FileMan FileNo | FileMan Filename | Package |
---|---|---|
9002313.57 | BPS LOG OF TRANSACTIONS | E Claims Management Engine |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | ENTRY NUMBER | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
1 | STATUS | 0;2 | NUMBER |
|
1.05 | POLICY NUMBER | 1;5 | NUMBER |
|
1.07 | PHARMACY | 1;7 | POINTER TO BPS PHARMACIES FILE (#9002313.56) | BPS PHARMACIES(#9002313.56)
|
1.08 | PINS PIECE | 1;8 | NUMBER |
|
1.09 | PRIOR AUTHORIZATION NUMBER | 1;9 | FREE TEXT |
|
1.11 | PRESCRIPTION NUMBER | 1;11 | POINTER TO PRESCRIPTION FILE (#52) | PRESCRIPTION(#52)
|
1.1199 | RXI INTERNAL | COMPUTED |
|
|
1.12 | RESUBMIT AFTER REVERSAL | 1;12 | SET |
|
1.13 | NCPDP OVERRIDES | 1;13 | POINTER TO BPS NCPDP OVERRIDE FILE (#9002313.511) | BPS NCPDP OVERRIDE(#9002313.511)
|
1.15 | PRIOR AUTHORIZATION TYPE CODE | 1;15 | FREE TEXT |
|
2 | HL7 MESSAGE ID | 0;3 | FREE TEXT |
|
3 | CLAIM | 0;4 | POINTER TO BPS CLAIMS FILE (#9002313.02) | BPS CLAIMS(#9002313.02)
|
3.1 | CLAIM IEN | COMPUTED |
|
|
4 | RESPONSE | 0;5 | POINTER TO BPS RESPONSES FILE (#9002313.03) | BPS RESPONSES(#9002313.03)
|
4.0098 | RESULT WITH REVERSAL | COMPUTED |
|
|
4.0099 | RESULT | COMPUTED |
|
|
4.1 | RESPONSE IEN | COMPUTED |
|
|
5 | PATIENT | 0;6 | POINTER TO PATIENT FILE (#2) | PATIENT(#2)
|
6 | SUBMIT DATE | 0;7 | DATE |
|
7 | LAST UPDATE | 0;8 | DATE |
|
9 | FILL NUMBER | 1;1 | NUMBER |
|
10 | NDC | 1;2 | FREE TEXT |
|
10.0099 | USER NUMBER | COMPUTED |
|
|
11 | PHARMACY DIVISION | 1;4 | POINTER TO OUTPATIENT SITE FILE (#59) | OUTPATIENT SITE(#59)
|
13 | USER | 0;10 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
14 | POSITION IN CLAIM | 0;9 | NUMBER |
|
15 | START TIME | 0;11 | DATE |
|
16 | SUBMIT REQUEST | 0;12 | POINTER TO BPS REQUESTS FILE (#9002313.77) | BPS REQUESTS(#9002313.77)
|
17 | SUBMIT REQUEST DATE TIME | 0;13 | DATE |
|
18 | COB INDICATOR | 0;14 | SET |
|
19 | TRANSACTION TYPE | 0;15 | SET |
|
20 | MCCF EDI TAS PROGRESS | 15;1 | SET |
|
111 | COMMENT MULTIPLE | 11;0 | DATE Multiple #9002313.57111 | 9002313.57111
|
201 | RESULT CODE | 2;1 | NUMBER |
|
202 | RESULT TEXT | 2;2 | FREE TEXT |
|
301 | NON-BILLABLE REASON | 3;1 | FREE TEXT |
|
302 | NON-BILLABLE CLOSED | 3;2 | SET |
|
303 | NON-BILLABLE DATE CLOSED | 3;3 | DATE |
|
304 | NON-BILLABLE CLOSED BY | 3;4 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
