND EI OVERRIDE FLAG 2;9 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: NOV 28, 2008
HELP-PROMPT: Enter "Yes" if SC/EI answers should be overridden, "No" if not.
DESCRIPTION: Service Connected and Environmental Indicators override flag. 0 - the system should use the
existing answers to SC and EI questions, if there is no answer then SC/EI determination needed and
the RX/refill cannot be billed. 1 - the user chose to override
all SC and EI related answers with "NO", which means the RX/refill should be billed.
9002313.77,2.1DELAY REASON CODE 2;10 POINTER TO BPS NCPDP DELAY REASON CODE FILE (#9002313.29)
LAST EDITED: OCT 19, 2010
HELP-PROMPT: Enter the delay reason code that will be used for NCPDP request.
DESCRIPTION: This is the Delay Reason Code that is entered by the user from the IB Back Billing Option of Claims
Tracking and passed to ECME. It will be be put into field 357-NV of the billing request that is
created for third-party billing.
9002313.77,3 DUR 3;0 Multiple #9002313.771 (Add New Entry without Asking)
DESCRIPTION:
DUR multiple
9002313.771,.01 DUR REASON CODE 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 19, 2008
HELP-PROMPT: Enter the DUR Reason for the Service Code for the claim
DESCRIPTION:
Drug Utilization Review (DUR) Reason for the Service Code for the claim.
CROSS-REFERENCE: 9002313.771^B
1)= S ^BPS(9002313.77,DA(1),3,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,DA(1),3,"B",$E(X,1,30),DA)
9002313.771,.02 DUR PROFESSIONAL SERVICE CODE 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 19, 2008
HELP-PROMPT: Enter the DUR Professional Service Code for the claim
DESCRIPTION:
Drug Utilization Review (DUR) Professional Service Code for the claim.
9002313.771,.03 DUR RESULT OF SERVICE CODE 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 19, 2008
HELP-PROMPT: Enter the DUR Result of Service Code for the claim
DESCRIPTION:
Drug Utilization Review (DUR) Result of Service Code for the claim.
9002313.77,4.01QUANTITY 4;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999999)!(X<-1)!(X?.E1"."4.N) X
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Type a number between -1 and 999999, 3 Decimal Digits
DESCRIPTION: NCPDP quantity (Billing Quantity) - the amount of medication that was dispensed (stored in
PRESCRIPTION file (#52)) multiplied by the NCPDP QUANTITY MULTIPLIER (stored in DRUG file (#50)).
The negative value -1 indicates an invalid drug.
9002313.77,4.02UNIT PRICE 4;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."7N.N) X
LAST EDITED: OCT 22, 2007
HELP-PROMPT: Type a Number between 0 and 9999999, 6 Decimal Digits
DESCRIPTION:
Price per unit of prescription.
9002313.77,4.03NDC 4;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>11!($L(X)<5) X
LAST EDITED: OCT 22, 2007
HELP-PROMPT: Answer must be 5-11 characters in length.
DESCRIPTION:
The NDC number of the drug involved in this transaction.
9002313.77,4.04REFILL 4;4 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: OCT 22, 2007
HELP-PROMPT: Type a Number between 0 and 99, 0 Decimal Digits
DESCRIPTION:
Refill number. 0-original
9002313.77,4.05CERTIFY MODE 4;5 SET
'0' FOR OFF;
'1' FOR ON;
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Enter null or 0 for certify mode off. Enter 1 for certify mode on.
DESCRIPTION:
Certify mode is used for certifying software when required by switches and claims end processors.
9002313.77,4.06CERTIFICATION IEN 4;6 POINTER TO BPS CERTIFICATION FILE (#9002313.31)
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Select the certification record
DESCRIPTION: This field is used during certification testing, and points to the entry to use to pull
certification data.
9002313.77,4.07UNIT OF MEASURE 4;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>2!($L(X)<1) X
LAST EDITED: OCT 22, 2007
HELP-PROMPT: Answer must be 1-2 characters in length.
