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Global: ^BPS(9002313.31

Package: E Claims Management Engine

Global: ^BPS(9002313.31


Information

FileMan FileNo FileMan Filename Package
9002313.31 BPS CERTIFICATION E Claims Management Engine

Description

Accessed By FileMan Db Calls, Total: 1

Package Total Routines
E Claims Management Engine 1 BPSNCPD2    

Pointed To By FileMan Files, Total: 4

Package Total FileMan Files
E Claims Management Engine 4 BPS REQUESTS(#9002313.77)[4.06]    BPS INSURER DATA(#9002313.78)[.06]    BPS TRANSACTION(#9002313.59)[#9002313.59902(902.23)]    BPS LOG OF TRANSACTIONS(#9002313.57)[#9002313.57902(902.23)]    

Pointer To FileMan Files, Total: 5

Package Total FileMan Files
E Claims Management Engine 4 BPS NCPDP OTHER PAYER AMT PAID QUAL(#9002313.2)[#9002313.31231(.02)]    BPS CLAIMS(#9002313.02)[.03]    BPS NCPDP FIELD DEFS(#9002313.91)[#9002313.311(.01), #9002313.3121(.01)]    BPS NCPDP FORMATS(#9002313.92)[.04, .05, .08]
Registration 1 PATIENT(#2)[903]    

Fields, Total: 10

Field # Name Loc Type Details
.01 NAME 0;1 FREE TEXT
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3)!'(X'?1P.E) X
  • LAST EDITED:  JAN 16, 2004
  • HELP-PROMPT:  Answer must be 3-30 characters in length.
  • DESCRIPTION:  
    Name of the certification - typically whichever Processor the certification is being done for.
  • CROSS-REFERENCE:  9002313.31^B
    1)= S ^BPS(9002313.31,"B",$E(X,1,30),DA)=""
    2)= K ^BPS(9002313.31,"B",$E(X,1,30),DA)
.03 CLAIM 0;3 POINTER TO BPS CLAIMS FILE (#9002313.02) BPS CLAIMS(#9002313.02)

  • LAST EDITED:  MAR 14, 2007
  • HELP-PROMPT:  Enter the BPS Claim number
  • DESCRIPTION:  
    This is the last BPS CLAIMS (#9002313.02) record that was created.
.04 BILLING PAYER SHEET 0;4 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  JAN 05, 2011
  • HELP-PROMPT:  Enter the billing payer sheet to be used for this certification claim.
  • DESCRIPTION:  
    This is the payer sheet to be used for Certification Testing when the test claim is a billing request.
.05 REVERSAL PAYER SHEET 0;5 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  JAN 05, 2011
  • HELP-PROMPT:  Enter the reversal payer sheet used for certification testing.
  • DESCRIPTION:  
    This is the payer sheet that will be used for certification testing when the test is a reversal.
.06 MAX CLAIMS PER TRANSMISSION 0;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>4)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  JAN 04, 2011
  • HELP-PROMPT:  Type a number between 1 and 4, 0 decimal digits.
  • DESCRIPTION:  
    This is the maximum number of claims that can be bundled in a transmission. If not entered, the certification code will set this to 1.
.07 COB INDICATOR 0;7 SET
  • '1' FOR PRIMARY;
  • '2' FOR SECONDARY;
  • '3' FOR TERTIARY;

  • LAST EDITED:  JAN 05, 2011
  • HELP-PROMPT:  Enter whether this claim is for the primary, secondary, or tertiary payer.
  • DESCRIPTION:  
    This field is used to indicate the order of the payer (first-primary, second-secondary, third-tertiary).
.08 ELIGIBILITY PAYER SHEET 0;8 POINTER TO BPS NCPDP FORMATS FILE (#9002313.92) BPS NCPDP FORMATS(#9002313.92)

  • LAST EDITED:  AUG 17, 2011
  • HELP-PROMPT:  Enter the eligibility payer sheet to be used for this certification claim.
  • DESCRIPTION:  
    This is the payer sheet to be used for Certification Testing when the test claim is an eligibility verification claim.
1 NCPDP FIELD # 1;0 POINTER Multiple #9002313.311 9002313.311

  • DESCRIPTION:  
    Contains field information for any NCPDP fields which need to be defaulted.
2 RX IN POSITION # 2;0 Multiple #9002313.312 9002313.312

  • DESCRIPTION:  
    The prescription order when submitting multiple claims in one transmission.
903 PATIENT IEN 4;2 POINTER TO PATIENT FILE (#2) PATIENT(#2)

  • LAST EDITED:  NOV 05, 2003
  • DESCRIPTION:  
    Pointer to the patient file to link the patient being used for certification to the certification being performed.
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