Parent File | Name | Number | Package |
---|---|---|---|
BPS RESPONSES(#9002313.03) | RESPONSES | 9002313.0301 | E Claims Management Engine |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | TRANSACTION ORDER | 0;1 | NUMBER |
|
112 | TRANSACTION RESPONSE STATUS | 110;2 | SET |
|
114 | MEDICAID SUBROGATION ICN/TCN | 100;14 | FREE TEXT |
|
128 | SPENDING ACCOUNT AMT REMAINING | 120;8 | FREE TEXT |
|
129 | HEALTH PLAN-FUNDED ASSTNCE AMT | 120;9 | FREE TEXT |
|
130 | ADDITIONAL MESSAGE INFO COUNT | 120;10 | FREE TEXT |
|
130.01 | ADDITIONAL MESSAGE MLTPL | 130.01;0 | Multiple #9002313.13001 | 9002313.13001
|
133 | AMT ATTRIB TO PRVDR NTWRK SEL | 130;3 | FREE TEXT |
|
134 | AMT ATTR PROD SEL BRAND DRUG | 130;4 | FREE TEXT |
|
135 | AMT ATTR PRD NON-PREF FRMLRY | 130;5 | FREE TEXT |
|
136 | AMT ATTR BRAND NON-PREF FRMLRY | 130;6 | FREE TEXT |
|
137 | AMOUNT ATTRIB TO COVERAGE GAP | 130;7 | FREE TEXT |
|
138 | CMS LICS LEVEL | 130;8 | FREE TEXT |
|
139 | MEDICARE PART D COVERAGE CODE | 130;9 | FREE TEXT |
|
140 | NEXT MEDICARE PART D EFFCTV DT | 130;10 | FREE TEXT |
|
141 | NEXT MEDICARE PART D TERM DATE | 140;1 | FREE TEXT |
|
148 | INGRED COST CNTRCTD REIMB AMT | 140;8 | FREE TEXT |
|
149 | DISP FEE CNTRCTD REIMB AMOUNT | 140;9 | FREE TEXT |
|
240 | CONTRACT NUMBER | 230;10 | FREE TEXT |
|
346 | BASIS OF CALC-DISPENSING FEE | 340;6 | SET |
|
347 | BASIS FOR COPAY | 340;7 | SET |
|
348 | BASIS OF CALC-FLAT SALES TAX | 340;8 | SET |
|
349 | BASIS FOR PERCENTAGE TAX | 340;9 | SET |
|
355 | OTHER PAYER ID COUNT | 350;5 | FREE TEXT |
|
355.01 | OTHER PAYER ID MLTPL | 355.01;0 | Multiple #9002313.035501 | 9002313.035501
|
392 | BENEFIT STAGE COUNT | 390;2 | FREE TEXT |
|
392.01 | BENEFIT STAGE INFO | 392.01;0 | Multiple #9002313.039201 | 9002313.039201
|
402 | PRESCRIPTION REFERENCE NUMBER | 400;2 | FREE TEXT |
|
455 | RX REFERENCE NUMBER QUALIFIER | 450;5 | SET |
|
498.14 | PRIOR AUTH NUMBER-ASSIGNED | 498;6 | FREE TEXT |
|
498.51 | DATE OF PRIOR AUTHORIZATION | 498;1 | FREE TEXT |
|
498.52 | PRIOR AUTHORIZATION START | 498;2 | FREE TEXT |
|
498.53 | PRIOR AUTHORIZATION END | 498;3 | FREE TEXT |
|
498.54 | PRIOR AUTH NO REFILLS AUTHRZD | 498;4 | NUMBER |
|
498.55 | PRIOR AUTH QTY ACCUMULATED | 498;5 | FREE TEXT |
|
498.57 | PRIOR AUTHORIZATION QUANTITY | 498;7 | FREE TEXT |
