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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

Accessed By FileMan Db Calls, Total: 2

Package Total Routines
E Claims Management Engine 2 BPSTEST    BPSTEST2    

Pointer To FileMan Files, Total: 8

Package Total FileMan Files
E Claims Management Engine 8 BPS NCPDP REASON FOR SERVICE CODE(#9002313.23)[2.11]    BPS NCPDP PATIENT PAY COMPONENT QUALIFIER(#9002313.37)[4.14]    BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)[4.11]    BPS NCPDP COMPOUND PROD ID QUALIFIER(#9002313.39)[5.13]    BPS NCPDP OTHER PHARMACY ID QUALIFIER(#9002313.4)[5.05]    BPS NCPDP OTHER PRESCRIBER ID QUALIFIER(#9002313.41)[5.09]    BPS NCPDP INVALID PROVIDER DATA SOURCE(#9002313.42)[5.01]    BPS NCPDP REJECT CODES(#9002313.93)[#9002313.321(.01)]    

Fields, Total: 68

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 OF PAID;
  • 'P' FOR PAID;
  • 'Q' FOR DUPLICATE OF CAPTURED;
  • 'R' FOR REJECTED;
  • 'S' FOR DUPLICATE OF APPROVED;
  • 'T' FOR STRANDED;

  • LAST EDITED:  APR 21, 2020
  • HELP-PROMPT:  Enter the override for the payer response status fields.
  • DESCRIPTION:  
    The payer response for claims submissions (B1 transactions). This will be used for field 112 (Transaction Response Status) and field 501 (Header Response Status) on the RESPONSES sub-file of the BPS RESPONSES file.
.04 TOTAL AMOUNT PAID 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:  APR 15, 2021
  • 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 AMOUNT OF COPAY 0;6 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:  APR 15, 2021
  • HELP-PROMPT:  Enter the copay amount between 0 and 999999.99, returned by the payer, 2 decimal digits.
  • DESCRIPTION:  
    This is an override copay amount returned by a payer to be sent to Integrated Billing for copay creation.
  • TECHNICAL DESCR:  
    Corresponds to NCPDP field 518-FI AMOUNT OF COPAY.
.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 PROGRAM 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:  APR 21, 2020
  • HELP-PROMPT:  Enter override value for Adjudicated Program 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 PROGRAM 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 TAX BASIS PAID 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:  APR 20, 2020
  • HELP-PROMPT:  Enter override value for the Percentage 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 TAX BASIS PAID (#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/HEALTH PLAN 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:  APR 07, 2020
  • HELP-PROMPT:  Enter override value for the Payer/Health Plan 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/HEALTH PLAN 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 POINTER TO BPS NCPDP REASON FOR SERVICE CODE FILE (#9002313.23) BPS NCPDP REASON FOR SERVICE CODE(#9002313.23)

  • INPUT TRANSFORM:  S DIC("S")="I $P($G(^BPS(9002313.23,Y,0)),""^"",3)'=1" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  APR 14, 2023
  • HELP-PROMPT:  Enter the Reason for Service Code.
  • DESCRIPTION:  
    NCPDP field indicating reason for service code. This corresponds to NCPDP code 439-E4.
  • SCREEN:  S DIC("S")="I $P($G(^BPS(9002313.23,Y,0)),""^"",3)'=1"
  • EXPLANATION:  Value is not a valid code or is inactive.
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:  APR 27, 2020
  • HELP-PROMPT:  Enter the Maximum Age override value between 0 and 999, 0 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 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:  APR 27, 2020
  • HELP-PROMPT:  Enter the Patient Pay Component Count, between 0 and 99, 0 decimcal 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 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:  APR 27, 2020
  • HELP-PROMPT:  Enter a Minimum 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.
5.01 INVALID PROVIDER DATA SOURCE 5;1 POINTER TO BPS NCPDP INVALID PROVIDER DATA SOURCE FILE (#9002313.42) BPS NCPDP INVALID PROVIDER DATA SOURCE(#9002313.42)

