{"aaData": [["101", "IIN NUMBER\n", "NUMERIC\n", "A1\n", "6\n", "6\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("NCPDP","BIN Number"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),100),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6)\n\n\n"], ["305", "PATIENT GENDER CODE\n", "NUMERIC\n", "C5\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Gender Code"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["334", "SMOKER/NONSMOKER\n", "NUMERIC\n", "1C\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),330),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),1)\n\n\n"], ["335", "PREGNANCY INDICATOR\n", "NUMERIC\n", "2C\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),330),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),1)\n\n\n"], ["336", "FACILITY ID\n", "ALPHA/NUMERIC\n", "8C\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Insurer","Facility ID"))\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),330),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),10)\n\n\n"], ["337", "COB/OTHER PAYMENTS COUNT\n", "NUMERIC\n", "4C\n", "1\n", "1\n", "NUMERIC\n", "", "COORDINATION OF BENEFITS/OTHER PAYMENTS COUNT\n", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nD SET337^BPSFLD01\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["338", "OTHER PAYER COVERAGE TYPE\n", "NUMERIC\n", "5C\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE OTHER PAYERS\n", "\nD SET338^BPSFLD01\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["339", "OTHER PAYER ID QUALIFIER\n", "NUMERIC\n", "6C\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE OTHER PAYERS\n", "\nD SET339^BPSFLD01\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["340", "OTHER PAYER ID\n", "ALPHA/NUMERIC\n", "7C\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "RESPONSE OTHER PAYERS\n", "\nD SET340^BPSFLD01\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["341", "OTHER PAYER AMOUNT PAID COUNT\n", "NUMERIC\n", "HB\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nD SET341^BPSFLD01\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["342", "OTHER PAYER AMT PAID QUALIFIER\n", "ALPHA/NUMERIC\n", "HC\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "OTHER PAYER AMOUNT PAID QUALIFIER\n", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD SET342^BPSFLD01\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["343", "DISPENSING STATUS\n", "ALPHA/NUMERIC\n", "HD\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),340),U,3)=""\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["306", "PATIENT RELATIONSHIP CODE\n", "NUMERIC\n", "C6\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Insurer","Relationship"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["344", "QTY INTENDED TO BE DISPENSED\n", "NUMERIC\n", "HF\n", "10\n", "10\n", "NUMERIC\n", "", "QUANTITY INTENDED TO BE DISPENSED\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\\1\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),340),U,4)=""\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["345", "DAYS SUPPLY INTEND TO BE DISP\n", "NUMERIC\n", "HG\n", "3\n", "3\n", "NUMERIC\n", "", "DAYS SUPPLY INTENDED TO BE DISPENSED\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Days Supply"))*1000\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),340),U,5)=""\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["346", "BASIS OF CALC - DISPENSING FEE\n", "ALPHA/NUMERIC\n", "HH\n", "8\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["347", "BASIS OF CALC - COPAY\n", "ALPHA/NUMERIC\n", "HJ\n", "8\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["348", "BASIS OF CALC - REGULATORY FEE\n", "ALPHA/NUMERIC\n", "HK\n", "8\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["349", "BASIS OF CALC - % TAX\n", "ALPHA/NUMERIC\n", "HM\n", "8\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),340),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["350", "PATIENT E-MAIL ADDRESS\n", "ALPHA/NUMERIC\n", "HN\n", "80\n", "80\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Patient E-Mail Address"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),80)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),340),U,10)=$G(BPS("X"))\n\n\n", ""], ["351", "OTHER PAYER-PAT RESP AMT QLFR\n", "ALPHA/NUMERIC\n", "NP\n", "1\n", "2\n", "ALPHANUMERIC\n", "", "OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT QUALIFIER\n", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD SET351^BPSFLD01\n
\n\n", ""], ["352", "OTHER PAYER-PAT RESP AMOUNT\n", "SIGNED NUMERIC\n", "NQ\n", "10\n", "10\n", "SIGNED NUMERIC\n", "", "OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT\n", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nD SET352^BPSFLD01\n
\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["353", "OTHER PAYER-PAT RESP AMT CNT\n", "NUMERIC\n", "NR\n", "1\n", "2\n", "NUMERIC\n", "", "OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT COUNT\n", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD SET353^BPSFLD01\n
\n\n", ""], ["308", "OTHER COVERAGE CODE\n", "NUMERIC\n", "C8\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Other Coverage Code"))\nS:'BPS("X") BPS("X")=0\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),300),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["445", "ORIG PRESCRIBED PROD/SERV CODE\n", "ALPHA/NUMERIC\n", "EA\n", "19\n", "19\n", "ALPHANUMERIC\n", "", "ORIGINALLY PRESCRIBED PRODUCT/SERVICE CODE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,5)="" \n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),19)\n\n\n"], ["446", "ORIGINALLY PRESCRIBED QUANTITY\n", "NUMERIC\n", "EB\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\\1\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,6)=BPS("X") ;VA\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["454", "SCHEDULED PRESCRIPTION ID NUM\n", "NUMERIC\n", "EK\n", "12\n", "12\n", "ALPHANUMERIC\n", "", "SCHEDULED PRESCRIPTION ID NUMBER\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM(BPS("X"),12)\n\n\n"], ["456", "ASSOC PRESCRIPTION/SERV REF NO\n", "ALPHA/NUMERIC\n", "EN\n", "7\n", "12\n", "NUMERIC\n", "", "ASSOCIATED PRESCRIPTION/ SERVICE REFERENCE NUMBER\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),12)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,6)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),7)\n\n\n"], ["457", "ASSOC PRESCRIPTION/SERV DATE\n", "ALPHA/NUMERIC\n", "EP\n", "8\n", "8\n", "NUMERIC\n", "", "ASSOCIATED PRESCRIPTION/ SERVICE DATE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,7)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"")\n\n\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n"], ["458", "PROCEDURE MODIFIER CODE COUNT\n", "NUMERIC\n", "SE\n", "1\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,8)=""\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM(BPS("X"),1)\n\n\n"], ["459", "PROCEDURE MODIFIER CODE\n", "ALPHA/NUMERIC\n", "ER\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\n; Not implemented\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),2)\n\n\n"], ["461", "PRIOR AUTHORIZATION TYPE CODE\n", "NUMERIC\n", "EU\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Prior Auth Type"))\nS:BPS("X")="" BPS("X")=0\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["462", "PRIOR AUTH NUMBER SUBMITTED\n", "ALPHA/NUMERIC\n", "EV\n", "11\n", "11\n", "NUMERIC\n", "", "PRIOR AUTHORIZATION NUMBER SUBMITTED\n", "\nS BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Prior Auth Num Sub"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11)\n\n\n"], ["464", "INTERMEDIARY AUTHORIZATION ID\n", "ALPHA/NUMERIC\n", "EX\n", "11\n", "11\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Intermediary Auth ID"))\nS:BPS("X")="" BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),11)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),11)\n\n\n"], ["401", "DATE OF SERVICE\n", "NUMERIC\n", "D1\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("NCPDP","DOS"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "RESPONSE HEADER\n", "\nS $P(^BPSC(BPS(9002313.02),401),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["471", "OTHER PAYER REJECT COUNT\n", "NUMERIC\n", "5E\n", "2\n", "2\n", "NUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD SET471^BPSFLD01\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["472", "OTHER PAYER REJECT CODE\n", "ALPHA/NUMERIC\n", "6E\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nD SET472^BPSFLD01\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["473", "DUR/PPS CODE COUNTER\n", "NUMERIC\n", "7E\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=1\n\n\n", "DUR/PPS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nD FLD473^BPSOSSG\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["474", "DUR/PPS LEVEL OF EFFORT\n", "NUMERIC\n", "8E\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=12\n\n\n", "DUR/PPS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD FLD474^BPSOSSG\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["475", "DUR/DUE CO-AGENT ID QUALIFIER\n", "ALPHA/NUMERIC\n", "J9\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "DUR/PPS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD FLD475^BPSOSSG\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["476", "DUR/DUE CO-AGENT ID\n", "ALPHA/NUMERIC\n", "H6\n", "19\n", "19\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "DUR/PPS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n", "", "\nD FLD476^BPSOSSG\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n"], ["477", "PROF SERVICE FEE SUBMITTED\n", "SIGNED NUMERIC\n", "BE\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "PROFESSIONAL SERVICE FEE SUBMITTED\n", "\nS BPS("X")=0\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),470),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["481", "REGULATORY FEE AMT SUBMITTED\n", "SIGNED NUMERIC\n", "HA\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "REGULATORY FEE AMOUNT SUBMITTED\n", "\nS BPS("X")=0\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,1)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM(BPS("X"),8)\n\n\n"], ["307", "PLACE OF SERVICE\n", "ALPHA/NUMERIC\n", "C7\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Place of Service"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["482", "PERCENT TAX AMT SUBMITTED\n", "SIGNED NUMERIC\n", "GE\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "PERCENT TAX AMOUNT SUBMITTED\n", "\nS BPS("X")=0\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,2)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["483", "PERCENT TAX RATE SUBMITTED\n", "SIGNED NUMERIC\n", "HE\n", "7\n", "7\n", "SIGNED NUMERIC\n", "", "PERCENTAGE SALES TAX RATE SUBMITTED\n", "\nS BPS("X")=+$G(BPS("Insurer","Percent Sales Tax Rate Sub"))\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),7,4)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,3)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),7,4)\n\n\n"], ["484", "PERCENTAGE TAX BASIS SBMTTD\n", "ALPHA/NUMERIC\n", "JE\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "PERCENTAGE SALES TAX BASIS SUBMITTED\n", "\nS BPS("X")=""\n\n\n", "PRICING\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,4)=$S($G(BPS("NCPDP","Version"))=51:BPS("X"),1:"")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),2)\n\n\n"], ["485", "COUPON TYPE\n", "ALPHA/NUMERIC\n", "KE\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COUPON\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["486", "COUPON NUMBER\n", "ALPHA/NUMERIC\n", "ME\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COUPON\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["487", "COUPON VALUE AMOUNT\n", "SIGNED NUMERIC\n", "NE\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COUPON\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),480),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["491", "DIAGNOSIS CODE COUNT\n", "NUMERIC\n", "VE\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=1\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),490),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["492", "DIAGNOSIS CODE QUALIFIER\n", "ALPHA/NUMERIC\n", "WE\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")="02"\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),490),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["493", "CLINICAL INFORMATION COUNTER\n", "NUMERIC\n", "XE\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["498.01", "REQUEST TYPE\n", "NUMERIC\n", "PA\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=""\n\n\n", "", "", "\nS BPS("X")=""\n\n\n"], ["309", "ELIGIBILITY CLARIFICATION CODE\n", "NUMERIC\n", "C9\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Insurer","Eligibility Clarification Code"))\nS:BPS("X")="" BPS("X")=0\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["498.02", "REQUEST PERIOD DATE-BEGIN\n", "ALPHA/NUMERIC\n", "PB\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "", ""], ["498.03", "REQUEST PERIOD DATE-END\n", "ALPHA/NUMERIC\n", "PC\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "", ""], ["498.04", "BASIS OF REQUEST\n", "ALPHA/NUMERIC\n", "PD\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["498.05", "AUTHORIZED REP FIRST NAME\n", "ALPHA/NUMERIC\n", "PE\n", "12\n", "12\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n", "", "", ""], ["498.06", "AUTHORIZED REP LAST NAME\n", "ALPHA/NUMERIC\n", "PF\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "", ""], ["498.07", "AUTHORIZED REP STREET ADDRESS\n", "ALPHA/NUMERIC\n", "PG\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "", ""], ["498.08", "AUTH REP CITY ADDRESS\n", "ALPHA/NUMERIC\n", "PH\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "", ""], ["498.09", "AUTHORIZED REP STATE/PROV ADDR\n", "ALPHA/NUMERIC\n", "PJ\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["498.11", "AUTHORIZED REP ZIP/POSTAL ZONE\n", "ALPHA/NUMERIC\n", "PK\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "AUTHORIZED REPRESENTATIVE ZIP/POSTAL ZONE\n", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "", ""], ["498.12", "PRESCRIBER TELEPHONE NUMBER\n", "NUMERIC\n", "PM\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=$TR($G(BPS("RX",BPS(9002313.0201),"Prescriber Phone #")),"#() -_*.