BPSNCPDP ICR (4415)

Name

Value

NUMBER

4415

IA #

4415

DATE CREATED

2004/06/21

CUSTODIAL PACKAGE

E CLAIMS MGMT ENGINE

CUSTODIAL ISC

Birmingham

USAGE

Controlled Subscription

TYPE

Routine

DBIC APPROVAL STATUS

APPROVED

ROUTINE

BPSNCPDP

NAME

BPSNCPDP

GENERAL DESCRIPTION

This API is used by external applications to generate
claims in the Electronic Claims Management Engine.

STATUS

Active

KEYWORDS

BPS
ECME
HIPAA
NCPDP

DURATION

Till Otherwise Agreed

BPSNCPDP

COMPONENT/ENTRY POINT

COMPONENT DESCRIPTION

VARIABLES

$$EN

This Component is called with the variables outlined
in the following format:
$$EN(BRXIEN,BFILL,DOS,BWHERE,BILLNDC,REVREAS,DURREC,
BPOVRIEN, BPSCLARF,BPSAUTH,BPCOBIND,BPJOBFLG,BPREQIEN,
BPSCLOSE,BPSPLAN,BPSPRDAT,BPSRTYPE,BPSDELAY)

This API returns seven "^" pieces of information.
RESPONSE
0  Submitted through ECME
1  No submission through ECME
2  IB not billable
3  Claim was closed, not submitted (RTS/Deletes)
4  Unable to queue claim
5  Incorrect information supplied to ECME
6  Inactive ECME - Primarily used for TRICARE and
CHAMPVA to say OK to calling application
(Outpatient Pharmacy) to process the
prescription
10 Reversal but no resubmit
MESSAGE
Text message with more details regarding the reason the
claim was not submitted to the payer or more information
on the successful submission.
ELIGIBILITY
Patient eligibility: V-Veteran, T-TRICARE, C-CHAMPVA
CLAIM STATUS
The current claim status:
Null or IN PROGRESS/E PAYABLE/etc...
COB
Coordination Of Benefits indicator of the insurance as
it is stored in the PATIENT file:
1 - Primary, 2 - Secondary, 3 - Tertiary
RXCOB
The payer sequence indicator of the claim which was sent
to the payer as a result of the call:
1 - Primary, 2 - Secondary, 3 - Tertiary
INSURANCE
Name of the insurance company that was billed as a result
of the call.


Examples:

0^Prescription XYZ successfully submitted to ECME for
claim generation.^V^E PAYABLE^1^1^AETNA
0^Prescription XYZ successfully submitted to ECME for
claim generation.^V^E PAYABLE^3^2^BCBS
1^ECME switch is not on for the site^^E REVERSAL ACCEPTED
2^Null DEA Special Handling field^V^
3^Claim was not payable so it has been closed.  No ECME
claim created. ^^E REJECTED
4^Error: There is a SCHEDULED request without ACTIVATED
requests, RXIEN=XYZ, REFILL=0^^IN PROGRESS
5^RX Action parameter missing^^E PAYABLE

VARIABLES	TYPE	VARIABLES DESCRIPTION
BRXIEN	Input	(Required) Internal Entry Number of PRESCRIPTION File (#52)
BFILL	Input	(Optional) Fill Number (0 for Original, 1 for 1st refill, 2 for the 2nd refill, etc.). This will be defaulted to 0 if not passed in.
DOS	Input	(Optional) Date of Service. If not passed in or has a future date, it is set to the Release Date of the Prescription and Fill. If the Release Date does not have a value, it is set to the current date.
BWHERE	Input	(Required) Calling Function: AREV - Auto-Reversal BB - Back Billing CRLB - CMOP/OPAI Release & Rebill CRLR - CMOP/OPAI Release & Reverse (successful release) CRLR - CMOP/OPAI Release & Reverse (successful release) CRRL - CMOP/OPAI Release - Original claim not paid, submit another claim, no reversal DC - Discontinue - only reverse un-released PAYABLE DC's, release date check should be in calling routine DE - Delete ED - Edit (includes RX release with NDC edit) ERES - Resubmit from ECME user screen EREV - Reversal from ECME user screen OF - Original Fill P2 - Original submission from PRO Option, no reversal P2S - Resubmit from PRO Option PC - Pull CMOPs PE - Pull early from suspense PL - Pull local from suspense PP - Pull RX (PP) action from Patient Prescription Processing option RF - Refill RN - Renew RRL - Release - Original claim not paid, submit another claim, no reversal RS - Return-to-Stock
BILLNDC	Input	(Optional) NDC that pharmacist entered at release. Only required on release function.
REVREAS	Input	(Optional) Reversal Reason. This is only needed for reversal events. It will be defaulted to 'Unknown' if not passed in.
DURREC	Input	(Optional) String of up to three sets of DUR info. Sets are delimited with "~". Each set consists of the following three "^" pieces: Reason for Service Code Professional Service Code Result of Service Code
BPOVRIEN	Input	(Optional) IEN of the BPS NCPDP OVERRIDE file. This should always be NULL or not passed with the exception of the Resubmit with Edit action on the ECME User Screen.
BPSCLARF	Input	(Optional) Submission Clarification Code to be included in the claim.
BPSAUTH	Input	(Optional) String of prior authorization info - Two "^" pieces: Piece 1 - Prior Authorization Type Code Piece 2 - Prior Authorization Number
BPCOBIND	Input	(Optional) Coordination Of Benefits (COB) indicator. 1 - Primary Payer (default) 2 - Secondary Payer
BPJOBFLG	Input	(Optional) Background Job Flag B - if is called by unqueueing logic in background F - by other (foreground) process
BPREQIEN	Input	(Optional) Internal Entry Number of the BPS REQUEST file record that needs to be unqueued.
BPSCLOSE	Input	(Optional, By Reference) Local array used for Close After Reversal functionality when the user had chosen to close the claim after successful reversal. Used with BWHERE="EREV" only. If claim needs to be closed then: BPSCLOSE("CLOSE AFT REV")=1 BPSCLOSE("CLOSE AFT REV REASON")=IEN of the file (#356.8) BPSCLOSE("CLOSE AFT REV COMMENT")=Text of the comment
BPSPLAN	Input	(Optional) IEN of the entry in the GROUP INSURANCE PLAN file(#355.3)
BPSPRDAT	Input	(Optional, By Reference) Local array passed by reference containing data needed to submit a secondary claim. This parameter should only be used internally by ECME and should not by be passed by external applications.
BPSRTYPE	Input	(Optional) Internal Entry Number of RATE TYPE file (#399.3)
BPSDELAY	Input	(Optional) Delay Reason Code that will be entered on an NCPCP claim (field 357-NV).

SUBSCRIBING PACKAGE

SUBSCRIBING PACKAGE	ISC
OUTPATIENT PHARMACY	Birmingham
INTEGRATED BILLING

DATE ACTIVATED

2011/01/04