|
498.58 | PRIOR AUTHORIZATION AMOUNT | 498;8 | FREE TEXT |
|
501 | HEADER RESPONSE STATUS | 500;1 | SET |
|
503 | AUTHORIZATION NUMBER | 500;3 | FREE TEXT |
|
504 | MESSAGE | 504;1 | FREE TEXT |
|
505 | PATIENT PAY AMOUNT | 500;5 | FREE TEXT |
|
506 | INGREDIENT COST PAID | 500;6 | FREE TEXT |
|
507 | DISPENSING FEE PAID | 500;7 | FREE TEXT |
|
509 | TOTAL AMOUNT PAID | 500;9 | FREE TEXT |
|
510 | REJECT COUNT | 500;10 | FREE TEXT |
|
511 | REJECT CODE | 511;0 | Multiple #9002313.03511 | 9002313.03511
|
512 | ACCUMULATED DEDUCTIBLE AMOUNT | 500;12 | FREE TEXT |
|
513 | REMAINING DEDUCTIBLE AMOUNT | 500;13 | FREE TEXT |
|
514 | REMAINING BENEFIT AMOUNT | 500;14 | FREE TEXT |
|
517 | AMT APPLD PERIODIC DEDUCTIBLE | 500;17 | FREE TEXT |
|
518 | AMOUNT OF COPAY | 500;18 | FREE TEXT |
|
519 | AMT ATTRIB TO PROD SELECTION | 500;19 | FREE TEXT |
|
520 | AMT EXCEEDING PERIOD BNFT MAX | 500;20 | FREE TEXT |
|
521 | INCENTIVE AMOUNT PAID | 500;21 | FREE TEXT |
|
522 | BASIS OF REIMB DETERMINATION | 500;22 | FREE TEXT |
|
523 | AMOUNT ATTRIBUTED TO SALES TAX | 500;23 | FREE TEXT |
|
525 | DUR RESPONSE DATA | 525;1 | FREE TEXT |
|
526 | *ADDITIONAL MESSAGE INFORMATIO | 526;1 | FREE TEXT |
|
547 | APPROVED MESSAGE CODE COUNT | 540;7 | FREE TEXT |
|
548 | APPROVED MESSAGE CODE | 548;0 | Multiple #9002313.301548 | 9002313.301548
|
549 | HELP DESK PHONE QUALIFIER | 540;9 | FREE TEXT |
|
550 | HELP DESK TELEPHONE NUMBER | 540;10 | FREE TEXT |
|
551 | PREFERRED PRODUCT COUNT | 550;1 | NUMBER |
|
551.01 | PREFERRED PRODUCT REPEATING | 551.01;0 | Multiple #9002313.1301 | 9002313.1301
|
557 | TAX EXEMPT INDICATOR | 550;7 | SET |
|
558 | FLAT SALES TAX PAID | 550;8 | FREE TEXT |
|
559 | PERCENTAGE SALES TAX PAID | 550;9 | FREE TEXT |
|
560 | PERCENTAGE SALES TAX RATE PAID | 550;10 | FREE TEXT |
|
561 | PERCENTAGE SALES TAX BASIS PD | 560;1 | SET |
|
562 | PROFESSIONAL SERVICE FEE PAID | 560;2 | FREE TEXT |
|
563 | OTHER AMOUNT PAID COUNT | 560;3 | FREE TEXT |
|
563.01 | OTHER AMOUNTS PAID | 563.01;0 | Multiple #9002313.1401 | 9002313.1401
|
566 | OTHER PAYER AMOUNT RECOGNIZED | 560;6 | FREE TEXT |
|
567.01 | DUR PPS | 567.01;0 | Multiple #9002313.1101 | 9002313.1101
|
571 | AMOUNT ATTRIBUTED TO PROC FEE | 570;1 | FREE TEXT |
|