@")\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),498),U,12)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM(BPS("X"),10)\n\n\n"], ["310", "PATIENT FIRST NAME\n", "ALPHA/NUMERIC\n", "CA\n", "12\n", "12\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","First Name"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n", "RESPONSE PATIENT\n", "\nS $P(^BPSC(BPS(9002313.02),300),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n"], ["498.13", "PRIOR AUTH SUPPORTING DOCUMENT\n", "ALPHA/NUMERIC\n", "PP\n", "200\n", "500\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),500)\n\n\n", "", "", ""], ["498.14", "PRIOR AUTH NUMBER-ASSIGNED\n", "NUMERIC\n", "PY\n", "8\n", "11\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11)\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["498.52", "PRIOR AUTH EFFECTIVE DATE\n", "ALPHA/NUMERIC\n", "PS\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["498.53", "PRIOR AUTH EXPIRATION DATE\n", "ALPHA/NUMERIC\n", "PT\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["498.54", "PRIOR AUTH NO REFILLS AUTH\n", "NUMERIC\n", "PW\n", "8\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["498.55", "PRIOR AUTH QTY ACCUMULATED\n", "NUMERIC\n", "PX\n", "8\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["498.57", "PRIOR AUTHORIZATION QUANTITY\n", "ALPHA/NUMERIC\n", "RA\n", "3\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["498.58", "PRIOR AUTH DOLLARS AUTHORIZED\n", "NUMERIC\n", "RB\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["498.59", "AUTH REP CITY ADDRESS\n", "ALPHA/NUMERIC\n", "PH\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "", ""], ["501", "HEADER RESPONSE STATUS\n", "ALPHA/NUMERIC\n", "F1\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE HEADER\n", "\nS $P(^BPSR(BPS(9002313.02),500),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["311", "PATIENT LAST NAME\n", "ALPHA/NUMERIC\n", "CB\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Last Name"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "RESPONSE PATIENT\n", "\nS $P(^BPSC(BPS(9002313.02),300),U,11)=$G(BPS("X"))\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["503", "AUTHORIZATION NUMBER\n", "ALPHA/NUMERIC\n", "F3\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,3)=BPS("X")\n\n\n", ""], ["504", "MESSAGE\n", "ALPHA/NUMERIC\n", "F4\n", "200\n", "200\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE MESSAGE\n", "\nS $P(^BPSR(BPS(9002313.02),504),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),200)\n\n\n"], ["505", "PATIENT PAY AMOUNT\n", "ALPHA/NUMERIC\n", "F5\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,5)=S BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["506", "INGREDIENT COST PAID\n", "ALPHA/NUMERIC\n", "F6\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["507", "DISPENSING FEE PAID\n", "ALPHA/NUMERIC\n", "F7\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["509", "TOTAL AMOUNT PAID\n", "ALPHA/NUMERIC\n", "F9\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,9)\n
\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["510", "REJECT COUNT\n", "NUMERIC\n", "FA\n", "2\n", "2\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["511", "REJECT CODE\n", "ALPHA/NUMERIC\n", "FB\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),511,DUR,0),U,1)\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["512", "ACCUMULATED DEDUCTIBLE AMOUNT\n", "ALPHA/NUMERIC\n", "FC\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["513", "REMAINING DEDUCTIBLE AMOUNT\n", "ALPHA/NUMERIC\n", "FD\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,13)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["402", "PRESCRIPTION/SERVICE REF NO\n", "NUMERIC\n", "D2\n", "7\n", "12\n", "NUMERIC\n", "", "PRESCRIPTION/SERVICE REFERENCE NUMBER\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"RX IEN"))\n\n\n", "CLAIM\n", "\nI $L($G(BPS("X")))>12 S BPS("X")=$E(BPS("X"),$L(BPS("X"))-11,$L(BPS("X")))\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),12)\n\n\n", "RESPONSE CLAIM\n", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,2)=BPS("X")\n\n\n", "\nI $L(BPS("X"))>7 S BPS("X")=$E(BPS("X"),$L(BPS("X"))-6,$L(BPS("X")))\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),7)\n\n\n"], ["514", "REMAINING BENEFIT AMOUNT\n", "ALPHA/NUMERIC\n", "FE\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,14)\n
\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["517", "AMT APPLIED TO PERIODIC DEDUCT\n", "SIGNED NUMERIC\n", "FH\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",17)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["518", "AMOUNT OF COPAY\n", "SIGNED NUMERIC\n", "FI\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",18)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["519", "AMT ATTRIBUTED TO PRODUCT SEL\n", "SIGNED NUMERIC\n", "FJ\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n; Field 519-FJ was added to file 9002313.91 in error. It should never\n; be populated.\n
\n\n", "", "", "", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,19)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["520", "AMOUNT EXCEEDING PERIODIC MAX\n", "SIGNED NUMERIC\n", "FK\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,20)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["521", "INCENTIVE AMOUNT PAID\n", "ALPHA/NUMERIC\n", "FL\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\n$P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,21)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["522", "BASIS OF REIMB DETERMINATION\n", "NUMERIC\n", "FM\n", "2\n", "2\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),U,22)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["523", "AMOUNT ATTRIBUTED TO SALES TAX\n", "SIGNED NUMERIC\n", "FN\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),500),"^",23)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["524", "PLAN ID\n", "ALPHA/NUMERIC\n", "FO\n", "8\n", "8\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Insurer","Plan ID"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n", "RESPONSE INSURANCE\n", "\nS $P(^BPSC(BPS(9002313.02),520),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),8)\n\n\n"], ["403", "FILL NUMBER\n", "NUMERIC\n", "D3\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Refill #"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["526", "ADDITIONAL MESSAGE INFORMATION\n", "ALPHA/NUMERIC\n", "FQ\n", "200\n", "40\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS ^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),526)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),200)\n\n\n"], ["528", "CLINICAL SIGNIFICANCE CODE\n", "ALPHA/NUMERIC\n", "FS\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "\nS ^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),525)=$G(BPS("X"))\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["529", "OTHER PHARMACY INDICATOR\n", "ALPHA/NUMERIC\n", "FT\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "RESPONSE DUR/PPS\n", "", ""], ["530", "PREVIOUS DATE OF SERVICE\n", "ALPHA/NUMERIC\n", "FU\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X"))\n\n\n"], ["531", "QTY OF PREVIOUS DISPENSING\n", "NUMERIC\n", "FV\n", "8\n", "10\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["532", "DATABASE INDICATOR\n", "ALPHA/NUMERIC\n", "FW\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,BPS(9002313.020101),0),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["533", "OTHER PRESCRIBER INDICATOR\n", "ALPHA/NUMERIC\n", "FX\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["544", "DUR/DUE FREE TEXT MESSAGE\n", "ALPHA/NUMERIC\n", "FY\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n"], ["102", "VERSION/RELEASE NUMBER\n", "ALPHA/NUMERIC\n", "A2\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("NCPDP","Version"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE HEADER\n", "\nS $P(^BPSC(BPS(9002313.02),100),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["B87", "QUAN LIMIT PER SPC TM PD COUNT\n", "", "3P\n", "", "1\n", "NUMERIC\n", "2087\n", "QUANTITY LIMIT PER SPECIFIC TIME PERIOD COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["545", "NETWORK REIMBURSEMENT ID\n", "ALPHA/NUMERIC\n", "2F\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "RESPONSE INSURANCE\n", "", ""], ["546", "REJECT FIELD OCCURRENCE INDCTR\n", "ALPHA/NUMERIC\n", "4F\n", "2\n", "2\n", "NUMERIC\n", "", "REJECT FIELD OCCURRENCE INDICATOR\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),511,DUR,0),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["547", "APPROVED MESSAGE CODE COUNT\n", "ALPHA/NUMERIC\n", "5F\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),540),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["548", "APPROVED MESSAGE CODE\n", "ALPHA/NUMERIC\n", "6F\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),548,0),B,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["549", "HELP DESK PHONE NUMBER QUAL\n", "ALPHA/NUMERIC\n", "7F\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "HELP DESK TELEPHONE NUMBER QUALIFER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),540),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["550", "HELP DESK TELEPHONE NUMBER\n", "ALPHA/NUMERIC\n", "8F\n", "18\n", "18\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),540),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),18)\n\n\n"], ["551", "FORMULARY ALT PRODUCT COUNT\n", "ALPHA/NUMERIC\n", "9F\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "RESPONSE CLAIM\n", "", ""], ["552", "FORMULARY ALT ID QUALIFIER\n", "ALPHA/NUMERIC\n", "AP\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["553", "FORMULARY ALTERNATIVE ID\n", "ALPHA/NUMERIC\n", "AR\n", "19\n", "19\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n"], ["554", "FORMULARY ALT INCENTIVE\n", "ALPHA/NUMERIC\n", "AS\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["405", "DAYS SUPPLY\n", "NUMERIC\n", "D5\n", "3\n", "3\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Days Supply"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["555", "FRMULRY ALT ESTMTD PT COST SHR\n", "ALPHA/NUMERIC\n", "AT\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["556", "FORMULARY ALT DESCRIPTION\n", "ALPHA/NUMERIC\n", "AU\n", "40\n", "40\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),551.01,DUR,1),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n"], ["557", "PERCENT TAX EXEMPT INDICATOR\n", "ALPHA/NUMERIC\n", "AV\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "PERCENTAGE TAX EXEMPT INDICATOR\n", "\n;This is Response-only field which does not use the GET FORMAT or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),550),U,7)\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["558", "REGULATORY FEE AMOUNT PAID\n", "ALPHA/NUMERIC\n", "AW\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),550),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["559", "PERCENTAGE TAX AMOUNT PAID\n", "ALPHA/NUMERIC\n", "AX\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),550),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["560", "PERCENTAGE TAX RATE PAID\n", "ALPHA/NUMERIC\n", "AY\n", "8\n", "7\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),7)\n\n\n", "RESPONSE PRICING\n", "", ""], ["561", "PERCENTAGE TAX BASIS PAID\n", "ALPHA/NUMERIC\n", "AZ\n", "8\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE PRICING\n", "", ""], ["562", "PROFESSIONAL SERVICE FEE PAID\n", "ALPHA/NUMERIC\n", "J1\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),560),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["563", "OTHER AMOUNT PAID COUNT\n", "NUMERIC\n", "J2\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),563.01,DUR,0)),U,1)\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["564", "OTHER AMOUNT PAID QUALIFIER\n", "ALPHA/NUMERIC\n", "J3\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),563.01,DUR,1),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["406", "COMPOUND CODE\n", "NUMERIC\n", "D6\n", "407\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Compound Code"))\nS:BPS("X")="" BPS("X")=1\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["565", "OTHER AMOUNT PAID\n", "ALPHA/NUMERIC\n", "J4\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),563.01,DUR,1),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["566", "OTHER PAYER AMOUNT RECOGNIZED\n", "ALPHA/NUMERIC\n", "J5\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nD SET566^BPSFLD01\n