DESCRIPTION: Enter the Unit of Measure for the drug. This is usually GR (grams), ML (milliliters), or EA
(Each).
9002313.77,4.08BILLING QUANTITY 4;8 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."4.N) X
LAST EDITED: JUL 06, 2011
HELP-PROMPT: Type a number between 0 and 99999999, 3 decimal digits.
DESCRIPTION: This is the quantity from the prescription and is used to calculate the ingredient cost. It may be
different than the quantity used in the actual NCPDP submission.
9002313.77,4.09BILLING UNIT 4;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 07, 2011
HELP-PROMPT: Answer must be 1-10 characters in length.
DESCRIPTION:
This is the billing units associated with the billing quantity.
9002313.77,5 INSURER DATA 5;0 SET Multiple #9002313.772 (Add New Entry without Asking)
LAST EDITED: NOV 26, 2007
DESCRIPTION: Contains set of IB determination data for all billable payers - primary, secondary and tertiary.
Should contain at least one entry - usually for the primary payer.
9002313.772,.01 COB INDICATOR 0;1 SET
'1' FOR PRIMARY;
'2' FOR SECONDARY;
'3' FOR TERTIARY;
LAST EDITED: JUN 24, 2008
HELP-PROMPT: Is the payer a primary, secondary or tertiary insurer?
DESCRIPTION:
Coordination Of Benefits (COB) indicator for the payer.
CROSS-REFERENCE: 9002313.772^B
1)= S ^BPS(9002313.77,DA(1),5,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,DA(1),5,"B",$E(X,1,30),DA)
9002313.772,.02 USED FOR THE REQUEST 0;2 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUN 24, 2008
HELP-PROMPT: Should this payer be used for billing in this request?
DESCRIPTION: The INSURER DATA multiple can store up to three entries with details for primary, secondary and
tertiary insurers. This field marks the active payer entry, which points to the payer data to be
used to process this request.
CROSS-REFERENCE: 9002313.772^C
1)= S ^BPS(9002313.77,DA(1),5,"C",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,DA(1),5,"C",$E(X,1,30),DA)
To find an active COB indicator.
9002313.772,.03 INSURER DATA 0;3 POINTER TO BPS INSURER DATA FILE (#9002313.78)
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Select insurer for the request
DESCRIPTION:
Contains IB determination data for the payer (insurer).
9002313.77,6.01REQUEST DATE AND TIME 6;1 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Enter date/time
DESCRIPTION:
The Date and Time when the request record was created.
9002313.77,6.02USER WHO MADE THE REQUEST 6;2 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Enter the user who made the request
DESCRIPTION:
The user who created the request
9002313.77,6.03ACTIVATED DATE TIME 6;3 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Enter the date and time when the request was activated
DESCRIPTION:
The date and time when the request was activated
9002313.77,6.04USER WHO ACTIVATED REQUEST 6;4 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Enter the user who activated the request
DESCRIPTION:
The user who activated the request.
9002313.77,6.05DATE AND TIME UPDATED 6;5 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Enter the date and time when the request was updated
DESCRIPTION:
The date and time when the request was updated.
CROSS-REFERENCE: 9002313.77^E
1)= S ^BPS(9002313.77,"E",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,"E",$E(X,1,30),DA)
The cross-reference to get the select records by the date/time the record was updated
9002313.77,6.06USER WHO UPDATED THE REQUEST 6;6 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Enter the user who updated the request
DESCRIPTION:
The user who updated the request.
9002313.77,7.01CLOSE AFT REV 7;1 SET
'0' FOR NO;
'1' FOR YES;
LAST EDITED: JUN 24, 2008
HELP-PROMPT: Should the claim be closed after accepted reversal?
DESCRIPTION: This field indicates whether the claim should be closed after successful reversal. The ECME engine
checks this field when it receives a response from the payer. If the field is set to YES and the
reversal was accepted by the payer then the claim will be closed automatically.