305 | NON-BILLABLE CLOSED COMMENT | 3;5 | FREE TEXT |
|
306 | NON-BILLABLE DATE RE-OPENED | 3;6 | DATE |
|
307 | NON-BILLABLE RE-OPENED BY | 3;7 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
308 | NON-BILLABLE RE-OPENED COMMENT | 3;8 | FREE TEXT |
|
401 | REVERSAL CLAIM | 4;1 | POINTER TO BPS CLAIMS FILE (#9002313.02) | BPS CLAIMS(#9002313.02)
|
402 | REVERSAL RESPONSE | 4;2 | POINTER TO BPS RESPONSES FILE (#9002313.03) | BPS RESPONSES(#9002313.03)
|
404 | REVERSAL REASON | 4;4 | FREE TEXT |
|
405 | REVERSAL REQUEST | 4;5 | POINTER TO BPS REQUESTS FILE (#9002313.77) | BPS REQUESTS(#9002313.77)
|
406 | REVERSAL REQUEST DATE TIME | 4;6 | DATE |
|
501 | QUANTITY | 5;1 | NUMBER |
|
502 | UNIT PRICE | 5;2 | NUMBER |
|
503 | SUBTOTAL | 5;3 | NUMBER |
|
504 | DISPENSING FEE | 5;4 | NUMBER |
|
505 | TOTAL PRICE | 5;5 | NUMBER |
|
507 | ADMINISTRATIVE FEE | 5;7 | FREE TEXT |
|
508 | UNIT OF MEASURE | 5;8 | FREE TEXT |
|
509 | BILLING QUANTITY | 5;9 | NUMBER |
|
510 | BILLING UNIT | 5;10 | FREE TEXT |
|
801 | ASLEEP PAYER | 8;1 | POINTER TO BPS ASLEEP PAYERS FILE (#9002313.15) | BPS ASLEEP PAYERS(#9002313.15)
|
901 | CURRENT VA INSURER | 9;1 | FREE TEXT |
|
901.04 | ELIGIBILITY | 9;4 | SET |
|
902 | PATIENT INSURANCE MULTIPLE | 10;0 | POINTER Multiple #9002313.57902 | 9002313.57902
|
1201 | RX ACTION | 12;1 | FREE TEXT |
|
1202 | DATE OF SERVICE | 12;2 | DATE |
|
1203 | SUBMISSION CLARIFICATION CODE | 12;3 | FREE TEXT |
|
1204 | COB OTHER PAYMENTS COUNT | 12;4 | NUMBER |
|
1205 | OTHER COVERAGE CODE | 12;5 | SET |
|
1300 | DUR DATA | 13;0 | Multiple #9002313.5713 | 9002313.5713
|
1400 | COB OTHER PAYERS | 14;0 | Multiple #9002313.5714 | 9002313.5714
|
9999.92 | HRN FAC | COMPUTED |
|
|
9999.93 | DRUG NAME | COMPUTED |
|
|
9999.94 | DRUG IEN | COMPUTED |
|
|
9999.95 | RELEASED DATE | COMPUTED |
|
|
9999.96 | NET PAID BY INSURER | COMPUTED |
|
|
9999.97 | ELAPSED TIME PRINTABLE | COMPUTED |
|
|
9999.98 | ELAPSED TIME SECONDS | COMPUTED |
|
|
9999.99 | RESULT CATEGORY | COMPUTED |
|
|
10101 | BIN NUMBER | COMPUTED |
|
|
10102 | VERSION RELEASE NUMBER | COMPUTED |
|
|
10103 | TRANSACTION CODE | COMPUTED |
|
|
10104 | PROCESSOR CONTROL NUMBER | COMPUTED |
|
|
10201 | PHARMACY NUMBER | COMPUTED |
|
|
10301 | GROUP NUMBER | COMPUTED |
|
|
10302 | CARDHOLDER ID NUMBER | COMPUTED |
|
|