\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),6)\n\n\n"], ["567", "DUR/PPS RESPONSE CODE COUNTER\n", "NUMERIC\n", "J6\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),567.01,DUR,0),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["568", "PAYER/HEALTH PLAN ID QUALIFIER\n", "ALPHA/NUMERIC\n", "J7\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE\n", "\nS $P(^BPSR(BPS(9002313.02),560),U,8)\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["569", "PAYER/HEALTH PLAN ID\n", "ALPHA/NUMERIC\n", "J8\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE\n", "\nS $P(^BPSR(BPS(9002313.02),560),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["600", "UNIT OF MEASURE\n", "ALPHA/NUMERIC\n", "28\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Unit of Measure"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),600),U,1)=""\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["407", "PRODUCT/SERVICE ID\n", "ALPHA/NUMERIC\n", "D7\n", "19\n", "19\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"NDC"))\nS BPS("X")=$$NDCF^BPSECFM(BPS("X"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n"], ["408", "DAW PRODUCT SELECTION CODE\n", "NUMERIC\n", "D8\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "DISPENSE AS WRITTEN (DAW)/ PRODUCT SELECTION CODE\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DAW"))\nS:BPS("X")="" BPS("X")=0\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["478", "OTHER AMT CLAIMED SBMTTD COUNT\n", "NUMERIC\n", "H7\n", "1\n", "1\n", "NUMERIC\n", "", "OTHER AMOUNT CLAIMED SUBMITTED COUNT\n", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n", "PRICING\n", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n", "", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n"], ["479", "OTHER AMT CLAIMED SUBM QLFR\n", "ALPHA/NUMERIC\n", "H8\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "OTHER AMOUNT CLAIMED SUBMITTED QUALIFIER\n", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n", "PRICING\n", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n", "", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n", "\n; fields 478, 479, 480 handled by FLD480^BPSOSSG (see SET CODE in field 480)\n
\n\n"], ["463", "INTERMEDIARY AUTH TYPE ID\n", "NUMERIC\n", "EW\n", "2\n", "2\n", "NUMERIC\n", "", "INTERMEDIARY AUTHORIZATION TYPE ID\n", "\nS BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Intermediary Auth Type ID"))\nS:BPS("X")="" BPS("X")=0\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["E09", "PATIENT MIDDLE NAME\n", "", "0C\n", "", "25\n", "ALPHANUMERIC\n", "2309\n", "PATIENT MIDDLE NAME\n", "\nS BPS("X")=$G(BPS("Patient","Middle Name"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),25)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"E00"),U,9)=BPS("X")\n\n\n", ""], ["E10", "PATIENT NAME PREFIX\n", "", "0D\n", "", "10\n", "ALPHANUMERIC\n", "2310\n", "PATIENT NAME PREFIX\n", "\nS BPS("X")=$G(BPS("Patient","Prefix"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"E00"),U,10)=BPS("X")\n\n\n", ""], ["E11", "PATIENT NAME SUFFIX\n", "", "0E\n", "", "10\n", "ALPHANUMERIC\n", "2311\n", "PATIENT NAME SUFFIX\n", "\nS BPS("X")=$G(BPS("Patient","Suffix"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"E10"),U,1)=BPS("X")\n\n\n", ""], ["E12", "PRESCRIBER MIDDLE NAME\n", "", "0F\n", "", "25\n", "ALPHANUMERIC\n", "2312\n", "PRESCRIBER MIDDLE NAME\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Middle Name"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),25)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"E10"),U,2)=BPS("X")\n\n\n", ""], ["E06", "SPECIES\n", "", "S8\n", "", "9\n", "ALPHANUMERIC\n", "2306\n", "SPECIES\n", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),9)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"E00"),U,6)=BPS("X")\n\n\n", ""], ["618", "PATIENT ID COUNT\n", "", "RR\n", "", "1\n", "NUMERIC\n", "", "PATIENT ID COUNT\n", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),610),U,8)=BPS("X")\n\n\n", ""], ["409", "INGREDIENT COST SUBMITTED\n", "SIGNED NUMERIC\n", "D9\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Ingredient Cost"))\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["411", "PRESCRIBER ID\n", "ALPHA/NUMERIC\n", "DB\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber NPI"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,11)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["451", "COMPOUND DISP UNIT FORM INDCTR\n", "NUMERIC\n", "EG\n", "1\n", "1\n", "NUMERIC\n", "", "COMPOUND DISPENSING UNIT FORM INDICATOR\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["450", "COMPOUND DOSAGE FORM DESC CODE\n", "ALPHA/NUMERIC\n", "EF\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "COMPOUND DOSAGE FORM DESCRIPTION CODE\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["490", "COMP INGRED BASIS COST DETERM\n", "ALPHA/NUMERIC\n", "UE\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "COMPOUND INGREDIENT BASIS OF COST DETERMINATION\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["447", "COMPOUND INGREDIENT COMP COUNT\n", "NUMERIC\n", "EC\n", "2\n", "2\n", "NUMERIC\n", "", "COMPOUND INGREDIENT COMPONENT COUNT\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["449", "COMPOUND INGREDIENT DRUG COST\n", "NUMERIC\n", "EE\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["414", "DATE PRESCRIPTION WRITTEN\n", "NUMERIC\n", "DE\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Date Written"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,14)=BPS("X")\n\n\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n"], ["489", "COMPOUND PRODUCT ID\n", "ALPHA/NUMERIC\n", "TE\n", "19\n", "19\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n", "", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n"], ["488", "COMPOUND PRODUCT ID QUALIFIER\n", "ALPHA/NUMERIC\n", "RE\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["452", "COMPOUND ROUTE OF ADMIN\n", "NUMERIC\n", "EH\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n; Field 452-EH was added to file 9002313.91 in error. It should never\n; appear on a payer sheet, and it should never be populated.\n\n\n", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["415", "NUMBER OF REFILLS AUTHORIZED\n", "NUMERIC\n", "DF\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"# Refills"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,15)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["419", "PRESCRIPTION ORIGIN CODE\n", "NUMERIC\n", "DJ\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Origin Code"))\nS:BPS("X")="" BPS("X")="0"\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,19)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["103", "TRANSACTION CODE\n", "NUMERIC\n", "A3\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Transaction Code"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE HEADER\n", "\nS $P(^BPSC(BPS(9002313.02),100),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["420", "SUBMISSION CLARIFICATION CODE\n", "NUMERIC\n", "DK\n", "2\n", "2\n", "NUMERIC\n", "", "", "\n; GET CODE handled by FLD420^BPSOSSG\n
\n\n", "CLAIM\n", "\n; vD.0 FORMAT CODE handled by FLD420^BPSOSSG\n
\n\n", "", "\nD FLD420^BPSOSSG\n
\n\n", "\n; FORMAT CODE handled by FLD420^BPSOSSG\n
\n\n"], ["448", "COMPOUND INGREDIENT QUANTITY\n", "NUMERIC\n", "ED\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["453", "ORIG PRESCR PROD/SERV ID QUAL\n", "NUMERIC\n", "EJ\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "ORIGINALLY PRESCRIBED PRODUCT/SERVICE ID QUALIFIER\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,3)=""\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM(BPS("X"),2)\n\n\n"], ["B88", "QUAN LIMIT PER SPC TIME PERIOD\n", "", "3R\n", "", "10\n", "NUMERIC\n", "2088\n", "QUANTITY LIMIT PER SPECIFIC TIME PERIOD\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["494", "MEASUREMENT DATE\n", "ALPHA/NUMERIC\n", "ZE\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n"], ["496", "MEASUREMENT DIMENSION\n", "ALPHA/NUMERIC\n", "H2\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["495", "MEASUREMENT TIME\n", "NUMERIC\n", "H1\n", "4\n", "4\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4)\n\n\n", "", "", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4)\n\n\n"], ["497", "MEASUREMENT UNIT\n", "ALPHA/NUMERIC\n", "H3\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["499", "MEASUREMENT VALUE\n", "ALPHA/NUMERIC\n", "H4\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["990", "OTHER PAYER BIN NUMBER\n", "NUMERIC\n", "MG\n", "6\n", "6\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),980),U,10)=""\n
\n\n", ""], ["423", "BASIS OF COST DETERMINATION\n", "ALPHA/NUMERIC\n", "DN\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Basis of Cost Determination"))\n\n\n", "PRICING\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,23)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["991", "OTHER PAYER PROC CONTROL NUM\n", "ALPHA/NUMERIC\n", "MH\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "OTHER PAYER PROCESSOR CONTROL NUMBER\n", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "RESPONSE OTHER PAYERS\n", "\nS $P(^BPSC(BPS(9002313.02),990),U,1)=""\n
\n\n", ""], ["356", "OTHER PAYER CARDHOLDER ID\n", "ALPHA/NUMERIC\n", "NU\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "RESPONSE OTHER PAYERS\n", "\nS $P(^BPSC(BPS(9002313.02),350),U,6)=""\n
\n\n", ""], ["992", "OTHER PAYER GROUP ID\n", "ALPHA/NUMERIC\n", "MJ\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "RESPONSE OTHER PAYERS\n", "\nS $P(^BPSC(BPS(9002313.02),990),U,2)=""\n
\n\n", ""], ["359", "MEDIGAP ID\n", "ALPHA/NUMERIC\n", "2A\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),350),U,9)=""\n
\n\n", ""], ["360", "MEDICAID INDICATOR\n", "NUMERIC\n", "2B\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),350),U,10)=""\n
\n\n", ""], ["361", "PROVIDER ACCEPT ASSGNMT INDCTR\n", "ALPHA/NUMERIC\n", "2D\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "PROVIDER ACCEPT ASSIGNMENT INDICATOR\n", "\nS BPS("X")="Y"\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),360),U,1)=$G(BPS("X"))\n\n\n", ""], ["997", "CMS PART D DEFND QLFD FACILITY\n", "ALPHA/NUMERIC\n", "G2\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "CMS PART D DEFINED QUALIFIED FACILITY\n", "\nS BPS("X")="N"\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),990),U,7)=$G(BPS("X"))\n\n\n", ""], ["115", "MEDICAID ID NUMBER\n", "ALPHA/NUMERIC\n", "N5\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "RESPONSE INSURANCE\n", "\nS $P(^BPSC(BPS(9002313.02),110),U,5)=""\n
\n\n", ""], ["116", "MEDICAID AGENCY NUMBER\n", "ALPHA/NUMERIC\n", "N6\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "RESPONSE INSURANCE\n", "\nS $P(^BPSC(BPS(9002313.02),110),U,6)=""\n
\n\n", ""], ["384", "PATIENT RESIDENCE\n", "NUMERIC\n", "4X\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Patient Residence"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),380),U,4)=$G(BPS("X"))\n\n\n", ""], ["424", "DIAGNOSIS CODE\n", "ALPHA/NUMERIC\n", "DO\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Diagnosis Code"))\n\n\n", "CLINICAL\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,24)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["354", "SUBMISSION CLARIF CODE COUNT\n", "NUMERIC\n", "NX\n", "2\n", "1\n", "NUMERIC\n", "", "SUBMISSION CLARIFICATION CODE COUNT\n", "\n; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420)\n
\n\n", "CLAIM\n", "\n; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420)\n
\n\n", "", "\n; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420)\n
\n\n", "\n; fields 354 & 420 handled by FLD420^BPSOSSG (see SET CODE in field 420)\n
\n\n"], ["357", "DELAY REASON CODE\n", "NUMERIC\n", "NV\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Claim",BPS(9002313.0201),"Delay Reason Code"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),350),U,7)=$S($G(BPS("X"))="NV00":"",1:$G(BPS("X")))\n\n\n", ""], ["880", "TRANSACTION REFERENCE NUMBER\n", "ALPHA/NUMERIC\n", "K5\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "RESPONSE STATUS\n", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),870),U,10)=""\n
\n\n", ""], ["391", "PATIENT ASSIGNMENT INDICATOR\n", "ALPHA/NUMERIC\n", "MT\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "PATIENT ASSIGNMENT INDICATOR (DIRECT MEMBER REIMBURSEMENT INDICATOR)\n", "\nS BPS("X")="Y"\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),390),U,1)=$G(BPS("X"))\n\n\n", ""], ["995", "ROUTE OF ADMINISTRATION\n", "ALPHA/NUMERIC\n", "E2\n", "1\n", "11\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),11)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),990),U,5)=$G(BPS("X"))\n\n\n", ""], ["996", "COMPOUND TYPE\n", "ALPHA/NUMERIC\n", "G1\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),990),U,6)=""\n
\n\n", ""], ["114", "MEDICAID SUBROGATION ICN/TCN\n", "ALPHA/NUMERIC\n", "N4\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "MEDICAID SUBROGATION INTERNAL CONTROL NUMBER/TRANSACTION CONTROL NUMBER (ICN/TCN)\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "RESPONSE CLAIM\n", "\nS $P(^BPSC(BPS(9002313.02),110),U,4)=""\n
\n\n", ""], ["147", "PHARMACY SERVICE TYPE\n", "NUMERIC\n", "U7\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Pharmacy Service Type"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),140),U,7)=$G(BPS("X"))\n\n\n", ""], ["364", "PRESCRIBER FIRST NAME\n", "ALPHA/NUMERIC\n", "2J\n", "12\n", "12\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber First Name"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,4)=$G(BPS("X"))\n\n\n", ""], ["365", "PRESCRIBER STREET ADDRESS\n", "ALPHA/NUMERIC\n", "2K\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Street Address"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,5)=$G(BPS("X"))\n\n\n", ""], ["430", "GROSS AMOUNT DUE\n", "SIGNED NUMERIC\n", "DU\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Gross Amount Due"))\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,30)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["366", "PRESCRIBER CITY ADDRESS\n", "ALPHA/NUMERIC\n", "2M\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber City Address"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,6)=$G(BPS("X"))\n\n\n", ""], ["367", "PRESCRIBER STATE/PROV ADDRESS\n", "ALPHA/NUMERIC\n", "2N\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "PRESCRIBER STATE/PROVINCE ADDRESS\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber State/Province Address"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,7)=$G(BPS("X"))\n\n\n", ""], ["368", "PRESCRIBER ZIP/POSTAL ZONE\n", "ALPHA/NUMERIC\n", "2P\n", "2\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Zip/Postal Zone"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,8)=$G(BPS("X"))\n\n\n", ""], ["993", "INTERNAL CONTROL NUMBER\n", "ALPHA/NUMERIC\n", "A7\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "RESPONSE STATUS\n", "\n; This field currently not implemented\n