9002313.77,7.02CLOSE AFT REV REASON 7;2 POINTER TO CLAIMS TRACKING NON-BILLABLE REASONS FILE (#356.8)
LAST EDITED: JUN 20, 2008
HELP-PROMPT: Select NON-BILLABLE reason for the claim
DESCRIPTION:
The NON-BILLABLE REASON selected by the user to be used in IB CLAIM TRACKING system.
9002313.77,7.03CLOSE AFT REV COMMENT 7;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: MAY 30, 2008
HELP-PROMPT: Answer must be 1-40 characters in length.
DESCRIPTION:
Comment for CLOSE action
9002313.77,8 COB OTHER PAYERS 8;0 Multiple #9002313.778 (Add New Entry without Asking)
LAST EDITED: JUN 07, 2010
DESCRIPTION: This multiple structure stores information about each of the other payers involved in the payment
or rejection of the claim.
NCPDP has a maximum of 9 occurrences here with a recommendation of less than or equal to 3
occurrences. However, VA only stores data for at most 3 insurance policies for any given claim.
So at most there will only be 2 occurrences of this other payer multiple.
9002313.778,.01 OTHER PAYER COUNTER 0;1 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Type a number between 0 and 9, 0 decimal digits.
DESCRIPTION:
This is a multiple counter field to store the count of the other payers.
CROSS-REFERENCE: 9002313.778^B
1)= S ^BPS(9002313.77,DA(1),8,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,DA(1),8,"B",$E(X,1,30),DA)
9002313.778,.02 OTHER PAYER COVERAGE TYPE 0;2 SET
'01' FOR PRIMARY;
'02' FOR SECONDARY;
'03' FOR TERTIARY;
'98' FOR ZZCOUPON;
'99' FOR ZZCOMPOSITE;
LAST EDITED: MAR 02, 2023
HELP-PROMPT: Select other payer coverage type.
DESCRIPTION:
NCPDP field 338-5C - Code identifying the type of 'Other Payer ID'
9002313.778,.03 OTHER PAYER ID QUALIFIER 0;3 SET
'01' FOR STANDARD UNIQUE HEALTH PLAN ID;
'02' FOR HEALTH INDUSTRY NUMBER (HIN);
'03' FOR BANK INFORMATION NUMBER (BIN);
'04' FOR NAT. ASSOC. OF INS. COM.(NAIC);
'05' FOR MEDICARE CARRIER NUMBER;
'09' FOR COUPON;
'99' FOR OTHER;
LAST EDITED: NOV 25, 2014
HELP-PROMPT: Select Other Payer ID Qualifier.
9002313.778,.04 OTHER PAYER ID 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<1) X
LAST EDITED: JUN 09, 2010
HELP-PROMPT: Enter Other Payer ID (1-10 characters).
DESCRIPTION:
NCPDP field 340-7C - ID assigned to the payer.
9002313.778,.05 OTHER PAYER DATE 0;5 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:X<1 X
LAST EDITED: JUN 09, 2010
HELP-PROMPT: Enter the payment/denial date of the claim submitted to the other payer.
DESCRIPTION: NCPDP field 443-E8 - Payment or denial date of the claim submitted to the other payer. Used for
coordination of benefits.
9002313.778,.06 OTHER PAYER AMOUNT PAID COUNT 0;6 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter the count (0-9) of the payer amount paid occurrences.
DESCRIPTION:
NCPDP field 341-HB - Count of the payer amount paid occurrences.
9002313.778,.07 OTHER PAYER REJECT COUNT 0;7 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>20)!(X<0)!(X?.E1"."1.N) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter the count (0-20) of the other payer reject code occurrences.
DESCRIPTION:
NCPDP field 471-5E - Count of 'Other Payer Reject Code' occurrences.
9002313.778,.11 OTHER PAYER RECONCILIATION ID 0;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
MAXIMUM LENGTH: 30
LAST EDITED: MAY 16, 2018
HELP-PROMPT: Enter an ID between 1 and 30 characters.
