File BPS_LOG_OF_TRANSACTIONS(9002313.57) Data List
| ENTRY NUMBER |
STATUS |
POLICY NUMBER |
PHARMACY |
PINS PIECE |
PRIOR AUTHORIZATION NUMBER |
PRESCRIPTION NUMBER |
RXI INTERNAL |
RESUBMIT AFTER REVERSAL |
NCPDP OVERRIDES |
PRIOR AUTHORIZATION TYPE CODE |
NDC |
USER NUMBER |
BIN NUMBER |
VERSION RELEASE NUMBER |
TRANSACTION CODE |
PROCESSOR CONTROL NUMBER |
PHARMACY NUMBER |
GROUP NUMBER |
CARDHOLDER ID NUMBER |
PERSON CODE |
DATE OF BIRTH |
SEX CODE |
RELATIONSHIP CODE |
CUSTOMER LOCATION |
OTHER COVERAGE CODE CALCULATED |
ELIGIBILITY CLARIFICATION CODE |
PATIENT FIRST NAME |
PATIENT LAST NAME |
CARDHOLDER FIRST NAME |
CARDHOLDER LAST NAME |
HOME PLAN |
EMPLOYER NAME |
EMPLOYER STREET ADDRESS |
EMPLOYER CITY ADDRESS |
EMPLOYER STATE |
EMPLOYER ZIP CODE |
EMPLOYER PHONE NUMBER |
EMPLOYER CONTACT NAME |
PATIENT STREET ADDRESS |
PATIENT CITY ADDRESS |
PATIENT STATE |
PATIENT ZIP CODE |
PATIENT PHONE NUMBER |
CARRIER ID NUMBER |
PATIENT WEIGHT |
PATIENT SSN |
DATE FILLED |
PRESCRIPTION NUMBER SEVEN |
NEW REFILL CODE |
METRIC QUANTITY |
DAYS SUPPLY |
COMPOUND CODE |
NDC NUMBER |
DISPENSE AS WRITTEN |
INGREDIENT COST |
SALES TAX |
PRESCRIBER ID |
DISPENSING FEE SUBMITTED |
DATE PRESCRIPTION WRITTEN |
NUMBER OF REFILLS AUTHORIZED |
PRIOR AUTH/MC CODE AND NUMBER |
LEVEL OF SERVICE |
PRESCRIPTION ORIGIN CODE |
PRESCRIPTION CLARIFICATION |
PRIMARY PRESCRIBER |
CLINIC ID NUMBER |
BASIS OF COST DETERMINATION |
DIAGNOSIS CODE |
DRUG TYPE |
USUAL AND CUSTOMARY CHARGE |
PRESCRIBER LAST NAME |
POSTAGE AMOUNT CLAIMED |
UNIT DOSE INDICATOR |
GROSS AMOUNT DUE |
OTHER PAYOR AMOUNT |
BASIS OF DAYS SUPPLY DET |
PATIENT PAID AMOUNT |
DATE OF INJURY |
CLAIM REF ID NUMBER |
ALT PRODUCT TYPE |
ALT PRODUCT CODE |
INCENTIVE AMOUNT SUBMITTED |
DUR CONFLICT CODE |
DUR INTERVENTION CODE |
DUR OUTCOME CODE |
METRIC DECIMAL QUANTITY |
OTHER PAYOR DATE |
PHARMACIST ID |
RESPONSE STATUS |
AUTHORIZATION NUMBER |
MESSAGE |
PATIENT PAY AMOUNT |
INGREDIENT COST PAID |
CONTRACT FEE PAID |
SALES TAX PAID |
TOTAL AMOUNT PAID |
REJECT COUNT |
REJECT CODES |
REJECT CODE 1 |
REJECT CODE 2 |
REJECT CODE 3 |
REJECT CODE 4 |
REJECT CODE 5 |
REJECT CODE 6 |
REJECT CODE 7 |
REJECT CODE 8 |
REJECT CODE 9 |
REJECT CODE 10 |
REJECT CODE 11 |
REJECT CODE 12 |
REJECT CODE 13 |
REJECT CODE 14 |
REJECT CODE 15 |
REJECT CODE 16 |
REJECT CODE 17 |
REJECT CODE 18 |
REJECT CODE 19 |
REJECT CODE 20 |
ACCUMULATED DEDUCTIBLE AMOUNT |
REMAINING DEDUCTIBLE AMOUNT |
REMAINING BENEFIT AMOUNT |
