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Global: ^BPS(9002313.32

Package: E Claims Management Engine

Global: ^BPS(9002313.32


Information

FileMan FileNo FileMan Filename Package
9002313.32 BPS PAYER RESPONSE OVERRIDES E Claims Management Engine

Description

Directly Accessed By Routines, Total: 2

Package Total Routines
E Claims Management Engine 2 BPSTEST    BPSTEST2    

Accessed By FileMan Db Calls, Total: 2

Package Total Routines
E Claims Management Engine 2 BPSTEST    BPSTEST2    

Pointer To FileMan Files, Total: 3

Package Total FileMan Files
E Claims Management Engine 3 BPS NCPDP PATIENT PAY COMPONENT QUALIFIER(#9002313.37)[4.14]    BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)[4.11]    BPS NCPDP REJECT CODES(#9002313.93)[#9002313.321(.01)]    

Fields, Total: 51

Field # Name Loc Type Details
.01 TRANSACTION NUMBER 0;1 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:+X'=X!(X>999999999.99999)!(X<0)!(X?.E1"."6N.N) X
  • LAST EDITED:  SEP 28, 2007
  • HELP-PROMPT:  Type a Number between 0 and 999999999.99999, 5 Decimal Digits
  • DESCRIPTION:  
    The transaction number of the claim
  • CROSS-REFERENCE:  9002313.32^B
    1)= S ^BPS(9002313.32,"B",$E(X,1,30),DA)=""
    2)= K ^BPS(9002313.32,"B",$E(X,1,30),DA)
.02 TYPE 0;2 SET
  • 'R' FOR REVERSAL;
  • 'RS' FOR RESUBMIT WITH REVERSAL;
  • 'S' FOR SUBMIT;
  • 'E' FOR ELIGIBILITY;

  • LAST EDITED:  OCT 21, 2010
  • HELP-PROMPT:  Enter the type of submission that is being sent to the payer.
  • DESCRIPTION:  
    This is the type of request that is being overridden.
.03 SUBMISSION RESPONSE 0;3 SET
  • 'D' FOR DUPLICATE;
  • 'P' FOR PAID;
  • 'R' FOR REJECTED;
  • 'S' FOR STRANDED;

  • LAST EDITED:  SEP 28, 2007
  • HELP-PROMPT:  Enter the override for the payer response status fields
  • DESCRIPTION:  
    The payer response for claims submissions (B1 transactions) - 'P' for Payable or 'R' for Rejected. This will be used for the 112 (Transaction Response Status) and 501 (Response Status) fields or BPS Responses.
.04 PAID AMOUNT 0;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99)!(X?.E1"."3.N) X
  • LAST EDITED:  SEP 28, 2007
  • HELP-PROMPT:  Type a Dollar amount between -99999.99 and 99999.99, 2 Decimal Digits
  • DESCRIPTION:  
    This is the override for the 509 (Total Amount Paid) field of BPS Responses
.05 REVERSAL RESPONSE 0;5 SET
  • 'A' FOR ACCEPTED;
  • 'D' FOR DUPLICATE;
  • 'R' FOR REJECTED;
  • 'S' FOR STRANDED;

  • LAST EDITED:  SEP 28, 2007
  • HELP-PROMPT:  Enter the override for the payer response status fields
  • DESCRIPTION:  
    The payer response for claims reversals (B2 transactions) - 'A' for Accepted or 'R' for Rejected. This will be used for the 112 (Transaction Response Status) and 501 (Response Status) fields or BPS Responses.
.06 COPAY AMOUNT 0;6 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999.99)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  FEB 28, 2008
  • HELP-PROMPT:  Enter the copay amount returned by the payer
  • DESCRIPTION:  
    This is an override copay amount returned by a payer to be sent to Integrated Billing for copay creation.
.07 DELAY 0;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>5)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  NOV 13, 2008
  • HELP-PROMPT:  Enter number of minutes to delay processing (a number between 0 and 5 with up to 2 digits after the decimal point).
  • DESCRIPTION:  
    Processing delay in minutes.
.08 ELIGIBILITY RESPONSE 0;8 SET
  • 'A' FOR ACCEPTED;
  • 'R' FOR REJECTED;
  • 'S' FOR STRANDED;

  • LAST EDITED:  OCT 20, 2010
  • HELP-PROMPT:  Enter the response override for eligibility verification payer sheets.
  • DESCRIPTION:  This is the override value that will be used for the payer response for eligibility verification requests. The value will be used to populate the 112 (Transaction Response Status) and 501 (Response Status) fields of BPS
    Responses.
.09 NEXT AVAILABLE FILL DATE 0;9 DATE

