File BPS_INSURER_DATA(9002313.78) Data List
| TRANSACTION ID |
B1 PAYER SHEET |
B2 PAYER SHEET |
B3 PAYER SHEET |
CERTIFY MODE |
CERTIFICATION |
INSURANCE NAME |
PLAN ID |
COB INDICATOR |
E1 PAYER SHEET |
POLICY NUMBER |
BIN |
PCN |
GROUP ID |
CARDHOLDER ID |
PATIENT RELATIONSHIP CODE |
CARDHOLDER FIRST NAME |
CARDHOLDER LAST NAME |
HOME PLAN STATE |
PERSON CODE |
DISPENSING FEE SUBMITTED |
BASIS OF COST DETERMINATION |
USUAL & CUSTOMARY CHARGE |
GROSS AMOUNT DUE |
ADMINISTRATIVE FEE |
SOFTWARE VENDOR CERT ID |
MAXIMUM NCPDP TRANSACTIONS |
INGREDIENT COST |
GROUP NAME |
INSURANCE CO PHONE # |
PHARMACY PLAN ID |
ELIGIBILITY |
INSURANCE COMPANY |
PLAN COB |
B1 PAYER SHEET NAME |
B2 PAYER SHEET NAME |
B3 PAYER SHEET NAME |
E1 PAYER SHEET NAME |
USER |
DATE AND TIME WAS CREATED |