\n\n", ""], ["392", "BENEFIT STAGE COUNT\n", "NUMERIC\n", "MU\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "RESPONSE PRICING\n", "\nD SET392^BPSFLD01\n
\n\n", ""], ["393", "BENEFIT STAGE QUALIFIER\n", "ALPHA/NUMERIC\n", "MV\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE PRICING\n", "\nD SET393^BPSFLD01\n
\n\n", ""], ["394", "BENEFIT STAGE AMOUNT\n", "NUMERIC\n", "MW\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "RESPONSE PRICING\n", "\nD SET394^BPSFLD01\n
\n\n", ""], ["117", "BILLING ENTITY TYPE INDICATOR\n", "NUMERIC\n", "TR\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,7)=""\n
\n\n", ""], ["118", "PAY TO QUALIFIER\n", "ALPHA/NUMERIC\n", "TS\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,8)=""\n
\n\n", ""], ["119", "PAY TO ID\n", "ALPHA/NUMERIC\n", "TT\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,9)=""\n
\n\n", ""], ["433", "PATIENT PAID AMOUNT REPORTED\n", "SIGNED NUMERIC\n", "DX\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "PATIENT PAID AMOUNT SUBMITTED\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Patient Paid Amount"))\nS:BPS("X")="" BPS("X")="0.00"\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["120", "PAY TO NAME\n", "ALPHA/NUMERIC\n", "TU\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,10)=""\n
\n\n", ""], ["121", "PAY TO STREET ADDRESS\n", "ALPHA/NUMERIC\n", "TV\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,1)=""\n
\n\n", ""], ["122", "PAY TO CITY ADDRESS\n", "ALPHA/NUMERIC\n", "TW\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,2)=""\n
\n\n", ""], ["124", "PAY TO ZIP/POSTAL ZONE\n", "ALPHA/NUMERIC\n", "TY\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,4)=""\n
\n\n", ""], ["125", "GENERIC EQUIV PROD ID QLFR\n", "ALPHA/NUMERIC\n", "TZ\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "GENERIC EQUIVALENT PRODUCT ID QUALIFIER\n", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,5)=""\n
\n\n", ""], ["126", "GENERIC EQUIVALENT PRODUCT ID\n", "ALPHA/NUMERIC\n", "UA\n", "19\n", "19\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,6)=""\n
\n\n", ""], ["113", "MEDICAID PAID AMOUNT\n", "NUMERIC\n", "N3\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),110),U,3)=""\n
\n\n", ""], ["362", "COMPOUND INGRED MOD CODE CNT\n", "NUMERIC\n", "2G\n", "2\n", "2\n", "NUMERIC\n", "", "COMPOUND INGREDIENT MODIFIER CODE COUNT\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["363", "COMPOUND INGRED MODIFIER CODE\n", "ALPHA/NUMERIC\n", "2H\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "COMPOUND INGREDIENT MODIFIER CODE\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["369", "ADDITIONAL DCMNTN TYPE ID\n", "ALPHA/NUMERIC\n", "2Q\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "ADDITIONAL DOCUMENTATION TYPE ID\n", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,9)=""\n
\n\n", ""], ["439", "REASON FOR SERVICE CODE\n", "ALPHA/NUMERIC\n", "E4\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DUR","DUR Conflict Code",439))\n\n\n", "DUR/PPS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE DUR/PPS\n", "\nD FLD439^BPSOSSG\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["370", "LENGTH OF NEED\n", "NUMERIC\n", "2R\n", "3\n", "3\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),360),U,10)=""\n
\n\n", ""], ["371", "LENGTH OF NEED QUALIFIER\n", "NUMERIC\n", "2S\n", "3\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,1)=""\n
\n\n", ""], ["372", "PRESCRIBER/SUPPLIER DT SIGNED\n", "NUMERIC\n", "2T\n", "9\n", "8\n", "NUMERIC\n", "", "PRESCRIBER/SUPPLIER DATE SIGNED\n", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,2)=""\n
\n\n", ""], ["373", "REQUEST STATUS\n", "ALPHA/NUMERIC\n", "2U\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,3)=""\n
\n\n", ""], ["374", "REQUEST PERIOD BEGIN DATE\n", "NUMERIC\n", "2V\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,4)=""\n
\n\n", ""], ["375", "REQ PERIOD RECERT/REVISED DT\n", "NUMERIC\n", "2W\n", "8\n", "8\n", "NUMERIC\n", "", "REQUEST PERIOD RECERT/REVISED DATE\n", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,5)=""\n
\n\n", ""], ["376", "SUPPORTING DOCUMENTATION\n", "ALPHA/NUMERIC\n", "2X\n", "65\n", "65\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),65)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),370),U,6)=""\n
\n\n", ""], ["377", "QUESTION NUMBER/LETTER COUNT\n", "ALPHA/NUMERIC\n", "2Z\n", "65\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["378", "QUESTION NUMBER/LETTER\n", "ALPHA/NUMERIC\n", "4B\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["379", "QUESTION PERCENT RESPONSE\n", "NUMERIC\n", "4D\n", "5\n", "5\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),5)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["440", "PROFESSIONAL SERVICE CODE\n", "ALPHA/NUMERIC\n", "E5\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DUR","DUR Intervention Code",440))\n\n\n", "DUR/PPS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD FLD440^BPSOSSG\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["380", "QUESTION DATE RESPONSE\n", "NUMERIC\n", "4G\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["381", "QUESTION DOLLAR AMT RESPONSE\n", "NUMERIC\n", "4H\n", "9\n", "11\n", "SIGNED NUMERIC\n", "", "QUESTION DOLLAR AMOUNT RESPONSE\n", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),11)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["382", "QUESTION NUMERIC RESPONSE\n", "NUMERIC\n", "4J\n", "11\n", "11\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),11)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["383", "QUESTION ALPHANUMERIC RESPONSE\n", "ALPHA/NUMERIC\n", "4K\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "ADDITIONAL DOCUMENTATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\n; This field currently not implemented\n
\n\n", ""], ["385", "FACILITY NAME\n", "ALPHA/NUMERIC\n", "3Q\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,5)=""\n
\n\n", ""], ["386", "FACILITY STREET ADDRESS\n", "ALPHA/NUMERIC\n", "3U\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,6)=""\n
\n\n", ""], ["387", "FACILITY STATE/PROV ADDRESS\n", "ALPHA/NUMERIC\n", "3V\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "FACILITY STATE/PROVINCE ADDRESS\n", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,7)=""\n
\n\n", ""], ["388", "FACILITY CITY ADDRESS\n", "ALPHA/NUMERIC\n", "5J\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,8)=""\n
\n\n", ""], ["389", "FACILITY ZIP/POSTAL ZONE\n", "ALPHA/NUMERIC\n", "6D\n", "16\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),380),U,9)=""\n
\n\n", ""], ["390", "NARRATIVE MESSAGE\n", "ALPHA/NUMERIC\n", "BM\n", "200\n", "200\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "NARRATIVE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),200)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),389),U,2)=""\n
\n\n", ""], ["441", "RESULT OF SERVICE CODE\n", "ALPHA/NUMERIC\n", "E6\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"DUR","DUR Outcome Code",441))\nS:BPS("X")="" BPS("X")="00"\n\n\n", "DUR/PPS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nD FLD441^BPSOSSG\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["130", "ADDITIONAL MESSAGE INFO COUNT\n", "NUMERIC\n", "UF\n", "2\n", "2\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["132", "ADDITIONAL MSG INFO QUALIFIER\n", "ALPHA/NUMERIC\n", "UH\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["131", "ADDITIONAL MSG INFO CONTINUITY\n", "NUMERIC\n", "UG\n", "2\n", "1\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["987", "URL\n", "ALPHA/NUMERIC\n", "MA\n", "255\n", "255\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["571", "AMOUNT ATTRIB TO PROCESSOR FEE\n", "NUMERIC\n", "NZ\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["575", "PATIENT PERCENTAGE TAX AMOUNT\n", "NUMERIC\n", "EQ\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["574", "PLAN SALES TAX AMOUNT\n", "NUMERIC\n", "2Y\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["572", "AMOUNT OF COINSURANCE\n", "NUMERIC\n", "4U\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["573", "BASIS OF CALC - COINSURANCE\n", "ALPHA/NUMERIC\n", "4V\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["577", "ESTIMATED GENERIC SAVINGS\n", "NUMERIC\n", "G3\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["104", "PROCESSOR CONTROL NUMBER\n", "ALPHA/NUMERIC\n", "A4\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("NCPDP","PCN"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),100),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["442", "QUANTITY DISPENSED\n", "NUMERIC\n", "E7\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\\1\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["128", "SPENDING ACCOUNT AMT REMAINING\n", "NUMERIC\n", "UC\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["129", "HEALTH PLAN-FUNDED ASSIST AMT\n", "NUMERIC\n", "UD\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["133", "AMT ATTR TO PROV NETWORK SLCTN\n", "NUMERIC\n", "UJ\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["134", "AMT ATTR TO PROD SEL BRND DRUG\n", "NUMERIC\n", "UK\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["135", "AMT ATTR NON-PREF FRMLRY SEL\n", "NUMERIC\n", "UM\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["136", "AMT ATTR TO N-PREF FRMLRY SEL\n", "NUMERIC\n", "UN\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["137", "AMOUNT ATTR TO COVERAGE GAP\n", "NUMERIC\n", "UP\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["148", "INGRED COST CNTRCTD REIMB AMT\n", "NUMERIC\n", "U8\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["149", "DISP FEE CNTRCTD REIMB AMT\n", "NUMERIC\n", "U9\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["570", "DUR ADDITIONAL TEXT\n", "ALPHA/NUMERIC\n", "NS\n", "100\n", "100\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["B89", "QUANTITY LIMIT TIME PERIOD\n", "", "3S\n", "", "5\n", "NUMERIC\n", "2089\n", "QUANTITY LIMIT TIME PERIOD\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["355", "OTHER PAYER ID COUNT\n", "NUMERIC\n", "NT\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["142", "OTHER PAYER PERSON CODE\n", "ALPHA/NUMERIC\n", "UV\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["127", "OTHER PAYER HELP DESK PH NUM\n", "ALPHA/NUMERIC\n", "UB\n", "18\n", "18\n", "ALPHANUMERIC\n", "", "OTHER PAYER HELP DESK TELEPHONE NUMBER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["143", "OTHER PAYER PATIENT REL CODE\n", "NUMERIC\n", "UW\n", "1\n", "1\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["144", "OTHER PAYER EFFECTIVE DATE\n", "NUMERIC\n", "UX\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["145", "OTHER PAYER TERMINATION DATE\n", "NUMERIC\n", "UY\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["139", "MEDICARE PART D COVERAGE CODE\n", "NUMERIC\n", "UR\n", "2\n", "2\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE ADDITIONAL INFORMATION\n", "", ""], ["138", "CMS LICS LEVEL\n", "ALPHA/NUMERIC\n", "UQ\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE ADDITIONAL INFORMATION\n", "", ""], ["240", "CONTRACT NUMBER\n", "ALPHA/NUMERIC\n", "U1\n", "8\n", "8\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE ADDITIONAL INFORMATION\n", "", ""], ["926", "FORMULARY ID\n", "ALPHA/NUMERIC\n", "FF\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE ADDITIONAL INFORMATION\n", "", ""], ["412", "DISPENSING FEE SUBMITTED\n", "SIGNED NUMERIC\n", "DC\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Dispensing Fee"))\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,12)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["757", "BENEFIT ID\n", "ALPHA/NUMERIC\n", "U6\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE ADDITIONAL INFORMATION\n", "", ""], ["140", "NEXT MEDICARE PART D EFF DATE\n", "NUMERIC\n", "US\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE ADDITIONAL INFORMATION\n", "", ""], ["141", "NEXT MEDICARE PART D TERM DATE\n", "NUMERIC\n", "UT\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE ADDITIONAL INFORMATION\n", "", ""], ["123", "PAY TO STATE/PROVINCE ADDRESS\n", "ALPHA/NUMERIC\n", "TX\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "PAY TO STATE/ PROVINCE ADDRESS\n", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),120),U,3)=""\n
