Global: ^BPSC

FileMan FileNo	FileMan Filename	Package
9002313.02	BPS CLAIMS	E Claims Management Engine

Package	Total	Routines
E Claims Management Engine	40	BPS10P11 BPS10P7 BPS10PST BPSBCKJ BPSBUTL BPSECA1 BPSECA8 BPSECMC2 BPSECMP2 BPSECX0 BPSELG BPSFLD01 BPSOPR2 BPSOS03 BPSOSCE BPSOSH2 BPSOSQG BPSOSQL BPSOSRB BPSOSSG BPSOSU BPSPRRX6 BPSREOP1 BPSRES BPSRPC02 BPSRPT1 BPSRPT2 BPSRPT6 BPSRPT7 BPSSCR03 BPSSCR05 BPSSCRCL BPSSCRL1 BPSSCRLG BPSSCRU1 BPSSCRU2 BPSSCRU3 BPSSCRU5 BPSUTIL2 BPSVRX1
Integrated Billing	2	IB20P276 IBCNRXI1

Package	Total	Routines
E Claims Management Engine	15	BPSBUTL BPSECA1 BPSECMP2 BPSNCPD3 BPSOS57 BPSOSCE BPSOSH2 BPSOSU BPSRES BPSRES1 BPSRPC02 BPSRPC03 BPSRPT6 BPSSCRCL BPSSCRLG
Outpatient Pharmacy	1	PSOBPSU3

Package	Total	FileMan Files
E Claims Management Engine	4	BPS CERTIFICATION(#9002313.31)[.03] BPS RESPONSES(#9002313.03)[.01] BPS TRANSACTION(#9002313.59)[3, 401] BPS LOG OF TRANSACTIONS(#9002313.57)[3, 401]

Package	Total	FileMan Files
E Claims Management Engine	6	BPS NCPDP PRESCRIBER PLACE OF SERVICE(#9002313.34)[#9002313.0201(2257)] BPS NCPDP BENEFIT STAGE INDICATOR(#9002313.35)[#9002313.0201(2151)] BPS NCPDP LTPAC DISPENSE FREQUENCY(#9002313.36)[#9002313.0201(2191)] BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)[#9002313.0201(2147)] BPS NCPDP FORMATS(#9002313.92)[.02] BPS TRANSACTION(#9002313.59)[.08]
Integrated Billing	2	GROUP INSURANCE PLAN(#355.3)[1.04] CLAIMS TRACKING NON-BILLABLE REASONS(#356.8)[904]
Kernel	1	NEW PERSON(#200)[903, 907]
Outpatient Pharmacy	1	PRESCRIPTION(#52)[#9002313.0201(.05)]

