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Sub-Field: 52.49304

Package: Outpatient Pharmacy

ERX HOLDING QUEUE(#52.49)-->52.49304

Sub-Field: 52.49304


Information

Parent File Name Number Package
ERX HOLDING QUEUE(#52.49) 2017 BENEFITS COORDINATION 52.49304 Outpatient Pharmacy

Details

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

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  NOV 07, 2019
  • HELP-PROMPT:  Enter the sequence number. Type a number between 1 and 99, 0 decimal digits.
  • DESCRIPTION:  
    This is the benefits coordination sequence number related to the incoming eRx.
  • CROSS-REFERENCE:  52.49304^B
    1)= S ^PS(52.49,DA(1),304,"B",$E(X,1,30),DA)=""
    2)= K ^PS(52.49,DA(1),304,"B",$E(X,1,30),DA)
.02 PAYER ID 0;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the payer ID. Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    This is the payer ID relating to the benefits coordination section of the incoming eRx.
.03 PROCESSOR ID NUMBER 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the processor identification number. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the processor identification number relating to the benefits coordination section of the incoming eRx.
.04 NAIC CODE 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the NAIC code. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the NAIC code relating to the benefits coordination section of the incoming eRx.
1.1 MUTUALLY DEFINED 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 06, 2019
  • HELP-PROMPT:  Enter mutually defined. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the mutually defined field associated with the benefits coordination section of the incoming eRx.
1.2 HEALTH PLAN IDENTIFIER 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the health plan identifier. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the health plan identifier relating to the benefits coordination section of the incoming eRx.
1.3 IIN NUMBER 1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the IIN number. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the health plan identifier relating to the benefits coordination section of the incoming eRx.
2.1 PAYER NAME 2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<1) X
    MAXIMUM LENGTH: 70
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the payer name. Answer must be 1-70 characters in length.
  • DESCRIPTION:  
    This is the payer name relating to the benefits coordination section of the incoming eRx.
2.2 CARDHOLDER ID 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the cardholder ID. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the cardholder ID relating to the benefits coordination section of the incoming eRx.
3.1 CARDHOLDER LAST NAME 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the cardholder last name. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the cardholder last name relating to the benefits coordination section of the incoming eRx.
3.2 CARDHOLDER FIRST NAME 3;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the cardholder first name. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the cardholder first name relating to the benefits coordination section of the incoming eRx.
3.3 CARDHOLDER MIDDLE NAME 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the cardholder middle name. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the cardholder middle name relating to the benefits coordination section of the incoming eRx.
3.4 CARDHOLDER SUFFIX 3;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the cardholder suffix. Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the cardholder suffix relating to the benefits coordination section of the incoming eRx.
3.5 CARDHOLDER PREFIX 3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the cardholder prefix. Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the cardholder prefix relating to the benefits coordination section of the incoming eRx.
4.1 GROUP ID 4;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the group ID. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the group ID relating to the benefits coordination section of the incoming eRX.
4.3 PAYER RESPONSIBILITY CODE 4;3 SET
  • 'P' FOR PRIMARY;
  • 'S' FOR SECONDARY;
  • 'T' FOR TERTIARY;
  • 'U' FOR UNKNOWN;
  • 'PP' FOR PRIVATE PARTY;

  • LAST EDITED:  OCT 06, 2019
  • HELP-PROMPT:  Enter the payer responsibility code.
  • DESCRIPTION:  
    This is the payer responsibility code relating to the benefits coordination section of the incoming eRx.
4.4 PATIENT RELATIONSHIP CODE 4;4 SET
  • '1' FOR CARDHOLDER;
  • '2' FOR SPOUSE;
  • '3' FOR CHILD;
  • '4' FOR OTHER;

