
File BPS_REQUESTS(9002313.77) Data List
| KEY1 |
KEY2 |
ACTING COB |
PROCESS FLAG |
NEXT REQUEST |
ECME TRANSACTION RECORD |
WAITING RESOLUTION? |
DONT PROCESS UNTIL |
RX ACTION |
OUTPATIENT SITE |
TRANSACTION TYPE |
BILLING DETERMINATION |
ELIGIBILITY |
CLAIM STATUS |
RATE TYPE |
PRIMARY PAYER BILL |
PRIOR PAYMENT |
COB OTHER PAYMENTS COUNT |
OTHER COVERAGE CODE |
RX NUMBER |
FILL NO |
PATIENT |
POLICY NUMBER |
DATE OF SERVICE |
REVERSAL REASON |
DURREC |
OVERRIDE CODE |
CLARIFICATION CODE |
BILL NDC |
PRE AUTH TYPE CODE |
PRE AUTH NUM SUB |
SC AND EI OVERRIDE FLAG |
DELAY REASON CODE |
DIAGNOSIS CODE |
DUR |
QUANTITY |
UNIT PRICE |
NDC |
REFILL |
CERTIFY MODE |
CERTIFICATION IEN |
UNIT OF MEASURE |
BILLING QUANTITY |
BILLING UNIT |
INSURER DATA |
REQUEST DATE AND TIME |
USER WHO MADE THE REQUEST |
ACTIVATED DATE TIME |
USER WHO ACTIVATED REQUEST |
DATE AND TIME UPDATED |
USER WHO UPDATED THE REQUEST |
CLOSE AFT REV |
CLOSE AFT REV REASON |
CLOSE AFT REV COMMENT |
COB OTHER PAYERS |
INACTIVATION REASON |