Fields, Total: 77

Field #	Name	Loc	Type	Details
.01	CLAIM ID	0;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>32!($L(X)<1) X` LAST EDITED: `JUN 04, 2008` HELP-PROMPT: `Answer must be 1-32 characters in length.` DESCRIPTION: `External Claim ID value. This value is a concatenation of the text 'VA' along with the current year, the pharmacy ID, the VA National Plan ID (without the alpha prefix), and a unique sequence number. Each of the four` `pieces is delimited by the equal sign ("=").` CROSS-REFERENCE: `9002313.02^B^MUMPS` `1)= S ^BPSC("B",$E(X,1,32),DA)=""` `2)= K ^BPSC("B",$E(X,1,32),DA)`
.02	ELECTRONIC PAYER	0;2	POINTER TO BPS NCPDP FORMATS FILE (#9002313.92)	BPS NCPDP FORMATS(#9002313.92) LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Enter the payer sheet for the claim` DESCRIPTION: `This is the payer sheet used by the claim`
.04	TRANSMIT FLAG	0;4	SET	'1' FOR YES (BATCH FILE); '0' FOR NO; '2' FOR YES (POINT OF SALE); LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Specify if this claim should be transmitted and the mode.` DESCRIPTION: `Numerical code to indicate a transmit status. Current values are 0 for 'No' 1 for 'Yes' Batch and 2 for 'Yes' Point of Sale.` CROSS-REFERENCE: `9002313.02^AD` `1)= S ^BPSC("AD",$E(X,1,30),DA)=""` `2)= K ^BPSC("AD",$E(X,1,30),DA)`
.05	TRANSMITTED ON	0;5	DATE	INPUT TRANSFORM: `S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X` OUTPUT TRANSFORM: `S Y=$$FM2EXT^BPSOSU1(Y)` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Enter Date/Time this claim was transmitted` DESCRIPTION: `Date on which the data was transmitted.` CROSS-REFERENCE: `9002313.02^AE` `1)= S ^BPSC("AE",$E(X,1,30),DA)=""` `2)= K ^BPSC("AE",$E(X,1,30),DA)`
.06	CREATED ON	0;6	DATE	INPUT TRANSFORM: `S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X` OUTPUT TRANSFORM: `S Y=$$FM2EXT^BPSOSU1(Y)` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Enter Date/Time this claim was created` DESCRIPTION: `Date on which this record was created.`
.07	AUTO REVERSE FLAG	0;7	SET	'0' FOR NO; '1' FOR UNRELEASED CLAIM; '2' FOR INPATIENT CLAIM; LAST EDITED: `JAN 05, 2006` HELP-PROMPT: `If auto-reversed, enter the type of auto-reversal` DESCRIPTION: `This flag is marking ECME Claims that were automatically reversed because the Prescription was not released in time or the claim was an inpatient claim.`
.08	TRANSACTION	0;8	POINTER TO BPS TRANSACTION FILE (#9002313.59)	BPS TRANSACTION(#9002313.59) LAST EDITED: `APR 14, 2021` HELP-PROMPT: `Enter the transaction for the claim.` DESCRIPTION: `This is the ECME transaction that generates the claim.`
1.01	PATIENT NAME	1;1	FREE TEXT	INPUT TRANSFORM: `K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>30!($L(X)<1) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 1-30 characters in length.` DESCRIPTION: `Patient name extracted from the VA patient file. This entry is free text to accommodate the NCPDP formatting requirements.` CROSS-REFERENCE: `9002313.02^C` `1)= S ^BPSC("C",$E(X,1,30),DA)=""` `2)= K ^BPSC("C",$E(X,1,30),DA)`
1.04	GROUP INSURANCE PLAN	1;4	POINTER TO GROUP INSURANCE PLAN FILE (#355.3)	GROUP INSURANCE PLAN(#355.3) LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Enter the Group Insurance` DESCRIPTION: `Internal identifier number for the Group Insurance Record`
101	IIN NUMBER	100;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>6!($L(X)<6) X` LAST EDITED: `APR 22, 2021` HELP-PROMPT: `Answer must be 6 characters in length.` DESCRIPTION: `Card Issuer ID or Bank ID Number used for network routing.`
102	VERSION/RELEASE NUMBER	100;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>2!($L(X)<2) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 2 characters in length.` DESCRIPTION: `Code identifying the Enrollment Standard format of the file sent or received.`
103	TRANSACTION CODE	100;3	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>2!($L(X)<2) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 2 characters in length.` DESCRIPTION: `Code to identify the transaction type for this claim. E1=Eligibility Verification B1=Billing B2=Reversal B3=Rebill P1=P.A. Request & Billing P2=P.A. Reversal P3=P.A. Inquiry P4=P.A. Request Only N1=Information Reporting` `N2=Information Reporting Reversal N3=Information Reporting Rebill C1=Controlled Substance Reporting C2=Controlled Substance Reporting Reversal C3=Controlled Substance Reporting Rebill`
