| Parent File | Name | Number | Package |
|---|---|---|---|
| FEE BASIS PHARMACY INVOICE(#162.1) | PRESCRIPTION NUMBER | 162.11 | Fee Basis |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | PRESCRIPTION NUMBER | 0;1 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 1 | DRUG NAME | 0;2 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 1.4 | MANUFACTURER | 2;2 | FREE TEXT |
|
| 1.5 | STRENGTH | 0;12 | FREE TEXT |
|
| 1.6 | QUANTITY | 0;13 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 2 | DATE PRESCRIPTION FILLED | 0;3 | DATE | ************************REQUIRED FIELD************************
|
| 3 | AMOUNT CLAIMED | 0;4 | NUMBER | ************************REQUIRED FIELD************************
|
| 4 | PATIENT | 0;5 | POINTER TO FEE BASIS PATIENT FILE (#161) | ************************REQUIRED FIELD************************ FEE BASIS PATIENT(#161)
|
| 5 | RED BOOK COST | 0;6 | NUMBER |
|
| 6 | AMOUNT SUSPENDED | 0;7 | NUMBER |
|
| 6.5 | AMOUNT PAID | 0;16 | NUMBER |
|
| 7 | SUSPEND CODE | 0;8 | POINTER TO FEE BASIS SUSPENSION FILE (#161.27) | FEE BASIS SUSPENSION(#161.27)
|
| 8 | LINE ITEM STATUS | 0;9 | SET | ************************REQUIRED FIELD************************
|
| 8.5 | SUBSTITUTE GENERIC DRUG | 0;21 | SET |
|
| 9 | GENERIC DRUG | 0;10 | POINTER TO DRUG FILE (#50) | ************************REQUIRED FIELD************************ DRUG(#50)
|
| 10 | PHARMACY DETERMINATION | 0;11 | SET |
|
| 11 | PHARMACIST | 0;14 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
| 12 | DATE OF DETERMINATION | 0;15 | DATE |
|
| 13 | BATCH NUMBER | 0;17 | POINTER TO FEE BASIS BATCH FILE (#161.7) | ************************REQUIRED FIELD************************ FEE BASIS BATCH(#161.7)
|
| 14 | OBLIGATION NUMBER | 0;18 | FREE TEXT | ************************REQUIRED FIELD************************
|
| 15 | DATE CERTIFIED FOR PAYMENT | 0;19 | DATE |
|
| 16 | PAYMENT TYPE CODE | 0;20 | SET |
|
| 17 | REJECT STATUS | FBREJ;1 | SET |
|
| 18 | REJECT REASON | FBREJ;2 | FREE TEXT |
|
| 19 | OLD BATCH NUMBER | FBREJ;3 | POINTER TO FEE BASIS BATCH FILE (#161.7) | FEE BASIS BATCH(#161.7)
|
| 19.3 | INTERFACE REJECT | FBREJ;4 | SET |
|
| 19.6 | REJECT CODE | FBREJC;0 | Multiple #162.111 | 162.111
|
| 20 | SUSPENSION DESCRIPTION | 1;0 | WORD-PROCESSING #162.12 |
|
| 21 | GENERIC DRUG ONLY STATUS | 2;1 | SET |
|
| 22 | PHARMACY REMARKS | 0;22 | FREE TEXT |
|
| 23 | VOID PAYMENT | 2;3 | SET |
|
| 23.5 | REASON FOR VOIDED PAYMENT | R;1 | FREE TEXT |
|
| 24 | SUPERVISOR | 2;4 | POINTER TO NEW PERSON FILE (#200) | NEW PERSON(#200)
|
| 25 | PRIMARY SERVICE FACILITY | 2;5 | POINTER TO INSTITUTION FILE (#4) | INSTITUTION(#4)
|
| 26 | ASSOCIATED 7078/583 | 2;6 | VARIABLE POINTER | VA FORM 10-7078(#162.4) FEE BASIS UNAUTHORIZED CLAIMS(#162.7)
|
| 27 | AUTHORIZATION POINTER | 2;7 | NUMBER |
|
| 28 | DATE PAID | 2;8 | DATE |
|
| 29 | PROMPT PAY TYPE | 2;9 | SET |
|
| 30 | CHECK NUMBER | 2;10 | FREE TEXT |
|
| 31 | CANCELLATION DATE | 2;11 | DATE |
|
| 32 | REASON CODE | 2;12 | POINTER TO FEE BASIS CHECK CANCELLATION REASON FILE (#162.95) | FEE BASIS CHECK CANCELLATION REASON(#162.95)
|
| 33 | CANCELLATION ACTIVITY | 2;13 | SET |
|
| 34 | DISBURSED AMOUNT | 2;14 | NUMBER |
|
| 35 | INTEREST AMOUNT | 2;15 | NUMBER |
|
| 36 | FPPS LINE ITEM | 3;1 | FREE TEXT |
|
| 37 | ADJUSTMENT | 4;0 | POINTER Multiple #162.14 | 162.14 |
| 38 | REMITTANCE REMARK | 5;0 | POINTER Multiple #162.15 | 162.15 |
| 39 | DoD INVOICE NUMBER | 6;1 | FREE TEXT |
|
| 40 | AUTHORIZATION NUMBER | 3;2 | FREE TEXT |
|