POSTAGE AMOUNT PAID |
DRUG DESCRIPTION |
AMOUNT APP TO PER DEDUCTIBLE |
AMOUNT OF COPAY COINSURANCE |
AMOUNT ATTR TO PRODUCT SELECT |
AMOUNT EXCEED PER BENEFIT MAX |
INCENTIVE FEE PAID |
BASIS OF REIMBURSEMENT DET |
AMOUNT ATTRIBUTED TO SALES TAX |
PLAN ID |
DUR RESPONSE DATA |
DUR COUNT |
DUR 1 RAW DATA |
DUR 1 DRUG CONFLICT CODE |
DUR 1 SEVERITY INDEX CODE |
DUR 1 OTHER PHARMACY INDIC |
DUR 1 PREVIOUS DATE OF FILL |
DUR 1 QTY OF PREVIOUS FILL |
DUR 1 DATABASE INDICATOR |
DUR 1 OTHER PRESCRIBER INDIC |
DUR 1 FREE TEXT |
DUR 1 RESERVE SPACE |
DUR 2 RAW DATA |
DUR 2 DRUG CONFLICT CODE |
DUR 2 SEVERITY INDEX CODE |
DUR 2 OTHER PHARMACY INDIC |
DUR 2 PREVIOUS DATE OF FILL |
DUR 2 QTY OF PREVIOUS FILL |
DUR 2 DATABASE INDICATOR |
DUR 2 OTHER PRESCRIBER INDIC |
DUR 2 FREE TEXT |
DUR 2 RESERVE SPACE |
DUR 3 RAW DATA |
DUR 3 DRUG CONFLICT CODE |
DUR 3 SEVERITY INDEX CODE |
DUR 3 OTHER PHARMACY INDIC |
DUR 3 PREVIOUS DATE OF FILL |
DUR 3 QTY OF PREVIOUS FILL |
DUR 3 DATABASE INDICATOR |
DUR 3 OTHER PRESCRIBER INDIC |
DUR 3 FREE TEXT |
DUR 3 RESERVE SPACE |
ADDITIONAL MESSAGE INFORMATION |
CLINICAL SIGNIFICANCE CODE |
OTHER PHARMACY INDICATOR |
PREVIOUS DATE OF FILL |
QUANTITY OF PREVIOUS FILL |
DATABASE INDICATOR |
OTHER PRESCRIBER INDICATOR |
DUR OVERFLOW |
FREE TEXT |
PHARMACY DIVISION |
COMMENT MULTIPLE |
RX ACTION |
DATE OF SERVICE |
SUBMISSION CLARIFICATION CODE |
COB OTHER PAYMENTS COUNT |
OTHER COVERAGE CODE |
USER |
DUR DATA |
POSITION IN CLAIM |
COB OTHER PAYERS |
START TIME |
SUBMIT REQUEST |
SUBMIT REQUEST DATE TIME |
COB INDICATOR |
TRANSACTION TYPE |
HL7 MESSAGE ID |
MCCF EDI TAS PROGRESS |
RESULT CODE |
RESULT TEXT |
CLAIM |
CLAIM IEN |
NON-BILLABLE REASON |
NON-BILLABLE CLOSED |
NON-BILLABLE DATE CLOSED |
NON-BILLABLE CLOSED BY |
NON-BILLABLE CLOSED COMMENT |
NON-BILLABLE DATE RE-OPENED |
NON-BILLABLE RE-OPENED BY |
NON-BILLABLE RE-OPENED COMMENT |
RESPONSE |
RESULT WITH REVERSAL |
RESULT |
RESPONSE IEN |
REVERSAL CLAIM |
REVERSAL RESPONSE |
REVERSAL REASON |
REVERSAL REQUEST |
REVERSAL REQUEST DATE TIME |
PATIENT |
QUANTITY |
UNIT PRICE |
SUBTOTAL |
DISPENSING FEE |
TOTAL PRICE |
ADMINISTRATIVE FEE |
UNIT OF MEASURE |
BILLING QUANTITY |
BILLING UNIT |
SUBMIT DATE |
LAST UPDATE |
ASLEEP PAYER |
FILL NUMBER |
CURRENT VA INSURER |
ELIGIBILITY |
PATIENT INSURANCE MULTIPLE |
HRN FAC |
DRUG NAME |
DRUG IEN |
RELEASED DATE |
NET PAID BY INSURER |
ELAPSED TIME PRINTABLE |
ELAPSED TIME SECONDS |
RESULT CATEGORY |