104	PROCESSOR CONTROL NUMBER	100;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<10) X` `MAXIMUM LENGTH: 10` LAST EDITED: `JUN 14, 2017` HELP-PROMPT: `Answer must be 10 characters in length.` DESCRIPTION: `Number which will uniquely identify the submitter of the claim. NCPDP field 104-A4.`
109	TRANSACTION COUNT	100;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>1!($L(X)<1) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 1 character in length.` DESCRIPTION: `Count of transactions in the transmission. NCPDP standard field 109-A9.` TECHNICAL DESCR: `A transaction count of >1 is not allowed for Eligibility and Prior Authorization transactions. REQUEST TRANSACTION HEADER SEGMENT.`
110	SOFTWARE VENDOR/CERT ID	100;10	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<10) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 10 characters in length.` DESCRIPTION: `Certification number which Identifies the patient's insurance carrier. NCPDP standard field 110-AK.` TECHNICAL DESCR: `REQUEST TRANSACTION HEADER SEGMENT.`
114	MEDICAID SUBROGATION ICN/TCN	110;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>22!($L(X)<1) X` LAST EDITED: `OCT 04, 2010` HELP-PROMPT: `Answer must be 1-22 characters.` DESCRIPTION: `This is used to store NCPDP field 114-N4 (Medicaid Subrogation Internal Control Number/Transaction Control Number (ICN/TCN)), which is defined as "Claim number assigned by the Medicaid Agency."` TECHNICAL DESCR: `REQUEST CLAIM SEGMENT. RESPONSE CLAIM SEGMENT.`
115	MEDICAID ID NUMBER	110;5	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>20!($L(X)<1) X` LAST EDITED: `AUG 31, 2010` HELP-PROMPT: `Answer must be 1-20 characters.` DESCRIPTION: `This is used to store NCPDP field 115-N5 (Medicaid ID Number), which is defined as "A unique member identification number assigned by the Medicaid Agency."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.`
116	MEDICAID AGENCY NUMBER	110;6	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>15!($L(X)<1) X` LAST EDITED: `AUG 31, 2010` HELP-PROMPT: `Answer must be 1-15 characters.` DESCRIPTION: `This is used to store NCPDP field 116-N6 (Medicaid Agency Number), which is defined as "Number assigned by processor to identify the individual Medicaid Agency or representative."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.`
201	SERVICE PROVIDER ID	200;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>15!($L(X)<15) X` LAST EDITED: `MAY 24, 2018` HELP-PROMPT: `Answer must be 15 characters in length` DESCRIPTION: `ID assigned to a pharmacy or provider. NCPDP standard field 201-B1.` TECHNICAL DESCR: `REQUEST TRANSACTION HEADER SEGMENT. RESPONSE HEADER SEGMENT.`
202	SERV PROVIDER ID QUALIFIER	200;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>2!($L(X)<2) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 2 characters in length.` DESCRIPTION: `Qualifier indicating which ID number was used. NCPDP standard field 202-B2.` TECHNICAL DESCR: `REQUEST TRANSACTION HEADER SEGMENT. RESPONSE HEADER SEGMENT.`
301	GROUP ID	300;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>17!($L(X)<17) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 17 characters in length` DESCRIPTION: `ID assigned to the cardholder group or employer group. NCPDP standard field 301-C1.` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.`
302	CARDHOLDER ID	300;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>20!($L(X)<2) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 2-20 characters in length` DESCRIPTION: `Insurance ID assigned to the cardholder or identification number used by the plan. NCPDP standard field 302-C2.` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.`
303	PERSON CODE	300;3	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>5!($L(X)<5) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 5 characters in length` DESCRIPTION: `Code assigned to a specific person within a family. NCPDP standard field 303-C3.` TECHNICAL DESCR: `Regarding the Telecommunication Standard: REQUEST INSURANCE SEGMENT.` `- - - - - - - - - - - - - - - - - - - - - - -` `Enrollment Standard Examples: Examples: 001=Cardholder 002=Spouse 003-999=Dependents and Others (including second spouses, etc.)`