\n\n", ""], ["579", "ASSOC RX/SERVICE PROV ID QUAL\n", "ALPHA/NUMERIC\n", "XX\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "ASSOCIATED PRESCRIPTION / SERVICE PROVIDER ID QUALIFIER\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),570),U,9)=$G(BPS("X"))\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["580", "ASSOC RX/SERVICE PROVIDER ID\n", "ALPHA/NUMERIC\n", "XY\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "ASSOCIATED PRESCRIPTION / SERVICE PROVIDER ID\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),570),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["581", "ASSOC RX/SERVICE REF NUM QUAL\n", "ALPHA/NUMERIC\n", "XZ\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "ASSOCIATED PRESCRIPTION / SERVICE REFERENCE NUMBER QUALIFIER\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["582", "ASSOC RX/SERVICE FILL NUMBER\n", "NUMERIC\n", "X0\n", "2\n", "2\n", "NUMERIC\n", "", "ASSOCIATED PRESCRIPTION SERVICE FILL NUMBER\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,2)=$G(BPS("X"))\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["583", "SERVICE PROVIDER NAME\n", "ALPHA/NUMERIC\n", "YK\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "SERVICE PROVIDE NAME\n", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n"], ["584", "SERVICE PROVIDER STREET\n", "ALPHA/NUMERIC\n", "YM\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "SERVICE PROVIDER STREET ADDRESS\n", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n"], ["B90", "DAYS SUP LIM PER SPC TM PD CNT\n", "", "3T\n", "", "1\n", "NUMERIC\n", "2090\n", "DAYS SUPPLY LIMIT PER SPECIFIC TIME PERIOD COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["585", "SERVICE PROVIDER CITY\n", "ALPHA/NUMERIC\n", "YN\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "SERVICE PROVIDER CITY ADDRESS\n", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n"], ["586", "SERVICE PROVIDE STATE/PROVINCE\n", "ALPHA/NUMERIC\n", "YP\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "SERVICE PROVIDER STATE/PROVINCE ADDRESS\n", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["587", "SERVICE PROVIDER ZIP/POST CODE\n", "ALPHA/NUMERIC\n", "YQ\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "SERVICE PROVIDER ZIP/POSTAL CODE\n", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["590", "SELLER INITIALS\n", "ALPHA/NUMERIC\n", "YT\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "SELLER INITIALS\n", "\nS BPS("X")=BPS("Provider",MEDN,"Pharmacist Initials")\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),580),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["591", "PURCHASER ID QUALIFIER\n", "NUMERIC\n", "YU\n", "2\n", "2\n", "NUMERIC\n", "", "PURCHASER ID QUALIFIER\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["592", "PURCHASER ID\n", "ALPHA/NUMERIC\n", "YV\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "PURCHASER ID\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n"], ["593", "PURCHASER ID STATE/PROVINCE\n", "ALPHA/NUMERIC\n", "YW\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "PURCHASER ID ASSOCIATED STATE/PROVINCE ADDRESS\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["594", "PURCHASER DATE OF BIRTH\n", "NUMERIC\n", "YX\n", "8\n", "8\n", "NUMERIC\n", "", "PURCHASER DATE OF BIRTH\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["595", "PURCHASER GENDER CODE\n", "NUMERIC\n", "YY\n", "1\n", "1\n", "NUMERIC\n", "", "PURCHASER GENDER CODE\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["596", "PURCHASER FIRST NAME\n", "ALPHA/NUMERIC\n", "YZ\n", "12\n", "12\n", "ALPHANUMERIC\n", "", "PURCHASER FIRST NAME\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n"], ["418", "LEVEL OF SERVICE\n", "NUMERIC\n", "DI\n", "2\n", "2\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Level of Service"))\nS:BPS("X")="" BPS("X")=0\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,18)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["597", "PURCHASER LAST NAME\n", "ALPHA/NUMERIC\n", "Y0\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "PURCHASER LAST NAME\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["598", "PURCHASER STREET ADDRESS\n", "ALPHA/NUMERIC\n", "Y1\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "PURCHASER STREET ADDRESS\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n"], ["599", "PURCHASER CITY ADDRESS\n", "ALPHA/NUMERIC\n", "Y2\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "PURCHASER CITY ADDRESS\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),590),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n"], ["675", "PURCHASER STATE/PROVINCE CODE\n", "ALPHA/NUMERIC\n", "Y3\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "PURCHASER ADDRESS STATE/PROVINCE CODE\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["676", "PURCHASER ZIP/POSTAL CODE\n", "ALPHA/NUMERIC\n", "Y4\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "PURCHASER ZIP/POSTAL CODE\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["677", "PURCHASER COUNTRY CODE\n", "ALPHA/NUMERIC\n", "Y5\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "PURCHASER COUNTRY CODE\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["678", "TIME OF SERVICE\n", "NUMERIC\n", "Y6\n", "6\n", "6\n", "NUMERIC\n", "", "TIME OF SERVICE\n", "\nS BPS("X")=BPS("Claim",MEDN,"Time of Service")\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6)\n\n\n"], ["679", "SELLER ID\n", "ALPHA/NUMERIC\n", "Y9\n", "70\n", "70\n", "ALPHANUMERIC\n", "", "SELLER ID\n", "\nS BPS("X")=BPS("Provider",MEDN,"Pharmacist ID")\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),70)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),70)\n\n\n"], ["680", "SELLER ID QUALIFIER\n", "NUMERIC\n", "ZB\n", "2\n", "2\n", "NUMERIC\n", "", "SELLER ID QUALIFIER\n", "\nS BPS("X")="01"\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),670),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["681", "SALES TRANSACTION ID\n", "ALPHA/NUMERIC\n", "ZF\n", "80\n", "80\n", "ALPHANUMERIC\n", "", "SALES TRANSACTION ID\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),80)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),680),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),80)\n\n\n"], ["421", "PRIMARY CARE PROVIDER ID\n", "ALPHA/NUMERIC\n", "DL\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Primary Care Provider NPI"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,21)=""\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["A22", "PATIENT ID STATE/PROVINCE\n", "ALPHA/NUMERIC\n", "YR\n", "2\n", "2\n", "ALPHANUMERIC\n", "1022\n", "PATIENT ID ASSOCIATED STATE/PROVINCE ADDRESS\n", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"A20"),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["A23", "PURCHASER RELATIONSHIP CODE\n", "ALPHA/NUMERIC\n", "YS\n", "2\n", "2\n", "ALPHANUMERIC\n", "1023\n", "PURCHASER RELATIONSHIP CODE\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["A24", "PRESCRIBER ID STATE/PROVINCE\n", "ALPHA/NUMERIC\n", "ZK\n", "2\n", "2\n", "ALPHANUMERIC\n", "1024\n", "PRESCRIBER ID ASSOCIATED STATE/PROVINCE CODE\n", "\nS BPS("X")=""\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["A25", "PRESCRIBER ALTERNATE ID QUAL\n", "ALPHA/NUMERIC\n", "ZM\n", "2\n", "2\n", "ALPHANUMERIC\n", "1025\n", "PRESCRIBER ALTERNATE ID QUALIFIER\n", "\nS BPS("X")=""\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["A26", "PRESCRIBER ALTERNATE ID\n", "ALPHA/NUMERIC\n", "ZP\n", "15\n", "15\n", "ALPHANUMERIC\n", "1026\n", "PRESCRIBER ALTERNATE ID\n", "\nS BPS("X")=""\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["A27", "PRESCRIBER ALTERNATE STATE\n", "ALPHA/NUMERIC\n", "ZQ\n", "2\n", "2\n", "ALPHANUMERIC\n", "1027\n", "PRESCRIBER ALTERNATE ID ASSOCIATED STATE/PROVINCE ADDRESS\n", "\nS BPS("X")=""\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["A28", "ADJUDICATED PROGRAM TYPE\n", "NUMERIC\n", "ZR\n", "2\n", "2\n", "NUMERIC\n", "1028\n", "ADJUDICATED PAYMENT TYPE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["A29", "REPORTED ADJUDICATED PROG TYPE\n", "NUMERIC\n", "ZS\n", "2\n", "2\n", "NUMERIC\n", "1029\n", "REPORTED ADJUDICATED PROGRAM TYPE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["A30", "RELEASED DATE\n", "NUMERIC\n", "ZT\n", "8\n", "8\n", "NUMERIC\n", "1030\n", "RELEASED DATE\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A20"),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["A31", "RELEASED TIME\n", "NUMERIC\n", "ZU\n", "6\n", "6\n", "NUMERIC\n", "1031\n", "RELEASED TIME\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A30"),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),6)\n\n\n"], ["426", "USUAL AND CUSTOMARY CHARGE\n", "SIGNED NUMERIC\n", "DQ\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Usual & Customary"))\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,26)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["A32", "COMPOUND PREPARATION TIME\n", "NUMERIC\n", "ZW\n", "4\n", "4\n", "NUMERIC\n", "1032\n", "COMPOUND PREPARATION TIME\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A30"),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4)\n\n\n"], ["A43", "PATIENT COUNTRY CODE\n", "ALPHA/NUMERIC\n", "1K\n", "2\n", "2\n", "ALPHANUMERIC\n", "1043\n", "PATIENT COUNTRY CODE\n", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"A40"),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["A45", "VETERINARY USE INDICATOR\n", "ALPHA/NUMERIC\n", "1R\n", "1\n", "1\n", "ALPHANUMERIC\n", "1045\n", "VETERINARY USE INDICATOR\n", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"A40"),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["B04", "NEXT AVAILABLE FILL DATE\n", "NUMERIC\n", "BT\n", "8\n", "8\n", "NUMERIC\n", "2004\n", "NEXT AVAILABLE FILL DATE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["B08", "PATIENT STREET ADDRESS LINE 1\n", "", "7A\n", "", "40\n", "ALPHANUMERIC\n", "2008\n", "", "\nS BPS("X")=$G(BPS("Patient","Street Address Line 1"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"B00"),U,8)=BPS("X")\n\n\n", ""], ["B09", "PATIENT STREET ADDRESS LINE 2\n", "", "7B\n", "", "40\n", "ALPHANUMERIC\n", "2009\n", "", "\nS BPS("X")=$G(BPS("Patient","Street Address Line 2"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"B00"),U,9)=BPS("X")\n\n\n", ""], ["B38", "PATIENT ID ASSOC COUNTRY CODE\n", "", "1Y\n", "", "2\n", "ALPHANUMERIC\n", "2038\n", "PATIENT ID ASSOCIATED COUNTRY CODE\n", "\nS BPS("X")="US"\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"B30"),U,8)=BPS("X")\n\n\n", ""], ["B26", "PRESCRIBER PHONE NUMBER EXT\n", "", "7T\n", "", "8\n", "NUMERIC\n", "2026\n", "PRESCRIBER TELEPHONE NUMBER EXTENSION\n", "\nS BPS("X")=""\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,6)=BPS("X")\n\n\n", ""], ["B27", "PRESCRIBER STREET ADDR LINE 1\n", "", "7U\n", "", "40\n", "ALPHANUMERIC\n", "2027\n", "PRESCRIBER STREET ADDRESS LINE 1\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Street Address Line 1"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,7)=BPS("X")\n\n\n", ""], ["B28", "PRESCRIBER STREET ADDR LINE 2\n", "", "7V\n", "", "40\n", "ALPHANUMERIC\n", "2028\n", "PRESCRIBER STREET ADDRESS LINE 2\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Street Address Line 2"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,8)=BPS("X")\n\n\n", ""], ["429", "SPECIAL PACKAGING INDICATOR\n", "NUMERIC\n", "DT\n", "1\n", "1\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Unit Dose Indicator"))\nS:BPS("X")="" BPS("X")=0\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,29)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["B40", "PRES ALT ID ASSOC COUNTRY CODE\n", "", "3A\n", "", "2\n", "ALPHANUMERIC\n", "2040\n", "PRESCRIBER ALTERNATE ID ASSOCIATED COUNTRY CODE\n", "\nS BPS("X")=""\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,10)=BPS("X")\n\n\n", ""], ["B41", "PRES ID ASSOC COUNTRY CODE\n", "", "3B\n", "", "2\n", "ALPHANUMERIC\n", "2041\n", "PRESCRIBER ID ASSOCIATED COUNTRY CODE\n", "\nS BPS("X")="US"\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,1)=BPS("X")\n\n\n", ""], ["B42", "PRESCRIBER COUNTRY CODE\n", "", "3C\n", "", "2\n", "ALPHANUMERIC\n", "2042\n", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Country"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,2)=BPS("X")\n\n\n", ""], ["B15", "EMPLOYER STREET ADDRESS LINE 1\n", "", "8D\n", "", "40\n", "ALPHANUMERIC\n", "2015\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,5)=BPS("X")\n\n\n", ""], ["B16", "EMPLOYER STREET ADDRESS LINE 2\n", "", "7G\n", "", "40\n", "ALPHANUMERIC\n", "2016\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,6)=BPS("X")\n\n\n", ""], ["B17", "EMPLOYER CONTACT FIRST NAME\n", "", "7H\n", "", "35\n", "ALPHANUMERIC\n", "2017\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,7)=BPS("X")\n\n\n", ""], ["B18", "EMPLOYER CONTACT LAST NAME\n", "", "7J\n", "", "35\n", "ALPHANUMERIC\n", "2018\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,8)=BPS("X")\n\n\n", ""], ["B19", "EMPLOYER PHONE NUMBER EXT\n", "", "7K\n", "", "8\n", "NUMERIC\n", "2019\n", "EMPLOYER TELEPHONE NUMBER EXTENSION\n", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,9)=BPS("X")\n\n\n", ""], ["B24", "PAY TO STREET ADDRESS LINE 1\n", "", "7R\n", "", "40\n", "ALPHANUMERIC\n", "2024\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,4)=BPS("X")\n\n\n", ""], ["B25", "PAY TO STREET ADDRESS LINE 2\n", "", "7S\n", "", "40\n", "ALPHANUMERIC\n", "2025\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,5)=BPS("X")\n\n\n", ""], ["431", "OTHER PAYER AMOUNT PAID\n", "SIGNED NUMERIC\n", "DV\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nD SET431^BPSFLD01\n
\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["B35", "EMPLOYER COUNTRY CODE\n", "", "1V\n", "", "2\n", "ALPHANUMERIC\n", "2035\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,5)=BPS("X")\n\n\n", ""], ["B39", "PAY TO COUNTRY CODE\n", "", "1Z\n", "", "2\n", "ALPHANUMERIC\n", "2039\n", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,9)=BPS("X")\n\n\n", ""], ["B13", "AUTH REP STREET ADDRESS LINE 1\n", "", "7D\n", "", "40\n", "ALPHANUMERIC\n", "2013\n", "AUTHORIZED REPRESENTATIVE STREET ADDRESS LINE 1\n", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,3)=BPS("X")\n\n\n", ""], ["B14", "AUTH REP STREET ADDRESS LINE 2\n", "", "8B\n", "", "40\n", "ALPHANUMERIC\n", "2014\n", "AUTHORIZED REPRESENTATIVE STREET ADDRESS LINE 2\n", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,4)=BPS("X")\n\n\n", ""], ["B34", "AUTH REP COUNTRY CODE\n", "", "1U\n", "", "2\n", "ALPHANUMERIC\n", "2034\n", "AUTHORIZED REPRESENTATIVE COUNTRY CODE\n", "\nS BPS("X")=""\n\n\n", "PRIOR AUTHORIZATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,4)=BPS("X")\n\n\n", ""], ["B20", "FACILITY STREET ADDRESS LINE 1\n", "", "7M\n", "", "40\n", "ALPHANUMERIC\n", "2020\n", "", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B10"),U,10)=BPS("X")\n\n\n", ""], ["B21", "FACILITY STREET ADDRESS LINE 2\n", "", "7N\n", "", "40\n", "ALPHANUMERIC\n", "2021\n", "", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,1)=BPS("X")\n\n\n", ""], ["B37", "FACILITY COUNTRY CODE\n", "", "1X\n", "", "2\n", "ALPHANUMERIC\n", "2037\n", "", "\nS BPS("X")=""\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,7)=BPS("X")\n\n\n", ""], ["B29", "PURCHASER STREET ADDRESS LINE1\n", "", "7W\n", "", "40\n", "ALPHANUMERIC\n", "2029\n", "PURCHASER STREET ADDRESS LINE 1\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,9)=BPS("X")\n\n\n", ""], ["B30", "PURCHASER STREET ADDRESS LINE2\n", "", "7X\n", "", "40\n", "ALPHANUMERIC\n", "2030\n", "PURCHASER STREET ADDRESS LINE 2\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B20"),U,10)=BPS("X")\n\n\n", ""], ["438", "INCENTIVE AMOUNT SUBMITTED\n", "SIGNED NUMERIC\n", "E3\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "", "\nS BPS("X")=0\n\n\n", "PRICING\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,8)=""\n