10303 | PERSON CODE | COMPUTED |
|
|
10304 | DATE OF BIRTH | COMPUTED |
|
|
10305 | SEX CODE | COMPUTED |
|
|
10306 | RELATIONSHIP CODE | COMPUTED |
|
|
10307 | CUSTOMER LOCATION | COMPUTED |
|
|
10308 | OTHER COVERAGE CODE CALCULATED | COMPUTED |
|
|
10309 | ELIGIBILITY CLARIFICATION CODE | COMPUTED |
|
|
10310 | PATIENT FIRST NAME | COMPUTED |
|
|
10311 | PATIENT LAST NAME | COMPUTED |
|
|
10312 | CARDHOLDER FIRST NAME | COMPUTED |
|
|
10313 | CARDHOLDER LAST NAME | COMPUTED |
|
|
10314 | HOME PLAN | COMPUTED |
|
|
10315 | EMPLOYER NAME | COMPUTED |
|
|
10316 | EMPLOYER STREET ADDRESS | COMPUTED |
|
|
10317 | EMPLOYER CITY ADDRESS | COMPUTED |
|
|
10318 | EMPLOYER STATE | COMPUTED |
|
|
10319 | EMPLOYER ZIP CODE | COMPUTED |
|
|
10320 | EMPLOYER PHONE NUMBER | COMPUTED |
|
|
10321 | EMPLOYER CONTACT NAME | COMPUTED |
|
|
10322 | PATIENT STREET ADDRESS | COMPUTED |
|
|
10323 | PATIENT CITY ADDRESS | COMPUTED |
|
|
10324 | PATIENT STATE | COMPUTED |
|
|
10325 | PATIENT ZIP CODE | COMPUTED |
|
|
10326 | PATIENT PHONE NUMBER | COMPUTED |
|
|
10327 | CARRIER ID NUMBER | COMPUTED |
|
|
10328 | PATIENT WEIGHT | COMPUTED |
|
|
10329 | PATIENT SSN | COMPUTED |
|
|
10401 | DATE FILLED | COMPUTED |
|
|
10402 | PRESCRIPTION NUMBER SEVEN | COMPUTED |
|
|
10403 | NEW REFILL CODE | COMPUTED |
|
|
10404 | METRIC QUANTITY | COMPUTED |
|
|
10405 | DAYS SUPPLY | COMPUTED |
|
|
10406 | COMPOUND CODE | COMPUTED |
|
|
10407 | NDC NUMBER | COMPUTED |
|
|
10408 | DISPENSE AS WRITTEN | COMPUTED |
|
|
10409 | INGREDIENT COST | COMPUTED |
|
|
10410 | SALES TAX | COMPUTED |
|
|
10411 | PRESCRIBER ID | COMPUTED |
|
|
10412 | DISPENSING FEE SUBMITTED | COMPUTED |
|
|
10414 | DATE PRESCRIPTION WRITTEN | COMPUTED |
|
|
10415 | NUMBER OF REFILLS AUTHORIZED | COMPUTED |
|
|
10416 | PRIOR AUTH/MC CODE AND NUMBER | COMPUTED |
|
|
10418 | LEVEL OF SERVICE | COMPUTED |
|
|
10419 | PRESCRIPTION ORIGIN CODE | COMPUTED |
|
|
10420 | PRESCRIPTION CLARIFICATION | COMPUTED |
|
|
10421 | PRIMARY PRESCRIBER | COMPUTED |
|
|
10422 | CLINIC ID NUMBER | COMPUTED |
|
|
10423 | BASIS OF COST DETERMINATION | COMPUTED |
|
|
10424 | DIAGNOSIS CODE | COMPUTED |
|
|
10425 | DRUG TYPE | COMPUTED |
|
|
10426 | USUAL AND CUSTOMARY CHARGE | COMPUTED |
|
|
10427 | PRESCRIBER LAST NAME | COMPUTED |
|
|
10428 | POSTAGE AMOUNT CLAIMED | COMPUTED |
|
|
10429 | UNIT DOSE INDICATOR | COMPUTED |