304	DATE OF BIRTH	300;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<10) X` OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 10 characters in length` DESCRIPTION: `Date of birth of patient. NCPDP standard field 304-C4.` TECHNICAL DESCR: `Format=CCYYMMDD CC=Century YY=Year MM=Month DD=Day Examples: If a patient was born on July 27, 1970, this field would reflect: 19700727. REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT.`
305	PATIENT GENDER CODE	300;5	SET	'C50' FOR NOT SPECIFIED; 'C51' FOR MALE; 'C52' FOR FEMALE; 'C53' FOR NON-BINARY; OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `MAR 31, 2022` HELP-PROMPT: `Enter the patient's gender.` DESCRIPTION: `Code indicating the gender of patient.` `NCPDP standard field 305-C5.` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT.`
306	PATIENT RELATIONSHIP CODE	300;6	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>3!($L(X)<3) X` OUTPUT TRANSFORM: `S Y=$S(Y="C60":"NOT SPECIFIED",Y="C61":"CARDHOLDER",Y="C62":"SPOUSE",Y="C63":"CHILD",Y="C64":"OTHER",1:Y)` LAST EDITED: `MAR 09, 2011` HELP-PROMPT: `Answer must be 3 characters in length` DESCRIPTION: `Code indicating relationship of patient to cardholder. NCPDP standard field 306-C6.` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT.`
307	PLACE OF SERVICE	300;7	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<4) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 4 characters in length` DESCRIPTION: `Code identifying the location of the patient when receiving pharmacy services. NCPDP standard field 307-C7. (was PATIENT LOCATION)` `Ø=Not Specified 1=Home 2=Inter-Care 3=Nursing Home 4=Long Term/Extended Care 5=Rest Home 6=Boarding Home 7=Skilled Care Facility 8=Sub-Acute Care Facility 9=Acute Care Facility 1Ø=Outpatient 11=Hospice` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT.`
309	ELIGIBILITY CLARIFICATION CODE	300;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>3!($L(X)<3) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 3 characters in length` DESCRIPTION: `Code indicating that the pharmacy is clarifying eligibility based on receiving a denial. NCPDP standard field 309-C9.` TECHNICAL DESCR: `Examples: The patient has become a student but eligibility has not yet been updated. The pharmacy can indicate "3" so that the carrier may override eligibility for this patient. REQUEST INSURANCE SEGMENT.`
310	PATIENT FIRST NAME	300;10	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>14!($L(X)<14) X` LAST EDITED: `OCT 08, 2019` HELP-PROMPT: `Answer must be 14 characters in length` DESCRIPTION: `First name of patient receiving the prescription. NCPDP standard field 310-CA.` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT`
311	PATIENT LAST NAME	300;11	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>17!($L(X)<17) X` LAST EDITED: `OCT 08, 2019` HELP-PROMPT: `Answer must be 17 characters in length` DESCRIPTION: `Last Name of patient receiving the prescription. NCPDP standard field 311-CB.` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT. RESPONSE PATIENT SEGMENT`
312	CARDHOLDER FIRST NAME	300;12	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>14!($L(X)<14) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 14 characters in length` DESCRIPTION: `First name of the Cardholder/Subscriber. NCPDP standard field 312-CC.` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT`
313	CARDHOLDER LAST NAME	300;13	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>17!($L(X)<17) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 17 characters in length` DESCRIPTION: `Last name of the cardholder/subscriber. NCPDP standard field 313-CD.` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT`