DESCRIPTION: NCPDP field C49-9V - Other Payer Reconciliation ID. Reconciliation ID (B98-34) as reported by the
Other Payer for Paid/Accepted transactions OR for Information Reporting transactions, the
designated default value for reporting a previous payer's rejected response as designated in the
Other Payer Reject Code value(s) reported in the COB claim.
9002313.778,1 OTHER PAYER AMT PAID MULTIPLE 1;0 Multiple #9002313.7781 (Add New Entry without Asking)
LAST EDITED: JUN 09, 2010
DESCRIPTION: This multiple stores the NCPDP fields:
431-DV - Other Payer Amount Paid
342-HC - Other Payer Amount Paid Qualifier
Up to 9 occurrences are allowed by the NCPDP standard. This limit is dictated by the NCPDP
standard and enforced within the ECME claim building process (i.e. the ECME application
software). There are no such limits built into this data dictionary.
9002313.7781,.01 OTHER PAYER AMOUNT PAID 0;1 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0)!(X?.E1"."3.N) X
LAST EDITED: JUN 10, 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: 9002313.7781^B
1)= S ^BPS(9002313.77,DA(2),8,DA(1),1,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,DA(2),8,DA(1),1,"B",$E(X,1,30),DA)
9002313.7781,.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).
9002313.7781,.03 OTHER PAYER-PATIENT RESP AMT 0;3 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99) X
LAST EDITED: DEC 15, 2017
HELP-PROMPT: Type a dollar amount between -99999.99 and 99999.99, 2 decimal digits.
DESCRIPTION: NCPDP field 505-F5 - Patient Pay Amount. This is the amount that is calculated by the
processor and returned to the pharmacy as the TOTAL amount to be paid by the patient to the
pharmacy; the patient's total cost share, including co-payments, amounts applied to deductible,
over maximum amounts, penalties, etc.
9002313.778,2 OTHER PAYER REJECT MULTIPLE 2;0 Multiple #9002313.7782 (Add New Entry without Asking)
LAST EDITED: JUN 09, 2010
DESCRIPTION: This multiple stores the NCPDP field:
NCPDP field 472-6E - Other Payer Reject Code
Up to 20 occurrences are allowed by the NCPDP standard. This limit is dictated by the NCPDP
standard and enforced within the ECME claim building process (i.e. the ECME application
software). There are no such limits built into this data dictionary.
9002313.7782,.01 OTHER PAYER REJECT CODE 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>3!($L(X)<1) X
LAST EDITED: JUN 14, 2010
HELP-PROMPT: Enter a reject code returned by the Other Payer.
DESCRIPTION: NCPDP field 472-6E - The error encountered by the previous "Other Payer" in 'Reject Code'
(511-FB).
CROSS-REFERENCE: 9002313.7782^B
1)= S ^BPS(9002313.77,DA(2),8,DA(1),2,"B",$E(X,1,30),DA)=""
2)= K ^BPS(9002313.77,DA(2),8,DA(1),2,"B",$E(X,1,30),DA)
9002313.77,9.01INACTIVATION REASON 9;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>100!($L(X)<1) X
LAST EDITED: OCT 18, 2010
HELP-PROMPT: Enter the reason the request was inactivated (1-100 characters).
DESCRIPTION: When a request is inactivated, the reason that it was inactivated will be stored here so that the
cause of the inactivation can be investigated.