|
|
10430 | GROSS AMOUNT DUE | COMPUTED |
|
|
10431 | OTHER PAYOR AMOUNT | COMPUTED |
|
|
10432 | BASIS OF DAYS SUPPLY DET | COMPUTED |
|
|
10433 | PATIENT PAID AMOUNT | COMPUTED |
|
|
10434 | DATE OF INJURY | COMPUTED |
|
|
10435 | CLAIM REF ID NUMBER | COMPUTED |
|
|
10436 | ALT PRODUCT TYPE | COMPUTED |
|
|
10437 | ALT PRODUCT CODE | COMPUTED |
|
|
10438 | INCENTIVE AMOUNT SUBMITTED | COMPUTED |
|
|
10439 | DUR CONFLICT CODE | COMPUTED |
|
|
10440 | DUR INTERVENTION CODE | COMPUTED |
|
|
10441 | DUR OUTCOME CODE | COMPUTED |
|
|
10442 | METRIC DECIMAL QUANTITY | COMPUTED |
|
|
10443 | OTHER PAYOR DATE | COMPUTED |
|
|
10444 | PHARMACIST ID | COMPUTED |
|
|
10501 | RESPONSE STATUS | COMPUTED |
|
|
10503 | AUTHORIZATION NUMBER | COMPUTED |
|
|
10504 | MESSAGE | COMPUTED |
|
|
10505 | PATIENT PAY AMOUNT | COMPUTED |
|
|
10506 | INGREDIENT COST PAID | COMPUTED |
|
|
10507 | CONTRACT FEE PAID | COMPUTED |
|
|
10508 | SALES TAX PAID | COMPUTED |
|
|
10509 | TOTAL AMOUNT PAID | COMPUTED |
|
|
10510 | REJECT COUNT | COMPUTED |
|
|
10511 | REJECT CODES | COMPUTED |
|
|
10511.01 | REJECT CODE 1 | COMPUTED |
|
|
10511.02 | REJECT CODE 2 | COMPUTED |
|
|
10511.03 | REJECT CODE 3 | COMPUTED |
|
|
10511.04 | REJECT CODE 4 | COMPUTED |
|
|
10511.05 | REJECT CODE 5 | COMPUTED |
|
|
10511.06 | REJECT CODE 6 | COMPUTED |
|
|
10511.07 | REJECT CODE 7 | COMPUTED |
|
|
10511.08 | REJECT CODE 8 | COMPUTED |
|
|
10511.09 | REJECT CODE 9 | COMPUTED |
|
|
10511.1 | REJECT CODE 10 | COMPUTED |
|
|
10511.11 | REJECT CODE 11 | COMPUTED |
|
|
10511.12 | REJECT CODE 12 | COMPUTED |
|
|
10511.13 | REJECT CODE 13 | COMPUTED |
|
|
10511.14 | REJECT CODE 14 | COMPUTED |
|
|
10511.15 | REJECT CODE 15 | COMPUTED |
|
|
10511.16 | REJECT CODE 16 | COMPUTED |
|
|
10511.17 | REJECT CODE 17 | COMPUTED |
|
|
10511.18 | REJECT CODE 18 | COMPUTED |
|
|
10511.19 | REJECT CODE 19 | COMPUTED |
|
|
10511.2 | REJECT CODE 20 | COMPUTED |
|
|
10512 | ACCUMULATED DEDUCTIBLE AMOUNT | COMPUTED |
|
|
10513 | REMAINING DEDUCTIBLE AMOUNT | COMPUTED |
|
|
10514 | REMAINING BENEFIT AMOUNT | COMPUTED |
|
|
10515 | POSTAGE AMOUNT PAID | COMPUTED |
|
|
10516 | DRUG DESCRIPTION | COMPUTED |
|
|
10517 | AMOUNT APP TO PER DEDUCTIBLE | COMPUTED |
|
|
10518 | AMOUNT OF COPAY COINSURANCE | COMPUTED |
|
|
10519 | AMOUNT ATTR TO PRODUCT SELECT | COMPUTED |