314	HOME PLAN	300;14	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>5!($L(X)<5) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 5 characters in length` DESCRIPTION: `Code identifying the Blue Cross or Blue Shield plan ID which indicates where the member's coverage has been designated. Usually where the member lives or purchased their coverage. NCPDP standard field 314-CE.` TECHNICAL DESCR: `Used for interstate processing between Blue Cross and Blue Shield plans. The Blue Cross codes are in the range less than 600 and Blue Shield codes are greater than 599. REQUEST INSURANCE SEGMENT`
322	PATIENT STREET ADDRESS	321;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>32!($L(X)<32) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 32 characters in length` DESCRIPTION: `Free-form text for Patient address information. NCPDP standard field 322-CM.` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT`
323	PATIENT CITY ADDRESS	321;3	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>22!($L(X)<22) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 22 characters in length` DESCRIPTION: `Free-form text for city name. NCPDP standard field 323-CN.` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT`
324	PATIENT STATE/PROVINCE ADDRESS	321;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<4) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 4 characters in length` DESCRIPTION: `Standard State/Province Code as defined by appropriate government agency. NCPDP standard field 324-CO.` TECHNICAL DESCR: `Standard United States and Canadian province two-letter postal service abbreviations should be used. REQUEST PATIENT SEGMENT`
325	PATIENT ZIP/POSTAL ZONE	321;5	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>17!($L(X)<1) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 1-17 characters in length` DESCRIPTION: `Code defining international postal zone excluding punctuation and blanks (zip code for US). NCPDP standard field 325-CP.` TECHNICAL DESCR: `This left-justified field contains the five-digit zip code, and may include the four-digit expanded zip code in which the patient is located.` `Examples: If the zip code is 98765-4321, this field would reflect: 987654321.` `If the zip code is 98765, this field would reflect: 98765 left justified.` `REQUEST PATIENT SEGMENT`
326	PATIENT TELEPHONE NUMBER	321;6	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>12!($L(X)<12) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Answer must be 12 characters in length` DESCRIPTION: `Ten-digit phone number of patient. NCPDP standard field 326-CQ.` TECHNICAL DESCR: `Format=AAAEEENNNN AAA=Area Code EEE=Exchange NNNN=Number` `Examples: If the phone number is (313) 555-1212, this field would reflect: 3135551212.` `REQUEST PATIENT SEGMENT`
331	PATIENT ID QUALIFIER	330;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<4) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 4 characters in length` DESCRIPTION: `Code qualifying the 'Patient ID'(332-CY). NCPDP standard field 331-CX.` `Blank=Not Specified Ø1=Social Security Number Ø2=Driver's License Number Ø3=U.S. Military ID 99=Other` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT`
332	PATIENT ID	330;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>22!($L(X)<22) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 22 characters in length` DESCRIPTION: `ID assigned to the patient. NCPDP standard field 332-CY.` TECHNICAL DESCR: `Qualified by Patient Id Qualifier (331-CX). REQUEST PATIENT SEGMENT`
333	EMPLOYER ID	330;3	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>17!($L(X)<17) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 17 characters in length` DESCRIPTION: `ID assigned to employer. NCPDP standard field 333-CZ.` TECHNICAL DESCR: `The Internal Revenue Service, Department of the Treasury, assigns the Employer ID. The format of this field is nine-digits with a hyphen, as in 00-0000000. The hyphen must be transmitted as part of the Employer ID Number.` `Information on the Employer ID may be found at http://www.irs.ustreas.gov/. REQUEST PATIENT SEGMENT`
334	SMOKER/NONSMOKER	330;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>3!($L(X)<3) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 3 characters in length` DESCRIPTION: `Code indicating the patient as a smoker or non-smoker. NCPDP standard field 334-1C.` `Blank=Not Specified 1=Non-Smoker 2=Smoker` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT`