FILES POINTED TO FIELDS
BILL/CLAIMS (#399) PRIMARY PAYER BILL (#1.09)
BPS CERTIFICATION (#9002313.31) CERTIFICATION IEN (#4.06)
BPS INSURER DATA (#9002313.78) INSURER DATA:INSURER DATA (#.03)
BPS NCPDP DELAY REASON CODE
(#9002313.29) DELAY REASON CODE (#2.1)
BPS NCPDP OTHER PAYER AMT PAID
(#9002313.2) FIELD^NL^.03^3:OTHER PAYER AMT PAID QUALIFIER (#.02)
BPS NCPDP OVERRIDE (#9002313.511) OVERRIDE CODE (#2.04)
BPS REQUESTS (#9002313.77) NEXT REQUEST (#.05)
BPS TRANSACTION (#9002313.59) ECME TRANSACTION RECORD (#.06)
CLAIMS TRACKING NON-BILLABLE R
(#356.8) CLOSE AFT REV REASON (#7.02)
NEW PERSON (#200) USER WHO MADE THE REQUEST (#6.02)
USER WHO ACTIVATED REQUEST (#6.04)
USER WHO UPDATED THE REQUEST (#6.06)
OUTPATIENT SITE (#59) OUTPATIENT SITE (#1.02)
PATIENT (#2) PATIENT (#1.15)
PRESCRIPTION (#52) RX NUMBER (#1.13)
RATE TYPE (#399.3) RATE TYPE (#1.08)
File #9002313.77
Record Indexes:
AC (#804) RECORD MUMPS IR SORTING ONLY
Short Descr: By the Process Flag
Description: This index is used to retrieve entries with certain PROCESS FLAG value.
Set Logic: S ^BPS(9002313.77,"AC",$E(X(1),1,30),$E(X(2),1,30),+$E(X(3),1,30),DA)=X(4)
Kill Logic: K ^BPS(9002313.77,"AC",$E(X(1),1,30),$E(X(2),1,30),+$E(X(3),1,30),DA)
Whole Kill: K ^BPS(9002313.77,"AC")
X(1): PROCESS FLAG (9002313.77,.04) (Subscr 1) (Len 2) (forwards)
X(2): KEY1 (9002313.77,.01) (Subscr 2) (Len 10) (forwards)
X(3): KEY2 (9002313.77,.02) (Subscr 3) (Len 3) (forwards)
X(4): ACTING COB (9002313.77,.03) (forwards)
AN (#805) RECORD MUMPS IR SORTING ONLY
Short Descr: The Next Request
Description: This index is used to determine the Next Request that needs to be processed after the current is completed.
Set Logic: I X(3)<3 S ^BPS(9002313.77,"AN",DA,$E(X(2),1,30))=X(3)_"^"_X(4)_"^"_X(5)
Kill Logic: K ^BPS(9002313.77,"AN",DA,$E(X(2),1,30))
Whole Kill: K ^BPS(9002313.77,"AN")
X(1): Computed Code: S X=DA
(Subscr 1)
X(2): NEXT REQUEST (9002313.77,.05) (Subscr 2) (Len 30) (forwards)
X(3): PROCESS FLAG (9002313.77,.04) (Len 2) (forwards)
X(4): TRANSACTION TYPE (9002313.77,1.04) (Len 2) (forwards)
X(5): ACTING COB (9002313.77,.03) (Len 2) (forwards)
D (#806) RECORD REGULAR IR LOOKUP & SORTING
Short Descr: By Prescription #, Refill#, COB and Process Flag
Description: This index is used to retrieve all requests by the Prescription #, the refill #, the type of the insurer
(Primary/Secondary/Tertiary) and by the PROCESS FLAG value (request status).
Set Logic: S ^BPS(9002313.77,"D",X(1),X(2),X(3),X(4),DA)=""
Kill Logic: K ^BPS(9002313.77,"D",X(1),X(2),X(3),X(4),DA)
Whole Kill: K ^BPS(9002313.77,"D")
X(1): KEY1 (9002313.77,.01) (Subscr 1) (forwards)
X(2): KEY2 (9002313.77,.02) (Subscr 2) (forwards)
X(3): ACTING COB (9002313.77,.03) (Subscr 3) (forwards)
X(4): PROCESS FLAG (9002313.77,.04) (Subscr 4) (forwards)
INPUT TEMPLATE(S):
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):