  • LAST EDITED:  MAY 14, 2020
  • HELP-PROMPT:  Enter the data source of the Invalid Provider Determination.
  • DESCRIPTION:  
    This is the data source used to determine the invalid provider status.
  • TECHNICAL DESCR:  
    The value will be used to populate the DATA SOURCE OF INVALID PROVIDER DETERMINATION (#2387) field of the BPS RESPONSES- RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E87-ZV.
5.02 FORMULARY ALTERNATIVE EFF DATE 5;2 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:X<1 X
  • LAST EDITED:  MAY 01, 2020
  • HELP-PROMPT:  Enter the Formulary Alternative Effective Date.
  • DESCRIPTION:  
    This is the future date of the Formulary Alternative returned in the Formulary Alternative ID (533-AR) field.
  • TECHNICAL DESCR:  
    The value will be used to populate the FORMULARY ALTERNATIVE EFFECTIVE DATE (#2389) field of the BPS RESPONSE-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E93-ZC.
5.03 DUR/DUE CO-AGENT DESCRIPTION 5;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
    MAXIMUM LENGTH: 40
  • LAST EDITED:  APR 14, 2020
  • HELP-PROMPT:  Enter the DUR/DUE Co-Agent Description, 1 to 40 characters.
  • DESCRIPTION:  
    This is the description of the co-existing agent contributing to the DUR/DUE event.
  • TECHNICAL DESCR:  
    The value will be used to populate the DUR/DUE CO-AGENT DESCRIPTION (#2393) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E93-ZC.
5.04 UNIT OF PRIOR DISPENSED QTY 5;4 SET
  • 'EA' FOR Each;
  • 'GM' FOR Grams;
  • 'ML' FOR Milliliters;

  • LAST EDITED:  JUN 08, 2020
  • HELP-PROMPT:  Enter the Unit of Measure for the Previous Dispensed Quantity.
  • DESCRIPTION:  
    This is the code indicating the Unit of Measure associated with the 'Quantity of Previous Dispensed' (531-FV) field.
  • TECHNICAL DESCR:  
    The value will be used to populate the UNIT OF MEASURE FOR PREVIOUS DISPENSED QUANTITY (#2394) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E94-ZA.
5.05 OTHER PHARMACY ID QUALIFIER 5;5 POINTER TO BPS NCPDP OTHER PHARMACY ID QUALIFIER FILE (#9002313.4) BPS NCPDP OTHER PHARMACY ID QUALIFIER(#9002313.4)

  • LAST EDITED:  APR 15, 2020
  • HELP-PROMPT:  Enter value for the Other Pharmacy ID Qualifier.
  • DESCRIPTION:  
    This is the code qualifying the value in 'Other Pharmacy ID' (E96-Z8).
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PHARMACY ID QUALIFIER (#2395) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E95-Z9 and qualifies OTHER PHARMACY ID E96-Z8.
5.06 OTHER PHARMACY NAME 5;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<1) X
    MAXIMUM LENGTH: 70
  • LAST EDITED:  APR 15, 2020
  • HELP-PROMPT:  Enter the Other Pharmacy Name, 1 to 70 characters.
  • DESCRIPTION:  
    This is the name of the pharmacy associated to the prescription or previous event contributing to the DUR/DUE conflict.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PHARMACY NAME (#2397) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E97-Z7.
5.07 OTHER PHARMACY TELEPHONE 5;7 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 04, 2020
  • HELP-PROMPT:  Enter the Other Pharmacy Telephone, a 10-digit number.
  • DESCRIPTION:  
    This is the telephone number of the pharmacy associated with the prescription or previous event contributing to the DUR/DUE conflict.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PHARMACY TELEPHONE (#2398) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E98-Z6.
5.08 OTHER PRESCRIBER LAST NAME 5;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  JUN 08, 2020
  • HELP-PROMPT:  Enter the Other Prescriber Last Name, 1 to 35 characters.
  • DESCRIPTION:  
    This is the last name of the prescriber associated with the prescription or previous event contributing to the DUR/DUE conflict.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PRESCRIBER LAST NAME (#2399) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code E99-Z5.
5.09 OTHER PRESCRIBER ID QUALIFIER 5;9 POINTER TO BPS NCPDP OTHER PRESCRIBER ID QUALIFIER FILE (#9002313.41) BPS NCPDP OTHER PRESCRIBER ID QUALIFIER(#9002313.41)

  • LAST EDITED:  MAY 01, 2020
  • HELP-PROMPT:  Enter the code that qualifies the Other Prescriber ID.
  • DESCRIPTION:  
    This is the code qualifying the value in 'Other Prescriber ID' (F02-Z3).
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PRESCRIBER ID QUALIFIER (#2401) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F01-Z4 and qualifies OTHER PRESCRIBER ID F02-Z3.
5.1 OTHER PRESCRIBER ID 5;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  MAY 01, 2020
  • HELP-PROMPT:  Enter the Other Prescriber ID, 1 to 35 characters.
  • DESCRIPTION:  
    This is the ID assigned to the prescriber associated with the prescription or previous event contributing to the DUR/DUE conflict.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PRESCRIBER ID (#2402) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F02-Z3.
5.11 OTHER PRESCRIBER PHONE NUMBER 5;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<1000000000)!(X?.E1"."1.N) X
  • LAST EDITED:  MAY 04, 2020
  • HELP-PROMPT:  Enter the Other Prescriber Telephone, a 10-digit number.
  • DESCRIPTION:  
    This is the 10-digit telephone number of the prescriber of the prescription causing the DUR/DUE conflict.
  • TECHNICAL DESCR:  
    The value will be used to populate the OTHER PRESCRIBER TELEPHONE NUMBER (#2403) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F03-Z2.
5.12 DUR/DUE COMPOUND PRODUCT ID 5;12 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
    MAXIMUM LENGTH: 40
  • LAST EDITED:  MAY 13, 2020
  • HELP-PROMPT:  Enter the Compound Product ID, 1 to 40 characters.
  • DESCRIPTION:  
    Identifies the specific compound ingredient within the submitted compound claim, contributing to the DUR/DUE event.
  • TECHNICAL DESCR:  
    The value will be used to populate the DUR/DUE COMPOUND PRODUCT ID (#2404) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F04-Z1.
5.13 DUR/DUE CMPND PRDUCT ID QUALIF 5;13 POINTER TO BPS NCPDP COMPOUND PROD ID QUALIFIER FILE (#9002313.39) BPS NCPDP COMPOUND PROD ID QUALIFIER(#9002313.39)