335	PREGNANCY INDICATOR	330;5	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>3!($L(X)<3) X` LAST EDITED: `JAN 02, 2008` HELP-PROMPT: `Answer must be 3 characters in length` DESCRIPTION: `Code indicating the patient as pregnant or non-pregnant. NCPDP standard field 335-2C.` `Blank=Not Specified 1=Not pregnant 2=Pregnant` TECHNICAL DESCR: `REQUEST PATIENT SEGMENT`
336	FACILITY ID	330;6	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>12!($L(X)<12) X` `MAXIMUM LENGTH: 12` LAST EDITED: `JUN 01, 2017` HELP-PROMPT: `Answer must be 12 characters in length.` DESCRIPTION: `ID assigned to the patient's clinic/host party. NCPDP standard field 336-8C.` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT`
350	PATIENT E-MAIL ADDRESS	340;10	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>82!($L(X)<1) X` LAST EDITED: `JUL 27, 2010` HELP-PROMPT: `Answer must be 1-82 characters in length.` DESCRIPTION: `This is used to store NCPDP field 350-HN (Patient E-Mail Address), which is defined as "The E-Mail address of the patient (member)."`
356	OTHER PAYER CARDHOLDER ID	350;6	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>22!($L(X)<1) X` LAST EDITED: `AUG 31, 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."` TECHNICAL DESCR: `RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT. REQUEST INSURANCE SEGMENT.`
359	MEDIGAP ID	350;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>22!($L(X)<1) X` LAST EDITED: `AUG 31, 2010` HELP-PROMPT: `Answer must be 1-22 characters.` DESCRIPTION: `This is used to store NCPDP field 359-2A (Medigap ID), which is defined as "Patient's ID assigned by the Medigap Insurer."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT.`
360	MEDICAID INDICATOR	350;10	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<1) X` LAST EDITED: `OCT 07, 2010` HELP-PROMPT: `Answer must be 1-4 characters.` DESCRIPTION: `This is used to store NCPDP field 360-2B (Medicaid Indicator), which is defined as "Two character State Postal Code indicating the state where Medicaid coverage exists."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT.`
361	PROVIDER ACCEPT ASSGNMT INDCTR	360;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>3!($L(X)<1) X` LAST EDITED: `SEP 01, 2010` HELP-PROMPT: `Answer must be 1-3 characters.` DESCRIPTION: `This is used to store NCPDP field 361-2D (Provider Accept Assignment Indicator), which is defined as "Code indicating whether the provider accepts assignment."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT.`
384	PATIENT RESIDENCE	380;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>2!($L(X)<1) X` LAST EDITED: `JUL 27, 2010` HELP-PROMPT: `Answer must be 1-2 characters.` DESCRIPTION: `This is used to store NCPDP field 384-4X (Patient Residence), which is defined as "Code identifying the patient's place of residence."`
400	TRANSACTIONS	400;0	Multiple #9002313.0201	9002313.0201 LAST EDITED: `SEP 22, 2010`
401	DATE OF SERVICE	401;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>8!($L(X)<8) X` LAST EDITED: `JUN 04, 2008` HELP-PROMPT: `Answer must be 8 characters in length` DESCRIPTION: `Date prescription was dispensed. NCPDP standard field 401-D1.` TECHNICAL DESCR: `Format=CCYYMMDD` `CC=Century YY=Year MM=Month DD=Day` `Examples: If the prescription was dispensed on April 22, 2000, this field would reflect 20000422.` `REQUEST TRANSACTION HEADER SEGMENT. RESPONSE HEADER SEGMENT.` CROSS-REFERENCE: `9002313.02^AF` `1)= S ^BPSC("AF",$E(X,1,30),DA)=""` `2)= K ^BPSC("AF",$E(X,1,30),DA)`
524	PLAN ID	520;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<10) X` LAST EDITED: `JAN 04, 2008` HELP-PROMPT: `Answer must be 10 characters in length` DESCRIPTION: `Assigned by the processor to identify a set of parameters, benefit, or coverage criteria used to adjudicate a claim. NCPDP standard field 524-FO.` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT. RESPONSE INSURANCE SEGMENT.`
618	PATIENT ID COUNT	610;8	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>9)!(X<0)!(X?.E1"."1.N) X` LAST EDITED: `OCT 08, 2019` HELP-PROMPT: `Type a number between 0 and 9, 0 decimal digits.` DESCRIPTION: `Count of patient ID occurrences. NCPDP standard field 618-RR.`