572 | AMOUNT OF COINSURANCE | 570;2 | FREE TEXT |
|
573 | BASIS OF CALC-COINSURANCE | 570;3 | FREE TEXT |
|
574 | PLAN SALES TAX AMOUNT | 570;4 | FREE TEXT |
|
575 | PATIENT SALES TAX | 570;5 | FREE TEXT |
|
577 | ESTIMATED GENERIC SAVINGS | 570;7 | FREE TEXT |
|
757 | BENEFIT ID | 750;7 | FREE TEXT |
|
880 | TRANSACTION REFERENCE NUMBER | 870;10 | FREE TEXT |
|
926 | FORMULARY ID | 920;6 | FREE TEXT |
|
931 | MAXIMUM AGE QUALIFIER | 930;1 | SET |
|
932 | MAXIMUM AGE | 930;2 | NUMBER |
|
933 | MAXIMUM AMOUNT | 930;3 | FREE TEXT |
|
934 | MAXIMUM AMOUNT QUALIFIER | 930;4 | SET |
|
935 | MAXIMUM AMOUNT TIME PERIOD | 930;5 | SET |
|
936 | MAX AMT TIME PERIOD START DATE | 930;6 | FREE TEXT |
|
937 | MAX AMT TIME PERIOD END DATE | 930;7 | FREE TEXT |
|
938 | MAX AMT TIME PERIOD UNITS | 930;8 | NUMBER |
|
943 | MINIMUM AGE QUALIFIER | 940;3 | SET |
|
944 | MINIMUM AGE | 940;4 | NUMBER |
|
987 | URL | 987;1 | FREE TEXT |
|
993 | INTERNAL CONTROL NUMBER | 990;3 | FREE TEXT |
|
1000 | DUPLICATE RESPONSE DATA | 1000;1 | FREE TEXT |
|
1028 | ADJUDICATED PAYMENT TYPE | A20;8 | FREE TEXT |
|
2004 | NEXT AVAIL FILL DATE | B00;4 | FREE TEXT |
|
2022 | HELP DESK TELEPHONE NUMBER EXT | B20;2 | FREE TEXT |
|
2033 | PRO SERVICE FEE CONT/REIM AMT | B30;3 | FREE TEXT |
|
2052 | RESPONSE INTERMEDIARY AUTH CNT | B50;2 | NUMBER |
|
2052.01 | INTERMEDIARY MULTIPLE | B52;0 | Multiple #9002313.032052 | 9002313.032052
|
2087 | QUAN LIMIT PER SPC TM PD COUNT | B80;7 | NUMBER |
|
2087.01 | QUAN LIMIT TIME PERIOD MLTPL | B87;0 | Multiple #9002313.032087 | 9002313.032087
|
2090 | DAYS SUP LIM PER SPC TM PD CNT | B80;10 | NUMBER |
|
2090.01 | DAYS SUPPLY LIM TM PD MULTIPLE | B90;0 | Multiple #9002313.032091 | 9002313.032091
|
2098 | RECONCILIATION ID | B98;1 | FREE TEXT |
|
2147 | OTHER PAYER PROGRAM TYPE | C40;7 | POINTER TO BPS NCPDP OTHER PAYER PROGRAM TYPE FILE (#9002313.38) | BPS NCPDP OTHER PAYER PROGRAM TYPE(#9002313.38)
|
2150 | BENEFIT STAGE INDICATOR COUNT | C40;10 | NUMBER |
|
2151 | BENEFIT STAGE INDICATOR | C50;1 | POINTER TO BPS NCPDP BENEFIT STAGE INDICATOR FILE (#9002313.35) | BPS NCPDP BENEFIT STAGE INDICATOR(#9002313.35)
|
2158 | BENEFIT TYPE OPPORTUNITY | C50;8 | SET |
|
2159 | BENEFIT TYPE OPPORTUNITY COUNT | C50;9 | NUMBER |
|
2166 | HELP DESK BUS UNIT TYPE | C60;6 | SET |