  • LAST EDITED:  APR 15, 2020
  • HELP-PROMPT:  Enter the code that qualifies the Compound Product ID.
  • DESCRIPTION:  
    This is the code qualifying the value in 'DUR/DUE Compound Product ID' (F04-Z1).
  • TECHNICAL DESCR:  The value will be used to populate the DUR/DUE COMPOUND PRODUCT ID QUALIFIER (#2405) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F05-ZO and qualifies DUR/DUE COMPOUND PRODUCT
    ID F04-Z1.
5.14 DUR/DUE MAXIMUM DAILY DOSE QTY 5;14 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999.999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  APR 28, 2020
  • HELP-PROMPT:  Enter the maximum quantity between 0 and 9999999.999, 3 decimal digits.
  • DESCRIPTION:  
    This is the Maximum quantity associated to the DUR/DUE daily dose limitation.
  • TECHNICAL DESCR:  
    The value will be used to populate the DUR/DUE MAXIMUM DAILY DOSE QUANTITY (#2406) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F06-YO.
5.15 DUR/DUE MAX DAILY DOSE - UNIT 5;15 SET
  • 'MME' FOR Morphine Milligram Equivalent(s) (MME) ;
  • 'GM' FOR Gram(s);
  • 'EA' FOR Each(es);
  • 'MG' FOR Milligram(s);
  • 'UN' FOR Unit(s);
  • 'ML' FOR Milliliter(s);
  • 'INH' FOR Inhalation(s);
  • 'DRP' FOR Drop(s);

  • LAST EDITED:  APR 15, 2020
  • HELP-PROMPT:  Enter the Unit of Measure for the DUR/DUE Maximum Daily Dose Qty.
  • DESCRIPTION:  
    This is the code indicating the Unit of Measure associated to the 'DUR/DUE Maximum Daily Dose Quantity' (F06-YO).
  • TECHNICAL DESCR:  
    The value will be used to populate the DUR/DUE MAXIMUM DAILY DOSE UNIT OF MEASURE (#2407) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F07-YL.
5.16 DUR/DUE MINIMUM DAILY DOSE QTY 5;16 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999.999)!(X<0)!(X?.E1"."4.N) X
  • LAST EDITED:  APR 27, 2020
  • HELP-PROMPT:  Enter the minimum quantity between 0 and 9999999.999, 3 decimal digits.
  • DESCRIPTION:  
    This is the minimum quantity associated to the DUR/DUE daily dose limitation.
  • TECHNICAL DESCR:  
    The value will be used to populate the DUR/DUE MINIMUM DAILY DOSE QUANTITY (#2408) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F08-YJ.
5.17 DUR/DUE MIN DAILY DOSE - UNIT 5;17 SET
  • 'MME' FOR Morphine Milligram Equivalent(s) (MME) ;
  • 'GM' FOR Gram(s);
  • 'EA' FOR Each(es);
  • 'MG' FOR Milligram(s);
  • 'UN' FOR Unit(s);
  • 'ML' FOR Milliliter(s);
  • 'INH' FOR Inhalation(s);
  • 'DRP' FOR Drop(s);

  • LAST EDITED:  MAY 01, 2020
  • HELP-PROMPT:  Enter the Unit of Measure for the DUR/DUE Minimum Daily Dose Qty.
  • DESCRIPTION:  
    This is the code indicating the Unit of Measure associated to the 'DUR/DUE Minimum Daily Dose Quantity' (F08-YJ).
  • TECHNICAL DESCR:  
    The value will be used to populate the DUR/DUE MINIMUM DAILY DOSE UNIT OF MEASURE (#2409) field of the BPS RESPONSES-RESPONSES (#9002313.0301) sub-file. Corresponds to NCPDP code F09-YI.
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