  • INPUT TRANSFORM:  S %DT="E" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAY 16, 2013
  • HELP-PROMPT:  Enter override value for Next Available Fill Date.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the NEXT AVAILABLE FILL DATE (#2004) field of RESPONSES (#9002313.0301) subfile of the BPS
    RESPONSES (#9002313.03) file. Corresponds to NCPDP code B04-BT.
.1 ADJUDICATED PAYMENT TYPE 0;10 SET
  • '1' FOR MEDICAID;
  • '2' FOR MEDICARE;
  • '3' FOR COMMERCIAL;
  • '4' FOR WORKERS COMPENSATION;
  • '5' FOR DISCOUNT PROGRAM;
  • '6' FOR COUPON REIMBURSEMENT;
  • '7' FOR VOUCHER;
  • '8' FOR MILITARY/VA;
  • '9' FOR UNKNOWN;
  • '99' FOR OTHER;

  • LAST EDITED:  MAY 26, 2015
  • HELP-PROMPT:  Enter override value for Adjudicated Payment Type.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the ADJUDICATED PAYMENT TYPE (#1028) field of RESPONSES (#9002313.0301) subfile of the BPS
    RESPONSES (#9002313.03) file. Corresponds to NCPDP code A28-ZR.
.11 QUAN LIMIT PER SPC TIME PERIOD 0;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999.999)!(X<1)!(X?.E1"."4.N) X
  • LAST EDITED:  SEP 16, 2015
  • HELP-PROMPT:  Type a number between 1 and 9999999.999, 3 decimal digits.
  • DESCRIPTION:  Maximum quantity allowed over the designated time period.
    This is the override value that will be used for the payer response for billing requests. The value will be used to populate the QUAN LIMIT PER SPC TIME PERIOD field (#2088) of the QUAN LIMIT TIME PERIOD MLTPL multiple
    (#9002313.032087) of the RESPONSES subfile (#9002313.0301) of the BPS RESPONSES file (#9002313.03). This is NCPDP field B88-3R.
.12 QUANTITY LIMIT TIME PERIOD 0;12 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  SEP 16, 2015
  • HELP-PROMPT:  Type a number between 1 and 99999, 0 decimal digits.
  • DESCRIPTION:  Number of days to which the maximum quantity is allowed.
    This is the override value that will be used for the payer response for billing requests. The value will be used to populate the QUANTITY LIMIT TIME PERIOD field (#2089) of the QUAN LIMIT TIME PERIOD MLTPL multiple
    (#9002313.032087) of the RESPONSES subfile (#9002313.0301) of the BPS RESPONSES file (#9002313.03). This is NCPDP field B89-3S.
.13 DAYS SUP LIM PER SPC TM PERIOD 0;13 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  SEP 16, 2015
  • HELP-PROMPT:  Type a number between 1 and 999, 0 decimal digits.
  • DESCRIPTION:  Maximum days supply allowed over the designated time period.
    This is the override value that will be used for the payer response for billing requests. The value will be used to populate the DAYS SUP LIM PER SPC TM PERIOD field (#2091) of the DAYS SUPPLY LIM TM PD MULTIPLE
    (9002313.032091) of the RESPONSES subfile (#9002313.0301) of the BPS RESPONSES file (#9002313.03). This is NCPDP field B91-3W.
.14 DAYS SUPPLY LIMIT TIME PERIOD 0;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  SEP 16, 2015
  • HELP-PROMPT:  Type a number between 1 and 99999, 0 decimal digits.
  • DESCRIPTION:  This is an informational field to convey the maximum days supply over a set number of days for this medication.
    This is the override value that will be used for the payer response for billing requests. The value will be used to populate the DAYS SUPPLY LIMIT TIME PERIOD field (#2092) of the DAYS SUPPLY LIM TM PD MULTIPLE
    (9002313.032091) of the RESPONSES subfile (#9002313.0301) of the BPS RESPONSES file (#9002313.03). This is NCPDP field B92-3X.
.15 INGREDIENT COST PAID 0;15 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99)!(X?.E1"."3.N) X
  • LAST EDITED:  DEC 29, 2015
  • HELP-PROMPT:  Type a dollar amount between -99999.99 and 99999.99, 2 decimal digits.
  • DESCRIPTION:  
    This field overrides the value for NCPDP field 506-F6 Ingredient Cost Paid in the BPS Response. This is the drug ingredient cost paid which is included in the Total Amount Paid field (509-F9).
.16 DISPENSING FEE PAID 0;16 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99)!(X?.E1"."3.N) X
  • LAST EDITED:  DEC 29, 2015
  • HELP-PROMPT:  Type a dollar amount between -99999.99 and 99999.99, 2 decimal digits.
  • DESCRIPTION:  
    This field overrides the value for NCPDP field 507-F7 Dispensing Fee Paid in the BPS Response. This is the dispensing fee paid which is included in the Total Amount Paid field (509-F9).
.17 REMAINING DEDUCTIBLE AMOUNT 0;17 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99)!(X?.E1"."3.N) X
  • LAST EDITED:  DEC 29, 2015
  • HELP-PROMPT:  Type a dollar amount between -99999.99 and 99999.99, 2 decimal digits.
  • DESCRIPTION:  
    This field overrides the value in NCPDP field 513-FD Remaining Deductible Amount in the BPS Response. This is the amount not met by the patient/family in the deductible plan.
.18 AMT APPLIED TO PERIODIC DEDUCT 0;18 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99)!(X?.E1"."3.N) X
  • LAST EDITED:  DEC 29, 2015
  • HELP-PROMPT:  Type a dollar amount between -99999.99 and 99999.99, 2 decimal digits.
  • DESCRIPTION:  This field overrides the value in NCPDP field 517-FH Amount Applied To Periodic Deductible in the BPS Response. This is the amount to be collected from a patient that is included in the Patient Pay Amount (505-F5) that is
    applied to a periodic deductible.
1 REJECT CODES 1;0 POINTER Multiple #9002313.321 9002313.321

