File BPS_PAYER_RESPONSE_OVERRIDES(9002313.32) Data List
| TRANSACTION NUMBER |
TYPE |
SUBMISSION RESPONSE |
TOTAL AMOUNT PAID |
REVERSAL RESPONSE |
AMOUNT OF COPAY |
DELAY |
ELIGIBILITY RESPONSE |
NEXT AVAILABLE FILL DATE |
ADJUDICATED PROGRAM TYPE |
QUAN LIMIT PER SPC TIME PERIOD |
QUANTITY LIMIT TIME PERIOD |
DAYS SUP LIM PER SPC TM PERIOD |
DAYS SUPPLY LIMIT TIME PERIOD |
INGREDIENT COST PAID |
DISPENSING FEE PAID |
REMAINING DEDUCTIBLE AMOUNT |
AMT APPLIED TO PERIODIC DEDUCT |
REJECT CODES |
PERCENTAGE TAX BASIS PAID |
OTHER AMOUNT PAID QUALIFIER |
PAYER/HEALTH PLAN ID QUALIFIER |
HELP DESK TELEPHONE NUMBER EXT |
PRO SERVICE FEE CONT/REIM AMT |
OTHER PAYER HELPDESK PHONE EXT |
RESPONSE INTERMED AUTH TYPE ID |
RESPONSE INTERMEDIARY AUTH ID |
RECONCILIATION ID |
PATIENT PAY AMOUNT |
REASON FOR SERVICE CODE |
INTERMEDIARY MESSAGE |
MAXIMUM AGE QUALIFIER |
MAXIMUM AGE |
MAXIMUM AMOUNT |
MAXIMUM AMOUNT QUALIFIER |
MAXIMUM AMOUNT TIME PERIOD |
MAX AMT TIME PERIOD START DATE |
MAX AMT TIME PERIOD END DATE |
MAX AMT TIME PERIOD UNITS |
MINIMUM AGE QUALIFIER |
MINIMUM AGE |
OTHER PAYER PROGRAM TYPE |
PATIENT PAY COMPONENT AMOUNT |
PATIENT PAY COMPONENT COUNT |
PATIENT PAY COMPONENT QUAL |
MINIMUM AMOUNT |
MINIMUM AMOUNT QUALIFIER |
OTHER PAYER NAME |
REMAINING AMOUNT |
REMAINING AMOUNT QUALIFIER |
OTHER PAYER RELATIONSHIP TYPE |
INVALID PROVIDER DATA SOURCE |
FORMULARY ALTERNATIVE EFF DATE |
DUR/DUE CO-AGENT DESCRIPTION |
UNIT OF PRIOR DISPENSED QTY |
OTHER PHARMACY ID QUALIFIER |
OTHER PHARMACY NAME |
OTHER PHARMACY TELEPHONE |
OTHER PRESCRIBER LAST NAME |
OTHER PRESCRIBER ID QUALIFIER |
OTHER PRESCRIBER ID |
OTHER PRESCRIBER PHONE NUMBER |
DUR/DUE COMPOUND PRODUCT ID |
DUR/DUE CMPND PRDUCT ID QUALIF |
DUR/DUE MAXIMUM DAILY DOSE QTY |
DUR/DUE MAX DAILY DOSE - UNIT |
DUR/DUE MINIMUM DAILY DOSE QTY |
DUR/DUE MIN DAILY DOSE - UNIT |