|
2167 | HELP DESK BUS UNIT TYPE COUNT | C60;7 | NUMBER |
|
2168 | HELP DESK CONTACT INFORMATION | C60;8 | FREE TEXT |
|
2169 | HELP DESK CONTACT INFO EXT | C60;9 | FREE TEXT |
|
2170 | HELP DESK CONTACT INFO QUAL | C60;10 | SET |
|
2171 | HELP DESK SUPPORT TYPE | C70;1 | SET |
|
2172 | HELP DESK SUPPORT TYPE COUNT | C70;2 | NUMBER |
|
2180 | INTERMEDIARY HELP DESK TYPE | C70;10 | SET |
|
2181 | INTERMEDIARY HLPDSK BUS COUNT | C80;1 | NUMBER |
|
2182 | INTERMEDIARY HLPDSK CONTACT | C80;2 | FREE TEXT |
|
2183 | INTERMEDIARY HLPDSK EXTENSION | C80;3 | FREE TEXT |
|
2184 | INTERMEDIARY HLPDSK QUALIFIER | C80;4 | SET |
|
2185 | INTERMEDIARY HLPDSK SUPPT TYPE | C80;5 | SET |
|
2186 | INTERMEDIARY HLPDSK TYP COUNT | C80;6 | NUMBER |
|
2193 | PATIENT PAY COMPONENT AMOUNT | C90;3 | FREE TEXT |
|
2194 | PATIENT PAY COMPONENT COUNT | C90;4 | NUMBER |
|
2195 | PATIENT PAY COMPONENT QUAL | C90;5 | POINTER TO BPS NCPDP PATIENT PAY COMPONENT QUALIFIER FILE (#9002313.37) | BPS NCPDP PATIENT PAY COMPONENT QUALIFIER(#9002313.37)
|
2196 | PAYER/HEALTH PLAN ID COUNT | C90;6 | NUMBER |
|
2215 | SUBROGTN REQUESTR RECONCIL ID | D10;5 | FREE TEXT |
|
2219 | MINIMUM AMOUNT | D10;9 | FREE TEXT |
|
2220 | MINIMUM AMOUNT QUALIFIER | D10;10 | SET |
|
2223 | OTHER PAYER NAME | D20;3 | FREE TEXT |
|
2224 | REMAINING AMOUNT | D20;4 | FREE TEXT |
|
2225 | REMAINING AMOUNT QUALIFIER | D20;5 | SET |
|
2241 | OTHER PAYER RELATIONSHIP TYPE | D40;1 | SET |
|
2242 | FORMULARY ALT BENEFIT TIER | D40;2 | SET |
|
2243 | FORMULARY ALT REASON CODE | D40;3 | SET |
|
2244 | FORMULRY ALT REQ THERAPY COUNT | D40;4 | FREE TEXT |
|
2245 | FORMULRY ALT THERAPY INDICATOR | D40;5 | SET |
|
2246 | FORMULRY ALT THERAPY TIME QUAL | D40;6 | SET |
|
2247 | FORMULRY ALT THERAPY DURATION | D40;7 | FREE TEXT |
|
2248 | FORMULRY ALT THERAPY START DT | D40;8 | DATE |
|
2249 | FORMULRY ALT THERAPY END DATE | D40;9 | DATE |
|
2250 | OTHER PAYER BENEFIT CLASS | D40;10 | FREE TEXT |
|
2254 | PLAN OVERRIDE INDICATOR | D50;4 | FREE TEXT |
|
2255 | PLAN OVERRIDE VALUE COUNT | D50;5 | NUMBER |
|
2256 | PLAN BENEFIT OVERRIDE VALUE | D50;6 | FREE TEXT |
|
2261 | REGULATORY FEE TYPE CODE | D60;1 | SET |
|
2262 | REGULATORY FEE EXMPT INDICATOR | D60;2 | SET |
|
2265 | PATIENT REGULATORY FEE AMOUNT | D60;5 | NUMBER |
|