\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["B43", "PURCHASER ID ASSOC COUNTRY CD\n", "", "3D\n", "", "2\n", "ALPHANUMERIC\n", "2043\n", "PURCHASER ID ASSOCIATED COUNTRY CODE\n", "\nS BPS("X")=""\n\n\n", "PURCHASER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,3)=BPS("X")\n\n\n", ""], ["B31", "SERVICE PROV STREET ADD LINE 1\n", "", "7Y\n", "", "40\n", "ALPHANUMERIC\n", "2031\n", "SERVICE PROVIDER STREET ADDRESS LINE 1\n", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,1)=BPS("X")\n\n\n", ""], ["B32", "SERVICE PROV STREET ADD LINE 2\n", "", "7Z\n", "", "40\n", "ALPHANUMERIC\n", "2032\n", "SERVICE PROVIDER STREET ADDRESS LINE 2\n", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),40)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B30"),U,2)=BPS("X")\n\n\n", ""], ["A93", "SERVICE PROVIDER COUNTRY CODE\n", "", "1T\n", "", "2\n", "ALPHANUMERIC\n", "1093\n", "", "\nS BPS("X")=""\n\n\n", "SERVICE PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"A90"),U,3)=BPS("X")\n\n\n", ""], ["B44", "INTERMEDIARY ID COUNT\n", "", "8G\n", "", "1\n", "NUMERIC\n", "2044\n", "", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B40"),U,4)=BPS("X")\n\n\n", ""], ["B45", "INTERMEDIARY ID TYPE CODE\n", "", "8H\n", "", "2\n", "ALPHANUMERIC\n", "2045\n", "", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["B46", "INTERMEDIARY ID TYPE ENTITY\n", "", "8J\n", "", "2\n", "ALPHANUMERIC\n", "2046\n", "", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["B47", "INTERMEDIARY ID QUALIFIER\n", "", "8K\n", "", "2\n", "ALPHANUMERIC\n", "2047\n", "", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["B48", "INTERMEDIARY ID\n", "", "8M\n", "", "20\n", "ALPHANUMERIC\n", "2048\n", "", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "", ""], ["B49", "INTERMEDIARY ID STATE/PROV ADD\n", "", "8N\n", "", "2\n", "ALPHANUMERIC\n", "2049\n", "INTERMEDIARY ID STATE/PROVINCE ADDRESS\n", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["201", "SERVICE PROVIDER ID\n", "ALPHA/NUMERIC\n", "B1\n", "12\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Site","NPI"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "RESPONSE HEADER\n", "\nS $P(^BPSC(BPS(9002313.02),200),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["B91", "DAYS SUP LIM PER SPC TM PERIOD\n", "", "3W\n", "", "3\n", "NUMERIC\n", "2091\n", "DAYS SUPPLY LIMIT PER SPECIFIC TIME PERIOD\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["B55", "INTERMEDIARY ID COUNTRY CODE\n", "", "8U\n", "", "2\n", "ALPHANUMERIC\n", "2055\n", "", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["B50", "INTERMEDIARY ID RELATION CODE\n", "", "8P\n", "", "1\n", "NUMERIC\n", "2050\n", "INTERMEDIARY ID RELATIONSHIP CODE\n", "\nS BPS("X")=""\n\n\n", "INTERMEDIARY\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "", ""], ["B56", "LAST KNOWN IIN NUMBER\n", "", "3E\n", "", "6\n", "NUMERIC\n", "2056\n", "", "\nS BPS("X")=""\n\n\n", "LAST KNOWN 4RX\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,6)=BPS("X")\n\n\n", ""], ["B57", "LAST KNOWN PROCESSOR CNTRL NUM\n", "", "3F\n", "", "10\n", "ALPHANUMERIC\n", "2057\n", "LAST KNOWN PROCESSOR CONTROL NUMBER\n", "\nS BPS("X")=""\n\n\n", "LAST KNOWN 4RX\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,7)=BPS("X")\n\n\n", ""], ["B58", "LAST KNOWN GROUP ID\n", "", "3G\n", "", "15\n", "ALPHANUMERIC\n", "2058\n", "", "\nS BPS("X")=""\n\n\n", "LAST KNOWN 4RX\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,8)=BPS("X")\n\n\n", ""], ["B59", "LAST KNOWN CARDHOLDER ID\n", "", "3H\n", "", "20\n", "ALPHANUMERIC\n", "2059\n", "", "\nS BPS("X")=""\n\n\n", "LAST KNOWN 4RX\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,9)=BPS("X")\n\n\n", ""], ["B60", "YEAR OF LAST PAID CLAIM\n", "", "3J\n", "", "4\n", "NUMERIC\n", "2060\n", "", "\nS BPS("X")=""\n\n\n", "LAST KNOWN 4RX\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),4)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B50"),U,10)=BPS("X")\n\n\n", ""], ["B61", "MONTH OF LAST PAID CLAIM\n", "", "3K\n", "", "2\n", "NUMERIC\n", "2061\n", "", "\nS BPS("X")=""\n\n\n", "LAST KNOWN 4RX\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B60"),U,1)=BPS("X")\n\n\n", ""], ["B22", "HELP DESK TELEPHONE NUMBER EXT\n", "", "7P\n", "", "8\n", "NUMERIC\n", "2022\n", "HELP DESK TELEPHONE NUMBER EXTENSION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["B33", "PRO SERVICE FEE CONT/REIM AMT\n", "", "6G\n", "", "6.2\n", "SIGNED NUMERIC\n", "2033\n", "PROFESSIONAL SERVICE FEE CONTRACTED/REIMBURSEMENT AMOUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["443", "OTHER PAYER DATE\n", "NUMERIC\n", "E8\n", "8\n", "8\n", "NUMERIC\n", "", "", "\n;GET code for this COB field is executed in COB^BPSOSHF\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "", "\nD SET443^BPSFLD01\n
\n\n", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n"], ["B23", "OTHER PAYER HELPDESK PHONE EXT\n", "", "7Q\n", "", "8\n", "NUMERIC\n", "2023\n", "OTHER PAYER HELP DESK TELEPHONE NUMBER EXTENSION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["B52", "RESPONSE INTERMEDIARY AUTH CNT\n", "", "8R\n", "", "1\n", "NUMERIC\n", "2052\n", "RESPONSE INTERMEDIARY AUTHORIZATION COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["B53", "RESPONSE INTERMED AUTH TYPE ID\n", "", "8S\n", "", "2\n", "NUMERIC\n", "2053\n", "RESPONSE INTERMEDIARY AUTHORIZATION TYPE ID\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["B54", "RESPONSE INTERMEDIARY AUTH ID\n", "", "8T\n", "", "20\n", "ALPHANUMERIC\n", "2054\n", "RESPONSE INTERMEDIARY AUTHORIZATION ID\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["B51", "INTERMEDIARY MESSAGE\n", "", "8Q\n", "", "200\n", "ALPHANUMERIC\n", "2051\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["931", "MAXIMUM AGE QUALIFIER\n", "ALPHA/NUMERIC\n", "F8\n", "1\n", "1\n", "ALPHANUMERIC\n", "931\n", "MAXIMUM AGE QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["932", "MAXIMUM AGE\n", "NUMERIC\n", "GA\n", "3\n", "3\n", "NUMERIC\n", "932\n", "MAXIMUM AGE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["933", "MAXIMUM AMOUNT\n", "NUMERIC\n", "GB\n", "10\n", "10\n", "NUMERIC\n", "933\n", "MAXIMUM AMOUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["934", "MAXIMUM AMOUNT QUALIFIER\n", "ALPHA/NUMERIC\n", "GC\n", "2\n", "2\n", "ALPHANUMERIC\n", "934\n", "MAXIMUM AMOUNT QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["935", "MAXIMUM AMOUNT TIME PERIOD\n", "ALPHA/NUMERIC\n", "GF\n", "2\n", "2\n", "ALPHANUMERIC\n", "935\n", "MAXIMUM AMOUNT TIME PERIOD\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["313", "CARDHOLDER LAST NAME\n", "ALPHA/NUMERIC\n", "CD\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Cardholder","Last Name"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,13)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),15)\n\n\n"], ["936", "MAX AMT TIME PERIOD START DATE\n", "NUMERIC\n", "GG\n", "8\n", "8\n", "NUMERIC\n", "936\n", "MAXIMUM AMOUNT TIME PERIOD START DATE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["937", "MAX AMT TIME PERIOD END DATE\n", "NUMERIC\n", "GH\n", "8\n", "8\n", "NUMERIC\n", "937\n", "MAXIMUM AMOUNT TIME PERIOD END DATE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["938", "MAX AMT TIME PERIOD UNITS\n", "NUMERIC\n", "GJ\n", "4\n", "4\n", "NUMERIC\n", "938\n", "MAXIMUM AMOUNT TIME PERIOD UNITS\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["C58", "BENEFIT TYPE OPPORTUNITY\n", "ALPHA/NUMERIC\n", "AE\n", "2\n", "2\n", "ALPHANUMERIC\n", "2158\n", "BENEFIT TYPE OPPORTUNITY\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["C59", "BENEFIT TYPE OPPORTUNITY COUNT\n", "NUMERIC\n", "AF\n", "1\n", "1\n", "NUMERIC\n", "2159\n", "BENEFIT TYPE OPPORTUNITY COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["C66", "HELP DESK BUSINESS UNIT TYPE\n", "ALPHA/NUMERIC\n", "BA\n", "2\n", "2\n", "ALPHANUMERIC\n", "2166\n", "HELP DESK BUSINESS UNIT TYPE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["C67", "HELP DESK BUS UNIT TYPE COUNT\n", "NUMERIC\n", "BB\n", "2\n", "2\n", "NUMERIC\n", "2167\n", "HELP DESK BUSINESS UNIT TYPE COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["C68", "HELP DESK CONTACT INFORMATION\n", "ALPHA/NUMERIC\n", "BC\n", "255\n", "255\n", "ALPHANUMERIC\n", "2168\n", "HELP DESK CONTACT INFORMATION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["C69", "HELP DESK CONTACT INFO EXT\n", "ALPHA/NUMERIC\n", "BD\n", "8\n", "8\n", "ALPHANUMERIC\n", "2169\n", "HELP DESK CONTACT INFORMATION EXTENSION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["312", "CARDHOLDER FIRST NAME\n", "ALPHA/NUMERIC\n", "CC\n", "12\n", "12\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Cardholder","First Name"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),12)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,12)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),12)\n\n\n"], ["C70", "HELP DESK CONTACT INFO QUAL\n", "ALPHA/NUMERIC\n", "BF\n", "2\n", "2\n", "ALPHANUMERIC\n", "2170\n", "HELP DESK CONTACT INFORMATION QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["C71", "HELP DESK SUPPORT TYPE\n", "ALPHA/NUMERIC\n", "BG\n", "2\n", "2\n", "ALPHANUMERIC\n", "2171\n", "HELP DESK SUPPORT TYPE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["C72", "HELP DESK SUPPORT TYPE COUNT\n", "NUMERIC\n", "BH\n", "2\n", "2\n", "NUMERIC\n", "2172\n", "HELP DESK SUPPORT TYPE COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "", ""], ["C80", "INTERMEDIARY HELP DESK TYPE\n", "ALPHA/NUMERIC\n", "G8\n", "2\n", "2\n", "ALPHANUMERIC\n", "2180\n", "INTERMEDIARY HELP DESK BUSINESS UNIT TYPE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["C81", "INTERMEDIARY HLPDSK BUS COUNT\n", "ALPHA/NUMERIC\n", "G9\n", "2\n", "2\n", "ALPHANUMERIC\n", "2181\n", "INTERMEDIARY HELP DESK BUSINESS UNIT TYPE COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["C82", "INTERMEDIARY HLPDSK CONTACT\n", "ALPHA/NUMERIC\n", "JP\n", "255\n", "255\n", "ALPHANUMERIC\n", "2182\n", "INTERMEDIARY HELP DESK CONTACT INFORMATION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["C83", "INTERMEDIARY HLPDSK EXTENSION\n", "ALPHA/NUMERIC\n", "JR\n", "8\n", "8\n", "ALPHANUMERIC\n", "2183\n", "INTERMEDIARY HELP DESK CONTACT INFORMATION EXTENSION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["C84", "INTERMEDIARY HLPDSK QUALIFIER\n", "ALPHA/NUMERIC\n", "KA\n", "2\n", "2\n", "ALPHANUMERIC\n", "2184\n", "INTERMEDIARY HELP DESK CONTACT INFORMATION QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["C85", "INTERMEDIARY HLPDSK SUPPT TYPE\n", "ALPHA/NUMERIC\n", "KB\n", "2\n", "2\n", "ALPHANUMERIC\n", "2185\n", "INTERMEDIARY HELP DESK SUPPORT TYPE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["322", "PATIENT STREET ADDRESS\n", "ALPHA/NUMERIC\n", "CM\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Street Address"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),321),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),30)\n\n\n"], ["C93", "PATIENT PAY COMPONENT AMOUNT\n", "NUMERIC\n", "KN\n", "8\n", "8\n", "NUMERIC\n", "2193\n", "PATIENT PAY COMPONENT AMOUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),"C90"),"^",3)=BPS("X")\n\n\n", "\nS BPS("X")=$$DFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["C94", "PATIENT PAY COMPONENT COUNT\n", "NUMERIC\n", "KP\n", "2\n", "2\n", "NUMERIC\n", "2194\n", "PATIENT PAY COMPONENT COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["C95", "PATIENT PAY COMPONENT QUAL\n", "ALPHA/NUMERIC\n", "KQ\n", "2\n", "2\n", "ALPHANUMERIC\n", "2195\n", "PATIENT PAY COMPONENT QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["C96", "PAYER/HEALTH PLAN ID COUNT\n", "NUMERIC\n", "KR\n", "1\n", "1\n", "NUMERIC\n", "2196\n", "PAYER/HEALTH PLAN ID COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INSURANCE\n", "", ""], ["D15", "SUBROGTN REQUESTR RECONCIL ID\n", "ALPHA/NUMERIC\n", "KY\n", "30\n", "30\n", "ALPHANUMERIC\n", "2215\n", "SUBROGATION REQUESTORS RECONCILIATION ID\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D19", "MINIMUM AMOUNT\n", "NUMERIC\n", "M1\n", "10\n", "10\n", "NUMERIC\n", "2219\n", "MINIMUM AMOUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D20", "MINIMUM AMOUNT QUALIFIER\n", "ALPHA/NUMERIC\n", "M2\n", "3\n", "3\n", "ALPHANUMERIC\n", "2220\n", "MINIMUM AMOUNT QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D23", "OTHER PAYER NAME\n", "ALPHA/NUMERIC\n", "M5\n", "70\n", "70\n", "ALPHANUMERIC\n", "2223\n", "OTHER PAYER NAME\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["D24", "REMAINING AMOUNT\n", "NUMERIC\n", "M6\n", "10\n", "10\n", "NUMERIC\n", "2224\n", "REMAINING AMOUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D25", "REMAINING AMOUNT QUALIFIER\n", "ALPHA/NUMERIC\n", "M7\n", "3\n", "3\n", "ALPHANUMERIC\n", "2225\n", "REMAINING AMOUNT QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["323", "PATIENT CITY