  • DESCRIPTION:  
    Multiple for reject code overrides, which will be stored in the 511 (Reject Code multiple) fields of BPS Responses
2.01 PERCENTAGE SALES TAX BASIS PD 2;1 SET
  • '01' FOR GROSS AMOUNT DUE;
  • '02' FOR INGREDIENT COST;
  • '03' FOR INGREDIENT COST + DISPENSING FEE;
  • '04' FOR PROFESSIONAL SERVICE FEE;

  • LAST EDITED:  JAN 13, 2015
  • HELP-PROMPT:  Enter override value for the Percentage Sales Tax Basis Paid
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the PERCENTAGE SALES TAX BASIS PD (#561) field of RESPONSES (#9002313.0301) subfile of the BPS
    RESPONSES (#9002313.03) file. This corresponds to NCPDP field 561-AZ.
2.02 OTHER AMOUNT PAID QUALIFIER 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JAN 14, 2015
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the OTHER AMOUNT PAID QUALIFIER (#564) field of RESPONSES (#9002313.0301) subfile of the BPS
    RESPONSES (#9002313.03) file. This corresponds to NCPDP field 564-J3.
2.03 PAYER ID QUALIFIER 2;3 SET
  • '01' FOR STANDARD UNIQUE HEALTH PLAN ID;
  • '02' FOR HIN;
  • '03' FOR BIN;
  • '04' FOR NAIC;
  • '99' FOR OTHER;