  • LAST EDITED:  JUL 08, 2020
  • HELP-PROMPT:  Enter the patient relationship code.
  • DESCRIPTION:  
    This is the patient relationship code relating to the benefits coordination section of the incoming eRx.
4.5 PERSON CODE 4;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>3)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the person code. Type a number between 1 and 3, 0 decimal digits.
  • DESCRIPTION:  
    This is the person code relating to the benefits coordination section of the incoming eRx.
4.6 GROUP NAME 4;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>70!($L(X)<1) X
    MAXIMUM LENGTH: 70
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the group name. Answer must be 1-70 characters in length.
  • DESCRIPTION:  
    This is the group name relating to the benefits coordination section of the incoming eRx.
5.1 ADDRESS LINE 1 5;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
    MAXIMUM LENGTH: 40
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the address line 1. Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    This is the address line 1 relating to the benefits coordination section of the incoming eRx.
5.2 ADDRESS LINE 2 5;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>40!($L(X)<1) X
    MAXIMUM LENGTH: 40
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the address line 2. Answer must be 1-40 characters in length.
  • DESCRIPTION:  
    This is the address line 2 relating to the benefits coordination section of the incoming eRx.
5.3 CITY 5;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the city. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the city relating to the benefits coordination section of the incoming eRx.
5.4 STATE/PROVINCE 5;4 POINTER TO STATE FILE (#5) STATE(#5)

  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the state/province
  • DESCRIPTION:  
    This is the state/province relating to the benefits coordination section of the incoming eRx.
5.5 POSTAL CODE 5;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>9!($L(X)<5) X
    MAXIMUM LENGTH: 9
  • LAST EDITED:  OCT 02, 2019
  • HELP-PROMPT:  Enter the postal code. Answer must be 5-9 characters in length.
  • DESCRIPTION:  
    This is the postal code relating to the benefits coordination section of the incoming eRx.
5.6 COUNTRY CODE 5;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
    MAXIMUM LENGTH: 2
  • LAST EDITED:  OCT 03, 2019
  • HELP-PROMPT:  Enter the country code. Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    This is the country code associated with the incoming eRx.
6 2017 BENEFITS COMM 6;0 Multiple #52.493046 52.493046

  • DESCRIPTION:  
    This subfile contains the communication information associated with the benefits coordination section of the eRx. This subfile was created to support the 2017 script standard.
7 2017 BENEFITS DIRECT ADDRESS 7;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>254!($L(X)<1) X
    MAXIMUM LENGTH: 254
  • LAST EDITED:  NOV 07, 2019
  • HELP-PROMPT:  Enter the direct address. Answer must be 1-254 characters in length.
  • DESCRIPTION:  
    This is the direct address associated with the benefits coordination communication.
15.1 PBM MEMBER ID 15;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
    MAXIMUM LENGTH: 80
  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter the pharmacy benefits management identification. Answer must be 1-80 characters in length.
  • DESCRIPTION:  
    This is the pharmacy benefits management identification associated with the benefits coordination section.
16.1 RESPONSIBLE PARTY LAST NAME 16;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter the responsible party last name. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the responsible party last name associated with the benefits coordination section.
16.2 RESPONSIBLE PARTY FIRST NAME 16;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter the responsible party first name. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the responsible party first name associated with the benefits coordination section.
16.3 RESPONSIBLE PARTY MIDDLE NAME 16;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>35!($L(X)<1) X
    MAXIMUM LENGTH: 35
  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter the responsible party middle name. Answer must be 1-35 characters in length.
  • DESCRIPTION:  
    This is the responsible party middle name associated with the benefits coordination section
16.4 RESPONSIBLE PARTY SUFFIX 16;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter the responsible party suffix. Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the responsible party suffix associated with the benefits coordination section.
16.5 RESPONSIBLE PARTY PREFIX 16;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>10!($L(X)<1) X
    MAXIMUM LENGTH: 10
  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter the responsible party prefix. Answer must be 1-10 characters in length.
  • DESCRIPTION:  
    This is the responsible party prefix associated with the benefits coordination section.
16.6 PAYER TYPE 16;6 POINTER TO ERX SERVICE REASON CODES FILE (#52.45) ERX SERVICE REASON CODES(#52.45)

  • LAST EDITED:  OCT 08, 2019
  • HELP-PROMPT:  Enter the payer type.
  • DESCRIPTION:  
    This is the payer type associated with the benefits coordination section.
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