ADDRESS\n", "ALPHA/NUMERIC\n", "CN\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","City"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),321),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),20)\n\n\n"], ["D41", "OTHER PAYER RELATIONSHIP TYPE\n", "ALPHA/NUMERIC\n", "PQ\n", "3\n", "3\n", "ALPHANUMERIC\n", "2241\n", "OTHER PAYER RELATIONSHIP TYPE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["D42", "FORMULARY ALT BENEFIT TIER\n", "ALPHA/NUMERIC\n", "PV\n", "2\n", "2\n", "ALPHANUMERIC\n", "2242\n", "FORMULARY ALTERNATIVE PLAN BENEFIT TIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D43", "FORMULARY ALT REASON CODE\n", "ALPHA/NUMERIC\n", "PZ\n", "2\n", "2\n", "ALPHANUMERIC\n", "2243\n", "FORMULARY ALTERNATIVE REASON CODE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D44", "FORMLRY ALT REQ THERAPY COUNT\n", "ALPHA/NUMERIC\n", "P0\n", "2\n", "2\n", "ALPHANUMERIC\n", "2244\n", "FORMULARY ALTERNATIVE REQUIRED THERAPY INDICATOR COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D45", "FORMLRY ALT THERAPY INDICATOR\n", "ALPHA/NUMERIC\n", "P1\n", "2\n", "2\n", "ALPHANUMERIC\n", "2245\n", "FORMULARY ALTERNATIVE REQUIRED THERAPY INDICATOR\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D46", "FORMLRY ALT THERAPY TIME QUAL\n", "ALPHA/NUMERIC\n", "P2\n", "2\n", "2\n", "ALPHANUMERIC\n", "2246\n", "FORMULARY ALTERNATIVE REQUIRED THERAPY TIME PERIOD QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D47", "FORMLRY ALT THERAPY DURATION\n", "ALPHA/NUMERIC\n", "P3\n", "3\n", "3\n", "ALPHANUMERIC\n", "2247\n", "FORMULARY ALTERNATIVE REQUIRED THERAPY TIME PERIOD DURATION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D48", "FORMLRY ALT THERAPY START DATE\n", "NUMERIC\n", "P4\n", "8\n", "8\n", "NUMERIC\n", "2248\n", "FORMULARY ALTERNATIVE REUQIRED THERAPY TIME PERIOD START DATE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D49", "FORMLRY ALT THERAPY END DATE\n", "NUMERIC\n", "P5\n", "9\n", "9\n", "NUMERIC\n", "2249\n", "FORMULARY ALTERNATIVE REQUIRED THERAPY TIME PERIOD END DATE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D50", "OTHER PAYER BENEFIT CLASS\n", "ALPHA/NUMERIC\n", "P6\n", "10\n", "10\n", "ALPHANUMERIC\n", "2250\n", "OTHER PAYER BENEFIT CLASSIFICATION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE OTHER PAYERS\n", "", ""], ["324", "PATIENT STATE/PROVINCE ADDRESS\n", "ALPHA/NUMERIC\n", "CO\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","State"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),321),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),2)\n\n\n"], ["D54", "PLAN OVERRIDE INDICATOR\n", "ALPHA/NUMERIC\n", "RC\n", "6\n", "6\n", "ALPHANUMERIC\n", "2254\n", "PLAN BENEFIT OVERRIDE INDICATOR\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D55", "PLAN OVERRIDE VALUE COUNT\n", "NUMERIC\n", "RD\n", "1\n", "1\n", "NUMERIC\n", "2255\n", "PLAN BENEFIT OVERRIDE VALUE COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D56", "PLAN BENEFIT OVERRIDE VALUE\n", "NUMERIC\n", "RF\n", "1\n", "1\n", "NUMERIC\n", "2256\n", "PLAN BENEFIT OVERRIDE VALUE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["D62", "REGULATORY FEE EXMPT INDICATOR\n", "ALPHA/NUMERIC\n", "RM\n", "1\n", "1\n", "ALPHANUMERIC\n", "2262\n", "REGULATORY FEE EXEMPT INDICATOR\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["D65", "PATIENT REGULATORY FEE AMOUNT\n", "NUMERIC\n", "RS\n", "8\n", "8\n", "NUMERIC\n", "2265\n", "PATIENT REGULATORY FEE AMOUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PRICING\n", "", ""], ["D17", "SUBMISSION TYPE CODE\n", "ALPHA/NUMERIC\n", "K8\n", "2\n", "2\n", "ALPHANUMERIC\n", "2217\n", "SUBMISSION TYPE CODE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["D18", "DO NOT DISPENSE BEFORE DATE\n", "NUMERIC\n", "K9\n", "8\n", "8\n", "NUMERIC\n", "2218\n", "DO NOT DISPENSE BEFORE DATE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["D21", "MULTIPLE RX/SVC GROUP ID\n", "ALPHA/NUMERIC\n", "M3\n", "35\n", "35\n", "ALPHANUMERIC\n", "2221\n", "MULTIPLE PRESCRIPTION/SERVICE ORDER GROUP ID\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D20"),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n"], ["D22", "MULT RX/SVC GROUP REASON CODE\n", "ALPHA/NUMERIC\n", "M4\n", "2\n", "2\n", "ALPHANUMERIC\n", "2222\n", "MULTIPLE PRESCRIPTION/SERVICE ORDER GROUP REASON CODE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D20"),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["D51", "OTHER PAYR TAX EXEMPT INDICATR\n", "ALPHA/NUMERIC\n", "P7\n", "1\n", "1\n", "ALPHANUMERIC\n", "2251\n", "OTHER PAYER PERCENTAGE TAX EXEMPT INDICATOR\n", "\nS BPS("X")=""\n\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["325", "PATIENT ZIP/POSTAL ZONE\n", "ALPHA/NUMERIC\n", "CP\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Zip"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$TR($G(BPS("X")),"-/._","")\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),321),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$TR(BPS("X"),"-/._","")\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),9)\n\n\n"], ["D52", "OTHER PAYR FEE EXMPT INDICATR\n", "ALPHA/NUMERIC\n", "P8\n", "1\n", "1\n", "ALPHANUMERIC\n", "2252\n", "OTHER PAYER REGULATORY FEE EXEMPT INDICATOR\n", "\nS BPS("X")=""\n\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["D53", "OTHER PAYR FEE TYPE COUNT\n", "NUMERIC\n", "P9\n", "1\n", "1\n", "NUMERIC\n", "2253\n", "OTHER PAYER REGULATORY FEE TYPE COUNT\n", "\nS BPS("X")=""\n\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["D57", "PRESCRIBER PLACE OF SERVICE\n", "NUMERIC\n", "RG\n", "2\n", "2\n", "NUMERIC\n", "2257\n", "PRESCRIBER PLACE OF SERVICE\n", "\nS BPS("X")=""\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D50"),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["D63", "OTHER PAYER FEE TYPE CODE\n", "ALPHA/NUMERIC\n", "RN\n", "2\n", "2\n", "ALPHANUMERIC\n", "2263\n", "OTHER PAYER REGULATORY FEE TYPE CODE\n", "\nS BPS("X")=""\n\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D60"),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["C49", "OTHER PAYER RECONCILIATION ID\n", "ALPHA/NUMERIC\n", "9V\n", "30\n", "30\n", "ALPHANUMERIC\n", "2149\n", "OTHER PAYER RECONCILIATION ID\n", "\n; Handled by SET2149^BPSFLD01\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "\n; Handled by SET2149^BPSFLD01\n
\n\n", "", "\nD SET2149^BPSFLD01\n
\n\n", "\n; Handled by SET2149^BPSFLD01\n
\n\n"], ["C60", "COMPOUND LEVEL OF COMPLEXITY\n", "ALPHA/NUMERIC\n", "AG\n", "2\n", "2\n", "ALPHANUMERIC\n", "2160\n", "COMPOUND LEVEL OF COMPLEXITY\n", "\nS BPS("X")=""\n\n\n", "COMPOUND\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C50"),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["C90", "LTPAC BILLING METHODOLOGY\n", "NUMERIC\n", "KH\n", "1\n", "1\n", "NUMERIC\n", "2190\n", "LTPAC BILLING METHODOLOGY\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C80"),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["C91", "LTPAC DISPENSE FREQUENCY\n", "NUMERIC\n", "KK\n", "2\n", "2\n", "NUMERIC\n", "2191\n", "LTPAC DISPENSE FREQUENCY\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["C92", "NUMBER LTPAC DISPENSING EVENTS\n", "NUMERIC\n", "KM\n", "3\n", "3\n", "NUMERIC\n", "2192\n", "NUMBER OF LTPAC DISPENSING EVENTS\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["C98", "PREPARATION ENVIRONMENT CODE\n", "NUMERIC\n", "KT\n", "3\n", "3\n", "NUMERIC\n", "2198\n", "PREPARATION ENVIRONMENT EVENT CODE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["314", "HOME PLAN\n", "ALPHA/NUMERIC\n", "CE\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Home Plan"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,14)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),3)\n\n\n"], ["C99", "PREPARATION ENVIRONMENT TYPE\n", "ALPHA/NUMERIC\n", "KU\n", "2\n", "2\n", "ALPHANUMERIC\n", "2199\n", "PREPARATION ENVIRONMENT TYPE\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C90"),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["D01", "PRESCRIBER DEA NUMBER\n", "ALPHA/NUMERIC\n", "KV\n", "15\n", "15\n", "ALPHANUMERIC\n", "2201\n", "PRESCRIBER DEA NUMBER\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber DEA"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D00"),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["D02", "TOTAL PRESCRIBED QTY REMAINING\n", "NUMERIC\n", "KW\n", "10\n", "10\n", "NUMERIC\n", "2202\n", "TOTAL PRESCRIBED QUANTITY REMAINING\n", "\n;Handled by FLDD02^BPSOSSG\n
\n\n", "CLAIM\n", "\n; Handled by FLDD02^BPSOSSG\n
\n\n", "", "\nD FLDD02^BPSOSSG\n
\n\n", "\n; Handled by FLDD02^BPSOSSG\n
\n\n"], ["D14", "SUBROGATION AMOUNT REQUESTED\n", "NUMERIC\n", "KX\n", "8\n", "9\n", "NUMERIC\n", "2214\n", "SUBROGATION AMOUNT REQUESTED\n", "\nS BPS("X")=""\n\n\n", "PRICING\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["D16", "SUBMISSION TYPE CODE COUNT\n", "NUMERIC\n", "KZ\n", "1\n", "1\n", "NUMERIC\n", "2216\n", "SUBMISSION TYPE CODE COUNT\n", "\nS BPS("S")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"D10"),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["C47", "OTHER PAYER PROGRAM TYPE\n", "ALPHA/NUMERIC\n", "9T\n", "3\n", "3\n", "ALPHANUMERIC\n", "2147\n", "OTHER PAYER ADJUDICATED PROGRAM TYPE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "", "RESPONSE OTHER PAYERS\n", "", ""], ["C50", "BENEFIT STAGE INDICATOR COUNT\n", "NUMERIC\n", "9W\n", "1\n", "1\n", "NUMERIC\n", "2150\n", "BENEFITS STAGE INDICATOR COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "", "RESPONSE PRICING\n", "", ""], ["C51", "BENEFIT STAGE INDICATOR\n", "ALPHA/NUMERIC\n", "9X\n", "2\n", "2\n", "ALPHANUMERIC\n", "2151\n", "BENEFITS STAGE INDICATOR\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "COORDINATION OF BENEFITS/OTHER PAYMENTS\n", "", "RESPONSE PRICING\n", "", ""], ["D60", "REGULATORY FEE COUNT\n", "NUMERIC\n", "RK\n", "1\n", "1\n", "NUMERIC\n", "2260\n", "REGULATORY FEE COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "PRICING\n", "", "RESPONSE PRICING\n", "", ""], ["D61", "REGULATORY FEE TYPE CODE\n", "ALPHA/NUMERIC\n", "RL\n", "2\n", "2\n", "ALPHANUMERIC\n", "2261\n", "REGULATORY FEE TYPE CODE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "PRICING\n", "", "RESPONSE PRICING\n", "", ""], ["315", "EMPLOYER NAME\n", "ALPHA/NUMERIC\n", "CF\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nD EMPL^BPSOSSG\nS BPS("X")=$G(BPS("Employer","Name"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),30)\n\n\n"], ["943", "MINIMUM AGE QUALIFIER\n", "ALPHA/NUMERIC\n", "GQ\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "MINIMUM AGE QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["944", "MINIMUM AGE\n", "NUMERIC\n", "GR\n", "3\n", "3\n", "NUMERIC\n", "", "MINIMUM AGE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["C86", "INTERMEDIARY HLPDSK TYP COUNT\n", "NUMERIC\n", "KC\n", "2\n", "2\n", "NUMERIC\n", "2186\n", "INTERMEDIARY HELP DESK SUPPORT TYPE COUNT\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE INTERMEDIARY\n", "", ""], ["E87", "INVALID PROVIDER DATA SOURCE\n", "ALPHA/NUMERIC\n", "ZV\n", "2\n", "2\n", "ALPHANUMERIC\n", "2387\n", "DATA SOURCE OF INVALID PROVIDER DETERMINATION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PROVIDER\n", "", ""], ["E88", "INVALID PROVIDER SOURCE-STATE\n", "ALPHA/NUMERIC\n", "ZZ\n", "2\n", "2\n", "ALPHANUMERIC\n", "2388\n", "STATE CODE FOR DATA SOURCE OF INVALID PROVIDER DETERMINATION\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE PROVIDER\n", "", ""], ["E89", "FORMULARY ALTERNATIVE EFF DATE\n", "NUMERIC\n", "ZO\n", "8\n", "8\n", "NUMERIC\n", "2389\n", "FORMULARY ALTERNATIVE EFFECTIVE DATE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["E93", "DUR/DUE CO-AGENT DESCRIPTION\n", "ALPHA/NUMERIC\n", "ZC\n", "40\n", "40\n", "ALPHANUMERIC\n", "2393\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["E94", "UNIT OF PRIOR DISPENSED QTY\n", "ALPHA/NUMERIC\n", "ZA\n", "3\n", "3\n", "ALPHANUMERIC\n", "2394\n", "UNIT OF MEASURE FOR PREVIOUS DISPENSED QUANTITY\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["301", "GROUP ID\n", "ALPHA/NUMERIC\n", "C1\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Insurer","Group #"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "RESPONSE INSURANCE\n", "\nS $P(^BPSC(BPS(9002313.02),300),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["316", "EMPLOYER STREET ADDRESS\n", "ALPHA/NUMERIC\n", "CG\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Employer","Address"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),30)\n\n\n"], ["E95", "OTHER PHARMACY ID QUALIFIER\n", "NUMERIC\n", "Z9\n", "2\n", "2\n", "NUMERIC\n", "2395\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["E96", "OTHER PHARMACY ID\n", "ALPHA/NUMERIC\n", "Z8\n", "35\n", "35\n", "ALPHANUMERIC\n", "2396\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["E97", "OTHER PHARMACY NAME\n", "ALPHA/NUMERIC\n", "Z7\n", "70\n", "70\n", "ALPHANUMERIC\n", "2397\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["E98", "OTHER PHARMACY TELEPHONE\n", "NUMERIC\n", "Z6\n", "10\n", "10\n", "NUMERIC\n", "2398\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["E99", "OTHER PRESCRIBER LAST NAME\n", "ALPHA/NUMERIC\n", "Z5\n", "35\n", "35\n", "ALPHANUMERIC\n", "2399\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F01", "OTHER PRESCRIBER ID QUALIFIER\n", "ALPHA/NUMERIC\n", "Z4\n", "2\n", "2\n", "ALPHANUMERIC\n", "2401\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F02", "OTHER PRESCRIBER ID\n", "ALPHA/NUMERIC\n", "Z3\n", "35\n", "35\n", "ALPHANUMERIC\n", "2402\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F03", "OTHER PRESCRIBER PHONE NUMBER\n", "NUMERIC\n", "Z2\n", "10\n", "10\n", "NUMERIC\n", "2403\n", "OTHER PRESCRIBER TELEPHONE NUMBER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F04", "DUR/DUE COMPOUND PRODUCT