  • LAST EDITED:  JAN 13, 2015
  • HELP-PROMPT:  Enter override value for the Payer ID Qualifier
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the PAYER ID QUALIFIER (#568) field of RESPONSES (#9002313.0301) subfile of the BPS RESPONSES
    (#9002313.03) file. This corresponds to NCPDP field 561-AZ.
2.04 HELP DESK TELEPHONE NUMBER EXT 2;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>8!($L(X)<1) X
  • LAST EDITED:  JAN 13, 2015
  • HELP-PROMPT:  Answer must be 1-8 characters in length.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the HELP DESK TELEPHONE NUMBER EXTENSION (#2022) field of RESPONSES (#9002313.0301) subfile of
    the BPS RESPONSES (#9002313.03) file. This corresponds to NCPDP field B22-7P.
2.05 PRO SERVICE FEE CONT/REIM AMT 2;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>99999.99)!(X<-99999.99) X
  • LAST EDITED:  JAN 13, 2015
  • HELP-PROMPT:  Type a dollar amount between -99999.99 and 99999.99, 2 decimal digits.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the PRO SERVICE FEE CONT/REIM AMT (#2033) field of RESPONSES (#9002313.0301) subfile of the BPS
    RESPONSES (#9002313.03) file. This corresponds to NCPDP field B33-6G.
2.06 OTHER PAYER HELPDESK PHONE EXT 2;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JAN 14, 2015
  • HELP-PROMPT:  Type a number between 0 and 99999999, 0 decimal digits.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the OTHER PAYER HELPDESK PHONE EXT (#2023) field of the OTHER PAYER ID MLTPL (#9002313.035501) of
    the RESPONSES (#9002313.0301) subfile of the BPS RESPONSES (#9002313.03) file. This corresponds to NCPDP field B23-7Q.
2.07 RESPONSE INTERMED AUTH TYPE ID 2;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
  • LAST EDITED:  JAN 14, 2015
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the RESPONSE INTERMEDIARY AUTH CNT (#2052) field of the INTERMEDIARY MULTIPLE (#9002313.032052)
    of the RESPONSES (#9002313.0301) subfile of the BPS RESPONSES (#9002313.03) file. This corresponds to NCPDP field B53-8S.
2.08 RESPONSE INTERMEDIARY AUTH ID 2;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JAN 14, 2015
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the RESPONSE INTERMEDIARY AUTH ID (#2054) field of the INTERMEDIARY MULTIPLE (#9002313.032052) of
    the RESPONSES (#9002313.0301) subfile of the BPS RESPONSES (#9002313.03) file. This corresponds to NCPDP field B54-8T.
2.09 RECONCILIATION ID 2;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
    MAXIMUM LENGTH: 30
  • LAST EDITED:  MAY 30, 2017
  • HELP-PROMPT:  Answer must be 1-30 characters in length.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the RECONCILIATION ID (#2098) field of RESPONSES (#9002313.0301) subfile of the BPS RESPONSES
    (#9002313.03) file. This corresponds to NCPDP code B98-34.
2.1 PATIENT PAY AMOUNT 2;10 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:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the PATIENT PAY AMOUNT (#505) field of RESPONSES (#9002313.0301) subfile of the BPS RESPONSES
    (#9002313.03) file. This corresponds to NCPDP code 505-F5.
2.11 REASON FOR SERVICE CODE 2;11 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
    MAXIMUM LENGTH: 4
  • LAST EDITED:  AUG 29, 2019
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  
    NCPDP field indicating reason for service code. This corresponds to NCPDP code 439-E4.
3.01 INTERMEDIARY MESSAGE 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>200!($L(X)<1) X
  • LAST EDITED:  JAN 14, 2015
  • HELP-PROMPT:  Answer must be 1-200 characters in length.
  • DESCRIPTION:  This is the override value that will be used for the payer response for billing requests. The value will be used to populate the INTERMEDIARY MESSAGE (#2051) field of the INTERMEDIARY MULTIPLE (#9002313.032052) of the
    RESPONSES (#9002313.0301) subfile of the BPS RESPONSES (#9002313.03) file. This corresponds to NCPDP field B51-8Q.
4.01 MAXIMUM AGE QUALIFIER 4;1 SET
  • 'D' FOR DAYS (24-hr periods);
  • 'Y' FOR YEARS (12-month periods);

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the override value for the Maximum Age Qualifier.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AGE QUALIFIER (#931) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 931-F8 and qualifies MAXIMUM AGE (932-GA).
4.02 MAXIMUM AGE 4;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value between 0 and 999, for the Maximum Age.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AGE (#932) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 932-GA.
4.03 MAXIMUM AMOUNT 4;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999.999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter between 0 and 999999.999, 3 decimal digits.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AMOUNT (#933) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 933-GB.
4.04 MAXIMUM AMOUNT QUALIFIER 4;4 SET
  • 'DL' FOR DOLLAR AMOUNT;
  • 'DS' FOR DAYS SUPPLY;
  • 'FL' FOR FILLS;
  • 'QY' FOR QUANTITY;

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Maximum Amount Qualifier.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AMOUNT QUALIFIER (#934) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 934-GC and qualifies MAXIMUM AMOUNT (933-GB).
4.05 MAXIMUM AMOUNT TIME PERIOD 4;5 SET
  • 'CM' FOR CALENDAR MONTH;
  • 'CQ' FOR CALENDAR QUARTER;
  • 'CY' FOR CALENDAR YEAR;
  • 'DY' FOR DAYS;
  • 'LT' FOR LIFETIME;
  • 'PD' FOR PER DISPENSING;
  • 'SP' FOR SPECIFIC DATE RANGE;