901	CLOSED	900;1	SET	'0' FOR NO; '1' FOR YES; LAST EDITED: `FEB 14, 2019` HELP-PROMPT: `Enter if this claim is closed or not.` DESCRIPTION: `Specify if the claim has been closed (no longer needed for followup) or not.` FIELD INDEX: `AC (#1706) MUMPS IR ACTION` `Short Descr: MCCF EDI TAS Progress` `Set Logic: D CLOSE^BPSRPC03(.DA)` `Kill Logic: D CLOSE^BPSRPC03(.DA)` `Whole Kill: Q` `X(1): CLOSED (9002313.02,901) (forwards)`
902	DATE CLOSED	900;2	DATE	INPUT TRANSFORM: `S %DT="ESTX" D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 04, 2008` HELP-PROMPT: `Enter the date this claim was closed.` DESCRIPTION: `This is automatically populated with the date a claim was closed.` CROSS-REFERENCE: `9002313.02^AG` `1)= S ^BPSC("AG",$E(X,1,30),DA)=""` `2)= K ^BPSC("AG",$E(X,1,30),DA)`
903	CLOSED BY	900;3	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `JAN 04, 2008` HELP-PROMPT: `Enter the person who closed this claim.` DESCRIPTION: `This is automatically populated with the user who closed the claim.`
904	CLOSED REASON	900;4	POINTER TO CLAIMS TRACKING NON-BILLABLE REASONS FILE (#356.8)	CLAIMS TRACKING NON-BILLABLE REASONS(#356.8) INPUT TRANSFORM: `S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` LAST EDITED: `JAN 04, 2008` HELP-PROMPT: `Enter the Claim Close Reason.` DESCRIPTION: `The ECME-supported non-billable reason entered by the user or defaulted by the system.` SCREEN: `S DIC("S")="I $P(^IBE(356.8,+Y,0),U,2)"` EXPLANATION: `Only ECME-supported non-billable reasons can be entered.`
905	DROP TO PAPER	900;5	SET	'D' FOR DROP TO PAPER; 'N' FOR NON-BILLABLE; LAST EDITED: `JAN 04, 2008` HELP-PROMPT: `Enter D if this claim should be billed on a paper claim.` DESCRIPTION: `If close reason is 90 DAY RX FILL NOT COVERED or NOT A CONTRACTED PROVIDER then user will be prompted: Treat as (N)on-Billable Episode or (D)rop Bill to Paper? the answer is stored in this field and sent to IB`
906	DATE REOPENED	900;6	DATE	INPUT TRANSFORM: `S %DT="E" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JAN 04, 2008` HELP-PROMPT: `Enter the date and time when the claim was re-opened` DESCRIPTION: `Date and time when the claim was re-opened.`
907	REOPENED BY	900;7	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `JUN 14, 2006` HELP-PROMPT: `Enter the user who re-opened the claim` DESCRIPTION: `The system user who re-opened the claim.`
908	REOPENED COMMENT	900;8	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>40!($L(X)<1) X` LAST EDITED: `JUN 14, 2006` HELP-PROMPT: `Enter the reason for the re-opening of the claim` DESCRIPTION: `User comments for the re-opening of the claim.`
990	OTHER PAYER BIN NUMBER	980;10	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>8!($L(X)<1) X` LAST EDITED: `AUG 31, 2010` HELP-PROMPT: `Answer must be 1-8 characters.` DESCRIPTION: `This is used to store NCPDP field 990-MG (Other Payer BIN Number), which is defined as "The secondary, tertiary, etc. card issuer or bank ID number used for network routing."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT.`
991	OTHER PAYER PROC CONTROL NUM	990;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>12!($L(X)<1) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 1-12 characters.` DESCRIPTION: `This is used to store NCPDP field 991-MH (Other Payer Processor Control Number), which is defined as "A number that uniquely identifies the secondary, tertiary, etc. payer to the processor."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT. RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.`
992	OTHER PAYER GROUP ID	990;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>17!($L(X)<1) X` LAST EDITED: `AUG 31, 2010` HELP-PROMPT: `Answer must be 1-17 characters.` DESCRIPTION: `This is used to store NCPDP field 992-MJ (Other Payer Group ID), which is defined as "ID assigned to the cardholder group or employer group by the secondary, tertiary, etc. payer."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT. RESPONSE COORDINATION OF BENEFITS/OTHER PAYERS SEGMENT.`
997	CMS PART D DEFND QLFD FACILITY	990;7	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>3!($L(X)<1) X` LAST EDITED: `MAR 29, 2021` HELP-PROMPT: `Answer must be 1-3 characters.` DESCRIPTION: `This is used to store NCPDP field 997-G2 (CMS Part D Defined Qualified Facility), which is defined as "Indicates that the patient resides in a facility that qualifies for the CMS Part D benefit."` TECHNICAL DESCR: `REQUEST INSURANCE SEGMENT.`