ID\n", "ALPHA/NUMERIC\n", "Z1\n", "40\n", "40\n", "ALPHANUMERIC\n", "2404\n", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F05", "DUR/DUE CMPND PRDUCT ID QUALIF\n", "ALPHA/NUMERIC\n", "Z0\n", "2\n", "2\n", "ALPHANUMERIC\n", "2405\n", "DUR/DUE COMPOUND PRODUCT ID QUALIFIER\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["317", "EMPLOYER CITY ADDRESS\n", "ALPHA/NUMERIC\n", "CH\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Employer","City"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),20)\n\n\n"], ["F06", "DUR/DUE MAXIMUM DAILY DOSE QTY\n", "NUMERIC\n", "YO\n", "10\n", "10\n", "NUMERIC\n", "2406\n", "DUR/DUE MAXIMUM DAILY DOSE QUANTITY\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F07", "DUR/DUE MAX DAILY DOSE - UNIT\n", "ALPHA/NUMERIC\n", "YL\n", "3\n", "3\n", "ALPHANUMERIC\n", "2407\n", "DUR/DUE MAXIMUM DAILY DOSE UNIT OF MEASURE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F08", "DUR/DUE MINIMUM DAILY DOSE QTY\n", "NUMERIC\n", "YJ\n", "10\n", "10\n", "NUMERIC\n", "2408\n", "DUR/DUE MINIMUM DAILY DOSE QUANTITY\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F09", "DUR/DUE MIN DAILY DOSE - UNIT\n", "ALPHA/NUMERIC\n", "YI\n", "3\n", "3\n", "ALPHANUMERIC\n", "2409\n", "DUR/DUE MINIMUM DAILY DOSE UNIT OF MEASURE\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE DUR/PPS\n", "", ""], ["F32", "SEX ASSIGNED AT BIRTH\n", "NUMERIC\n", "W8\n", "1\n", "1\n", "NUMERIC\n", "2432\n", "", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),1)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),"F30"),U,2)=BPS("X")\n\n\n", ""], ["318", "EMPLOYER STATE/PROV ADDRESS\n", "ALPHA/NUMERIC\n", "CI\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "EMPLOYER STATE/ PROVINCE ADDRESS\n", "\nS BPS("X")=$G(BPS("Employer","State"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,8)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),2)\n\n\n"], ["319", "EMPLOYER ZIP/POSTAL ZONE\n", "ALPHA/NUMERIC\n", "CJ\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Employer","Zip Code"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),15)\n\n\n"], ["327", "CARRIER ID\n", "ALPHA/NUMERIC\n", "CR\n", "12\n", "10\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Carrier ID #"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),320),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),12)\n\n\n"], ["B92", "DAYS SUPPLY LIMIT TIME PERIOD\n", "", "3X\n", "", "5\n", "NUMERIC\n", "2092\n", "DAYS SUPPLY LIMIT TIME PERIOD\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE CLAIM\n", "", ""], ["C01", "ORIG MANUFACTURER PRODUCT ID\n", "ALPHA/NUMERIC\n", "4N\n", "19\n", "19\n", "ALPHANUMERIC\n", "2101\n", "ORIGINAL MANUFACTURER PRODUCT ID\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C0"),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),19)\n\n\n"], ["427", "PRESCRIBER LAST NAME\n", "ALPHA/NUMERIC\n", "DR\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber Last Name"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),420),U,27)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),15)\n\n\n"], ["C02", "ORIG MANUFACTURER PROD ID QUAL\n", "ALPHA/NUMERIC\n", "4P\n", "2\n", "2\n", "ALPHANUMERIC\n", "2102\n", "ORIGINAL MANUFACTURER PRODUCT ID QUALIFIER\n", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"C0"),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["434", "DATE OF INJURY\n", "NUMERIC\n", "DY\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Date of Injury"))\nS BPS("X")=$$DTF1^BPSECFM(BPS("X"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,4)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["302", "CARDHOLDER ID\n", "ALPHA/NUMERIC\n", "C2\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Insurer","Policy #"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "RESPONSE INSURANCE\n", "\nS $P(^BPSC(BPS(9002313.02),300),U,2)=$TR(BPS("X")," ","")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n"], ["435", "CLAIM/REFERENCE ID\n", "ALPHA/NUMERIC\n", "DZ\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Claim/Ref ID #"))\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),400),U,35)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),30)\n\n\n"], ["436", "PRODUCT/SERVICE ID QUALIFIER\n", "ALPHA/NUMERIC\n", "E1\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Product ID Qualifier"))\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),430),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),2)\n\n\n"], ["B96", "PROVIDER FIRST NAME\n", "ALPHA/NUMERIC\n", "4A\n", "35\n", "35\n", "ALPHANUMERIC\n", "2096\n", "PROVIDER FIRST NAME\n", "\nS BPS("X")=""\n\n\n", "PHARMACY PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B90"),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n"], ["B97", "PROVIDER LAST NAME\n", "ALPHA/NUMERIC\n", "4M\n", "35\n", "35\n", "ALPHANUMERIC\n", "2097\n", "PROVIDER LAST NAME\n", "\nS BPS("X")=""\n\n\n", "PHARMACY PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B90"),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),35)\n\n\n"], ["498.51", "PRIOR AUTH PROCESSED DATE\n", "ALPHA/NUMERIC\n", "PR\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "", "\nS BPS("X")=$$DTF1^BPSECFM($G(BPS("X")))\n\n\n", "RESPONSE PRIOR AUTHORIZATION\n", "", ""], ["202", "SERV PROVIDER ID QUALIFIER\n", "ALPHA/NUMERIC\n", "B2\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "SERVICE PROVIDER ID QUALIFIER\n", "\nS BPS("X")="01"\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "RESPONSE HEADER\n", "\nS $P(^BPSC(BPS(9002313.02),200),U,2)=BPS("X") ;VA\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["110", "SOFTWARE VENDOR/CERT ID\n", "ALPHA/NUMERIC\n", "AK\n", "10\n", "10\n", "ALPHANUMERIC\n", "", "SOFTWARE VENDOR/ CERTIFICATION ID\n", "\nS BPS("X")=$G(BPS("NCPDP","Software Vendor/Cert ID"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),100),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),10) ;VA\n\n\n"], ["331", "PATIENT ID QUALIFIER\n", "ALPHA/NUMERIC\n", "CX\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")="01"\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),330),U,1)=BPS("X") ;VA\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["332", "PATIENT ID\n", "ALPHA/NUMERIC\n", "CY\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","SSN"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),330),U,2)=BPS("X") ;VA\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n"], ["326", "PATIENT TELEPHONE NUMBER\n", "NUMERIC\n", "CQ\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=$TR($G(BPS("Patient","Phone #")),"#() -_*.@")\n\n\n", "PATIENT\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),321),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["303", "PERSON CODE\n", "ALPHA/NUMERIC\n", "C3\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Insurer","Person Code"))\n\n\n", "INSURANCE\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),300),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["455", "PRESCRIPTION/SERV REF NO QLFR\n", "ALPHA/NUMERIC\n", "EM\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "PRESCRIPTION/ SERVICE REFERENCE NUMBER QUALIFIER\n", "\nS BPS("X")=1\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "RESPONSE CLAIM\n", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,5)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["460", "QUANTITY PRESCRIBED\n", "NUMERIC\n", "ET\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Quantity"))*1000\\1\n\n\n", "CLAIM\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),450),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["465", "PROVIDER ID QUALIFIER\n", "ALPHA/NUMERIC\n", "EY\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")="05"\n\n\n", "PHARMACY PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,5)=""\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["444", "PROVIDER ID\n", "ALPHA/NUMERIC\n", "E9\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Provider NPI"))\n\n\n", "PHARMACY PROVIDER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),440),U,4)=""\n
\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"], ["466", "PRESCRIBER ID QUALIFIER\n", "ALPHA/NUMERIC\n", "EZ\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Prescriber ID Qualifier"))\nS:BPS("X")="" BPS("X")="01"\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,6)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["467", "PRESCRIBER LOCATION CODE\n", "ALPHA/NUMERIC\n", "1E\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("RX",1,"Prescriber Billing Location"))\n; Field 467-1E was added to file 9002313.91 in error. It should never\n; appear on a payer sheet, and it should never be populated.\n\n\n", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,7)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["498", "PRESCRIBER TELEPHONE NUMBER\n", "NUMERIC\n", "PM\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=$TR($G(BPS("RX",BPS(9002313.0201),"Prescriber Phone #")),"#() -_*.@")\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),498),U,12)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n"], ["468", "PRIMARY CARE PROVIDER ID QLFR\n", "ALPHA/NUMERIC\n", "2E\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "PRIMARY CARE PROVIDER ID QUALIFIER\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Primary Care Prov ID Qual"))\nS:BPS("X")="" BPS("X")="01"\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,8)=""\n
\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["469", "PRIM CARE PROV LOCATION CODE\n", "NUMERIC\n", "H5\n", "3\n", "3\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","Primary Care Prov Location Code"))\n; Field 469-H5 was added to file 9002313.91 in error. It should never\n; appear on a payer sheet, and it should never be populated.\n\n\n", "", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),3)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),3)\n\n\n"], ["470", "PRIM CARE PROVIDER LAST NAME\n", "ALPHA/NUMERIC\n", "4E\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "PRIMARY CARE PROVIDER LAST NAME\n", "\nS BPS("X")=$G(BPS("RX",BPS(9002313.0201),"Primary Care Prov Last Name"))\n\n\n", "PRESCRIBER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),460),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),15)\n\n\n"], ["304", "DATE OF BIRTH\n", "NUMERIC\n", "C4\n", "8\n", "8\n", "NUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Patient","DOB"))\n\n\n", "PATIENT\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n", "RESPONSE PATIENT\n", "\nS $P(^BPSC(BPS(9002313.02),300),U,4)=$G(BPS("X"))\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),8)\n\n\n"], ["B95", "FACILITY ID QUALIFIER\n", "ALPHA/NUMERIC\n", "3Z\n", "2\n", "2\n", "ALPHANUMERIC\n", "2095\n", "FACILITY ID QUALIFIER\n", "\nS BPS("X")=$G(BPS("Insurer","Facility ID"))\nS BPS("X")=$S(BPS("X")'="":1,1:"")\n\n\n", "FACILITY\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),"B90"),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n"], ["480", "OTHER AMT CLAIMED SUBMITTED\n", "SIGNED NUMERIC\n", "H9\n", "8\n", "8\n", "SIGNED NUMERIC\n", "", "OTHER AMOUNT CLAIMED SUBMITTED\n", "\n; GET CODE handled by FLD480^BPSOSSG\n
\n\n", "PRICING\n", "\n; vD.0 format code handled by FLD480^BPSOSSG\n
\n\n", "", "\nD FLD480^BPSOSSG\n
\n\n", "\n; format code handled by FLD480^BPSOSSG\n
\n\n"], ["109", "TRANSACTION COUNT\n", "ALPHA/NUMERIC\n", "A9\n", "1\n", "1\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=$G(BPS("Transaction Count"))\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n", "RESPONSE HEADER\n", "\nS $P(^BPSC(BPS(9002313.02),100),U,9)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["111", "SEGMENT IDENTIFICATION\n", "ALPHA/NUMERIC\n", "AM\n", "2\n", "2\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "TRANSACTION HEADER\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),2)\n\n\n", "", "", ""], ["B98", "RECONCILIATION ID\n", "ALPHA/NUMERIC\n", "34\n", "30\n", "30\n", "ALPHANUMERIC\n", "2098\n", "RECONCILIATION ID\n", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "CLAIM\n", "", "RESPONSE STATUS\n", "", ""], ["112", "TRANSACTION RESPONSE STATUS\n", "ALPHA/NUMERIC\n", "AN\n", "2\n", "1\n", "ALPHANUMERIC\n", "", "", "\n; This is a response-only field which does not use the GET, FORMAT, or SET code\n
\n\n", "", "", "RESPONSE STATUS\n", "\nS $P(^BPSR(BPS(9002313.02),1000,BPS(9002313.0201),110),U,2)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),1)\n\n\n"], ["320", "EMPLOYER TELEPHONE NUMBER\n", "NUMERIC\n", "CK\n", "10\n", "10\n", "NUMERIC\n", "", "", "\nS BPS("X")=$TR($G(BPS("Employer","Phone")),"#() -_*.@")\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$NFF^BPSECFM($G(BPS("X")),10)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),310),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),10)\n\n\n"], ["321", "EMPLOYER CONTACT NAME\n", "ALPHA/NUMERIC\n", "CL\n", "30\n", "30\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "WORKER'S COMPENSATION\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),30)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),320),U,1)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM(BPS("X"),30)\n\n\n"], ["330", "ALTERNATE ID\n", "ALPHA/NUMERIC\n", "CW\n", "20\n", "20\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "CLAIM\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),20)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),400,BPS(9002313.0201),320),U,10)=BPS("X")\n\n\n", "\nS BPS("X")=$$NFF^BPSECFM(BPS("X"),20)\n\n\n"], ["333", "EMPLOYER ID\n", "ALPHA/NUMERIC\n", "CZ\n", "15\n", "15\n", "ALPHANUMERIC\n", "", "", "\nS BPS("X")=""\n\n\n", "PATIENT\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n", "", "\nS $P(^BPSC(BPS(9002313.02),330),U,3)=BPS("X")\n\n\n", "\nS BPS("X")=$$ANFF^BPSECFM($G(BPS("X")),15)\n\n\n"]]}