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Maximum Amount Time Period.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AMOUNT TIME PERIOD (#935) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 935-GF.
4.06 MAX AMT TIME PERIOD START DATE 4;6 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the date for the Maximum Amount Time Period Start Date.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AMOUNT TIME PERIOD START DATE (#936) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 936-GG.
4.07 MAX AMT TIME PERIOD END DATE 4;7 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter the date for the Maximum Amount Time Period End Date.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AMOUNT TIME PERIOD END DATE (#937) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 937-GH.
4.08 MAX AMT TIME PERIOD UNITS 4;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter an amount between 0 and 9999, 0 decimal digits, for the Maximum Amount Time Period Units.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AMOUNT TIME PERIOD UNITS (#938) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 938-GJ.
4.09 MINIMUM AGE QUALIFIER 4;9 SET
  • 'D' FOR DAYS;
  • 'Y' FOR YEARS;

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Minimum Age Qualifier.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MINIMUM AGE QUALIFIER (#943) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 934-GQ and qualifies MINIMUM AGE (944-GR).
4.1 MINIMUM AGE 4;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value between 0 and 999, for the Minimum Age.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MINIMUM AGE (#944) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code 944-GR.
4.11 OTHER PAYER PROGRAM TYPE 4;11 POINTER TO BPS NCPDP OTHER PAYER PROGRAM TYPE FILE (#9002313.38) BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Other Payer Adjudicated Program Type.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PAYER ADJUDICATED PROGRAM TYPE (#2147) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code C47-9T.
4.12 PATIENT PAY COMPONENT AMOUNT 4;12 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999.99)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a dollar amount between 0 and 999999.99, 2 decimal digits.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the PATIENT PAY COMPONENT AMOUNT (#2193) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code C93-KN.
4.13 PATIENT PAY COMPONENT COUNT 4;13 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter a value between 0 and 99, for the Patient Pay Component Count.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the PATIENT PAY COMPONENT COUNT (#2194) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code C94-KP.
4.14 PATIENT PAY COMPONENT QUAL 4;14 POINTER TO BPS NCPDP PATIENT PAY COMPONENT QUALIFIER FILE (#9002313.37) BPS NCPDP PATIENT PAY COMPONENT QUALIFIER(#9002313.37)

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Patient Pay Component Qualifier.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the PATIENT PAY COMPONENT QUALIFIER (#2195) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code C95-KQ and qualifies PATIENT PAY COMPONENT AMOUNT (C93-KN).
4.15 MINIMUM AMOUNT 4;15 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999.999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter an amount between 0 and 999999.999, 3 decimal digits.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MINIMUM AMOUNT (#2219) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code D19-M1.
4.16 MINIMUM AMOUNT QUALIFIER 4;16 SET
  • 'MDL' FOR MIN DOLLAR AMT;
  • 'MDS' FOR MIN DAY SUPPLY;
  • 'MFL' FOR MIN FILLS;
  • 'MQY' FOR MIN QTY;

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Minimum Amount Qualifier.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the MAXIMUM AMOUNT QUALIFIER (#2220) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code D20-M2 and qualifies MINIMUM AMOUNT (D19-M1).
4.17 OTHER PAYER NAME 4;17 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<1) X
    MAXIMUM LENGTH: 70
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Other Payer Name, 1 to 70 characters in length.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PAYER NAME (#2223) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code D23-M5.
4.18 REMAINING AMOUNT 4;18 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999999.999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter an amount between 0 and 999999.999, 3 decimal digits.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the REMAINING AMOUNT (#2224) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code D24-M6.
4.19 REMAINING AMOUNT QUALIFIER 4;19 SET
  • 'RFL' FOR REMAINING FILLS;
  • 'RQY' FOR REMAINING QTY;
  • 'RDS' FOR REMAINING DAYS SUPPLY;

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Remaining Amount Qualifier.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the REMAINING AMOUNT QUALIFIER (#2225) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code D25-M7 and qualifies REMAINING AMOUNT (D24-M6).
4.2 OTHER PAYER RELATIONSHIP TYPE 4;20 SET
  • 'CP' FOR COB COVERAGE PRIOR TO RESPONDING PAYER;
  • 'CS' FOR COB COVERAGE SUBSEQUENT TO RESPONDING PAYER;
  • 'MX' FOR MUTUALLY EXCLUSIVE BENEFITS;
  • 'CC' FOR CHANGE IN COVERAGE;
  • 'RP' FOR RESPONDING PAYER;
  • 'CE' FOR CENTRALIZED ELIGIBILITY;

  • LAST EDITED:  JUL 16, 2018
  • HELP-PROMPT:  Enter override value for the Other Payer Relationship Type.
  • DESCRIPTION:  
    This is the override value that will be used for the payer response for billing requests.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PAYER RELATIONSHIP TYPE (#2241) field of the BPS RESPONSES (#9002313.03) file. Corresponds to NCPDP code D41-PQ.
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