1022	PATIENT ID STATE/PROVINCE	A20;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<1) X` LAST EDITED: `MAR 01, 2013` HELP-PROMPT: `Answer must be 1-4 characters in length.` DESCRIPTION: `NCPDP Standard field A22-YR` `The postal state code abbreviation that is used in conjunction with the Patient ID Qualifier and the Patient ID fields to identify what state the identification is from.` TECHNICAL DESCR: `PATIENT SEGMENT`
1043	PATIENT COUNTRY CODE	A40;3	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<1) X` LAST EDITED: `MAR 01, 2013` HELP-PROMPT: `Answer must be 1-4 characters in length.` DESCRIPTION: `NCPDP Standard field A43-1K` `The country of the patient's permanent residence.` TECHNICAL DESCR: `PATIENT SEGMENT`
1045	VETERINARY USE INDICATOR	A40;5	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>3!($L(X)<1) X` LAST EDITED: `MAR 01, 2013` HELP-PROMPT: `Answer must be 1-3 characters in length.` DESCRIPTION: `NCPDP Standard field A45-1R` `To indicate that the prescription was dispensed for use on something other than human.` TECHNICAL DESCR: `PATIENT SEGMENT`
2008	PATIENT STREET ADDRESS LINE 1	B00;8	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>42!($L(X)<1) X` LAST EDITED: `FEB 28, 2017` HELP-PROMPT: `Answer must be 1-42 characters in length.` DESCRIPTION: `This is used to store NCPDP field B08-7A (Patient Street Address Line 1), which is defined as "Free-form text for address line 1 information".`
2009	PATIENT STREET ADDRESS LINE 2	B00;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>42!($L(X)<1) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Answer must be 1-42 characters in length.` DESCRIPTION: `This is used to store NCPDP field B09-7B (Patient Street Address Line 2), which is defined as "Free-form text for address line 2 information".`
2038	PATIENT ID ASSOC COUNTRY CODE	B30;8	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<1) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Answer must be 1-4 characters in length.` DESCRIPTION: `This is used to store NCPDP field B38-1Y (Patient ID Associated Country Code), which is defined as "Code of the country".`
2306	SPECIES	E00;6	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>9!($L(X)<1) X` `MAXIMUM LENGTH: 9` LAST EDITED: `OCT 08, 2019` HELP-PROMPT: `Answer must be 1-9 characters in length.` DESCRIPTION: `Species. Not used for humans. NCPDP standard field E06-S8.`
2309	PATIENT MIDDLE NAME	E00;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>25!($L(X)<1) X` `MAXIMUM LENGTH: 25` LAST EDITED: `OCT 08, 2019` HELP-PROMPT: `Answer must be 1-25 characters in length.` DESCRIPTION: `Patient middle name. NCPDP standard field E09-0C.`
2310	PATIENT NAME PREFIX	E00;10	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<1) X` `MAXIMUM LENGTH: 10` LAST EDITED: `OCT 08, 2019` HELP-PROMPT: `Answer must be 1-10 characters in length.` DESCRIPTION: `Patient name prefix. NCPDP standard field E10-0D.`
2311	PATIENT NAME SUFFIX	E10;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>10!($L(X)<1) X` `MAXIMUM LENGTH: 10` LAST EDITED: `OCT 08, 2019` HELP-PROMPT: `Answer must be 1-10 characters in length.` DESCRIPTION: `Patient name suffix. NCPDP standard field E11-0E.`
9999	RAW DATA SENT	M;0	WORD-PROCESSING #9002313.29999	HELP-PROMPT: `Enter the Raw data transmitted to the payer.` DESCRIPTION: `An exact copy of the record sent via the communications protocol.` LAST EDITED: `NOV 24, 2003` DESCRIPTION: `A copy of the raw packet is saved here. It's intended to be of help in times of dispute. This field could be winnowed before the rest of the 9002313.02 is winnowed. For instance, it might make sense to only keep a` `month of these around.`

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Package: E Claims Management Engine

Global: ^BPSC

Information

Description

Directly Accessed By Routines, Total: 44

Accessed By FileMan Db Calls, Total: 16

Pointed To By FileMan Files, Total: 4

Pointer To FileMan Files, Total: 10

Fields, Total: 77