|
|
10520 | AMOUNT EXCEED PER BENEFIT MAX | COMPUTED |
|
|
10521 | INCENTIVE FEE PAID | COMPUTED |
|
|
10522 | BASIS OF REIMBURSEMENT DET | COMPUTED |
|
|
10523 | AMOUNT ATTRIBUTED TO SALES TAX | COMPUTED |
|
|
10524 | PLAN ID | COMPUTED |
|
|
10525 | DUR RESPONSE DATA | COMPUTED |
|
|
10525.01 | DUR COUNT | COMPUTED |
|
|
10525.1 | DUR 1 RAW DATA | COMPUTED |
|
|
10525.1439 | DUR 1 DRUG CONFLICT CODE | COMPUTED |
|
|
10525.1528 | DUR 1 SEVERITY INDEX CODE | COMPUTED |
|
|
10525.1529 | DUR 1 OTHER PHARMACY INDIC | COMPUTED |
|
|
10525.153 | DUR 1 PREVIOUS DATE OF FILL | COMPUTED |
|
|
10525.1531 | DUR 1 QTY OF PREVIOUS FILL | COMPUTED |
|
|
10525.1532 | DUR 1 DATABASE INDICATOR | COMPUTED |
|
|
10525.1533 | DUR 1 OTHER PRESCRIBER INDIC | COMPUTED |
|
|
10525.1544 | DUR 1 FREE TEXT | COMPUTED |
|
|
10525.1999 | DUR 1 RESERVE SPACE | COMPUTED |
|
|
10525.2 | DUR 2 RAW DATA | COMPUTED |
|
|
10525.2439 | DUR 2 DRUG CONFLICT CODE | COMPUTED |
|
|
10525.2528 | DUR 2 SEVERITY INDEX CODE | COMPUTED |
|
|
10525.2529 | DUR 2 OTHER PHARMACY INDIC | COMPUTED |
|
|
10525.253 | DUR 2 PREVIOUS DATE OF FILL | COMPUTED |
|
|
10525.2531 | DUR 2 QTY OF PREVIOUS FILL | COMPUTED |
|
|
10525.2532 | DUR 2 DATABASE INDICATOR | COMPUTED |
|
|
10525.2533 | DUR 2 OTHER PRESCRIBER INDIC | COMPUTED |
|
|
10525.2544 | DUR 2 FREE TEXT | COMPUTED |
|
|
10525.2999 | DUR 2 RESERVE SPACE | COMPUTED |
|
|
10525.3 | DUR 3 RAW DATA | COMPUTED |
|
|
10525.3439 | DUR 3 DRUG CONFLICT CODE | COMPUTED |
|
|
10525.3528 | DUR 3 SEVERITY INDEX CODE | COMPUTED |
|
|
10525.3529 | DUR 3 OTHER PHARMACY INDIC | COMPUTED |
|
|
10525.353 | DUR 3 PREVIOUS DATE OF FILL | COMPUTED |
|
|
10525.3531 | DUR 3 QTY OF PREVIOUS FILL | COMPUTED |
|
|
10525.3532 | DUR 3 DATABASE INDICATOR | COMPUTED |
|
|
10525.3533 | DUR 3 OTHER PRESCRIBER INDIC | COMPUTED |
|
|
10525.3544 | DUR 3 FREE TEXT | COMPUTED |
|
|
10525.3999 | DUR 3 RESERVE SPACE | COMPUTED |
|
|
10526 | ADDITIONAL MESSAGE INFORMATION | COMPUTED |
|
|
10528 | CLINICAL SIGNIFICANCE CODE | COMPUTED |
|
|
10529 | OTHER PHARMACY INDICATOR | COMPUTED |
|
|
10530 | PREVIOUS DATE OF FILL | COMPUTED |
|
|
10531 | QUANTITY OF PREVIOUS FILL | COMPUTED |
|
|
10532 | DATABASE INDICATOR | COMPUTED |
|
|
10533 | OTHER PRESCRIBER INDICATOR | COMPUTED |
|
|
10535 | DUR OVERFLOW | COMPUTED |
|
|
10544 | FREE TEXT | COMPUTED |
|