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Sub-Field: 366.1412

Package: Integrated Billing

IB NCPDP EVENT LOG(#366.14)-->366.141-->366.1412

Sub-Field: 366.1412


Information

Parent File Name Number Package
366.141 INSURANCE 366.1412 Integrated Billing

Details

Field # Name Loc Type Details
.01 INSURANCE 0;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 999, 0 Decimal Digits
  • DESCRIPTION:  
    Sequential number for patients insurances.
  • CROSS-REFERENCE:  366.1412^B
    1)= S ^IBCNR(366.14,DA(2),1,DA(1),5,"B",$E(X,1,30),DA)=""
    2)= K ^IBCNR(366.14,DA(2),1,DA(1),5,"B",$E(X,1,30),DA)
.02 GROUP INSURANCE PLAN 0;2 POINTER TO GROUP INSURANCE PLAN FILE (#355.3) GROUP INSURANCE PLAN(#355.3)

  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Enter Group Insurance Plan
  • DESCRIPTION:  
    Group Insurance Plan
.03 BIN 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-10 characters in length
  • DESCRIPTION:  
    Bank Identification Number
.04 PCN 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>16!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-16 characters in length.
  • DESCRIPTION:  
    Processor Control Number
.05 PAYER SHEET B1 0;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Payer sheet B1
.06 GROUP ID 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>55!($L(X)<1) X
    MAXIMUM LENGTH: 55
  • LAST EDITED:  SEP 27, 2017
  • HELP-PROMPT:  Answer must be 1-55 characters in length.
.07 CARDHOLDER ID 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  SEP 27, 2017
  • HELP-PROMPT:  Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    Cardholder ID
.08 PATIENT RELATIONSHIP CODE 0;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Number between 0 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    Patient Relationship code
.09 PHARMACY PERSON CODE 0;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>3!($L(X)<1) X
  • LAST EDITED:  JUN 21, 2011
  • HELP-PROMPT:  Answer must be 1-3 characters in length.
  • DESCRIPTION:  This is the pharmacy person code value at the time of IB billing determination. This field is stored and maintained with the patient insurance policy data. This is the code that is assigned by the payer to identify
    the patient. The payer may use a unique person code to identify each specific person on the pharmacy insurance policy. This code may also describe the patient's relationship to the cardholder.
    Enrollment Standard Examples:
    001 = Cardholder
    002 = Spouse
    003 - 999 = Dependents and Others (including second spouses, etc.)
  • TECHNICAL DESCR:  
    This corresponds with field# 4.06 in subfile 2.312 of the PATIENT (#2) file. NCPDP field 303-C3 - Person Code
.101 CARDHOLDER FIRST NAME 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  SEP 27, 2017
  • HELP-PROMPT:  Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    Cardholder First Name
.102 CARDHOLDER LAST NAME 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>60!($L(X)<1) X
    MAXIMUM LENGTH: 60
  • LAST EDITED:  SEP 27, 2017
  • HELP-PROMPT:  Answer must be 1-60 characters in length.
  • DESCRIPTION:  
    Cardholder Last Name
.103 STATE 1;3 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  JUN 20, 2006
  • DESCRIPTION:  
    State
.104 PAYER SHEET B2 1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Payer sheet B2
.105 PAYER SHEET B3 1;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Payer sheet B3
.106 SOFTWARE/VENDOR CERT ID 1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Software/Vendor Certification ID
.107 INSURANCE NAME 1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    Insurance Name
.201 DISPENSING FEE 2;1 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    Dispensing Fee Submitted
.202 BASIS OF COST DETERMINATION 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  
    Basis of Cost Determination
  • TECHNICAL DESCR:  
    for basis of cost determination the following is used: "07" would be sent for Usual & Customary "01" would be sent for AWP "05" would be sent for Cost calculations
.203 AWP OR TORT RATE OR COST 2;3 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    Average Wholesale Price OR Tort dollar amount rate OR Cost amount
.204 GROSS AMOUNT DUE 2;4 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    Gross Amount Due. Base price plus Dispense fee/Administrative fee.
.205 ADMINISTRATIVE FEE 2;5 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999, 2 Decimal Digits
  • DESCRIPTION:  
    Administrative Fee
.206 INGREDIENT COST 2;6 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  MAY 17, 2011
  • HELP-PROMPT:  Type a dollar amount between 0 and 9999999, 2 decimal digits.
  • DESCRIPTION:  
    The ingredient cost is the calculation of quantity times unit price. No fees included.
.207 USUAL AND CUSTOMARY CHARGE 2;7 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999)!(X<0)!(X?.E1"."3.N) X
  • LAST EDITED:  MAY 26, 2011
  • HELP-PROMPT:  Type a dollar amount between 0 and 9999999, 2 decimal digits.
  • DESCRIPTION:  
    Usual & Customary Charges. Gross Amount Due less the administrative fees.
.301 GROUP NAME 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  SEP 27, 2017
  • HELP-PROMPT:  Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    Group Name
.302 INSURANCE PHONE NUMBER 3;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>20!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-20 characters in length.
  • DESCRIPTION:  
    Insurance Phone Number
.303 PLAN ID 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
  • LAST EDITED:  JUN 20, 2006
  • HELP-PROMPT:  Answer must be 1-50 characters in length.
  • DESCRIPTION:  
    Plan ID
.304 PT INSURANCE POLICY 3;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999)!(X<0)!(X?.E1"."1.N) X
  • LAST EDITED:  JUN 21, 2011
  • HELP-PROMPT:  Type a number between 0 and 99999999, 0 decimal digits.
  • DESCRIPTION:  
    This is the insurance policy at the time of IB billing determination. This is the internal entry number to the 2.312 subfile of the PATIENT (#2) file.
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